After giving birth to her second child, a woman in her early 30s found herself suffering from water retention as well as right heart failure and pulmonary hypertension. Unable to find any underlying cause for her heart issues, her cardiologist sent for a sleep study. Only then, when she was diagnosed with obstructive sleep apnea (OSA), did she finally have an answer for her health woes. 

OSA occurs when overly relaxed airway muscles collapse, causing a complete or partial blockage of the upper airway. This interrupted flow of oxygen causes the body to produce stress hormones in response that, when left untreated over time, can contribute to high blood pressure and other heart diseases. 

Dr Garvi Pandya, a consultant in advanced internal medicine and sleep physician at StarMed Specialist Centre, says that such cases, where patients don’t realise they have sleep disorders until they are diagnosed with health issues that stem from sleep disorders, are far more common than people realise. 

Dr Pandya has experience running an independent sleep clinic since 2017 where she manages various sleep disorders for patients. Her work also includes analysis of raw data for sleep studies and reports.

She is also a specialist in advanced internal medicine with a focus on areas such as acute and general medicine, as well as chronic disease management. 

In Singapore, such incidences could be even more prevalent. 

An online poll across 12 countries by American market research firm Wakefield Research in 2018 found that Singaporeans were the second most sleep-deprived people behind the Britons. In 2021, a global sleep survey by Philips found that Singaporeans got less sleep and experienced more sleep challenges during the pandemic. 

The main cause of it is a hectic work-life schedule, made worse by revenge bedtime procrastination.

“Many people work very long hours, and when they go home, they have familial duties or chores. By the time they have time to relax, it is often done at the expense of their sleep,” Dr Pandya explains.

Signs of trouble 

This means that Singaporeans have become accustomed to always feeling tired and relying on stimulants like coffee to power through the day. Many also tend to dismiss their lack of rest as an unavoidable consequence of a high-stress working culture. As a result, they often don’t realise they have a sleep disorder until far more serious health problems arise.

According to the Division of Sleep Medicine at Harvard Medical School, a lack of sleep in the short term can affect judgement, mood, ability to learn and retain information, and may increase the risk of serious accidents and injury. Over time, chronic sleep deprivation may lead to a host of health problems including obesity, diabetes, cardiovascular disease and even early mortality.

In Singapore, insomnia and OSA are two of the most common sleep disorders, with about 15 per cent and 30 per cent of the population suffering from each disorder respectively. 

Other common sleep disorders include parasomnia (commonly associated with sleepwalking, sleep talking and night terrors); narcolepsy (associated with daytime sleepiness or falling asleep suddenly or unexpectedly); circadian rhythm disorder (whereby your body's internal clock is out of sync with your environment); and sleep related movement disorders (such as restless legs syndrome).

But while sufferers often know that they should seek specialist help for these more disruptive conditions, other sleep disorders could manifest in less obvious ways and are often overlooked.

In general, healthy adults should get about an average of seven to eight hours of sleep every night and wake up feeling rested and alert. 

If you have trouble maintaining sleep (for example, not being able to fall back to sleep after going to the toilet in the middle of the night), or often wake up still feeling tired despite having spent a substantial amount of time in bed, you could have a sleep disorder and should consult a sleep physician.

Other warning signs, according to The Sleep Foundation, include not being able to fall asleep within 30 minutes of getting into bed; waking up regularly throughout the night; and lying awake for more than 20 minutes if you do wake up. 

Age and gender could also affect your risk for a sleep disorder. Generally, men in their 40s to 60s and women who are going through menopause are most likely to suffer from sleep disorders. 

Getting to the root of the issue 

So can you fix a sleep disorder for good? It all depends on the root cause of it, says Dr Pandya. 

If lifestyle choices are what’s affecting a patient’s quality of sleep, then the likelihood of finding a permanent solution is high. For Dr Pandya, a change of habits for her patients, such as reading a book instead of watching TV before bed; or avoiding coffee or tea after lunch and alcohol too close to bedtime is usually the recommended first course of action.

However, in cases where patients suffer from sleep disorders rooted in inherited facial crowded, soft and bony tissues – such as OSA, which is more common in east Asians because of a narrower facial structure – long-term, regular treatment is required for management of symptoms. 

For the most accurate results, it is important to undergo a sleep study, an overnight test that is conducted in a sleep laboratory or at home to diagnose sleep disorders. During the study, components such as breathing, heart rate, oxygen levels, brain activity and muscle movement are recorded and analysed while the patient is asleep. Specific components recorded may vary depending on the type of sleep study conducted.

Ultimately, Dr Pandya says, there is no one-size-fits-all solution. 

“We have to take detailed notes of the patient’s history and put them through physical medical examinations before customising the solution and treatment to their needs.”

StarMed’s sleep medicine clinic provides care and treatment for a wide spectrum of sleep disorders. Find out more at www.starmedspecialist.com/specialist/sleep-medicine.