Home » Sleep » Helping patients sleep better at night with daytime therapy

Dr Pavol Surda

Consultant ENT Surgeon, Signifier Medical

New technologies are helping patients tackle a sleep disorder and avoid daytime tiredness.

People with obstructive sleep apnoea (OSA), a common sleeping condition, can become caught in a ‘vicious cycle’ that sees them face increasing challenges as they endeavour to tackle their illness.

Latest research indicates that age and lifestyle factors contribute to people developing the disorder where sufferers face night-time breathing problems and choking episodes, leaving them tired during the day.

Ear, nose and throat (ENT) consultant Pavol Surda says that traditionally, patients are often encouraged to lose weight to ease their condition. However, because of their interrupted sleep, sufferers lack the energy to exercise and also tend to eat more.

Identifying choking episodes

Dr Surda is an ENT consultant at Guy’s and St Thomas’ NHS Foundation Trust in London with a focus on rhinology (the nose and sinuses), focussing on snoring and sleep in particular.

He explains that OSA is generally defined as a choking episode that lasts for 10 seconds, with more than five episodes per hour.

“We diagnose that by pulse oximetry, where we measure changes of oxygenation and heart rate,” he says. “Based on that, we can measure whether they are choking episodes.

“There is a certain subset of patients that are more prone to it and from the studies we know they are mainly older, ages 30-69, and/or overweight.”

Another contributing factor is a blocked nose, forcing people to breathe through their mouth and doubling the likelihood of snoring or OSA.

Stuck in a vicious cycle

Dr Surda says mild and moderate OSA is under-diagnosed, but a sign can be drowsiness during the day.

“It affects concentration, and performance at work and school,” he says “Students with OSA are more likely to have worse marks than their counterparts. A worst-case scenario is that people are more likely to have a road traffic accident, for example.

“Longer-term, there will be organ changes in the lungs and the heart because it has to pump more blood into the lungs.

“OSA is a vicious cycle; you are tired, are less likely to go to the gym and will gain weight, eat more and sleep less. People then exercise even less and the OSA gets worse and worse.”

OSA is a vicious cycle; you are tired, are less likely to go to the gym and will gain weight, eat more and sleep less.

Finding effective therapy options

An effective therapy for patients with mild OSA is NMES (neuromuscular electrical stimulation), particularly for patients with a body mass index (BMI) of less than 35.

Dr Surda explains: “We know one of the main reasons for OSA and snoring is that there is reduced tone of muscles in the tongue.”

When patients sleep on their back, the tongue tends to fall back which can collapse the airway and create the choking episodes.

The NMES device is inserted into the mouth for 20 minutes during the day to stimulate muscles and increases the tone of the tongue.

“Essentially, that means the tongue will be less likely to fall back and cause obstruction,” he adds. “This is ideal first line treatment and we are treating the root of the problem, not just the cause.”

Reducing NHS pressures

He says there are studies showing good evidence that this non-invasive technology is effective and can help avoid more invasive therapies, which can be challenging for some patients.

Dr Surda says this treatment can be offered quickly, easily and also helps shorten waiting times and pressure on the NHS, leaving ENT specialists to focus on the more severe cases.

He says the success rate is more than 80% for milder OSA patients. One product he points to is eXciteOSA from Signifier Medical Technologies: “It is user-friendly, patients use it 20 minutes every day for an initial two weeks and then afterwards use it only once a week just to keep the tone of the tongue increased.”

OSA is a serious condition that can have far-reaching consequences, meaning that early intervention is crucial in breaking the “vicious cycle” patients may find themselves in.

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