There are only two things that are certain, death and taxes’. This was famously quoted by Benjamin Franklin, in a letter he wrote in 1789. Another item that could be added to this list of inevitabilities is our need for sleep. We cannot live without it, and lack of sleep, or adverse features within it, can cause or contribute to a wide range of other medical problems.
In the USA – where the most up-to-date statistics are available – public health and safety is threatened by the rising prevalence of Obstructive Sleep Apnoea (OSA) and other sleep disorders. Obstructive Sleep Apnoea is diagnosed when occurrence is observed of at least five episodes per hour of sleep, during which respiration (breathing) temporarily ceases. It is now estimated that approximately 26% of the population in the US suffer from OSA or other sleep-related problems (American Academy of Sleep Medicine). The famous actress Carrie Fisher recently passed away due to a combination of problems related to sleep apnoea.
In Thailand Dr Jakrin Loplumlert is the country’s top expert in the field of sleep science, and he says that the trend in Thailand is following that observed in the USA. Dr Jakrin studied in Thailand at both Mahidol and Chula Universities’ medical faculties, and went on to further study in Cleveland, Ohio, where he left with a Research/Sleep Medicine Fellowship/Observer ship from the University Hospitals Case Medical Centre, in 2014. He subsequently returned to Thailand, and has since then led the sleep science team in the Neuroscience Centre at the Bangkok Hospital, located on New Petchaburi Road.
Dr Jakrin told us that there are a number of common sleep problems, such as sleep related breathing disorders, snoring, OSA, insomnia, inadequate sleep, narcolepsy, sleepwalking, etc. Of which the most commonly occurring is Obstructive Sleep Apnoea.
Dr Jakrin said, ‘OSA is found more within the male population, showing clinical manifestations such as snoring, waking up to go to the toilet, waking up gasping, waking up unrefreshed, morning headaches, daytime confusion, memory problems, or Excessive Day Time Sleepiness (EDTS).’
Dr Jakrin told us that OSA sufferers often exhibit a variety of more extreme medical problems as a result of their condition. It can cause or contribute to hypertension, coronary artery disease, cardiac arrhythmia, stroke, kidney disease, diabetes or mood disorders such as depression or irritability, to name the most common.
It can be seen, therefore, that OSA is a serious problem for the public health of a country, and urgently needs the help of experts such as Dr Jakrin. And the aid they can receive is thorough, meticulous, and has a great success rate.
Patients (Thai and foreign) from other hospitals in Thailand – and sometimes even other countries – are often referred to Dr Jakrin, and the process begins. The first step is to have a physical examination, followed by a polysomnography examination. This is an overnight stay (with an optimum 8 hours of sleep time) in a well-equipped hospital suite, where the patient’s brain activity, heart rate, digestive system, et al, is continuously monitored by a technician, who can also observe their sleep pattern on a CCTV screen. The evaluation for suspected obstructive sleep apnoea also involves a thorough review of their medical history, and a focused upper airway examination to look for sources of potential obstruction. Patients are provided with an in-depth analysis of the sleep study results, and a treatment plan is then tailored specifically to their needs.
This treatment could be supply of an oral appliance; drug treatment with melatonin or a medicine with a similar effect; Ear, Nose or Throat (ENT) surgery; or in 90% of cases the first-line therapy for most patients with OSA is Continuous Positive Airway Pressure (CPAP) treatment. This is a procedure that utilises a CPAP machine and a disposable facial mask to provide mild air pressure to keep breathing airways open.
Occasionally, patients find a full-face mask a little too claustrophobic, and opt for a mask covering only the nasal region. For the treatment to be most effective, the CPAP machine should be used every time a patient sleeps at home, while travelling, or during naps. Getting used to using a CPAP machine can take time and does require patience, but the benefits are many. The doctor may need to adjust the pressure settings for a particular patient, and he or she will have to work closely with the sleep doctor to find the most comfortable mask that works best for them.
Some patients notice immediate improvements after starting CPAP treatment, such as better sleep quality, reduction or elimination of snoring, and less daytime sleepiness. But equally important are the long-term benefits that cannot immediately be recognised, such as helping to prevent or control high blood pressure, lowering the risk of stroke, and improvement of memory and other cognitive functions.
The majority of patients quickly become used to using a CPAP machine, combined with the relevant mask, and the success rate in curing OSA and its and the success rate in curing OSA and its related medical problems is high.
Related medical problems is high. It not only has the effect of immediately reversing apnoea and hypopnea, it also decreases somnolence and increases quality of life, alertness, and mood.
If you suffer from snoring or other sleeping disorders it might be a good idea to make an appointment to see your doctor. And if you are here in Thailand you might soon find yourself making the acquaintance of the always amenable