"Early to bed, early to rise, makes a person healthy, wealthy, and wise" is a well-worn adage. Indeed, establishing good sleep habits is immensely beneficial for maintaining good health. However, if you snore constantly while sleeping, wake easily from light sleep, frequently urinate at night, still feel tired after waking, have difficulty concentrating, experience daytime sleepiness, or suffer from nighttime insomnia, you should be wary of sleep apnea! Dr. Lau Chu-leuk, a specialist in respiratory medicine, points out that many Hong Kong people "suffer from the condition unknowingly," simply assuming they have poor sleep quality that can be improved by catching up on sleep or changing bedding. However, because sleep apnea sufferers find it difficult to enter deep sleep for extended periods, they naturally feel more fatigued during the day. This poses a certain degree of danger for patients who need to drive or operate machinery, potentially leading to accidents, injuries, or even fatalities. Furthermore, oxygen deprivation can damage major organs, including cardiopulmonary function, and in severe cases, can even lead to sudden death in sleep. Dr. Lau urges that if you or your bed partner exhibit the aforementioned symptoms, you should seek medical attention early for further examination and address the hidden dangers of sleep apnea.
Dr. Lau Chu-leuk, Specialist in Respiratory Medicine
90% are Obstructive Sleep Apnea; Middle-aged, Male, and Obese are High-Risk Factors
Sleep apnea can be divided into three types: obstructive, central, and mixed, with obstructive being the most common, accounting for about 90% of all cases. Dr. Lau explains that during normal sleep, the tongue and soft palate muscles near the throat control and keep the airway open. However, in patients with obstructive sleep apnea, these muscles relax, narrowing the airway and causing difficulty breathing and snoring. When the muscles relax too much and completely block the airway, it can lead to suffocation. The brain then sends signals to wake the body to breathe, and after normal breathing resumes, this brief period of suffocation will recur after the patient falls asleep.
According to statistics, about 4% of middle-aged men and 2% of middle-aged women in Hong Kong suffer from sleep apnea, and the situation is becoming increasingly common. Dr. Lau states that people of all ages can develop this condition, but it is more common in middle-aged men between 40 and 50 years old: "The incidence rate in men is about 2 to 8 times higher than in women. In addition, other congenital factors including upper airway structural problems, such as enlarged tonsils or adenoids, deviated nasal septum, displaced nasal bones, nasal polyps, a small or retracted jaw, can also increase the chance of developing sleep apnea." Dr. Lau adds that acquired factors such as obesity, excessive alcohol consumption, and smoking are also high-risk factors: "Men with a neck circumference greater than 43cm and women with a neck circumference greater than 40.6cm should pay special attention."
Home sleep test equipment is easy to set up. Patients can generally operate it themselves at home according to instructions, offering more flexible testing times, and results are available after just one night.
Home Sleep Tests Approach Hospital Standards; Save Waiting Time and Facilitate Early Treatment
To diagnose sleep apnea, the first step is a clinical diagnosis and preliminary examination using a sleep apnea questionnaire, followed by a sleep test to clearly understand the degree of sleep apnea and the location and extent of airway obstruction. Dr. Lau states that public hospitals, private hospitals, and health examination centers all offer sleep apnea tests. However, public hospitals often have waiting lists of a year or more, and private medical institutions are expensive, which may deter many patients and cause them to miss the golden window for treatment. "Sleep apnea not only affects the patient's sleep quality but also increases the risk of hypertension and cardiovascular diseases, and the chance of developing coronary heart disease is twice as high as that of ordinary people. It should not be taken lightly."
In addition to inpatient examinations, patients can also opt for a Home Sleep Test (HST). You might wonder if home sleep tests are less accurate and professional than inpatient examinations. Dr. Lau points out that the equipment used for home sleep tests must also be provided by accredited sleep test suppliers, and current testing technology has reached the same standard as that in hospitals and sleep laboratories. Patients undergoing home sleep tests not only save waiting time but also find them more economical than inpatient stays. Moreover, patients can sleep more easily in a familiar environment, which may lead to more accurate test results: "HST can measure the patient's breathing patterns and flow, blood oxygen levels, pulse, and chest movements, among other data. This information is sufficient to help diagnose the severity of the patient's sleep apnea." Dr. Lau also adds that the setup of simple sleep test equipment is relatively easy, and patients can generally operate it themselves at home according to instructions. This means that testing time is not limited by inpatient examinations, offering greater flexibility. Furthermore, results are available after just one night, which can significantly reduce waiting times and allow for early diagnosis and appropriate treatment.
Dr. Lau recommends that patients personally try on and choose a nasal mask or full face mask that fits their face shape before renting or purchasing a CPAP machine, to increase comfort during use, which will contribute to long-term treatment effectiveness.
CPAP Machine Treatment Suitable for Most Patients; Adjust Mindset for Long-Term "Battle"
When asked about treatment methods for sleep apnea, Dr. Lau stated that for patients with mild conditions, caused by a small or retracted jaw, a custom-made oral appliance can be worn to increase airway space and reduce obstruction. Another suitable treatment for most patients is positive airway pressure therapy, which requires using a CPAP machine every time they sleep: "After all, 20 to 30% of patients cannot comply with CPAP machine treatment for various reasons. CPAP machines can be divided into fixed and automatic types. The former delivers a fixed pressure, while the latter automatically adjusts the pressure according to the user's needs. For example, when the user experiences airway obstruction, the automatic CPAP machine will automatically increase the pressure to open the airway; when the airway returns to normal, the machine will automatically reduce the output pressure, eliminating the need to continuously receive high pressure, thus offering greater comfort than fixed CPAP machines."
Modern CPAP machines have significantly improved in size, performance, durability, and ease of operation. Some CPAP machines are even as small as the palm of a hand, making them convenient for patients to carry. With the ability to automatically upload sleep data to the cloud, doctors and patients can download detailed reports at any time, helping to track the progression of the condition more accurately.
Of course, for those who need to use a CPAP machine for extended periods, Dr. Lau admits that many patients give up treatment after one or two trials due to discomfort or unfamiliarity: "Firstly, they must understand the significance of the treatment. Sleep apnea is not immediately life-threatening, but precisely because of this, patients overlook the importance of early treatment. Secondly, discomfort from using the CPAP machine can be addressed by trying different accessories. For example, if the bridge of the nose is red and swollen, a nasal cushion can be added, or a nasal pillow that only covers the nostrils can be chosen. If the mouth and throat are dry and uncomfortable, a humidifier and heated tubing can be used to increase humidity and temperature. Finally, patients also need to adjust their mindset, understanding that sleep apnea cannot be cured in a short period and they must be mentally prepared for a long-term 'battle.' When patients persist in using it and their sleep quality and daytime mental state significantly improve, they will naturally realize the benefits the CPAP machine brings to them."
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