Poor understanding of sleep disorders poses big risk

[LahoreEstate]

Monday, September 28, 2009
LAHORE

At a small pharmacy located along a busy road in Lahore, people stop by through the day. Some bring with them prescriptions written out by doctors, but Naeem Ahmed, who owns the store, says “Most do not have one. Sleeping tablets like ‘Xanax’ or ‘Lexotanil’ are among the medicines people often request because it seems sleeping disorders are common and people rarely consult a doctor about them”.

Both drugs are benzodiazepines, used to treat anxiety, insomnia, agitation and muscle spasms — among other conditions.

Unsupervised, long-term use can lead to dependence and tolerance, as higher and higher doses are used to achieve the same benefits. Naeem Ahmed said as a pharmicist he was aware of laws that barred the sale of drugs without prescriptions, but “Every chemist sells them openly and so do we.”

A 2005 study of over 300 pharmacies in Rawalpindi in the northern Punjab found only around 19 percent met licensing standards as laid down in the law and that the sale of prescription drugs without prescription was widespread.

“The problem is these medicines cover-up the underlying factor causing the sleep disorder. Benzodiazepines are not the solution in the long run because they can cause adverse effects. Also people who use them without medical advice sometimes do so in combination with other drugs or alcohol, and this can be very damaging, or even fatal,” General Practitioner Dr Azmat Qadir, said.

“I have had problems falling asleep since I was a student. I simply take a pill or two, and that solves the problem. I have never even considered consulting a doctor,” Sameen Aziz, 35, told IRIN.

The poor understanding and lack of diagnosis of sleeping disorders means that even potentially life threatening conditions go untreated. Sleep apnea, the most common sleeping disorder, is characterized by a reduction or periodic of cessation of breathing during sleep. Sleep apnea may be central, obstructive or mixed.

In central sleep apnea, the brain fails to send the signal to inhale appropriately, causing disrupted and unregulated breathing. In obstructive sleep apnea, the most common kind, the flow of air into the lungs is obstructed by narrowed or collapsed air passages, causing reduced breathing and airflow into the lungs.

Mixed apnea refers to a combination of the two other kinds.

Limited scientific studies carried out in the country suggest the risk of developing obstructive sleep is relatively high in Pakistan. This poses significant risks, given that obstructive sleep apnea has been associated with heart attack stroke and hypertension, in part because of reduced oxygen supply to the body as breathing briefly stops.

“Treating sleep apnea is possible. People do come to us seeking help as this problem is not uncommon, especially in people who are over-weight. If treatment is provided, this can stop the obstruction in breathing, improve sleep thereby increasing work productivity,” pulmologist Dr Shamshad Rasool Awan said.

However, the lack of awareness about sleep apnea means few sufferers seek help. The condition is often accompanied by snoring and the cessation in breathing may first be pointed out by a spouse.

“For a long time I had felt very tired at work and this was affecting my job performance. My boss even warned they could fire me. Doctors I saw had no idea. Then my wife told me I sometimes seemed to struggle to breathe at night. This helped in reaching a diagnosis, and since I was over-weight simply reducing this has helped with the apnea,” Irfan Saleem, 45, an office manager, said.

When more conservative measures fail, devices such as a mask which provides pressurised air to prevent the airways collapsing can help .But all this depends on an accurate diagnosis. With most people in the country lacking access to medical care, this is not easy to come by.

Facilities for specialized sleep studies too exist at a few places and usually involve significant cost. “There is a lack of awareness, as with all diseases. Many people may never seek help and this means the problem is not resolved,” Dr. Awan said.


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