Dr Shadi Sharifi Sleep Medicine Specialist Saudi German Hospital Courtesy: Dr Shadi Sharifi

Call it the Dubai syndrome. Too many hours awake and too little asleep. More and more people are treating sleep like a dispensable luxury. But that’s not the story we are getting into here. What we are talking about right now is sleep apnea, a lifestyle affliction that is increasing in Dubai. It goes like this; You go to bed at the usual time, wanting to catch up on your eight hours of sleep. But you get up the next morning with a headache, feeling listless and drowsy, desperately wanting to go back to sleep. What happened here? You were not on Facebook, or watching TV or doing any of the stuff that keeps you awake half the night. Where’s the problem? First, you need to answer these questions: Are you obese? Overweight? Yes? Well, that’s where the problem is. You are suffering from a sleep disorder known as sleep apnea which is a common problem here in the UAE and in the US and the main cause is due to obesity, says Dr Shadi Sharifi, sleep medicine specialist and neurophysiologist at Saudi German Hospital in Al Barsha, Dubai, who is also French board member of Neurology ans Sleep Medicine,

In this disorder, a person gets up from sleep briefly to breathe and get that vital oxygen to the brain. “You will get up about five to 10 times in a hour, correct your breathing, and go back to sleep,” says Dr Sharifi “Though you may not realise that you keep waking up for a few seconds every time, it affects the quality of your sleep, fragments it, and as a result, the next day you wake up tired,” she says.

In sleep apnea, you produce that dreadful sound that keeps your spouse awake through the night and it occurs when the throat muscles relax during sleep, the tongue falls backward toward your throat and the walls of your throat vibrate - what emanates is a mighty snore. It’s a common notion that most people only snore when they sleep on their back, as this is what allows the tongue to collapse into the back of the throat and obstruct breathing, says the doctor. But there are other reasons why people snore.

“Obstructive sleep apnea is the most common type of sleep apnea,” says Dr Sharifi. It is caused by the obstruction of the upper airway and is characterised by repetitive pauses in breathing during sleep. That leads to less oxygen reaching the brain. These pauses in breathing are called apneas and they typically last 20 to 40 seconds. Some of the underlying factors that lead to snoring include obesity and fat accumulation in the throat and narrowing of the nasal passage.

The UAE is ranked the 5th fattest nation in the world according to a study published by BMC Public Health journal, and the problem of sleeplessness is acute and is due to many people being overweight. Today, hospitals such as the Saudi German, have special sleep clinics to help the population get a proper sleep. It’s a very specialised field.

Obesity affects sleep

The extra weight we carry on our body affects many aspects of its functioning, including breathing. Research has also associated obesity with anatomical abnormalities of the nose and throat,

Functional abnormalities (such as inflammation of the nose or throat due to allergies), drinking alcohol before going to bed, as alcohol is a potent muscle relaxant, or taking muscle relaxants in the evening also lead to snoring and breathing disorders.

Lack of proper sleep is a serious problem though many write it off as a lifestyle casualty. Chronic lack of sleep can severely interfere with all our activities, leading to among many things nodding off at the wheel when driving to falling asleep at the desk at work and being unable to focus and concentrate during meetings.

Other serious repercussions due to lack of sleep are that it could lead to heart failure, stroke, personality disorders and depression. “Any condition that interferes with sleep should be regarded as serious,” says Dr Sharifi, “as too little sleep impacts the levels of thyroid and stress hormones, which in turn can affect memory and immune system, heart and metabolism, and much more.”

Over time, lack of sleep can lead to weight gain, high blood sugar, increase of heart disease, stroke, increase of blood pressure, accelerated aging and depression.

For chronically sleep derpived people, who are battling obesity or psyhological conditions, seeking treatment at the earliest is absolutely vital.

The concept of sleep clinics

Sleep medicine is a relatively new field but it is an important branch of medicine as many people today are suffering from lack of sleep due to various reasons, inclduing sleep apnea. The first sleep clinics opened in the US and were set up in the 1970s by interested physicians and technicians. But by 1999, any physician with no training could open a sleep laboratory.

During the second half of the 20th century as knowledge about sleep grew, doctors began paying it more attention. Within the next two decades, standardised clinics and laboratories on the study of sleep and its treatment of its disorders were established in the US and Europe,

The concept of a Sleep Clinic is relatively new in the region.

The patient comes for a sleep test after referral by the physician. In the Sleep Clinic at the Saudi German Hospital, a specialist team evaluates the patient and he is required to stay the night at the clinic. The doctor will advice that you should not nap earlier before you check in. The patient also should not take stimulants and caffienated drinks.

A specialist will question you about your sleep habits. Before the test, the patient is asked to fill in a detailed questionnaire about the patient’s lifestyle, family history and medical condition.

During the night, the patient is studied with regard to his brain waves, heartbeat, leg movement, breathing and oxygen content in his blood during sleep.

This sleep study is known as a polysomnogram. Dr Sharifi, and a specialist team record and evaluate the data.

The treatment room at the hospital’s Sleep Clinic is fitted out as lavishly as a room in a five-star hotel. “It is optimised for comfort,” says Dr Shadi. After the patient is tested to find the underlying factors for sleeplessness, as treatment, he is fitted with a machine called a C-Pap breathing machine.

The C-Pap (Continuous Positive Airwaves Pressure) machine is basically a mask with nose tubes. It allows you to breathe more easily during sleep by increasing the air pressure in your throat so that your airway does not collapse when you inhale. It releases the pressure when you exhale).

“It is a non-invasive form of treatment and is perfectly safe,” says Dr Sharifi.

The other types of treatment at the Sleep Clinic include surgery and laser removal of fat is blocking the respiratory airways. Some people who have sleep apnea might benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea. Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.

There are also three types of insomnia, says the doctor. “Transit insomnia, acute and chronic. Insomnia is a symptom, not the disease. If you are unable to sleep once a week or periodically, then you do not qualify for treatment, as it is transitory,” she says.

The diagnosis of sleep apnea is based on the evaluation of clinical symptoms (for example, excessive daytime sleepiness and fatigue) and of the results of a formal sleep study (polysomnography). The latter diagnoses the quantity of apneic events per hour of sleep (Apnea Hypopnea Index,AHI), or Respiratory Disturbance Index (RDI))

If this is above a threshold (see Slumber Numbers), the patient is considered as suffering from sleep apnea, and the severity of their sleep apnea can then be quantified, says Dr Sharifi.

“Obstructive sleep apnea is more common in men, while insomnia due to depression is more common in women.”

If you do not suffer from sleep apnea but cannot sleep, the best therapy is to work out. “Exercise is also an anti-depressant and will lead to deep sleep,” says Dr Sharifi, but recommends that exercise should not be done just before going to bed.

Though sleep is affected as you age and the number of hours you get become shorter and the quality of sleep diminishes, there are ways to get a better snooze. “Adopting a healthy lifestyle will get you better sleep and eat at least two hours before going to bed,” says the specialist. “Avoid eating foods cooked in trans-fats and saturated fats.”

On an average, we need between 7 to 8 hours of sleep per night. “Daytime naps will help your body to recover, but do not nap for more than 15 to 20 minutes or you will disturb the night sleep pattern.”