Sleep Apnea

Obstructive Sleep Apnoea (OSA) is when the airway repeatedly collapses during sleep, causing brief pauses in breathing. It's very common — especially in overweight adults and those with thick necks — and substantially raises the risk of high BP, heart disease, stroke, and diabetes. It's under-diagnosed in India because snoring is dismissed as harmless.

Classic features

• Loud snoring — reported by bed partner.
• Witnessed pauses in breathing — gasping, choking during sleep.
• Daytime sleepiness — falling asleep watching TV, at work, or (dangerously) driving.
• Morning headaches, dry mouth, sore throat.
• Difficulty concentrating, irritability, low mood.
• Uncontrolled high BP or diabetes despite multiple medicines — a major clue.
• Nocturia (frequent urination at night).
• Reduced sex drive.

Who is at higher risk

• Overweight, large neck (>40 cm in men, >37 cm in women).
• Male sex, age over 40.
• Family history.
• Large tonsils/adenoids (children), crowded oropharynx.
• Hypothyroidism, PCOS, acromegaly.
• Alcohol, sedatives, smoking.

Diagnosis

A sleep study (polysomnography or home sleep test) confirms the diagnosis and measures severity (apnoea-hypopnoea index, AHI). Home studies are increasingly available across Indian cities at lower cost.

Treatment

• Weight loss — the single biggest lifestyle lever for many.
• CPAP (continuous positive airway pressure) — the gold standard for moderate/severe OSA; well-tolerated when properly fitted.
• Positional therapy — avoid back sleeping if symptoms are positional.
• Oral/dental appliances — for mild/moderate cases.
• Surgery — for specific anatomical causes (tonsils, jaw).
• Treat nasal blockage, allergies — improves CPAP tolerance and OSA.
• Avoid alcohol and sedating medicines before bed.
• Treat hypothyroidism, acromegaly, PCOS if present.
• In children — adenotonsillectomy often curative.

Untreated OSA is a major driver of cardiovascular death in middle-aged Indians. Any bed partner reporting pauses in your breathing — or daytime sleepiness that affects driving — deserves a sleep study, not another cup of coffee.