The perils of fitful sleep

New Delhi: How often have you heard someone say, “I usually sleep soundly, even snore at night.”

That snoring is a sign of sound sleep has to be the biggest myth concerning sleep disorders, says Bidur Dhaul, senior director (home healthcare), at Philips Electronics India Ltd (PEIL).

Snoring, actually, is an indication of obstructive sleep apnea (OSA), the most common sleep disorder among Indians and a key link to other ailments such as diabetes and cardio-vascular disease.

India is emerging as one of the most sleep-deprived nations, with nearly 93% of Indians not getting enough sleep. A survey on sleep disorders conducted by AC Nielsen Co. and Philips in November 2009 found that nearly 11% of Indians took leave from work to catch up on sleep. The survey was conducted among 5,600 respondents in the age group of 35 to 65 years across 25 cities.

The latest global study, released earlier this month by Uppsala University in Sweden, found that one night of sleep deprivation increased the blood levels of molecules found only in the brain.

“These brain molecules typically rise in blood under conditions of brain damage. Thus, our results indicate that a lack of sleep may promote neurodegenerative processes,” researcher Christian Benedict from Uppsala University said in a press statement.

The study, published in the medical journal SLEEP, monitored 15 normal-weight men, half of whom were sleep-deprived while the rest got eight hours of sleep.

In the Indian context, sleep deprivation is frighteningly common and sleep medication, as an organized discipline, is still a work in progress, says Samhita Panda, Neurologist and Chairperson, Sleep Medicine, at Sir Gangaram Hospital in Delhi.

There are 82 known sleep disorders, of which the two more prevalent ailments are insomnia and OSA. Insomnia is the inability to fall asleep and OSA is a condition in which the flow of air pauses or decreases while sleeping. This is called an apnea episode and can last up to a few seconds.

In a study conducted at the National Institute of Mental Health and Neurosciences (NIMHANS) Panda found nearly 18% of healthy adults suffering from insomnia. An equal proportion was suffering from OSA while less than 2% suffered from the restless leg syndrome—a neurological disorder characterized by an irresistible urge to move one’s body, causing sleep disruption.

Another rare neurological sleep disorder is narcolepsy—in which the patient experiences bouts ranging between a few seconds to several minutes of overwhelming sleepiness during the day.

Sleep hygiene

Be it students, shift workers or new parents, sleep deprivation in Indian society is reaching epidemic proportions and addiction to gadgets such as smart phones and tablets is further compounding the challenge, said Panda.

Ample scientific evidence links lack of sleep to chronic diseases including diabetes, heart attacks and strokes but medical expertise on sleep medicine in India is still evolving, said Panda.

“Sleep medicine as an organized discipline has evolved in India only in the past decade. Even now, doctors ask patients about medical history but leave out sleeping habits. It is only now that experts from fields like neurology, respiratory ailments, psychiatry, ENT (ear, nose, throat) are showing interest in sleep medicine as it affects their patients,” she added.

Given the increasing incidence of sleep deprivation, most hospitals now run sleep clinics which monitor brain activity, eye and muscle movements, heart function, blood oxygen levels and breathing patterns while the patient is sleeping to diagnose the nature of the illness.

Meanwhile, companies such as Philips and GE Healthcare have moved in to service this market with anti-snoring devices, sleep aid products and even home visits to conduct sleep labs. Globally, the market for sleep aids products is estimated to be reach $33 billion by 2014, according to a study by BCC Research.

The Indian market is $2-3 billion. “Every two years, we double the amount of patients being treated. The macro view is that despite Philips being the market leader—we hold 60% market share in this segment—it reaches only 3-5% of people who need and can afford treatment for sleep disorders. Despite such a low penetration rate, the opportunity is huge,” said Dhaul.

Philips has so far opened 300 sleep labs in collaboration with hospital groups and doctors across the country. As per industry estimates, the urban India market—in the top 12 cities—has 8-10 million people living with OSA, he said.

With more money being poured into awareness campaigns, the service is being tailor-made for patients. A patient now has three ways to test the quality of sleep. One can check into a hospital for a night and let experts monitor sleep quality through a “polysomnogram”, a test that records physical activities while you sleep. This is the most accurate test and usually picks up most sleep disorders. Depending on the hospital, this test could cost between Rs.10,000 and Rs.12,000.

The second option is to have experts visit the patient’s residence with a portable machine and conduct the same test. The study costs Rs.7,000-8,000. The third option is a home sleep screening test; the test does not pick up specific disorders but simply suggests whether further examination is needed or not.

“The home screening device is pretty inaccurate but the home testing and fixed labs are comprehensive. While our labs focus on diagnostics, our therapeutic devices facilitate people living with these disorders to lead a better life,” added Dhaul.

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Besides sleep labs and clinics, applications for smart phones offering free hypnotherapy sessions and/or playing soothing music (like recordings of rain) are increasingly becoming popular as people seek help to sleep.

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