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| Sunday, 27 June 2004 |
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Features |  |
| News Business Features Editorial
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Phantom of the night The majority of people (95 per cent to be exact) do not know they have this condition. But Sleep Apnoea can strike anyone. This deadly phantom of the night can be potentially life threatening warns Dr. Rani Goonewardene
Are you subjected to the following - Ds? * Deep snoring * Day time somnolence * Dull morning headache * Dry mouth and sore throat * Drowsiness * Decreased libido * Disturbed and interrupted sleep * Dullness and fatigue If the answer is" yes" then you may have a silent disorder Sleep Apnoea (cessation of breathing) during sleep. In Greek the word Apnoea means want of breath. It is a potentially life threatening breathing disorder. Sleep Apnoea is far more common than generally understood, and the public are not aware of its dangers. When the phantom of Sleep Apnoea strikes in the night the sufferer may not be aware of the interrupted sleep, the night struggle to breathe and think that they had a good night sleep, the next morning. While the damage is done when you are asleep most people do not realise that they have Sleep Apnoea as most of the symptoms and signs while awake are not sleep related. Types of Sleep Apnoea : Obstructive and Central Sleep Apnoea whatever the type may be is characterised by frequent, repeated brief periods of Apnoea that stops you from breathing. In Obstructive Sleep Apnoea which is the more common type the muscles in the throat (pharynx) relax while you sleep. This closure /collapse of the pharyngeal wall result in cessation of breathing. The flow of air is obstructed and no gas exchange takes place. Apnoea last for about 10-30 seconds, or about 7 times per hour. There can be 300/600 such episodes taking place in one night in an obstructive Sleep Apnoeic person. This brief period of Apnoea is terminated, when the muscles in the throat regain its normal tone reliving the obstruction. Breathing starts again with arousal. A spouse or a partner of a sleep apnoeic person will describe the sequel of events of observed interrupted sleep as: "sleeping- loud snoring-apnoea-snort-waking-up-gasps-(cry for help) moan/mumble-movement in bed adjusting the position to breathe more easily- and finally falling back to sleep." Please remember that not every one who snores has Sleep Apnoea by any means and not every one with Apnoea necessarily snores (though most do). During the less common type of central Sleep Apnoea breathing is interrupted due to the failure of the brain to signal for a breath, and not due to snoring. During central sleep apnoea the level of carbon dioxide in the blood is raised and oxygen is lowered in the blood. Alerted by the change the brain wakes you just to start breathing often with a snort-gasp-or a choking sound. The lowered level of oxygen in the blood will also cause the heart to pump harder. Q: Is obstructive Sleep Apnoea dangerous? A: Absolutely-in rare cases it can be fatal People who snores deeply and pause for breathing may be at risk of heart disease, high blood pressure, secondary pulmonary hypertension, enlarged heart irregular heart rhythm, heart attack stroke and sudden death. Even if you have Obstructive Sleep Apnoea and your blood pressure is normal your chances of getting high blood pressure is three times more than a healthy person. People who have diabetes mellitus and high blood pressure are at a greater risk of developing Obstructive Sleep Apnoea. Obstructive Sleep Apnoea is associated with that of reduce blood pressure, oxygen levels, and blood flow to the brain and therefore may be linked to stroke. It is known that secondary pulmonary hypertension due to Obstructive Sleep Apnoea is due to the hypoxic (low oxygen) vasoconstriction (narrowing) of the pulmonary vessels. Dangers of Central Sleep Apnoea include high blood pressure, increase adrenaline levels, and irregular heart beats. Tests Simple studies like Pulse Oximetry and Sleep Video Recording will help in diagnosis. Other tests are Polysomnography (monitoring oxygen saturation ,air flow at the nose and mouth) EMG ECG chest wall and abdominal wall movement during sleep. Fifteen or more episodes of apnoea per one hour is diagnostic of Sleep Apnoea. Why don't people with Sleep Apnoea get treated? BecauseSleep Apnoeic suffers usually don't realize they have this conditions as they are asleep while the damage is being done. There is also a lack of trained physicians to recognise, diagnose and treat it as well as a lack of sleep disorder clinics and incomplete follow ups. Management If you think you have Sleep Apnoea see your doctor, who can accurately diagnose your condition and recommend the following appropriate management options; Weight reduction, Avoid alcohol, Avoid sedatives and narcotics, Quit smoking, Refer to a sleep clinic, Consult an ENT Surgeon, Otolaryngolist, or a head and neck surgeon. If surgery is not preferred the patient may sleep every night with a "CPAP: mask that delivers, in to the mask. Continuous positive air pressure. Please remember that 95 per cent of people with Sleep Apnoea may never suspect having this phantom "silent disorder", let alone being diagnosed by a doctor. It is not something to ignore, if you think it will go away by itself, don't. It won't. while there is no immediate danger, the long term serious complications are life threatening, therefore Sleep Apnoeic sufferers should' recognise it - get it diagnosed - get treatment and recover. ***** Medical update : Snoring differs in adults and children A consultant for Ear, Nose and Throat (ENT), Dr. Khalid Hamad Al-Subeih, has said that snoring in adults differs from snoring in children, in both diagnosis and treatment. Al-Subeih said that snoring in adults is due to loosening of the tissues surrounding the tonsils and the throat tissues. Many believe that snoring is linked to the nose. This is not true, said Al-Subeih. AL-Subeih added that snoring usually occurs when a person sleeps flat on the back, which leads to loosening of the throat tissues and body muscles. This results in the noise produced by the person known as 'snoring'. He said that snoring can cause suffocation during sleep, as the air stream gets blocked and less oxygen gets through the blood leading to body signals to the brain to 'wake up'. This process of awakening lasts less than a minute. Al-Subeih said that the repetitive awakening during sleep could cause insomnia, headaches and drowsiness during the day, in addition to affecting the person's activities and causing an increase in blood pressure. Meanwhile, snoring in children in 90 per cent due to the enlargement of the adenoids and the tonsils, Al-Subeih said. He added snoring affects children in many ways, it increases involuntary urination, and affects the child's intelligence and performance in school. Al-Subeih clarified that snoring is of genetic origin, except in special cases. Such a case is when the nose is too small, or with enlargement of the tongue such as in the case of Down's Syndrome children, noted Al-Subeih. He added that snoring in children can be treated through surgical removal of the tonsils and adenoids. In adults the treatment would include medication, radio waves or surgery, he stated. From Kuwait Times ###### When passing urine becomes an agony... Most people in their middle ages, sometime or the other, experience anguish during urination. They may feel that their bladder has not been fully emptied resulting in the frequent usage of toilets. Many may also feel that the force of urine has been drastically reduced to a few burning droplets. This is mainly due to biological system failures and negative emotional factors. They may also develop uneasiness and wariness physically and over a limited period of time, unnecessary anxieties and pain of mind. Some may not be able to withhold the incessant call of nature and experience incontinence, which further adds to unavoidable stress. For these patients the answer lies in SITZ Baths and Psycho Therapy. This can help to stimulate urine and overcome prostrate gland disorders. What is a SITZ Bath? It is a treatment of choice, a homogeneous and effective bath conducted in a sitting posture for about 30 minutes performed three to four times a week. The therapy involves the usage of luke-warm water introduced gradually in increasing temperatures to stimulate and activate the lower organs and their corresponding points or Chakras. The constant warmth, the comfortable posture and the state of calmness, revitalizes the malfunctions of the meridians and consequently corrects its vital organs. Many people have experienced immediate relief, ease of agony and the contentment of empting their full bladder. Psycho Therapy Psycho therapy now comes to play an invigorating role at this crucial juncture, to relieve all the pent-up negative emotions of anguish, anxiety, stress and frustrations. They promptly feel calm and relaxed due to the rebalanced and restored energy levels and stimulated circulation in their bodies. The SITZ Bath is an age-old therapy first recorded by the Greeks and now practised by a large group of Psycho-Therapists the world over and it is based and built on the simple principle that the human body has its own miraculous ability to heal and correct itself, under stimulation. Ishan Abdeen, Psycho-Therapist. Healing Chambers, Mt. Lavinia. ###### Cosmetic surgery of the breast : Who needs it ? An increasing number of men and women are opting for cosmetic surgery of the breast. DR. PURNIMA AIYER, Plastic and cosmetic surgeon discusses the pros and cons of this form of surgery, with Observer Health Editor CAROL ALOYSIUS.
Q: I understand that many men too are going in for cosmetic surgery of the breast. Why is this? A: Because of breast enlargement. Q: Why does, it occur? A: A small amount of enlargement of the male breast occurs in about 33 per cent of adolescents, starting at 14 years and is usually resolved at 20 years due to transient elevation of the female sex hormone oestrogen. Any enlargement occurring before puberty should make one suspect an endocrine pathology and the patient should be evaluated by an endocrinologist. Also, enlargement of only one breast is suspicious of malignancy. The male breast can also enlarge with abnormal liver function which leads to increase in oestrogen levels. Q: Can it disappear with time? A: Usually adolescent gynaecomastia is resolved by 20 years in the majority of cases. Q: When should surgery be advised? A: If in adolescents it persists for more than two years and bothers the patient. In adolescence, the patient may suffer psychologically due to the breasts enlargement at a time when the secondary sexual characteristics are developing. In adults surgery is undertaken purely for cosmetic reasons. Q: What are the methods used to treat it? A: Surgery involves liposuction and excision of the enlargement. Q: What about the scars? A: Scars are within the areola and not usually visible Q: What about folds or the skin and fat in the armpits? A: Patients are usually very self conscious of this. It makes it difficult for them to wear sleeveless blouses. The definite cause is not known. If only fat is excessive then liposuction is adequate. If there is associate excess skin, and excision of skin and fat with the scar hidden in the armpit is done. Q: What is the reason for small breasts in women? A: The cause may be a developmental illness with deficient fatty tissue and glandular tissue wherein genetics and hormones play an important role. Another reason is after delivery when the glandular tissue decreases with relative excess of skin leading to small breasts which droop. Q: Why do women seek treatment for this? A: Women with small breasts seek augmentation for enhancing their self image and having a more feminine appearance. Overall, the patients are more self assured after surgery, with better self image and positive effect on sexual life and interpersonal relationships. Q: What about the implants used? Can they cause cancer or other side effects? A: Textured silicone gel implants are used. They are not carcinogenic. The implants in some patients develop a capsule around their periphery and cause the breasts to feel firm. This is referred to as capsule formation. Patients are counselled preoperatively regarding all possible side effects. Q: What about the scares? A: Implants are usually introduced via an incision in the skin fold below the breast. Less commonly by a cut in the armpit or a cut in the areola. The natural lie and fall of the breast renders the inframammary scar inconspicuous. Q: Why do breasts lend to droop in some women? A: Usually a strong internal tissue support of the breast allows the breasts tissue to remain above the inframammary crease (skin fold beneath the breast). Drooping or ptosis is due to stretching and loss of elasticity of the tissues associated with gravity, change in size of the breasts which occurs with menopause or after delivery, excessive weight gain or weight loss. Q: What motivates the patient for surgery? A: To improve appearance and self image. Some patients may be dissatisfied with the size of the breasts and seek augmentation or a reduction. Q: How is this treated? A: Treatment involves removal of excess skin and raising the breasts to a more cosmetically acceptable level. In addition the glandular tissue is tailored depending on the individual problem. Q: What are the complications? A: Expected trade offs after surgery are decreased sensation in the breast usually lasting six months and scars around the areola and lower part of breast which usually fade with time. Actual complications such as asymmetry and distortion can be avoided by careful patient selection and prudent surgical technique. Q: What are the other problems in the breast needing cosmetic surgery? A: The nipple and areola may be missing due to damage from a previous burn injury or removal for cancer and can be reconstructed using plastic surgical techniques. Other problems include enlarged nipples and inverted nipples. ###### Health line Low-cost diagnostic checks Asiri Surgical Hospital has introduced a revolutionary, pain-free, non-invasive procedure to check for Coronary Artery Disease, which requires less than 10 minutes. Using the only state-of-the-art 32 slices per second CT scanner available in Sri Lanka, the test takes 70 to 90 images of the coronary arteries (the vessels that carry blood and oxygen to the heart), without using any intravenous injections or needles that were required earlier. This non-invasive coronary scan measures the amount of calcium plaque within the coronary arteries. Such a calcium score scan can detect heart diseases at a very early stage, even before any cardiac symptoms are noticeable, and even before a stress test indicates any abnormality. The more calcium plaque one has in the coronary arteries, the greater the chance that one will suffer a heart attack or need surgery in the future, unless early preventive steps are taken. This test is especially beneficial for those who have no symptoms, but are at a higher cardiac risk due to factors such as age (males above 40 and females above 45), smoking, high cholesterol, inactive lifestyle, family history of heart disease, high blood pressure, overweight, diabetes, or high stress level. The Calcium/cardiac scoring test also available at the Asiri Surgical Hospital at Kirimandala Mawatha, Narahenpita. |
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