An otorhinolaryngologist is quite a mouthful, and this expert tells ANNIE FREEDA CRUEZ that many Malaysians have a problem they just do not know that they have

Sleep apnea sufferers stop breathing repeatedly during their sleep, sometimes for as long as a minute, and this happens hundreds of times during the night.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches.

It is estimated that more than one million Malaysians are suffering from sleep apnea and the majority of them do not even know they have this problem.

"Sleep apnea can be diagnosed and treated. One of the biggest problem is that it has not been seen in its proper dimension," said otorhinolaryngologist (ear, nose and throat) Dr Kuljit Singh, who is the president of the Malaysian Society of Otorhinolaryngologist & Head Neck Surgeons.
"Although you think you sleep well, there could be an obstruction caused by a blockage of the airways, usually when the soft tissue in the rear of the throat collapses and closes during sleep."

The Greek word "apnea" means without breath. There are three types of apnea -- obstructive, central, and mixed.

Obstructive apnea is the most common. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two.

With each apnea event, the brain briefly arouses the sufferer in order for him to resume breathing, but consequently, sleep is extremely fragmented and of poor quality.

Despite the difference in the root causes of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes for a minute or longer.

Dr Kuljit said those at high risk are middle-aged males, with high body mass index, big neck and obese and also those who use heavy and dangerous machines or drive heavy vehicles. It can also affect anyone at any age, including children.

"It's very much an ear, nose and throat (ENT) problem. Thus far, it has been treated by a respiratory physician or a neurologist." He added that all ENT surgeons should take extra effort to check if their patients were having sleep apnea.

He said lack of awareness was one of the main reasons why many Malaysians were still undiagnosed and untreated for the disorder.

If you have obstructive sleep apnea, your airways could be blocked or narrowed during sleep because:

- your throat muscles and tongue relax more than normal,

- your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe,

- if you're overweight, the extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow and makes it harder to keep open,

- the shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area,

- the aging process limits the ability of brain signals to keep your throat muscles stiff during sleep, thus narrowing the airway or making it collapse, and

- not enough air flows into your lungs when your airways are fully or partly blocked during sleep.

This can cause loud snoring and a drop in your blood oxygen levels.

Dr Kuljit said a full overnight deep study called polysomnogram is usually done to ascertain a person's sleep disorders, which include breathing movement, oxygen saturation in the blood, brain activity and even ECG.

The frequent drop in oxygen levels and reduced sleep quality trigger the release of stress hormones.

These compounds raise heart rate and increase the risk for high blood pressure, heart attack, stroke, and irregular heartbeats. They also raise the risk for, or worsen, heart failure.

Untreated sleep apnea can also lead to changes in how your body uses energy and increases your risk for obesity and diabetes.

Dr Kuljit said there was a need for public awareness on the problem as studies have shown that at least one out of 10 people over the age of 65 has sleep apnea. Women are much more likely to develop sleep apnea after menopause.

Small children often have enlarged tonsil tissues in the throat which can make them prone to developing sleep apnea.

One of the most common signs of obstructive sleep apnea is loud and chronic snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. However, not everyone who snores has sleep apnea.

A common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving.

You may also find yourself falling asleep quickly when you're not active.