We are struggling for sleep to be recognized as an essential problem: Dr Nimish Shah

Shahid Akhter, editor, ETHealthworld spoke to Dr. Nimish Shah, Consultant, (Pulmonary & Sleep Medicine) at The Practice, Mumbai to know more about sleep medicine and the existing challenges associated with sleep disorder.

Sleep Medicine: Where is India placed
Sleep medicine is a very under-recognized but an upcoming field. Although, sleep is a multi-system problem, its importance is growing nationally as well as internationally. In India, we have created more awareness and people are picking up more sleep disorders. We are matching up with the western world which is probably a couple of steps ahead of us. For a country like the United States back in 2006, one of the Institute of Medicine declared it as a national health problem.

We are 13 years down the line and still picking up on our pieces and getting sleep to be recognized as an essential problem in the health care sector because of its nature i.e., a multi-system problem. So, multiple specialities are involved where sleep is affected and that's where we need to work on.


Sleep disorders impacting productivity:
Sleep disorders have a proven detrimental effect on productivity, for example- we have data from Australia, which was published around 6-7 years back, wherein it accounted for $818 million in terms of loss of productivity because of sleep disorders. In the UK, 10% of road crashes, which were attended by the police were all attributed to sleep disorders.

Laws are very stringent in the Western world, and you have to get yourself medically certified then, be on treatment and get a clearance from your treating doctor to actually resume work. We in India are lacking this and the number of road accidents and the deaths, that we are having especially in terms of heavy goods vehicle drivers, or shift workers, all of these are directly affecting our GDP.

Also, there has been a report which says that all four nuclear disasters had a common factor which was early in the morning, blinkered thinking, not thinking collaterally, shift work and sleep deprivation.

Sleep disorder challenges:
Patients don't present to us with one symptom. Mainly it is attributed to lack of awareness so the common symptoms that patients would experience is snoring at night, choking or gasping episodes at night, waking up to pass a lot of urine at night, waking up with a dry mouth, feeling thirsty, waking up feeling under-freshness and lack of concentration and work, excessively sleepiness at work.

These are the common symptoms which patients would encounter. Unfortunately, because of a lack of awareness patients don't know that these are the symptoms that we must look out for. So they come to different clinics and specialities with different problems.

A lot of people have this common myth that only obese people or people who are overweight suffer from this problem. But that's a completely biased opinion, hence we have had a number of patients who have a normal BMI, and normal stature, who have severe sleep apnea and have benefited from our expertise.

Sleep disorder latest breakthroughs:
In the olden days, we had CPAP which was the only therapy available. The machines were bulky, cumbersome, noisy but that has improved in leaps and bounds and we now have a very slim, sleek, compact machines which are noiseless and it also helps not only the patient but the partner as well whose sleeping with the patient.

There have been other advances in terms of non-CPAP therapies, where you have implantable devices, subcutaneous devices, mandible splints and there are operating options as well which would be the last resort.

Sleep disorder way forward:
The way forward for our country, especially, is to have more awareness, training of doctors institutes, where you have good training and we have people who are doing sleep studies and marking polysomnography, where we have technicians who are not adequately qualified.

Hence, you may have variable reports. We need institutes and academies where you have training for such technicians or physiologists who actually can do a good sleep report. We need doctors to be trained, to be made aware of sleep as a disorder in itself.