• H/o nasal obstruction with nasal as well as post nasal discharge
• H/o of occasional headache and irritability
• Sleepiness always
• Inability to concentrate at work
• Dryness of mouth and Feeling of giddiness
• According to her parents, patient had problem of snoring and mouth breathing since childhood along with nasal obstruction at times.
• At present she is breast feeding her infant son.
• No history of any intake of hormonal therapy
• H/o slight weight gain after the delivery due to sedentary lifestyle.
• No past history of any menstrual abnormality.
• No H/o any intake of medicines except for nasal drops and deriphyline at times.

PAST HISTORY:

• H/o similar episode in the past which increased many folds after delivery.
• No known history of hypertension or diabetes.

Patient was brought to the OPD by her husband. According to him patient was snoring, which was disturbing and he also mentioned that due to this he was getting sleepless at night. She had cessation of breathing many a times during night. Her snoring was quite annoying even to the other family members’ next room. She also tends to forget feeding her four months child many a time.

• History of day time sleepiness (ਪਾਠ ਕਰਦੇ-ਕਰਦੇ ਸੌਂ ਜਾਂਦੀ ਹੈ |)
• Mood swings and irritability.
• Extreme restlessness in the legs while trying to sleep.
• No history of trauma to the nose.
• No history of indigestion & chest pain.

CLINICAL EXAMINATION:

Patient was moderately built, clinically appeared to be anaemic, anxious looking, mouth breather, dry lips, slight overcrowding of teeth.

• On examination tonsils markedly enlarged.
• Mallam Patti score was calculated to be two.
• Nasal passages congested with mild running of nose.
• Patient complained of nasal obstruction.
• Evidence of multiple enlarged lymph nodes along the jugular chain
• FNAC was done (2-3 groups of cells having round to oval nuclei, cytoplasm moderate and the report was Round Cell Tumor), biopsy was advised, which sent shock waves in the family because there was history of death of her younger sister at age of 18 due to lymphoma.
• CT scan and MRI was done and the opinion given was astonishing and surprising and the reporting doctors said “hypertrophy of the adenoid tissue and the palatine tonsils bilaterally causing marked narrowing of the airways.”
• X-ray chest was normal.
• All the investigations except for haemoglobin and peripheral blood gas analysis were normal.
• Nasal endoscopy was done and it showed bilateral lobulated lesion. The mass was coming from roof of nasopharynx and occupying both choanae. There was limited space between mass and palate.
• Biopsy was taken and there wasn’t much bleeding.
• H/P report: Features suggestive of a lymphoproliferative lesion, possibly reactive type, could be consistent with the clinical and MRI impression of adenoids.

AIM OF TREATMENT:

• Our aim of treatment should be that the patient of sleep apnea and snoring should wake up completely relaxed having more energy during the day and fall asleep in his partner’s arms at night.
• Sleep restores us…………………….
• After anaethesia checkup patient was subjected to Tonsillo-Adenoidectomy. The mass was removed and sent for biopsy.  The report came consistent with the biopsy taken previously.

• Women snorers are embarrassed, which is a very unfortunate thing to do. 
• In women poor sleep is associated with psychological stress. 
• Severe snoring can disrupt the sex life of both partners. 
• Women who reported taking half an hour or more to fall asleep showed the worst risk profile. 
• Higher levels of biomarkers are associated with elevated risk of heart disease and type 2 diabetes - Stronger in women. There are also high levels of C-reactive protein.

One Who Has Sleep Apnea Continues to Risk Death Every Night......

• Sleep is a transient state of altered consciousness and perceptual disengagement from one’s environment.

• It is a basic physiologic need state like hunger or thirst that is vital to human survival. Deprivation of sleep causes sleepiness, and as eating and drinking satisfies hunger or thirst, sleeping reverses sleepiness.

• Sleep is not merely “Time Out”. It is an active state essential for mental and physical restoration. Although we spend approximately 1/3 of our lives in sleeping state, little is known about sleep.

                                                       SLEEP DISORDERS

• Insomnia

• Snoring

• Restless Leg Syndrome

• Periodic Leg Movement Syndrome

• Night Terrors

• Cessation of Breathing during Sleep (Sleep Apnea)

• Baffling Sleep Disorder – Sleep Sex known as Sexomia The role of snoring as a potential medical problem should be taken seriously even when it is asymptomatic. Sleep changes occur from cradle to grave.

Following are the commonly used options:

• Drug protryptiline (tricyclic antidepressant)
• Modalert tablets 100 or 200mg—it is a wakefulness promoting agent for oral administration and is indicated in patients with obstructive sleep apnea or hypopnoea syndrome patients. Till date it is almost impossible for us to have hopes for an ideal snoring operation on palate.
• Administration of oxygen
• Position of patient while sleeping- tbt-(tennis ball treatment) to prevent sleeping in supine position.
• Dental/Oral/Nasal Appliances
• CPAP (Continuous Positive Airway Pressure)
• Bariatric Surgery- It can be effective in reducing the RDI (Respiratory Disturbance Index) in grossly obese patients.
• Tracheostomy
• Pre-anesthetic check-up improvement prior to surgical procedures

• To ascertain the correct diagnosis, history is very important from the patient’s wife/family members.
• Behavior patterns need to be noted since they are different in children and adults.

Diagnosis to the exact sight of the sound produced by the snorer is crucial. However, following things need to be taken care of:

• There are snorers in whom the tongue is a component of the snoring noise.

• Second problem is that even if we are sure that the snoring noise is coming from soft palate vibration, we do not know how much palate removal or tightening is required in a given case.

• Third problem is that the evaluation of the snoring result is done by the bed partner.

• Weight reduction and regular exercise-like doing Yoga!
• Abstain smoking and alcohol consumption
• Glass of cold milk or a hot milky drink is useful
• Avoid food additives like colorings and MSG (Monosodium Glutamate)
• Say no to sleeping pills-they are no better than a band aid!
• Intake or garlic, ginger and marjoram essential oils- act as powerful decongestants
• Control of High Blood Pressure and Diabetes
• Sleep in side postures
• Role of ENT surgeon is very important
• Allay anxiety
• Meditation/Singing/Laughter are useful
• Tilt the head of your bed upwards four inches
• Establish regular sleeping patterns
• Respect the partner who is bearing the brunt on this war front!

WALK GROUNDLY

TALK PROFOUNDLY

DRINK ROUNDLY

SLEEP SOUNDLY

A non-invasive, comfortable and effective snoring solution can be the dentist prescribed oral snoring preventive device, such as SILENT NITE, which positions the lower jaw into forward position thus opening the airways in the throat, thereby reducing the vibrations of the muscles and soft tissue and preventing snoring. You can search Google for getting more information on that device.

Common causes of OSA (Obstructive Sleep Apnea) in women:

1. Obesity
2. Hypertension (High Blood Pressure)
3. Hypothyroidism
4. CHF (Congestive Heart Failure)
5. Non-Insulin Dependent Diabetes

Below are the most common questions asked about sleep apnea:

1. Is Snoring Serious?

• Socially, yes! It can be when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness.
• Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious long-term health problems, including obstructive sleep apnea.

2. Can heavy snoring be cured?

Heavy snorers those who snore in any position or are disruptive to the family should seek a medical advice to ensure that sleep apnea is not the problem. An otolaryngologist will provide a thorough examination of the nose, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is, and what effects it has on the snorer’s health.

3. Physical difference between men and women with OSAS (Obstructive Sleep Apnea Syndrome)

1. Women have a significantly higher BMI as compared with men.
2. Women have lower-body obesity and men have upper-body obesity predominantly.
3. Men have larger necks than women.
4. Women have a smaller pharynx (a portion of throat) than men.

4. Who are the children in whom we should consider sleep disorder?

Any child with attention deficit disorder.

5. How do the anti-snoring devices work?

It is probably they keep you awake!

6. Why surgical procedures fail?

Major weight gain was associated with surgical procedures.

7. What is an ideal CPAP (Continuous Positive Airway Pressure)?

Ideal CPAP is the one which is sufficient to abolish apneas, maintain an SaO₂ (saturation of oxygen in blood-checked for noticing if proper oxygenation of various body tissues is occurring while sleeping) well above 90% and reduced arousals to minimum-preferably 6/minute.

8. What are the comorbidities to be kept in mind?

• Diabetes
• Strokes
• Hypertension (Increased Blood Pressure)
• Esophageal and Laryngopharyngeal Reflux Disease
• Coronary Artery Disease
• Obesity may also contribute to deep vein thrombosis and pulmonary emboli

APNEA CAN BE A SYMPTOM OF DIABETES AND HYPOTHYROIDISM ALSO.

• High Blood Pressure
• Diabetes
• Coronary Heart Disease/ Cardiac Arrhythmias
• Myocardial Infarction due to reduction of Oxygen Saturation
• Stroke
• Obesity may also contribute to thrombosis and pulmonary emboli
• Prone to vehicular and road accidents

Below are considered the possible causes of snoring:

People who snore suffer from:

• Poor muscle tone in the tongue and throat
• Excessive bulkiness of throat tissue
• Children with large tonsils and adenoids
• Overweight people have bulky neck tissue
• Long soft palate and/or uvula
• Obstructed nasal airways

Natural disasters from lack of sleep and sleep apnea:

• Star Princess cruise ship grounded- June 22, 1985
• Chernobyl Accident- April 25, 1986.
• Space Shuttle Challenger- January 28, 1986
• Michigan train wreck- November, 2001

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as Obstructive sleep apnea.

Serious episodes last more than 10 seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

Symptoms Of Sleep Apnea (Midnight Blues)

Below are the symptoms of sleep apnea:

• Loud snoring
• Choking during sleep

•  Morning headaches

• Memory or Learning problems

• Feeling irritable

•  Lack of concentration

•  Mood swings

•  Over weight person

•  Reduced libido

•  Frequent nocturnal urination