Benny Tan had no idea he has been suffering from obstructive sleep apnoea (OSA) although he has had trouble sleeping for years!

For years, Tan Hsu Wen, fondly known as Benny among his friends and family, has had trouble sleeping. His friends often complained about his loud and incessant snoring whenever they went on holidays together in the past.

“I’ve never been able to get a good night’s sleep, and usually wake up many times throughout the night,” shares Benny, who is a Grab rider.

Although he often woke up lethargic and drowsy, and suffered from frequent headaches, he did not think there was something seriously wrong with him.

Then about two years ago, Benny experienced continuous tightness in the chest and breathing difficulties. He decided to consult a doctor, who then referred him to an ear nose and throat (ENT) specialist. Upon listening to his symptoms, Benny was advised to see a lung specialist and undergo a polysomnography, or a sleep study.

Alarming results

Benny was required to stay overnight in the hospital to complete the sleep study. While asleep, he was hooked up to equipment that monitored his heart, lung and brain activity, breathing patterns, leg movements, as well as blood oxygen levels.

The test results showed that Benny suffered from Obstructive Sleep Apnoea (OSA) and had insufficient oxygen supply to his lungs.

According to the lung specialist, one of the main contributing factors to Benny’s condition was his weight. At 170 cm, Benny then weighed over 100kg, which put him in the ‘obese’ category.

The 44-year-old is also an asthma patient, and has other co-morbidities such as diabetes and high blood pressure for which he is currently under medication.

Managing the condition

Due to the severity of his condition, the lung specialist recommended that Benny use the continuous positive airway pressure (CPAP) device at home to regulate his oxygen flow. He was also advised to reduce his weight.

Benny was reluctant to use the device at first, but eventually, upon learning about some of the adverse effects of sleep apnoea, such as an increased risk of a heart attack and stroke, he relented.

“However, I couldn’t afford the machine as it costs around S$2000. The lung specialist then approached a social welfare organisation to seek sponsorship for the machine. They agreed, and I was given a rented CPAP device by the welfare organisation to try out first to see how I responded to it,” he says.

Benny was first provided with a non-humidifier CPAP device, which caused him to wake up with a dry mouth in the mornings. He later tried out the CPAP with an in-built humidifier and preferred it, as it did not cause dry mouth.

“The machine takes some time to get used to. It’s not very comfortable having to sleep with a mask over your face and a device that makes a loud noise beside you. But I’m slowly getting used to it. The welfare organisation just gave me my permanent CPAP device in October,” says Benny.

“Even though it has only been a short time, I find that I sleep much better now. I have less frequent headaches and feel more refreshed in the mornings,” he adds.

Since being diagnosed with OSA in early 2020, Benny has become more careful and conscious about his food intake in an effort to reduce his weight. He has also cut down on smoking, from about two packs in two to three days to one pack a week.

The expert weighs in

Sleep apnoea can be either obstructive, central or mixed, according to Dr Jeeve Kanagalingam, consultant ENT/ Head and Neck Surgeon at Mount Elizabeth Novena Hospital.

“Apnoea means the absence or cessation of breathing. When this occurs during sleep it is referred to as sleep apnoea. In obstructive sleep apnoea, the patient’s airways are partially or completely blocked by the patient’s tongue, tonsils or soft palate. In central apnoea, the drive to breathe from the brain is disrupted, so the patient stops breathing despite having an adequate airway. Some patients have a combination of these two conditions, and are therefore said to have mixed apnoea,” explains Dr Jeeve.

Prolonged and persistent, very loud snoring is one of the more common symptoms of OSA, along with the feeling of being tired all the time, frequent morning headaches, and being prone to dozing off during the day.

When the airway gets obstructed, oxygen levels in the blood drop and the heart races to pump more blood to vital organs such as the brain.

“In some patients, oxygen levels may plummet to 70% and the pulse rises to 120 beats per minute. This puts strain on the heart muscles. Eventually, the patient is aroused by the brain, the airway opens and normal breathing resumes. This repeated cycle of apnoea and arousals, break up the normal sleep ‘architecture’ resulting in very fragmented and poor quality sleep.”

OSA remains an under-diagnosed condition, as people often delay consulting a doctor about their symptoms either because they are unaware or they consider snoring to be a ‘normal’ occurrence, even when it’s severe, such as in Benny’s case.

Risk factors and prevention

The single most important modifiable risk factor for OSA is obesity, says Dr Jeeve. Certain physiological traits may also predispose one to the condition, including having a large neck circumference (more than 17 inches), large tonsils, a narrow retrusive lower jaw with a large tongue, and a long soft palate.

“There is also a strong familial predisposition to sleep apnoea – in other words the condition is often ‘inherited’,” he adds.

When it comes to gender, men are more likely to women to develop OSA, he says, although the difference less evident in older men and women.

“There are various theories as to why this is so; the gender differences in the anatomy of the upper airway, fat distribution and hormones have important roles to play.”

Lifestyle factors such as alcohol consumption, smoking, and the use of sedative drugs can also increase the risk of OSA.

While weight reduction can help reduce or even cure the condition in some cases, more severe cases like Benny’s requires lifestyle changes coupled with the use of a CPAP device. Surgery is also an option for some patients, when other options don’t yield results.

“Ultimately, watching one’s weight and keeping healthy habits are the best ways to prevent this condition,” says Dr Jeeve.

For those who suspect they may have sleep apnoea or want to know if they should consult a specialist, Dr Jeeve recommends using the STOP-BANG questionnaire as a useful screening tool. Those who are deemed ‘high risk’ for OSA would be advised to see a specialist.