Sleep medicine and Physiological Measurements

Staff: Dr. M. O. Hassan, formerly Professor of Clinical Physiology at Sultan Qaboos University Hospital with a special commitment to Sleep medicine

What are sleep disorders

There is a wide range of sleep disorders the most common of which is heavy snoring associated with choking and frequent arousal (awakening from sleep). This is called obstructive sleep apnea (OSA). In adults OSA is caused by weak airway muscles. In children it is caused by large tonsils or adenoids in addition to weak airway muscles. Patients with heart failure can have OSA as well as CSA (Central Sleep Apnea)

If untreated OSA often is associated daytime tiredness with low work productivity and low school performance. OSA also affects the sleep quality of married couples or room partners. In addition, OSA patients have a higher probability of car accidents. Most patients with OSA are overweight or obese. They have high blood pressure which does not respond to medication. They may also have type 2 diabetes

Other sleep disorders:

1.Parasomnias: The most common of these is insomnia or inability to sleep. Another is the restless leg syndrome (RLS) which means leg twitching during sleep. Usually the bed partner is the one who complains. This causes the brain to wake up and therefore they have the same problems as those of OSA.

2.REM (Rapid Eye Movement) disorder:

Rapid eye movement indicates that the person is dreaming which typically happens after 90 minutes of sleep and occurs 3 or 4 times. The person remembers the last episode before awakening. If REM happens during the first few minutes of sleep the patient can develop sleep walking or eating and they may become obese. The most serious is sleep driving. Here the patient can drive his car safely but cannot remember what he or she did. Few may drive long distances and wake up not knowing how they got there. Rarely they may commit serious crimes.

Diagnosis:

This can only be done in a sleep medicine centre in a hospital set up or at home. Most patients cannot sleep in a hospital setup which they find disturbing.

Over the last 10 years there has been a shift from hospital to home sleep studies. This has now been adopted by CHC. The study is done at home using simple devices that the patient can connect at home after a very short demonstration. Now CHC is in the process of establishing 6 home sleep centres in large cities of Oman.

Treatment:

Home sleep monitoring and full sleep monitoring. Insomnia is treated at CHC by an experienced psychologist.

OSA and CSA are treated by Continuous Positive Airway Pressure (CPAP) or BiPAP ( Bi-level Airway Pressure), depending on body weight and the severity of the condition.

High blood pressure, diabetes and heart failure are treated by the CHC Cardiologist.

Children with OSA are referred to ENT surgeons well informed about this disorder.