(MENAFN- Khaleej Times) People who snore in their sleep don't often admit to being snorers. Snoring has as unglamorous comic and embarrassing image, which makes it difficult to admit to. But far from comic, it is, in fact, the 'first sign of a partial obstruction of the upper airway' - a phrase you will never hear outside a doctor's office.
"I don't know if his snores mean there's anything more seriously wrong with him, but we've been married 30 years, and I'm used to it by now. I just cover my ears with a pillow," says Shalini Merani (name changed), who, not surprisingly, didn't want Khaleej Times to use her or her husband's real name for an article on snoring and sleep disorders.
Dr Hassan S Alhariri of the respiratory and sleep department in Rashid Hospital, Dubai explains the workings of a C-Pap machine that is sometimes prescribed, and that pushes air into a mask so the patient is able to sleep. - KT photos by Nivriti Butalia
Obesity, smoking, alcohol, diabetes, vitamin D deficiency and sleep apnea are all factors that cause a person to snore. But snoring is just one indicator of a sleep disorder, one sign that you/your partner are not getting restful sleep. And "everyone needs five-six cycles of deep sleep each night", according to a specialist in pulmonary diseases, Dr Sherif Fayed.
Each cycle of deep sleep is on average 10-15 minutes. The hazards of not getting deep restful sleep are well-known. "Drivers of large vehicles need to be especially vigilant as it's 20 per cent sleepiness at the wheel that causes big accidents," says Dr Fayed in his office at Zulekha Hospital in Al Qusais, Dubai.
When and why to see a doctor
When people who are constantly tired and feel unrefreshed and who ail from poor sleep go to the doctors, they're sent to sleep specialists, a branch that falls either under ENT or Pulmonology.
As a first step, a patient is given a questionnaire of eight to 10 questions, the aim of which is to determine how sleepy you feel at different times. So the Epworth Sleep scale will ask you questions like 'what are the chances of you falling asleep in a car while stalled at a traffic light?' Your answers range from 0, 1, 2, 3, with 3 being the highest chance. If your total score causes the doctor to worry, then you are a candidate for sleep study, (and financial dilemma, if your insurance doesn't cover it).
There's a 'home sleep study' and a 'full sleep study'. Neither of this is cheap. The home one allows you to be hooked up to a C-Pap machine in your house. For the full sleep study, you have to enrol at the sleep clinic in the hospital, and they hook you to a few leads that gauge your heart rate, breathing patterns, etc.
Some hospitals use third party health service providers and connect patients with them. These providers bring the sleep apnea monitoring kit to your home, explain to you/your partner how it works, and come back the next
Staff Nurse Ajeesh Sasidharan at Zulekha Hospital demonstrates the workings of a sleep monitoring kit
day to collect the findings. A patient would have to shell out anything between Dh1,000 to Dh4,000 for hiring services of this sleep-monitoring gadget.
A source at Dynamic Medical Equipment Centre at Safa Park told KT that "five to six times a month they have requests for home study sleep apnea kits". Dynamic Medical Centre is also the distributor for DeVilbiss Health Care, which has tie-ups with Rashid Hospital, Al Ain Hospital, Al Noor Hospital, SKMC Hospital and American Hospital. Different hospitals have arrangements with different health care provides for the use of these kits.
Insurance companies lose
Because paying for the entire procedure can cost you the equivalent of the airfare to Europe and a comfortable stay there, we checked with a few insurance companies, and learnt that there is no strict rule. Some companies cover sleep studies, some don't. Some don't cover for individuals but do cover for companies. It depends on the insurance company's policy, and the policy of the company that employs you.
Daman Insurance told Khaleej Times: "It's not a yes, not a no. It is based on evaluation and depends from case to case, but we have given people coverage for sleep apnea studies."
Sales manager at Dubai National Insurance and Reinsurance Mahmoud Abdul El Salaam said: "It depends on age, and medical history of the candidate." He agreed with the view that few insurance companies cover sleep apnea. "Yes, it's a total loss for insurance companies."
MetLife said, "Sleep apnea is generally excluded, but it depends. Some company policies cover it."
At Zulekha Hospital, a staff nurse in a maroon-uniform, Ajeesh Sasidharan, takes us to a typical sleep studies room that is essentially a luxury suite, with one wall in the inside room painted peach. A nurse sits in the outer room when there is a patient who's being monitored.
Sasidharan explains that a video camera is positioned on top of a stand otherwise used for an IV drip. "Many people come and see and when they realise it's so costly, they don't come back. Insurance also doesn't cover, maybe only Alico and Daman." Sasidharan says he has monitored the sleeping patterns of about 20 patients in the last two years.
When oxygen dips
At government hospitals, especially in cases where the patient is covered, the scene is a bit different.
Dr Hassan Alhariri is a consultant of sleep medicine at Rashid Hospital. In his ground floor office in Rashid Hospital, he explains the significance of the data and patterns of sleep graphs on his computer. "Almost 24 per cent of males in the UAE probably have sleep disorders related to sleep apnea, and about 21 per cent of females," he says. The data is collected from almost 1,200 people surveyed in three months.
He hints that the figures are probably higher, because of the prevalence of obesity and diabetes in the region. "We notice there is significant obesity in the UAE - almost 70 per cent of them are overweight, mean and women."
He explains that the obstruction of airway is most likely to do with obesity but could also not be obesity but anatomical factors such as small jaw, large tonsils and large tongue. "Anything may obstruct the upper airway.
"When people go to sleep, they relax. That is when there will a higher chance of collapse of the airway - during the sleep. Then the flow will not go smoothly to the lungs."
Brain alarm
"A person starts snoring, and may stop breathing. That's why it's called Obstructive Sleep Apnea, the stopping of breath. When you're not getting enough oxygen," says Dr Alhariri.
He pulls up a graph on his computer where a person's oxygen rate fell in minutes from 93 to 81. "Then his brain will wake him up to get his breath back. This is when people wake themselves up with a loud snort/grunt sound." But the risk of heart attack exists when oxygen is low. "One man - his oxygen dropped 20 per cent - anything below 90 per cent there is a risk of heart attack."
Linked to obesity, diabetes
Obese people have a higher risk of collapsed airway. "When they lose weight, we repeat the test to rule out other factors," says Alhariri. "Some people who are not obese and have sleep apnea, the factors could be smoking, alcohol, sleeping pills."
Obesity in the UAE is higher than in Saudi Arabia. In schools in the UAE, you see more obese children than in the rest of the world.
"I am still collecting data. Diabetes is very common here in the UAE as compared to the rest of the world. Obesity, diabetes and sleep apnea linked to each other and probably higher than in the rest of the world. We are in the process of publishing this. It hasn't been published as yet (the diabetes, vitamin-D deficiency and sleep apnea studies). We're still collecting data."
Treatment and resistance
You have to lose and control weight. "Sometimes, we prescribe a C-Pap machine that pushes air into a mask so the patient will sleep," says Alhariri. "People resist treatment because it is different from the culture they grow up in. Compliance is very low - we're not reaching more than 20 per cent. Patients are embarrassed. Sleep like this? No way, they will not agree. Compliance has improved in the last few months.
"We can study one patient a night, up to four a week. So 16 patients a month. And now (the) waiting time for sleep test at the sleep clinic is nine months. So patients have started recognising the need, slowly."
Interestingly, he says, in the last two years, "we've been getting 16-18 patients a month but the waiting time used to be two-three months, now it is nine months". "So the trend is going up even without marketing."
What has changed? According to him, recognition that the disease exists and increased awareness.
According to Alhariri, Rashid Hospital and Zayed Military Hospital in Abu Dhabi are the only two government hospitals that focus on sleep studies. He warns patients against falling for private hospitals that may not have the certification to be carrying out sleep studies.
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