SLEEP YOUR WAY TO DIAGNOSIS

After a hard day’s work, its time for heading to a sleep chamber for some peaceful, undisturbed sleep. Many young working professionals in the city are referred to these sleep labs nowadays as there is an increasing problem of sleep disorders being reported. It’s not just popping the pills and attending counseling sessions for sleep disorder problems, as doctors in the city are now referring to this new diagnosis route via the sleep labs.

It’s a couple of nights spend at a plush chamber with medical equipments connected in such a way so that the vital parameters of the person can be continuously monitored. “There is a round the clock sleep technician, who is also around to keep an eye on the monitor as EEG, videograph recordings and the like are taken while the person is asleep. With the world average of sleep time coming down from 8.5 hours to 6.5 hours in past decade, there is a rise in the number of sleep associated disorders these days,” said Dr A Jagadish, consultant psychiatrist, Abhaya Hospital. He said that it is no longer only the common problem of Insomnia that was traditionally thought to be the only sleep disorder. “There are myriad problems like the Obstructive Sleep Apnea and Restless Leg Syndrome which are now being seen and only a detailed sleep episode study done at a sleep lab helps in diagnosing these problems,” added the doctor.

It was a strange problem of waking up due to a feeling of breathlessness and choking in the middle of the night so often that this 35-year-old was almost on the verge of giving up her job. “Due to this problem I could never have a peaceful, quality sleep as a result I always felt drowsy throughout the day accompanied by terrible lack of concentration. Despite taking sleeping pills there was no solution to the problem and instead this started reflecting on my professional life and that was when I was referred to the sleep lab and I was diagnosed of Obstructive Sleep Apnea,” said Rakhi Singh, a software engineer. Now that the root cause of her problem has been diagnosed she is on the right treatment path and is getting sound sleep at night.

“It is through continued night long diagnosis at these sleep labs that we can also identify whether the causative factor is physiological or psychological. The affected person’s respiratory, cardiac and sleep parameters are monitored in the sleep lab which helps us to identify the root cause of the problem and take on the required treatment option,” said Dr Padma Sundaram, HOD, pulmonology, Manipal Hospital. 

It's the sleep your way to diagnosis route that the doctors are now adopting to go to the depth of the disease and eliminate it from its root.

Care for the heart that literally breathes life

A casual outing on a weekend turned near fatal for this 25-year-old who suffered a sudden cardiac arrest in a busy shopping arcade. While for another 24-year-old it was a fun day out and a relaxing swim in a pool when his heart suddenly stopped functioning. These are not isolated cases, as doctors in the city say that cardiac diseases are no longer age specific as more and more cases are being seen of a sudden attack in young working professionals with no prior symptom or warning. 

“With the advent of MNC work culture here, increased work pressure and need for performance in the workplace has led to incidence of stress level in the executive lifestyles. This type of a lifestyle increases the risk of developing heart disease by 10-15 times,” said Dr. Ravindra L. Kulkarni, consultant cardiologist. He said that today’s working environment is such that individuals feel the time crunch, which prevents them from a routine work out schedule. “Modern life style has proven to be the stimulus for the growth of heart diseases among the youth. Improper food habits, lack of physical activity, high level of stress and increase in smoking and alcohol consumption are all classic risk factors which can put one high on the risk zone of coronary heart diseases,” he added. 

While youth is the driving force of Indian economy, it is the high prevalence of heart ailments among Young India which is now a cause for concern. “Sudden Cardiac Deaths have a direct relation with stress as this comes with increased adrenaline surge and those who are not attuned to handling this sudden increased adrenaline surge become victims of Sudden Cardiac Death, as the heart then stops functioning,” said Dr Srikanth Raghavan, Pediatric Cardiologist, BGS Global Hospitals. He explained while stress has a direct link to sudden cardiac deaths, there are a bunch of other diseases of which the first symptom is sudden cardiac death. “Early and routine screening is the only option to identify such problems and prevent sudden cardiac deaths. In fact this is also to a certain extent genetic because of which we always advise that those who have a history in the family of people dropping dead suddenly should go in for routine screening,” added the doctor. But the incidence of these cases can directly be attributed to increased stress levels.

This explains the reason for the theme of this year’s World Heart Day chosen as ‘Corporate Wellness’. Doctors insist that it is essential for companies and organizations to invest in the physical and mental well-being of its employees for their own benefit because ultimately Companies must realize that an unhealthy employee is a liability rather than an asset to the company. 

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Guest column

Dr Devi Prasad Shetty, eminent cardiologist and founder of Narayana Hrudayalaya

Indian’s are genetically three times more vulnerable for heart attack then European’s. Average age of my patients in England was 65-years while in India it is 45-years. It is not the young son bringing his old father for heart operation in India it is the old father brining his young son for the bypass. 

We are genetically three times more vulnerable for heart attack than Europeans. We have a very high incidence of diabetics and that is one of the reasons why we develop heart attack at the young age. 

For preventing sudden heart attack my recommendation is any one leading a stressful life must have a 64 slice CT scan at the age of 30 to detect early blockages in the coronary arteries. In good old days only way to know you have coronary artery disease is by doing an angiogram. Today technology allows us to detect heart attack 10 years in advance. People who have a family history of heart attack at the young age and who are diabetic, hypertensive, hyperthyroid must go for a 64 CT scan at least once in three to five years. This will detect early blockages in patients. If the blockage are found, then based on the extent of it we can advice further treatment. The most dreadful thing about heart attack is that large number of heart attack and ischemic heart disease is silent in nature called silent ischemia. You can have a major heart attack without you being aware of it. This is the worst thing about heart attack, especially in diabetics. Diabetics do not have sensation in the heart and they carry on as if there is no problem and on one fine day dropdown dead. 

Only way to know this problem happening in advance is by going in for 64 slice CT scan which only takes 5 seconds and it is an out patient test and totally painless.  

The writer is a renowned cardiologist and is Chairman, Narayana Hrudayalaya 

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In box:

Solutions for a healthy heart:

Take time off during lunch break to get some fresh air

Try exercising or stretching for five minutes twice a day

Walk everyday with an aim of covering 5 km in 45 minutes

Getting into a yoga or meditation works as good stress buster

Eat fresh and dried fruits and vegetables in abundance

Keep a regular check on your weight

Restrict intake of carbohydrates

Cut down on salt, caffeine and alcohol consumption

Reduce cholesterol level by consuming low fat dairy, egg yolk three to four times per week

BP should ideally be at 115/75

HDL (good cholesterol) level should be around 50mg/dL

Get into a habit of routine health checkups, especially those with a family history of cardiac ailments

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3 quotes:

Dr. Ravindra L. Kulkarni, consultant cardiologist:

Small changes, such as ban on smoking, making more fruit and vegetables available at canteens, and encouraging workers to incorporate physical activity into their daily routine, can make a big difference in terms of better health. Further, employers must ensure their workplaces are 100 per cent smoke-free and support the adoption of smoking cessation services and provide help to employees who wish to quit tobacco. 

Dr Shashidhar, consultant cardiologist and electrophysiologist, Fortis hospital: 

Asians in general and Indians in particular are genetically predisposed to cardiac ailments. So it is said that the genes loads the gun and environment pulls the trigger, which could be anything like smoking, obesity. That is the reason why we see many of these young guys, who have a normal heart sudden drop dead.

Dr. A.G.Ravikishore, part of the Indian Society of Electro-cardiology:

Atrial Fibrillation, is a condition that causes irregular or abnormal heart rhythm (arrhythmia) and has serious consequences if left untreated. It can affect a patient’s daily life and lead to long-term problems, including cardiovascular hospitalisation and greater risk of heart attack, stroke and even death. This at times does not have any symptom and people can die on the spot, so regular screening is essential to prevent this problem.

Not so sweet news for the little sweethearts

The sweets and pastries for Children’s Day might no longer taste so sweet, as the bitter truth about early onset diabetes in children starts shooting up especially in urban children. This temptation to give into that dessert, pizza or the yummy burger and sitting for hours on that video game might lead to a serious after effect in children as it might even serve as a stumbling block in the way of their higher education. Doctors say that children with diabetes face difficulties in concentration, hence in pursuing higher education, and the changing lifestyle is one of the important reasons leading to this problem.

Controlling this disease is extremely essential otherwise children and their parents face serious difficulties in fighting with this lifestyle disease. “Earlier children were seen to be affected only with Type-1 diabetes, which is an auto-immune disorder, but now there has been a sudden incidence of early onset Type-2 diabetes in children as well. Sedentary lifestyle, the junk food culture and a family history of diabetes is exposing more number of children to this threat,” said Dr Venkat Krishna Rao, consultant diabetologist, BGS Global Hospital. The increasing problem of diabetes in present generation parents is a causative factor for this problem in children and obesity in present generation children is a triggering factor for diabetes in these youngsters. “Due to hereditary factors coupled with the problem of obesity many of these children develop insulin resistance, and that is when they develop the problem of diabetes,” added Dr Rao. Doctors opine that there has been a 300 per cent increase of such cases of early onset Type-2 diabetes over the past two decades. 

Exhaustion and vision problems are some of the manifestations of this problem and this de-motivates children in their academics because of which they cannot pursue higher education if the problem is not controlled on time. At times identifying the onset of Type-2 diabetes also becomes difficult in children so doctors suggest identifying them in the pre-diabetic stage, when their blood sugar levels are anywhere between the normal and the diabetic level. “The Body Mass Index (BMI) of children should be checked once in six months to identify such problems,” said Dr Kavita Bhat, pediatric diabetologist, Manipal Hospital. The normal BMI for children is anywhere between 10 and 85 percentile. “So children with 86 percentile BMI and a family history of diabetes, hypertension and ischemic heart problems should immediately be taken for a blood sugar test and children with 96 percentile BMI should be taken for a blood sugar test irrespective of the family history,” said Dr Bhat. However she added that a sudden increase of the BMI even within the normal range should also be taken seriously and the child should be screened. 

“This problem is actually emerging as a serious threat especially in this urban fast-paced lifestyle, so it is essential that a child on the obese side be checked regularly for early detection of diabetes,” said Dr Srikanth, consultant diabetologist. A few cautious measures might go a long way in securing the future of a child by preventing the onset of diabetes. 

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The next component

A healthy bony baby is always an eye-candy as it looks lovely, but if the weight continues to increase in greater proportion with age then it exposes the child to the risk of diabetes. It is this problem that has affected many children especially in urban areas and the taboo about this illness not only spoils the childhood, but also the future of the child gets blurred.

Some children who are suffering of Type-1 diabetes, an auto-immune disorder for which the causative factors are not known well, have to depend on insulin shots throughout their life. This creates a peer complex in them and they fail to mingle well with their friends. “My 12-year-old son lost a year because he did not wish to go to school and take injection shots in between. He just refused to go to school for one long year, though now he does go but I can feel that he does not really enjoy school days,” said Savithri, a homemaker. 

Parents find it difficult to control the sugar levels in their children because sweets and confectioneries are favourites with children. “In birthday parties or during Christmas and New Year celebration it becomes very difficult to stop them from binging into cakes and pastries. So we have completely stopped bringing cakes and pastries at home and for my child’s birthday we usually go out on vacations so that we can avoid too much of indulgence into cakes,” said Parineeta, mother of a 15-year-old who is suffering of Type-2 diabetes.  

Tremendous exhaustion at even a little exertion makes it difficult for these children to enjoy a normal fun-filled childhood. “I feel really sad when I see my son just staring out of the window at the other children playing in the park. We cannot allow him to go out every evening because that might be harmful for his health as he gets exhausted very soon,” said Zayeeda Sheikh, whose 13-year-old son was detected a diabetic about two years ago. Apart from the lifestyle restrictions in the affected children, even controlling the blood sugar levels in these children is a big challenge for their parents. 

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Quotes

Akshatha Mishra (name changed), 14-year-old, Type-2 diabetes: I hate to stay away from cakes, pastries and even when I have pizzas it is always a limited number of only one at a time. I really miss enjoying the get together with friends where they go to restaurants and enjoy loads of pizzas, pastries and coffee. 

Shreyas P (name changed), 12-year-old Type-1 diabetes: I too want to play cricket and volley ball with my friends, but I don’t think I can ever play a full game because I get very tired if I run. Hope some day some medicine is invented that can give me enough energy to play these games.

Nisha Rao (name changed), 16-year-old Type-2 Diabetes: I hope by shedding this extra weight I can resume my normal life of going for outings with friends. I can’t go for excursions nor on day-long outings because I have been instructed to be on a very strict diet which is not possible to follow if I eat out.  

 Box 1

Every year, Nov 14 is celebrated as the World Diabetes Day, as a part of the primary global awareness campaign, lead by the International Diabetes Federation (IDF) and the World Health Organization (WHO). The International Diabetes Federation (IDF) had declared 2007 the 'Year of the Child with Diabetes' and the United Nations has declared 2008 as the 'Year of diabetes among children and adolescents'.

Box 2

1. Diabetes is a silent killer with India being the 'Diabetic Capital' of the World

2. Globally, every 10 seconds, a person dies of a diabetes-related illness and it is the fourth leading cause of death by disease

3. People in India take the cause of diabetes lightly especially in children, despite statistics showing that six out of 10 children with diabetes do not manage their diabetes successfully in school (according to their physicians)

4. Children with diabetes drop out of school earlier than others

Box 3

Today, India is called the 'Diabetes Capital' of the world with more than 8 per cent of the population affected by the pandemic. This equates to 41 million people. Of which about more than 50per cent of people with diabetes are unaware of their condition, costing society millions of rupees in treating the many serious complications like blindness, kidney failure, nerve diseases, limb amputations and cardiovascular diseases that arise from undiagnosed or poorly treated diabetes. 

Box 4

Different activities on World Diabetes Day: 

The Centre for Diabetes at Sagar Hospitals, Jayanagar will have a day-long activity called ‘Living With Diabetes’ at the hospital premises on November 14th 2008 observed as World Diabetes Day. The program from 9 am to 4 pm includes exhibitions, diabetes food court, health drink, diabetes foot care, audio visual presentations on diabetes awareness and distribution of patient education materials apart from various tests to ‘Know Your Risk’. 

Novo Nordisk, the pharamaceutical company has organised the World Diabetes Day Walk, a risk check-up camp and painting competition at the KSLTA stadium, Cubbon park. The walk would be starting at 8 am on Nov 14. They have also initiated the ‘DAWN Youth’ programme to spread awareness among parents and school management to let them know how they can be of help to their children without destroying their life at such an early stage.

Manipal Hospital 

The hospital has announced a comprehensive diabetes package on the occasion of World Diabetes Day. The package offers a host of screening tests for diabetes at a subsidized cost on Nov 14 between 9 am to 5pm at the Manipal Hospital on old Airport Road.