Datuk Dr Kuljit Singh   Consultant Ear, Nose and Throat Surgeon

Getting OSA under control

Dr Kuljit explains that, in order to diagnose an OSA, the patient would undergo a sleep test called polysomnography. This test takes place in a sleep laboratory. The patient would be hooked up to equipment that measures the activities of the heart, brain and lungs while he or she is asleep. The results would then be analysed.

Should the patient be diagnosed with OSA, Dr Kuljit says that the next step is to devise treatment according to the patient’s condition and its severity. “There is no single solution,” he explains. “We have to devise treatment on a case-by-case basis.”

Treatment options include:

• Surgery, to adjust the features that are creating the obstruction. This procedure may be painful, and there is a possibility that the OSA may come back in the future. However, this option may be suitable for certain people, depending on his or her condition.
• Respiratory aid. Continuous positive airway pressure (CPAP) treatment involves a portable machine that supplies a continuous stream of steady air through a mask or nose piece to the person with OSA as he or she sleeps. The pressure of this air flow keeps the airways open while the person sleeps, allowing for continuous breathing and the possibility of a good, restful sleep.  

CPAP for a better nap

Dr Kuljit reveals that CPAP treatment is currently the gold standard for OSA treatment. The CPAP machine is a non-surgical solution to help someone with OSA to achieve a restful sleep. It is basically equipment made up of four significant parts:

• The flow generator, which is the “box-like” part of the equipment that provides airflow by sucking it from the environment into the machine, up the hose, and into the patient’s nose and/or mouth. It has a sponge-like filter, ensuring that the air flowing into the machine is free from dust and other impurities.
• The hose, which connects the flow generator to the interface.
• The interface, which can be a nasal mask or a full-face mask depending on the person’s facial structure.

Recent models of CPAP machines also come with features such as humidifier (a water chamber that reduces the dryness of the air sent to the person with OSA) and automatic adjustment features.

Using the CPAP machine

The CPAP machine should be used every time the person with OSA falls asleep (including afternoon naps!), throughout the entire sleep.

Dr Kuljit admits that the biggest obstacle to using the CPAP machine properly is the patient’s own ability to comply with its use. “There are patients who give up,” he says. “Some would come to see me two weeks after they have purchased the CPAP machine, claiming that they don’t want to use it anymore.”

At the early stages, the person with OSA may need to make an effort to get used to sleeping while connected to the CPAP machine. This is why it is important to ensure that the interface is a good fit for the face, as a good fit makes it more comfortable to sleep with the CPAP device attached as well as prevents air from leaking out.

However, the perfect fit is of no use if the person with OSA does not view the CPAP machine in the correct light. “There are people who assume that having to depend on CPAP is a sign of weakness, and this attitude eventually discourages them from making a harder effort to get used to it,” says Dr Kuljit. “It does not have to be this way. The CPAP machine is not a sign of weakness. It is a useful device to help you get a restful sleep, so that your health would improve.”

In the long term

Will a person with OSA need to use the CPAP machine for life? “There is a strong possibility,” admits Dr Kuljit. However, this should not be a problem as the benefits of using the CPAP machine far outweigh any inconveniences experienced in the process.

In the meantime, regular exercise and a daily healthy, balanced diet may help improve one’s OSA, but there is no guarantee. Still, there is no harm in putting these into action, as a healthy lifestyle can never be wrong!

Dr Kuljit also advises on having another consultation with a respiratory or an ENT specialist five years down the road for an updated assessment of the OSA. Just like mobile phones, CPAP machines keep getting better and more sophisticated every year, so the specialist may also recommend investing in a new model every few years.

Some tips to avoid common CPAP issues

• Dry nose and mouth. Try adjusting the humidifier level. If things don’t improve, talk to your doctor. He or she may prescribe nasal saline sprays that can help.
• Leaky mask. Try tightening the straps of the mask. If that does not work, your mask may be of the wrong size – contact the supplier.
• Too noisy. Check that the filter and your mask are fitted properly. If there is still too much noise, contact your supplier to check whether the machine is working properly.
• Not used to it. You will need some time to get used to sleeping while connected to the CPAP machine, so don’t give up so soon.
• I find myself taking the mask off or shutting the machine off often while I am asleep. Some people wear mittens or gloves to make it harder for their fingers to undo the mask. Others set the alarm clock to wake them up in the middle of the night to check whether the CPAP machine is still on.
• My partner or roommate insists that the noise of the CPAP machine is keeping him/her awake. Just like you, the other person may need time to get used to the presence of the CPAP machine. If the problem persists, perhaps a change in sleeping arrangements may be necessary.

Second-hand CPAP?

It is possible to purchase a cheaper, second-hand CPAP machines from other sources, such as online vendors. Dr Kuljit however points out that each CPAP machine needs to be carefully calibrated by a qualified professional. Buying second-hand models bypasses this stage, making it likely that the CPAP machine will not function properly.

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