By Dr H K Susheen Dutt, MBBS, MS (ENT)
Millions of people worldwide have endured increased loneliness, depression, anxiety, and disturbance of sleep patterns through most of 2020, because of Covid-19 inspired lockdowns. Some experts have given a name to this: Covid-somnia or Corona-somnia, which was seen in almost 20% of the population. It was even more in frontline health workers and other high-risk environments.
Given that inadequate sleep results in a wide variety of physical and mental health issues, the natural tendency is for people to try and monitor their sleeping habits. This is usually achieved through remote monitoring devices that operate on cloud-based technology. There are many such wearable gadgets that provide a wide variety of data and information about your sleep patterns.
This has become even more important during the year just gone by because the Covid-19 pandemic made regular consultations with a doctor impossible. As the countrywide lockdowns continued for weeks, both clinicians and those needing healthcare advice had to resort to telemedicine – video consultations through Zoom or some other platforms. Some hospitals even offered the facility through dedicated channels accessible through their own website.
Thus the most basic wearable devices are sensors that detect movement when you are asleep; even subtle changes in position or your head on the pillow are recorded. Some gadgets can even detect whether you are sleeping deeply or light, or record the number of times you awoke during the night. More sophisticated instruments can simultaneously track your blood pressure, heartbeat, breathing, etc. as you sleep. Even better, these readings can be linked up with your sleep patterns. Thus the increase in blood pressure and stress on your heart, which had been reported extensively in scientific studies can now be documented in real-time! Besides, there are some devices that can even estimate the level of oxygen in your blood while you are sleeping. Needless to say, this is crucial in ensuring timely intervention in OSA patients, particularly if such a patient happens to catch the Corona Virus Disease.
Another option is a Sleep Study which can be conducted either in a Sleep Laboratory or at the patient’s home. The latter was developed because some people find it difficult to fall asleep in an unfamiliar environment. Sleep specialists believed this could affect the accuracy of the sleep study. A variation of this is polysomnography (PSG), that is, a printed record of the study. This is capable of assessing the depth and quality of sleep, including deep sleep and REM (rapid-eye-movement) sleep.
If the reason for disturbed sleep is OSA, the symptoms of disordered breathing, family members’ description of loud snoring, and Excessive Daytime Sleepiness (EDS) would usually be sufficient for the diagnosis of OSA.
A commonly used mechanism for the diagnosis of OSA is the STOP-BANG score. This uses a questionnaire about basic symptoms, obesity levels, and age. Thus loud snoring is allocated +1, and so is Body Mass Index of over 35, and age of over 50. Other factors are gender:(male is +1 and female is 0) and neck circumference (over 40 cm is +1, below is 0).
The CPAP (Continuous Positive Air Pressure) therapy is almost universally accepted as the gold standard in managing OSA and the resultant sleepless disorders. But it is most effective only when used for a minimum of four hours each night. However, discomfort associated with a poorly fitted device or some other issue could induce the user to remove it from time to time. Appropriate efforts towards patient education combined with the use of remote monitoring can improve compliance of using the CPAP device.
About the Author
The Author is a Senior Consultant ENT, Skullbase and Sleep Apnea Surgeon, Datta’s Speciality ENT Centre, Bangalore.
