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Doctors to accurately diagnose sleep apnea

Implications of Obstructive Sleep Apnea

Sleep Apnea Treatment in Singapore

Singapore Sleep Apnea Statistics

Alternatives to CPAP treatment

Sleep Apnea Diagnosis

Welcome to the sleep apnea site

February 2008 April 2008 May 2008

American Sleep Apnea Association
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Sleep Apnea Resource

Sleep Apnea Singapore

Friday, May 2, 2008

Doctors to accurately diagnose sleep apnea

Trust your doctor to diagnose your sleep apnea? Think again… I specifically wanted to address this issue as my very own doctor did not detect my classic tell tale signs of obstructive sleep apnea such as sudden weight gain, excessive tiredness with day time sleepiness, high blood pressure, rapid pulse rate and GERD. All I was given was more medication to control my high blood pressure and Mylanta for my “gastric” problems. When my blood pressure situation didn’t improve, a higher dosage of drugs was prescribed to control my high blood pressure or the medication was changed. When I had to often go to the toilet at night due to nocturia, caused by sleep apnea, I was prescribed hydro chlorothiazide to help both to control my blood pressure and help me urinate more during the day so that I will feel less of the urge to urinate in the night. While nocturia is naturally more common in elderly adults, Nocturia among younger individuals who are less likely to have other medical causes of nocturia is a strong indicator of sleep apnea according to this article.

I won’t want to dwell on the medical misdiagnoses nor blame my physician because of this. What I wanted to highlight was that I was not misdiagnosed due to lack or insufficient knowledge about sleep apnea. My doctor knew about sleep apnea and has heard about it, but he strongly didn’t believe all my symptoms were a result of obstructive sleep apnea. I was even lectured for putting on weight! It was not until I convinced him to set me up with an appointment to see a sleep specialist and the results came back positive that he realized that I had this condition. It is perhaps this medical prejudice that might lead to one doctor being more open to suggestion of a potential sleep disorder compared to another, as this 2004 study published by the Singapore Medical Association done on a group of Singapore medical students suggests.

This study was undertaken to assess the knowledge and attitude among medical students towards sleep medicine. It was also to examine if there was any correlation between a negative attitude and knowledge of sleep medicine. The results from this survey published from the Singapore Medical Association indicated some alarming statistics amongst 3rd, 4th and final year medical students. A complete copy of the study done by the Singapore Medical Association of the behavior and attitude of medical students and their knowledge of sleep medicine pdf copy can be downloaded here. The web version of the findings of the attitudes and behavior of Singapore medical students on sleep disorders can be view here. I have taken some of the key points from the study:
  • Sleep medicine knowledge is generally low in medical students.
  • Higher scores in basic sleep knowledge agreed with the statement that “sleep disorders should be included in medical school curriculum” and secondly, they disagreed that “most behavior changes to improve sleep quality are common sense and not a good use of time to learn”. Thus, a better “attitude” indicates a better learner and better knowledge scores
  • As expected, medical students with higher scores in basic sleep knowledge felt it was an important inclusion in their curriculum and of use to them. It is likely that these medical students had acquired this knowledge through their own reading and study, and had realized the usefulness of this knowledge.
  • In most countries, to date, medical school curricula do not include courses on sleep medicine and sleep- associated disorders.
  • In the United States, the average time spent on sleep medicine during medical school education is 1.6 hours, and pediatricians are reported to receive a mean of 4.8 hours of instruction on sleep medicine and sleep disorders.
  • Given the extent of sleep problems in the population, attempts must be made to incorporate sleep medicine topics as a module into psychiatry or neurology rotations. It can be further emphasized at all levels of medical education.
It further goes on to state:
“Given the extent of sleep problems in the population, attempts must be made to incorporate sleep medicine topics as a module into psychiatry or neurology rotations. It can be further emphasized at all levels of medical education”.
The point I am generally trying to bring across from what I gathered from this article is that although there is a high degree of sleep disorders in the population, sleep knowledge is generally low as observed in medical students. To make matters worse, there is also a certain degree of personal biasness where sleep disorders are concerned from some medical students and doctors. It all depends on how open a specific doctor is. The more the doctor is inclined towards the topic and seriousness of sleep related disorders, the more their personal interest in sleep disorders will be. This should NEVER be the case! It is however good that this issue has been addresses and now more emphasis is placed on sleep apnea and sleep related disorders.

After reading this I find it’s better to get a second opinion or err on the safe side. We trust our lives to doctors to give us their best medical advice based on their years of experience in their specific field of expertise. There is also a conflict of interest as many individuals would be either afraid to question their doctors or the doctors in turn would act defensively when questioned or when asked by a layman who is not a trained medical professional.

While I am not a doctor, it’s MY body and MY health that is at risk. I cannot risk my personal health being compromised should a doctor “thinks” that his diagnosis is final and should not be questioned. While I am not trying to say that you should NOT listen to your doctor, I am just emphasizing that when you’re in doubt, seek a second or third opinion from another doctor or seek treatment from certified sleep specialists. Its best to hear a couple of different opinions. After all, doctors are humans after all and they do make mistakes as we have seen or heard off in many instances. I usually find more resistance with more senior or older doctors as they usually feel “undermined” when questioned or when you simply ask more. I never had any issues with the younger doctors who tend to be more open with suggestions and who are more willing to listen to the concerns of their patients. After all, we’re paying for the bill and it’s our body who is being treated for a potential condition. We are all entitled to our medical rights.

My doctor was a very senior physician and had not detected the classic symptoms of my obstructive sleep apnea which had been going undetected and untreated for close to 2 years. While I had obstructive sleep apnea since birth, my condition actually became more severe over a routine health check. The doctors noticed that my blood pressure was on the high side. I was quickly put on dose of propranolol and later to atenolol to help control my high blood pressure. I had to actually “convince” him to refer me to a sleep specialist. Personally I think this shouldn’t have been the case at all. Sometimes persistence pays off. In my case, hadn’t I insisted I would have been already “dead” or very sick by now judging from my severe symptoms of obstructive sleep apnea. The video above indicates potential tell tale signs of sleep apnea. It provides good information on sleep apnea diagnosis as well as treatment with the aid of a CPAP device.


Monday, April 28, 2008

Implications of Obstructive Sleep Apnea

Many individuals simply don’t realize that obstructive apnea and other sleep related disorders can actually lead to other severe health implications. The true extent and severity of sleep apnea can be actually felt when multiple health implication arises which can cause numerous health related issues. In my case, I had high blood pressure, cold sweat, GERD, rapid heart rate and sudden weight gain. This in turn could possibly lead to a stroke, heart attack, kidney failure, gastric problems and a whole host of health related issues that are tied to obstructive sleep apnea.

When it is said that sleep apnea has the potential to kill you, many people simple brush it aside saying that this statement is flawed and over rated. While this may be true to a certain extent, I feel that sleep apnea can physically kill or cause bodily harm if you’re operating machinery or driving a car and you get involved in an accident. This might be when sleep apnea actually literal “kills” or “injures you”. The statement that sleep apnea can kill, usually refers to the other implications and detrimental side effects it has that will cause you health related problems later on. It is due to these other related diseases tied to sleep apnea, that could potentially lead to other health complications which in turn could kill you.

The main role of the Sleep Apnea Site is to create awareness about obstructive sleep apnea in Singapore and the potential health hazards that it can lead up to. Besides your health, there are other dangers that could also potentially ruin the quality of living. Losing your job to sleep apnea for instance, by not being attentive at the office or dozing off at your desk is indeed a potential career hazard. Spending quality time with your family and friends is also important, but remember, it has to be spent with you being attentive and awake not slumped at some corner snoring away. My take on obstructive sleep apnea is to tackle the problem head on. Do NOT let sleep apnea get the better of you! Just because you have it, doesn’t mean that you will have to live with it and suffer in silence for the rest of your life. You’re not alone, there are close to around 15% of Singapore’s population with obstructive sleep apnea (OSA). You can make a difference by being one of the few who seek treatment and getting cured to improve the quality of your life.

The video above highlighting the risks of sleep apnea is just one of the many examples of how being treated for sleep apnea can actually help improve the quality of your life. The lady in this video needed to undergo a heart transplant as she had been suffering from an enlarged and weakened heart to save her life. Cardio vascular disease and broken slumber shares a common link, sleep apnea. According to this video on sleep apnea, research shows that people with heart failure and untreated sleep apnea faces a significantly increased risk of death. The risk of dying is 2.5 times greater compared to people who didn’t have sleep apnea at all and treating obstructive sleep apnea can reduce that risk. CPAP treatment is one of the most dramatic treatments for sleep apnea and its impact can be seen just within a period of 24 to 48 hours!

What was described in this video about obstructive sleep apnea was exactly what I personally experienced before I was diagnosed with obstructive sleep apnea and when I was first initially put on the CPAP device. I thought this would be a great video to hightlight the dangers of sleep apnea and focus on the curative properties of the CPAP machine which totally relates to my sleep apnea experiences and its positive results. If you have sleep apnea or suspect that you do, I strongly suggest that you fix an appointment with any of these sleep specialists in Singapore today.

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Saturday, April 26, 2008

Sleep Apnea Treatment in Singapore

Obstructive sleep apnea is generally very much unknown in Singapore. You can hardly find any Singapore sleep apnea website with related information regarding sleep apnea, snoring or sleep disorders. Most references on sleep apnea are readily available from US based sleep apnea websites, medical journals or sleep apnea forums. If you’re new to the topic of obstructive sleep apnea and want to get more information about sleep apnea in Singapore you’ve come to the right place. SleepApneaSite.com was specially created to address and discuss the issues about sleep apnea in Singapore.

I personally have severe obstructive sleep apnea and I want everybody who visits my site to learn more about sleep apnea for patients in Singapore and the options available to them to be able to successfully treat sleep apnea, as well as potential cures and remedies for their specific sleep disorders. My main agenda is to get everybody who has this condition to be treated in whatever way that is financially possible to them. Nobody should suffer this debilitating condition as obstructive sleep apnea has a potential to kill you. Sleep apnea itself might not lead to fatalities unless you fall asleep at the wheel while driving and get into a car accident. It can however certainly lead to a host of other health related problems such as high blood pressure, heart attack, stroke and many other medical problems which these diseases are associated with. Sadly, many people refuse to address this issue and simply take the problem of sleep apnea as a bad case of snoring which is often not the case.

For those in Singapore who have realized the potential problem and want to seek out medical advice on how to identify sleep apnea, explore the possible ways to treat obstructive sleep apnea and perhaps find a cure or alternative treatment that you’re comfortable with, you have a made a wise decision. Identifying the problem as well as coming to terms with obstructive sleep apnea at an early stage will be a huge step towards getting your life back. As mentioned before, there is unfortunately very little or almost no helpful information about sleep apnea in Singapore. I have decided to scour the web to find as much Singapore based sleep apnea related articles as well as useful websites on how to treat sleep apnea in Singapore. These are from medical journals and research done by Singapore doctors, Singapore hospitals and private clinics that have dedicated sleep apnea departments or specialists trained in the field of obstructive sleep apnea and sleep related disorders. Other are from online articles related to Singapore’s local sleep apnea scene, describing new ways and procedures on how to treat sleep apnea and other related sleep disorders in Singapore.

Hospitals in Singapore providing treatment for Sleep Apnea and Sleep Related Disorders:
  1. Tan Tock Seng Hospital Singapore - Department of Respiratory Medicine.
  2. Singapore General Hospital - Department of Respiratory & Critical Care Medicine Sleep Disorder Unit.
  3. Alexandra Hospital Singapore - Department of Otolaryngology (Ear, Nose and Throat).
  4. Changi General Hospital Singapore - Ear, Nose, Throat (Otolaryngology).
  5. National University Hospital Singapore - NUH ENT Services, Department of Otolaryngology - Head & Neck Surgery.
  6. National University Hospital Singapore - Sleep Apnea and Snoring facts.
  7. Institute of Medical Health - Sleep Disorders Clinic.
  8. Other private hospitals in Singapore that deal with obstructive sleep apnea and other sleep related disorders.
Private Clinics or Consultants in Singapore who specializes in treating sleep apnea. These could be specialists or Doctors in the field of Ear Nose and Throat (ENT), Respiratory Medicine as well as Dentistry:
  1. Pacific Sleep Centre
  2. Medical Sleep Spa
  3. Singapore Neurology and Sleep Center
  4. Singapore Sleep Society
  5. Mount Elizabeth Medical Centre – Aesthetic Jaw Surgery for Sleep Apnea
Option 2, the medical sleep spa is supposedly to help cure sleep apnea and sleep related disorders according to this article. The specialist at the Singapore based medical sleep spa blend diagnosis, consultations and remedies with exercise like Pilates and yoga together with upper body/back massage and radio frequency de-stress therapy to help relax the patient.

I hope the information here will be able to give you the available options and alternatives you might be able to take to cure your sleep apnea problems in Singapore.

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Friday, April 25, 2008

Singapore Sleep Apnea Statistics

According a obstructive sleep apnea (osa) and snoring study in Singapore conducted by the Singapore General Hospital Sleep Disorder Unit back in 1999, It is estimated that around 15% of Singapore’s population suffers from obstructive sleep apnea. The estimated population of Singapore then was around 3.9 million people. In 2007, the population of Singapore was estimated to be around the 4.5 million mark. An “extrapolated amount” of the current Singapore population suffering from obstructive sleep apnea would be around 17% now. Get PDF format of Singapore's sleep apnea statistics.

Assuming that the Singapore sleep apnea statistics is around that level, it’s a fairly high about of sleep apnea cases in Singapore. I believe out of this 17% a large percentage of sleep apnea sufferings would have either not being diagnosed or treated for obstructive sleep apnea (osa) or their snoring disorders which in most cases taken for granted. Many Singaporeans who suffered from snoring had the following conditions as well - An estimated 24.09% of Singaporeans suffer from loud habitual snoring affecting both men and women. 87.5% of loud habitual snorers in Singapore have an Apnea Index (AI) more than 5 and 72% of these cases complained of Excessive Daytime Sleepiness (EDS) which has be attributed to many driving fatalities on the road worldwide. Another form of sleep disorder which is closely related to sleep apnea would be Narcolepsy. More statistics of Narcolepsy in Singapore can be found here. Sleep apnea and snoring disorders are not only prominent in adults.

In another study done by Singapore’s Tan Tock Seng Hospital to establish sleep apnea syndrome in obese children in Singapore, It was concluded that the risk of sleep apnea is more prevalent in for obese children. The Singapore medical journal had also published a finding on habitual snoring and sleep bruxism among children and younger patients. Sleep apnea cases is increasingly becoming more prevalent especially among the adolescence. Acoording to this artcle, you should consult the doctor if your child snores.

Apart from regular sleep disorders in Singapore. Singapore teenagers these days are being deprived from sleep or are suffering from lack of sleep. According to official statistics Singapore teenagers are not getting enough sleep. A poll recently conducted on 940 students in 26 secondary schools has revealed that 80% of them are getting less than eight hours of sleep on school days, while only 2.6% are getting the recommended 9 hours. The survey indicated that 66.5% of the students were up late doing homework or studying. Other late-night activities included watching tv, surfing the web or online chatting.

One of the dangerous things about sleep deprivation is that you lose insight into your lack of intellectual performance. Short term side effects would be decreased peformance in terms of alertness and vigilance. It's equivalent to drink driving as it replicates the effect of being intoxicated by alcohol according to Dr Lim Li Ling, medical director and consultant neurologist at the Singapore Neurology and Sleep Centre. Even though your physical activity is not impaired, your brain functions actually does. This, in turn, can lead to a deterioration in mood. This is always why children get cranky and throw tantrums when they do not get enough sleep.

Long term sleep deprivation can lead to a shorter life span. Other medication conditions that are associated with lack of sleep includes heart attacks, psychiatric problems such as depression, and chronic diseases like diabetes and attention deficit disorder (ADD). Extreme sleep deprivation can cause brain dysfunction in ways which simulate seizures or stroke. In most extreme cases individuals with severe sleep deprivation would drooping eyelids, jerky eyes and trembling hands. They might also even walk like a drunk.

Research into sleep has suggested a U-shaped mortality curve. Sleeping 6 to 7 hours a night would have a greater mortality rate compared to those who get 4 to 5 hours of sleep for instance. The greater amount of sleep you achieve, the higher your mortality rates. More about getting a good night's sleep here.


Monday, April 21, 2008

Alternatives to CPAP treatment

In my last post I mentioned that many who suffer from sleep apnea were unable to get their sleep apnea treated as they were unable to get used to the Continuous Positive Airway Pressure (CPAP) machine. I personally know of a few individuals who tried several times to be on the CPAP machine but gave up after a few attempts. Personally I did not have any problems getting accustomed to my CPAP machine. In fact, I am absolutely reliant on the CPAP machine now to ensure a good night’s sleep. My advice is that you should try your very best to use the CPAP upon the doctor’s recommendation.

To be honest, I was also initially very fearful and apprehensive about the CPAP device. I was wondering how it could cure my obstructive sleep apnea and how on earth was I going to sleep with a mask over my face? I also looked like I have been admitted to the intensive care unit with the CPAP mask and hooked on to the CPAP machine. In those days CPAP machines are much larger than what it is these days. When the Resmed technician showed me the machine which was incidentally the latest Resmed Autoset Sprit that was way back in 2002, I didn’t know what the CPAP machine is and what it does. To me, it looked like a scene from the Emergency Room in the hospital. I believe it is this fear which turns most people off. I know, as I have been there before and have gotten through it.

The other thing that went through my mind would be what my family members will be thinking? It would be like having a very sick person tied to a ventilator at home. It is this stigma and the initial fear which I personally feel is the main cause for the failure of taking to the CPAP machine. As a result of this, many would be immediately put off with using the CPAP machine or find ways and means not to use them citing all sorts of excuses. One of the main reasons would be discomfort and not being able to get use to the air pressure. Yes, there might be some slight discomfort initially, but so far, I have taken to the CPAP machine very well without any issues. I can also use the machine without the aid of a dehumidifier, but it could be due to the fact that I live in Singapore which is closer to the equator and the tropics so the humidity levels here are pretty high causing less discomfort compared to drier regions.

The issue about alternatives to the use of CPAP machines is serious enough that there are websites dedicated to those individuals who cannot tolerate the use of CPAP machines. These sites advocate alternative treatments to CPAP therapy. Depending on the severity of your Obstructive Sleep Apnea (OSA), some alternatives to CPAP treatment might actually work. I have never explored these forms of sleep apnea remedies and sleep apnea alternative treatments. I think the main issue here is how we can treat sleep apnea and cure sleep apnea in general. It also all depends on the severity of your obstructive sleep apnea condition. Each individual might have different levels of sleep apnea severity and the condition can only be treated on assessment by a qualified sleep specialist or a medical practitioner. Doctors specializing in sleep apnea primarily Ear and Nose Specialists or ENTs expert in the field of sleep studies and obstructive sleep apnea will be able to determine what kinds of alternative sleep treatment there are currently in the market and which forms of sleep apnea treatment would be more beneficial to a specific individual. It is always best to consult a qualified medical professional about your current obstructive sleep apnea condition and the alternatives available to cure it. Each form of sleep apnea treatment like the use of the CPAP machine might vary from person to person.

As mentioned earlier some individuals simply cannot tolerate the use of the CPAP machine. I did some research over the web and looked for some of the alternative treatments available to treat obstructive sleep apnea besides just the use of the CPAP machine. Let’s face it. Although CPAP machines have gotten smaller in size, if you’re totally reliant to the use of the CPAP, you’re hooked on to it for life. It has to be constantly with you at ALL times. The term “Don’t Leave Home Without It”! could be also used to describe a CPAP machine once reliant to CPAP therapy. I for one personally cannot sleep without the aid of the CPAP device. While I have gotten use to the fact that I constantly have to lug it around while traveling overseas which can be a great inconvenience at times, I would honestly have to say that if it was possible that I could do without such a device, it would be really a god sent. It’s also tough to sleep on the plane with a CPAP hooked on to you without bothering the person next to you. You will also need to invest on external battery for your CPAP device or a special power extension cords catered for use in the aircraft. Forget about an overnight camping or fishing trip in the outdoors without the use of electricity. You will have to carry an additional weight of your CPAP machine as well as supporting batteries as your backup power supply. All this inconveniences although considered minor could lead to severe complications if you’re totally reliant on a CPAP device to aid you with your sleep. This article will explore the different forms of alternative sleep apnea treatments and hope that this will give you a better idea of the options available to treat your sleep apnea and potentially cure obstructive sleep apnea condition without the aid of the CPAP device.

Dental or Oral Sleep Apnea Treatment

Obstructive sleep apnea has always been linked to the medical profession. Apparently now, some dental professionals and dentists are getting involved in treating sleep apnea as well. Some forms of minor sleep apnea can be treated with dental aids or oral aids. It was quite surprising to me that oral devices which are pretty small and compact in nature could be use to cure sleep apnea. If so, could they be a better alternative to the CPAP machines? According to what this video above demonstrates, by using the dental/oral aid many individuals who had difficulty sleeping due to sleep apnea were cured. How successful in treating sleep apnea and to what extent is still unknown to me. But its seems to be a pretty straight forward procedure and non intrusive compared to surgery or the use of the CPAP device. This article about Snorkil which manufacturers this dental anti snoring aid highlights the effectiveness of anti snoring dental devices. Incidentally, Singapore is one of the countries Snorkil is being piloted in to combat sleep apnea. It’s good to find out that we now have other alternative to CPAP devices here in Singapore.

Surgical Sleep Apnea Treatment

Besides the use of the nasal CPAP devices and oral dental aids, the next alternative available treatment for sleep apnea would be surgery (more about surgery and sleep apnea treatment here) From what I understand from my doctor, surgery does NOT always cure your obstructive sleep apnea problems. In some cases, the CPAP devices is still required after a very expensive surgical procedure. According to this article, the success rate for surgery is rarely higher than 65% often deteriorating over time averaging to around 50% in later years to come. One of the surgery procedure Uvulopalatopharyngoplasty (UPPP) which will be discuss later is considered to be one of the most painful treatments for sleep apnea as well as been reported have potentially serious complications. A study has shown that 42% of patients had complaints about this procedure. More information about the success rate of Uvulopalatopharyngoplasty (UPPP) for sleep apnea treatment and its complications here. Higher success rates have been with the use of CPAP devices and oral dental aids to cure sleep apnea problems with any pain, side effects or complications. Sleep apnea dental oral aids versus CPAP machines statistics here.

Before going under the knife to correct your obstructive sleep apnea, seek the expert opinion from your sleep specialist or doctor. They will go thought all the options available and give good sound advice about the different options you have available, how they will go about each of these procedures and the percentages of success and the risks involved. From my research these are some of the current surgical procedures for obstructive sleep apnea treatment:

• Uvulo-Palato-Pharyngo-Plasty (UPPP)
• Laser Assisted Uvulo-Palato-Plasty (LAUP)
• Orthognathic Surgery

Uvulopalatopharyngoplasty (UPPP)
is a procedure that removes excess tissue in the throat to make the airway wider. This sometimes can allow air to move through the throat more easily when you breathe, reducing the severity of obstructive sleep apnea (OSA). More information about Uvulopalatopharyngoplasty (UPPP) here. Another great article about what you should know and expect about Uvulopalatopharyngoplasty surgery here.

Laser Assisted uvulo-palato-plasty (LAUP) surgery. LAUP is performed under local or general anesthetics. Its considered to be a safer and cheaper procedure compared to UPPP. It uses laser to vaporize the soft palate and uvula. Unlike UPPP, the LAUP process can be repeated to achieve the desired effect. Procedure varies with individual patients, some requiring as much as four sessions for the sleep apnea treatment to be effective. Although LAUP surgery has fewer complications compared to LAUP, post operative pain has been reported as being severe. In clinical trials comparing both the UPPP and LAUP procedures, there was no significant differences where post operative pain was concerned. Due to the severe post operative pain, patience compliance could be undermined at times. Unlike UPPP, which is a one time process, LAUP had to be done over a few sessions causing severe pain over a period of time. Similar with UPPP, the success rates for LAUP has been generally low. 2 years after a successful LAUP surgery, only 55% reported that their bed partners were satisfied with the results. More information about LAUP surgery here.

Orthognathic surgery is where the bones of the upper and lower jaw may be repositioned to increase the size of the airway. This is a more complex Procedure compared to UPPP or LAUP. There is a clinic here in Singapore specializing in Orthognathic surgery for sleep apnea.

Studies in general have shown that surgery have around a 50% to 65% chances of success but this all depends on the patient’s sleep apnea condition. CPAP devices, dental and oral aids are cheaper and painless alternatives which enjoy a higher success rate should you be able to tolerate these devices. The oral aids for sleep apnea seems to be the most inexpensive solution compared to CPAP or surgery. As mentioned before, see you sleep specialist or doctor for a full recommendation as well as the alternative treatments available to cure your obstructive sleep apnea.

Please bear in mind that this article is strictly for personal research purposes. I have NOT personally used any of these devices (with the exception of the CPAP machine) or have undergone through any of these surgical procedures to treat my obstructive sleep apnea. I have NOT validated any of these claims. I am also neither promoting, advocating or advertising the services of these companies or their products. This article was written more with research in mind, rather than from any commercial perspective. You should always do your own research and consult a fully qualified medical practitioner in the medical or dental field specializing in sleep apnea or snoring treatment.

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Tuesday, April 8, 2008

Sleep Apnea Diagnosis

I was diagnosed with Obstructive Sleep Apnea (OSA) since early 2002 and have been long suffering from sleep apnea for years. It went undetected because no one knew about it as there was lack of understanding about sleep apnea here in Singapore. Nobody knew much about sleep apnea in Singapore and its potential underlying dangers that it can cause to an individual both physically and mentality. Sleep apnea has the potential to cause harm not only to yourself but others from driving accidents. Not forgetting to mention that it will have disastrous effects on your career by always looking tired and inattentive to your colleagues and bosses (late night of partying huh?) Try studying for that major exam tomorrow if you had not slept a wink for days? Eventually, if left untreated, sleep apnea will not only destroy your career but your health as well.
You also become a bane to your family members or your partner due to excessive snoring. You might think that you are the only one who suffers from the lack of sleep. That’s where you’re wrong! Your partner would also be deprived from the lack of rest due to your excessive snoring that will keep them awake throughout the night! So do yourself a favor by getting treated for sleep apnea and snoring as soon as possible. To date, not many individuals realizes the full gravity and extent of sleep apnea and how it can seriously damage one’s life. I hope the information provided here will persuade and convince yourself, or someone you know, to get treated for this sleep disorder today.

It was not until I’ve learnt about sleep apnea that it peaked my interest to start writing about my personal experiences, as well as wanting to have a sleep apnea resource site with the sole aim of provide information about sleep apnea and its related sleep disorders. Writing from a personal experience is also much easier, as you know what sleep apnea is all about and how to deal with this condition. I hope to give sufferers of sleep apnea like myself, encouragement and information on how to deal with this problem. I have learnt to live with this condition, and have gotten back to a normal life except for being totally reliant now on a CPAP machine. I also no longer drive in fear of falling asleep at the wheel! Due to the severity of my sleep apnea, I have since stopped driving totally as the risks involved are great. Individuals with sleep apnea double the risk of traffic accidents. Sleep apnea induced driving death statistics found here. You can also get more information about sleep apnea and driving here.

According to my parents, I have been snoring since I was 4 or 5 years old. My guess was that I had sleep apnea as a kid, but they didn't noticed it or realized the severity of the issue until 20 years later. Studies have shown that there have been large number of cases of child obstructive sleep apnea or OSA in very young children and infants. I remember that when I was around that age, I was constantly having problems breathing when trying to sleep, so my dad asked me to try to sleep breathing through my mouth. It helped somewhat, but this also attributed me to start snoring even louder due to an open mouth. Its only when I was later diagnosed that my ENT (Ear Nose & Throat Specialist) who is an expert in sleep apnea found out that I had a very narrow throat that had culminated with my obstructive sleep apnea (OSA).

That would have accounted for that fact why I was always tired and falling asleep while trying to study and could not concentrate well enough during my younger days. It was only until much later on after I was diagnosed as having sleep apnea that I realized why I was often tired while doing my revision and homework. At school, I'd always have difficulty concentrating and grasping new ideas. It was however not until much later on that the full effects for obstructive sleep apnea (OS) started haunting me resulting in many problems. My condition was left untreated for close to around 20 years until my life started spiraling out of control.

As a child while growing up, I think generally much of the lack of true sleep was compensated by a the raw bundle of energy attributed from youth. But as I've noticed when you start growing older, your lifestyle starts changing and so does your body mechanism and metabolism. When I was around 18 to 22 years of age I still could manage to cope with sleep apnea being undetected and untreated. I was however feeling the strain and constantly struggling when I was in the army trying not to fall asleep. I was still very fit and active then. My sleep apnea condition was more evident and pronounced after I started with a job. Working longer hours, I had less time for exercise. Sitting all day behind a desk didn't really help. I began to put on some weight. As you gain weight, being able to exercise starts becoming more difficult due to laziness and having to work extra hard to shed those additional pounds. The extra weight also made you tire easily and you tend to want to rest more, but due to sleep apnea, you can’t get proper rest. As a result of that, you tend to want to rest more than try to exercise.

My condition started deteriorating. Soon, the only thing that I was constantly preoccupied with was sleep. My whole day soon started revolving around sleep. Time at the office dragged as you constantly had to force yourself to stay awake. Minutes felt like days to me and I was constantly falling asleep at my desk. I was hardly able to concentrate and no matter how much sleep I tried to get at home and over the weekends it was never enough. My weekends were just spent sleeping and resting. But it was never enough, my body was constantly deprived of sleep and exercise. My weight started increasing, I hardly could enjoy a movie or the news on tv without falling asleep. A trip on the bus or in the taxi would find me dozing off and snoring away to the amusement of the taxi drivers and commuters. To this day, I still see sleep apnea suffers in the buses or trains having this problem and I also see people looking and laughing at them. I don’t laugh at these people, but shake my head and sympathize with them. Shuddering at the thought that I used to be one of these people that had been mocked and laughed at before I was treated for obstructive sleep apnea. Check out public service announcement from the American Sleep Apnea Association below.

The question that often comes to mind is that Why they don't get help? Why don’t their friends and family members help them? Together with awareness, this problem can be cured and you can live close to a normal existence with a few minor inconveniences. With proper treatment you will get the quality of life back. Victims are generally men who are more obese in nature. But it has been proven that sleep apnea does NOT only afflict obese individuals, a study has shown that it doesn’t matter if you’re obese or thin, obstructive sleep apnea (OSA) will still affect both individuals if conditions are right.

My blood pressure started increasing but my doctor then did not suspect it was sleep apnea and continue prescribing me medications for hypertension. My blood pressure was getting worst and I was always waking up with cold sweats every night and constantly going to the bathroom with the urge to urinate. The doc gave me some medication to make me urinate more in the morning so that I didn’t have this urge to go in the right, but this did not help, as I kept on having to visit the toilet averaging between 3 to 4 times a night. My life slowly began to fade away with this nightly routine. Going to work every day was absolutely a dread, keeping awake was an absolute torture. I was falling asleep during meetings and on my desk at 9am in the morning! The situation had gotten so bad that my boss had asked me if I was keeping late nights or if I had any problems at home causing me this day time sleepiness. Home and the bed was the only heavenly solace I had, well at least that was what I presumed.

Can you imagine life as a walking living zombie? Worst, I started getting nightmares about choking and having not enough air to breath, my wife and family members were saying that I was talking to myself in my sleep while snoring away. Then began the reflux attacks. I initially thought it was heart burn or gastic. While I was sleeping all of a sudden I could feel like I was vomiting out the contents from my stomach which incidentally smelt like puke. It got regurgitated on the my pillow. Again my doctor prescribe Mylanta to ease my “gastric problems” These attacks happened a couple of times. Only much later until after I was diagnosed with sleep apnea did I learnt that this was a case of acid reflux or gastroesophageal reflux disease (GERD) which is often commonly associated with sleep apnea.

Naturally, I had no energy to exercise and my weight was steadily increasing and so did all the complications that came with it. It was slowly turning into a was a vicious cycle with my health spiraling out of control. The last straw came when on a holiday with my parents almost by accident (as I don’t stay with them now) noticed me snoring loudly and stopped breathing for close to 15 to 20 seconds and thought I had died or past out. My dad shook me awake and when I suddenly woke up, he told me that whatever I was having, it was serious! They watched me grow up snoring but never experience me stop breathing so this was severe. He had read an article about this medical condition called "sleep apnea" and suspects that I might have this condition. I went back to my regularly doctor and told him about this, he initially dismissed this. It was only after I insisted that he referred me to see my current ENT specialist Dr John Abisheganaden a senior consultant at the Tan Tock Seng Hospital -Department of Respiratory Medicine here in Singapore.

Dr John Abisheganaden examined me initially and said that he suspected I had Obstructive Sleep Apnea (OSA) from the symptoms described. He however could not tell me how severe my condition was until I did a sleep study or sleep test to determine the severity of my sleep apnea. He offered me two suggestions, to do the sleep test at the hospital or at home. The home option would be a much cheaper and a more convenient solution, as I wouldn’t need to stay at the hospital for a night incurring additional costs, as well as being in more comfortable environment to fall asleep compared to an unfamiliar surroundings such as a hospital. The home option was also not performed by the hospital, but from a qualified technician from one of the major manufacturers of CPAP device RESMED dealing with the sleep equipments or CPAP machines.

The sleep test itself consists of a probe to your nose to measure your breathing, some straps to your chest as well as a blood pressure monitor that was attached to one of my fingers. All the data was recorded in small box like device the size of a compact disc player. It was relatively light and did not hinder any of your movements. In short, it was a relatively painless exercise done at the convenience of your own home. The technician from Resmed came sometime in the evening around 10pm set up the sleep test device. Setting up took around 5 minutes, he gave me some instructions on how to disable and dismantle the device should I need to go to the toilet in night. He left for the night and returned the following morning to collect the device which contained all the vital data collected. It will determine how severe my sleep apnea condition was.

My initial response to the data collecting device? I was worried that I could not fall asleep, but the technician assured me that they only needed to capture a couple of minutes worth of data to get an indication of how bad my obstructive sleep apnea was. Incidentally, this would be the same process done at the hospital only by the hospital attendants. Not being to sleep for somebody suffering from sleep apnea was an obvious understatement. Very soon, I was asleep and snoring away providing vital data to the sleep test survey and all the valuable information was recorded into the sleep test device.

Resmed sent the results of the test to Dr John and during my next visit he explained the findings to me. The initial prognoses was not good. He told me my OSA was severe and that I was fortunate to have seen him soon to have been diagnosed. I do not have a the actual results off hand, but I did remembered asking him how severe on a scale of one to ten and he said nine! He said the blood oxygen level in my body was very low due to the apneas. I had stopped breathing many times during the course of the night due to the my airway collapsing before I gasped for air when I sleep. He also explained to my family members which I was always cranky and moody as technically, I have not slept restfully, all this while which explains the constant tiredness and mood swings. He told me that I have two options to consider, either surgery which goes not guarantee 100% results or try using a device called a CPAP machine. His recommendation was to try the Continuous Positive Airway Pressure machine or CPAP machine for short and see how I take to it and to this day I have been on a CPAP machine ever since which has been my savior and lifesaver.

Since ResMed were the ones who did the Sleep Study for me, I went to them to get my CPAP machine. At that time, they had a rental policy to try the machines out before actually purchasing them. From what I understand, some people have problems adjusting to the machines so it wouldn’t be practical to buy the machines off hand and dumping about two thousand dollars on a machine that you cannot take to or use in the future. So I guess this rental trial program made more sense and was more practical. For me, I took to the CPAP machine rather easily. To this day, I can’t understand why some people are still having issues getting use to it. I guess maybe it’s just plain stubbornness or not having an open mind. Remember, this is a small price you have to pay to improve the quality of your life and its worth every penny and sacrifice for the results it will give you. I'd have to admit for someone new to the CPAP machine, it takes awhile adjusting to it, but you’ll need to come with an open mind to accept it. I had friends and relatives having been diagnosed with sleep apnea, but simply were just too stubborn to try to get accustomed to it. They gave up eventually and their sleep apnea has been left untreated.

Personally for me I adjusted well without any issues and have been on it ever since. On the first night with the cpap machine, I naturally had trouble adjusting to it, but I fell asleep after some time. It took me maybe a week or so to get adjusted to the new machine which was a Resmed AutoSet Sprit. For the first time, I noticed that I didn’t wake up to have to go relieve myself until the next morning compared to an average 3 to 4 times every night. I also realized that I was becoming less tired and feeling that I had more energy as I was finally getting some real sleep! I have been deprived from real sleep for nearly 20 odd years, so it was nice to finally experience what a real restful night's sleep felt like! I only noticed another major thing that I hadn’t realized in the past.

The office started getting very noisy. I attributed it to the fact that I was always in a dazed and confused sleepy state that I hadn’t really been paying much attention on what’s going on in the office and what’s happening in the background. All of a sudden, being finally rested, I realized that the office was indeed a lively place instead of a dull and quite place that I have always seen it to be. I also found out that I had much more time do so many more things that I had always wanted to do over the weekend. In the past I had been living to sleep. All my spare time or any available time I had was consumed by sleep. Now I didn’t need to sleep that much any longer as I was finally getting some real sleep. I found that I had much more time to start doing many things like going for a movie, getting more exercise doing shopping with my wife without falling asleep!

Clearly, the standard of living has gotten better. I was more attentive and more productive at work and could think clearly without thoughts of home and going to bed. The vicious downward spiral has shifted upwards. All thanks to the the CPAP machine. With more energy now, I started being more active and participating in sports and exercises, I began to lose weight and slowly my health started improving. Being diagnosed and treated for sleep apnea with the CPAP machine has clearly reversed my fortunes. I am now living for the sake of living and my quality of life has been greatly enhanced.

I could never have imagined what life would have been without having being diagnosed and treated for sleep apnea. Or consider life without the assistance of the CPAP machine. I shudder to think what would have happened if i did not get diagnosed or treated for sleep apnea. I would have been most likely either very dead or very sick by now. Definitely out of a job or maybe would have been prison for running over a person while falling asleep at the wheel. I am indebted for being diagnosed and freed by the CPAP machine. With my new found energy I started the sleep apnea site to convince everybody who has the means to be treated to get themselves well again. Why compromise on the quality of life and let you sleep apnea take over your life?

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Friday, February 15, 2008

Welcome to the sleep apnea site

Welcome to the Sleep Apnea Site. I created this site to discuss the problems of sleep apnea and how it has affected me. It’s estimated that close to 1 out of 15 Americans have sleep apnea which is around 6% of the entire population of America. More global sleep apnea statistics can be found here. It gives an estimated results and breakdown by country. As you look at the number of sleep apnea cases, one thing primarily stands out. The number of people who are affected and those that remain untreated. Personally, I find this stems from two main reasons outright denial and lack of knowledge pertaining to this condition.

In more developed countries, sleep apnea had been long documented and there are special clinics that specializes in these sleeping disorders. Unfortunately in my case, sleep study was something very new and not many doctors, especially general practitioners here in Singapore knew much about it or were able to determine the symptoms for sleep apnea at that time. In my case, my doctor continue prescribing medication for high blood pressure and hypertension. Prior to the time of my diagnosis, in 2002, there were also hardly any articles in the news papers or magazines about this serious condition. I was also very surprised that sleep apnea had not be upgraded in terms of importance and education only until much later. I believe that the situation has gotten better over the years in terms of recognition especially here in Singapore as shortly after 2003, health insurance forms now had a section that primarily deals with sleep apnea and if you were to declare that you have sleep apnea now, there will not only be an extra premium, but most insurance companies will NOT cover you for any major illnesses such as heart related ailments like a heart attack or stroke. These also generally includes all the other forms of heart related condition due to high blood pressure, including major organ failure of the kidneys as well. In other words everything can now be associated with sleep apnea some way or another so many of your insurance benefits will unfortunately have to be disqualified.

Denial is also another major problem, and I found this to be one of the problems why many sleep apnea cases have been left untreated. I personally know of a few individuals whom have been diagnosed with severe sleep apnea problems after undergoing a sleep study to monitor for potential sleep apnea. They were simply just not open to the available treatments or are just plain stubborn to continue with treatment which usually involves the use of a CPAP machine. In some cases, they had all the tell tale signs of a classic sleep apnea problem, but just simply refused to take the sleep test to determine if they have a problem. The statistics are staggering, but sometimes it make me wonder if the patient really died of a heart related complications such as a heart attack, obesity, stroke or kidney failure or was it simply all aggravated by the fact that the patient was suffering from sleep apnea that resulted or in some cases accelerated these problems by causing other medical complications. I believe the statistics for those with untreated sleep apnea are even higher than what’s originally reported. 1 out of 15 people in the US would be grossly underrated!

The aim of the sleep apnea site, is to provide knowledge and awareness. Hopefully by sharing my personal experiences and ordeals, it will give you a better understanding about what sleep apnea is all about, the treatments that are currently available for sleep apnea and how one can regain control of their lives and have a pretty close to normal existence once again. The threat of sleep apnea is very real, it can kill and ruin lives. So please, if you’re doing research or reading up on sleep apnea please take this condition very seriously. Trust me, once you’re decide to get treatment, your quality of life will be greatly enhanced. I hope you will find this site as informational and helpful as I did during my personal journey with sleep apnea.


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Disclaimer: The information found on SleepApneaSite.com is strictly for informational purposes only. It discusses possible ways to diagnose and cure obstructive sleep apnea. It also highlights the current treatment available for sleep related disorders. It is no way to be used as a medical guide to treat your sleep related ailments or problems. I am NOT a medical practitioner or doctor and the articles written here are NOT meant to be taken as medical advice. Please see a doctor or sleep specialist to get your sleep disorder treated by qualified personnel.