Despite
his inane and some kind-of insane doings, Syed Mohsin Ali, the
honorable minister of Bangladesh government who claims to have shared
smoke and/or smoked alongside the father of our all-powerful sitting
Prime Minister, deserves some credit to bring the not-so-peculiar
Pickwickian issue to the fore; this issue, indeed, is a public
health scourge, yet not a single newsman has written anything about
up to this time. May be we lack the astute sense of Dickensian
observation or we are too busy vilifying the ministers distasteful
testiness.
Dickens’s “The Pickwick Paper” described a young Joe who was generous in build, had a love for gastronomical delights and had an uncanny ability to fell asleep anywhere. One hundred twenty years later in 1956, Dr. Burwell and his colleagues described this medical entity in a medical case report titled “Extreme Obesity Associated With Hypoventilation: A PICKWICKIAN SYNDROME”. This was case of a 51-year-old obese business executive weighing over 260 pounds and standing only five foot 5. He was suffering from obesity, fatigue and daytime somnolence. Somnolence was quite disabling that during a poker game he failed to take the opportunity when dealt with a hand of three aces and two kings! Such was the peril … however, Syed Mohsin Ali, I bet, given his very busy and successful life is doing quite well …
We have new name for this condition. We call it OBSTRUCTICVE SLEEP APNEA, a disorder, usually occurring in obese persons, in which, during sleep, lax tissue crowds the access to the breathing tube leading to frequent micro-awakenings and a state of chronic sleep deprivation leading daytime somnolence to catch up. Loud snoring is a very common associated feature. There is another kind of less common sleep apnea that can happen in non-obese persons too; it is called CENTRAL SLEEP APNEA, because, here the brain is at fault. In this article, we will focus on the more prevalent obstructive type.
What
causes sleep apnea is a query that defies a clear or precise answer.
During the wakeful hours the active tone of the throat muscles keeps
the airway wide open. During sleep the absence of wakeful tone causes
the muscles to relax with subsequent throat narrowing. Normally this
is not a problem; however, in persons with obstructive sleep apnea
there is partial or complete obstruction. Enough air does not flow in
the lung, oxygen level in blood drops, that in turn wakes the brain
up which help tighten the upper airway muscles and open the wind
pipe. Normal breathing starts again, often with a loud snort or
choking sound.
This
oft repeated drop on blood oxygen level and reduced quality of sleep
can trigger the release of stress hormones which, in turn, increases
the risk of other nefarious maladies like high blood pressure, heart
attack, stroke and irregular heart rhythm. When untreated, sleep
apnea also alters the normal energy utilization leasing further
worsening obesity and the risk of diabetes.
Yes,
it is a nasty disease and commonly it comes with a loud bell –
snoring, which can prove sore in relationship too. However, its
symptoms are not as stealthy as early hypertension or diabetes or
cancer. Excessive day time sleepiness, fatigue, poor concentration,
morning headache etc. should prompt a doctor’s visit and subsequent
diagnostic work up including a possible polysomnogram (PSG) that does
simultaneous measurement of brain activity, eye movements and, hear
rate and blood pressure.
Once
diagnosed, treatment, cumbersome though, is very effective. However,
losing weight, avoiding alcohol and stopping tobacco smoking can be
an intial thumbs up ...And this brings us back to our honorable
minister Syed Mohsin Ali, who happened to an avid smoker too. Sir,
it’s time to stop smoking and see a doctor …
