How to Manage Back Pain?
Our backbone is a very important part of our body. It maintains our posture. The vertebrate is made up of 24 bones sitting one on top of the other with discs in between each of them except the tail bones. These bones are supported by muscles and ligaments. The spinal cord connects the base of the skull to the rest of the body. The spinal cord passes through the vertebrae. It acts as a protective structure for the spinal cord. There are facet joints placed on either side of the spine. Back Pain is a very common ailment. About 8 out of 10 people suffer from back pain at some point in their life due to various reasons such as any form of strenuous work, getting back to an old sport, or some underlying health condition such as arthritis or spondylitis. Types of back pain: Acute – It develops suddenly and lasts for less than six weeks. Subacute – It lasts for around three to four months. Chronic – It develops over a period of time and lasts for more than three months limiting our normal lifestyle. Causes of back pain: Mechanical causes: Muscle strain and ligament sprain are very common causes of acute back pain. Excessive strain, weight lifting, unsupervised training, etc can cause a strain on the muscles and ligaments resulting in back pain. Strenuous work or exercise: Being fit and exercising regularly strengthens our spinal and stomach muscles. Strenuous exercise or work e.g. lifting heavy objects suddenly, after a prolonged period of inactive lifestyle affects the back causing severe pain. Structural causes: These include ruptured or bulging discs present between each vertebra. Sciatica is a result of a bulged or herniated disc that causes pain to shoot and travel through the buttocks and downwards from the back of the leg. Arthritis, abnormal curvature of the spine(e.g.scoliosis), osteoporosis and kidney problems are also responsible for back pain. Ankylosing spondylitis: This is an inflammatory condition in which the joints of the spine swell up. This causes excessive pain, especially during the morning. There is stiffness which improves with movement. Age: As we age, the bones and discs of the back become very weak. Hence, the incidence of back pain is very common after the age of 45. Medical ailments such as cancer of the spine, Cauda Equina Syndrome, fibromyalgia, infections, sleep disorders, etc. are common causes that can cause or exacerbate back pain. Diagnosis of back pain: The consultation of a doctor becomes extremely important in managing back pain. Depending upon his examination, a tentative cause is identified and investigations suggested accordingly, such as diagnostic tests, which will help in reaching the root cause of the pain. A few of them have been listed below: X-ray: It gives a clear idea of the alignment of bones, broken bones, and arthritis. MRI or CT scans: The generated images reveal herniated discs, and problems with bones, muscles, tissues, etc. Blood tests : This helps in detecting underlying deficiencies, and infections that might be the cause of the back pain. Bone scan: This is used very rarely, but identifies the tumors or bone compressions caused due to osteoporosis. Nerve tests: measure the electrical impulses produced by the nerve cells and the response of the muscles. It can confirm nerve compression in case of herniated discs and spinal stenosis (narrowing of the spinal cord). Treatment of back pain: Medication – Pain killers are used. Non-steroidal anti-inflammatory drugs such as ibuprofen and narcotics such as codeine, hydrocodone, etc. are prescribed for a short period of time. If these medications do not work, cortisone, an anti-inflammatory drug is injected into the epidural space. This provides relief by reducing the inflammation around the nerve endings. Exercise – There are exercises that need to be under the guidance of trained professionals. Making a chart of exercises that may be relevant to a particular body type and the underlying problems in presence of a trained instructor is very effective. Manual therapy – It includes treatments where the trained therapist uses hands to massage and apply pressure to muscles, bones, and joints present along the spine. It is known to work wonders if supplemented with exercise. Nerve treatment – Needles are inserted into the nerves connected to the affected nerves. Radio waves are sent through the needles to these nerves. This heat prevents them from sending pain signals. A local anesthetic is used to numb the back before performing the procedure. The associated risk of bleeding, bruising, and accidental nerve damage should be discussed with the Surgeon beforehand. Transcutaneous electrical nerve stimulation (TENS) – This is popular among patients with chronic back pain. A machine provides electrical signals to the body through electrodes placed on the skin. It is non-invasive and cost-effective. The body releases endorphins that reduce pain signaling. Spinal fusion surgery – This is recommended only if our bones are significantly damaged. It fuses two vertebrates to strengthen the bones. It stops the damaged vertebrates from squeezing the nerves thereby reducing the pain. Self-management of back pain: Staying active: It was earlier believed that rest tends to relieve back pain. Now individual suffering from back pain should remain active in performing their regular activities and also find time to exercise regularly. Stretching and back exercises are of great help. Hot and cold packs: Heat works well to relieve back pain for some people. Therefore, placing a hot water bottle on the affected area is very helpful. Cold packs are also effective for the short term. Alternating between hot and cold packs works very well. Relaxing and staying positive: It is important that one stays positive irrespective of their condition. Believing that proper treatment and care shall be helpful. Relaxing helps relieve pain and muscle tension. Hence, we conclude that our back being such an important part of the body deserves our utmost care. We should exercise regularly to keep our backbone strong and in good condition. Eating good food, getting a good night’s sleep, etc. are measures that we need to inculcate in our life. Also,
Benefits of a PAP-NAP
Obstructive sleep apnoea (OSA) is the major sleep disorder prevalent in 3 to 7% of adult men and 2 to 5% of adult women in the general population. Given all the risk factors like obesity and high neck circumference, male gender, and the older man, and others, you may have OSA that contributes to severe consequences like hypertension, heart disease, stroke, diabetes, etc. The gold standard treatment which is proven for OSA is PAP therapy which is used during sleep. It gives positively pressurized air through a device called CPAP (Continuous positive airway pressure) which is connected to a patient with a mask via tube. This pressure keeps the airway patent and opens during sleep thus helping to stop snoring, maintaining the oxygen level, and reducing the frequent arousals due to choking or apnoea. This in return improves the daytime symptoms of fatigue, laziness, excessive daytime sleepiness, and anxiety by maintaining the daytime energy. WHAT IS A PAP NAP? PAP NAP as the name suggests is a daytime trial of CPAP for making you adjust to the mask and the therapy. WHY IS PAP NAP IMPORTANT? As the saying goes “Practice makes the man perfect.” Though the efficiency of CPAP therapy is proven and known, adherence to CPAP therapy is very low. PAP NAP is the supervised daytime trial with the mask and the device to make you comfortable with the interface, pressures, and a new lifestyle change and eradicate all your fears, doubts, and quarries. This will improve the tolerance to the sleep apnoea treatment and subsequently improves the overall compliance. The therapist counsel and make you comfortable with the mask and the pressure by keeping you under close observation in the daytime while you take a nap for 30 min to 1 hour or more as required so that you can use it better at night while sleeping for more than 4 hours. WHO NEEDS A PAP- NAP? After going through the sleep study test, if you are diagnosed with moderate to severe obstructive sleep apnoea, you must go for CPAP therapy. Since this therapy is meant for a long term use, it’s really important for you to get adjusted to the pressure and mask, resolve your doubts regarding your issues like nose blockage, mouth dryness, claustrophobia, settings adjustment according to your need and make you comfortable with the new adjunct in your life for better compliance and sleep. It also supports you emotionally and physically, to divert your attention from mask and pressure by giving you a daytime nap of 100 minutes. PROCEDURE: PAP NAP includes 5 components: Pre-test instructions to help patients take daytime naps with ease. Instructions on how to prepare for the test, like avoiding caffeine, nighttime sleep restrictions, and providing a ride to a sleep centre to avoid driving. Introduction of PAP therapy and barrier assessment. You are given a brief idea of how the mask and pressure would feel and how to manage your fears about it and then they are assisted to try different types of masks according to your comfort and need. The mask fitting and the feel of pressure are given to you in a sitting position and you are asked to breathe normally coordinating with the air pressure coming through the mask. Once you are comfortable with the mask, you are made to lie down and try taking a nap in your usual position of sleep except for the prone position. Emotional support. Talk about the fear, anxiety, stress, and other issues like how would the spouse react to it and the embarrassment of using a mask to sleep. All these issues are addressed one by one by the sleep therapist and reduce the anxiety. Since it’s done during regular working hours, any sudden reaction and problem can be immediately attended to and resolved by the sleep therapist. PAP NAP is conducted between 60– and 120 minutes. The primary goal is to allow you to get comfortable with the therapy and not to really do the titration part. You may or may not fall asleep but you will be able to figure out if you feel comfortable sleeping with the mask and pressure or not. Post-test follow-up. Discussion about the PAP therapy preliminary results, motivation, adherence, and usage is then elaborated on and explained in detail on how to use the device, how to get used to it by taking daytime trials with it, how to overcome any issues related to it like bloating, mouth dryness, leakage, pressure sores, and cleaning process is done. CONCLUSION: Obstructive sleep apnea is becoming a major health issue among people who have loud snoring and disturbed sleep due to choking and breathing cessation, multiple times during the night. This disorder if not addressed can result in severe day and nighttime symptoms like excessive daytime sleepiness, morning headaches, and disturbing the other’s sleep as well. In long run, it may cause major health consequences like stroke, diabetes, heart attacks, etc. PAP therapy is the golden standard for the management of OSA. But the adherence to the therapy can be intimidating initially. Hence a daytime trial called PAP NAP is suggested for better compliance with the therapy and machine. It has been found that this helps in clearing all the doubts and fears of the patient in advance by desensitizing them with a mask and pressure under the close observation of a sleep therapist and thus improving your overall health. “Don’t hesitate, take a PAP-NAP and sleep better” To seek help or know more about your sleep apnea, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 Book your sleep study/PAP-NAP today. BIBLIOGRAPHY: Cao, Michelle T., Joshua M. Sternbach, and C. Guilleminault. “Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea: Benefits and Alternatives.” Expert Review of Respiratory Medicine 11, no. 4 (April 2017): 259–72. https://doi.org/10.1080/17476348.2017.1305893. Krakow, Barry, Victor Ulibarri, Dominic Melendrez, Shara Kikta, Laura Togami, and Patricia
VEEG (Video-Electroencephalography)
“If you look at the anatomy, structure, function of the human body, there’s nothing in the universe that’s more complex, yet more beautiful than the human brain”. What is VEEG? Video EEG is a non-invasive diagnostic tool that records the electrical activity of your brain as well as your physical behavior. What is the aim of VEEG? VEEG aims to observe what is happening during a seizure or an event along with brain activity recorded via EEG simultaneously. How long does it take? Duration can vary from 1 to 7 hours or > 24 hours, depending on the indication for the test; doctors can suggest VEEG when the nature of the event is not clear, or want to determine the origin of the seizure. Why is it done? Video EEG is helpful to find out what is happening in your brain & also record your physical activity at the same time. VEEG is also helpful if you have any of the following neurological conditions such as- Seizure disorder- to determine the type, and the onset of the seizure esp prior to planning epilepsy surgery Fainting or blackouts episodes Determine the type of event –Epileptic or non-epileptic To differentiate the seizures types How is VEEG Performed? Preparation: Before performing the Video-EEG test, a technician will give you a few instructions as follows – You must wash your hair and dry them properly before coming for the test. Don’t apply any hair oil after hair wash. You can take your routine medications. Fasting is not required, you can take your breakfast or lunch. You can carry your comfortable clothes, sheet & pillow, etc. The procedure of the test: Technician measures on your head and mark where to place electrodes. Areas marked are cleaned with the Nuprep gel. Electrodes are attached to the scalp with 10 – 20 paste. Technicians can apply cotton to hold it in place, the head & electrodes are covered by gauze dressing. The room is kept clean, dark, and quiet, at your comfortable temperature and in dim light. There can also be a small music system to help you relax. A technician should check the audio, the video is on & camera is on focus. Complete instructions are given to you so that you can relax and then the recording will be started. If technicians see any event during recording, they should write the timing of the event and give a few commands to the patient like- Tell your name Raise your right hand Remember few words Pen Water Apple FAQ’s ABOUT THE TEST: Q. Is the test painful? A. No, it is painless; non-invasive procedure you will not feel any current or side effects. Q. Can I make some coffee or Tea? A. yes, you can take it. Q. Can I continue my work after the test is over? A. Yes, you can continue your routine. Q. Do I need to stay in bed the whole time? A.Yes, you can sit or lie down on a bed during the test, it is safe for you. Conclusion: To conclude we can say that VEEG is a highly technical test, so it requires complete knowledge to perform the test, also required patient cooperation performing the test, and the quality of the test and recording is a must. To seek help or know more about Video EEG & epilepsy, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
SURGERIES VS CPAP- TREATMENT OF OSA
WHAT IS OSA? Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which your breathing can be ceased for more than 10 seconds as long as even 100 to 120 seconds, repeatedly during the night while sleeping. This can lead to a drop in blood oxygen level, increased CO2 retention, the release of stress hormone- cortisol[1], and frequent arousals with loud snoring and choking sensation. This results in disturbed sleep, excessive daytime sleepiness, tiredness, concentration problems, and mood change issues. In a long run, this can even cause other major issues like increased chances of heart disease, stroke, memory loss, hypertension, diabetes, and even depression.[2] ENT Evaluation in OSA Various anatomical and pathophysiological factors are associated with the cause of OSA, which can determine the course of action for the treatment a little more complex. An ENT (eyes, nose, throat) specialist (Otorhinolaryngologist) can examine the upper airway to find out in detail what is causing that obstruction. [3] [1] “Stress and Sleep Apnea.” [2] “Osa Aasm – Google Search.” [3] “Sleep Apnea Treatment by ENT.” OSA is caused due to collapse of upper airway muscles during sleep. Certain ENT disorders that may lead to OSA are: Obstructed nasal airways: in cases of nasal polyps or inferior turbinate hypertrophy. Deformities of the nose or nasal septa, such as the deviated septum, double septum, and septal hematoma can cause an obstruction. Inflammatory conditions of the nose: cold, chronic rhinosinusitis, or allergic rhinitis. Long soft palate and/or uvula Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue. Cysts or tumors can also cause bulk which may cause snoring. The ENT causes are relatively simple conditions that can be treated by safe and simple medical and/or surgical procedures. OPTIONS FOR THE TREATMENT OF OSA. There are various treatment options for sleep apnea which can be majorly divided into non-invasive and invasive adjuncts.[1] NON-INVASIVE– The gold standard treatment for OSA that can be recommended for all the patients with moderate to severe apnea regardless of their anatomical differences in the upper airway causing OSA, is PAP (Positive Airway Pressure) therapy. More than a treatment, it is a control therapy to keep the airway open during sleep and can hence help in providing uninterrupted good quality sleep. With the correct fit and comfort of mask and straps, adherence and good compliance to the PAP (CPAP/BIPAP) can enhance your overall sleep quality. EXERCISES and DIET CONTROL- Weight reduction exercises and some oropharyngeal exercises to tone the muscles of the upper airway like the soft palate, throat, and tongue which can help the patients reduce the severity of OSA. However, a complete cure of the issue is only possible in mild OSA patients (AHI 5-15). ORAL APPLIANCES (MADs) (mandibular advancement devices)- These are specially designed mouthpieces to bring forward the jaw to facilitate the opening of the airway. Some hold the tongue in place hence avoiding closure of the airway by falling back of the tongue. UPPER AIRWAY STIMULATION- It’s a small electrical device placed in the chest just like a pacemaker, below the skin and above the ribs. It has an electrode that is connected to the nerve which controls tongue muscles by stimulating it during sleep and thus keeping the airway open. SWITCHING POSITIONS- Some of you may have sleep apnea and snoring by sleeping in a supine (lying on the back) position. Switching position from supine to either side may benefit you. SURGERY- The last resort is SURGERY – Uvulopalatopharyngoplasty (UPPP) -Surgeons remove the soft tissue from the back of your palate and may take out your tonsils and uvula (the soft tissue that hangs down the back of your throat). Other surgeries may involve your jawbones, other soft tissue, or your nose. WHICH OSA PATIENTS SHOULD BE REFERRED FOR SURGERIES? (1) Patients who are intolerant or unaccepting of PAP therapy, BMI <40 kg/m2. (2) Clinicians discuss referral to a bariatric surgeon with adults with OSA and obesity (class II/III, BMI ≥ 35) who are intolerant or unaccepting of PAP as part of a patient-oriented discussion of alternative treatment options (STRONG). (3) Adults with OSA, BMI < 40 kg/m2, and persistent inadequate PAP adherence due to pressure-related side effects as part of a patient-oriented discussion of adjunctive or alternative treatment options (CONDITIONAL). (4) Patients with obvious upper airway anatomic abnormalities are potentially amenable to surgery as initial OSA treatment. WHICH SURGERIES ARE PERFORMED FOR OSA? Surgical treatment may involve various procedures that are performed in different stages depending on the patient’s sites of obstruction.[2] Different sites for obstructions are nasal, nasopharyngeal, oropharyngeal, hypopharyngeal/retrolingual, or a combination of these. PROCEDURES: Nasal reconstruction: Removal of nasal polyps or turbinates, or straightening of a deviated nasal septum. This may increase airflow through the nose though it does not completely cure (OSA). It may improve daytime and nighttime breathing through the nose and may enable better use of a positive airway pressure device. Uvulopalatopharyngoplasty (UPPP): This is the most common operation which widens the airway behind the tongue by removing excess tissue from the sides of the throat behind the tongue, shortening the soft palate, and removing the uvula. It requires hospitalization and recovery may take several weeks. 2 variants of the operations can be performed With a laser (laser-assisted uvulopharyngoplasty, or LAUP) By a radiofrequency probe (somnoplasty). Although snoring is frequently improved with these operations, only approximately 40% of persons undergoing UPPP have resolution or major improvement in their OSA. Furthermore, it is unclear whether the success rates from LAUP or somnoplasty are comparable to those for UPPP. Mandibular osteotomy with genioglossus advancement prevents posterior collapse during sleep. Hyoid myotomy and suspension. In this hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size and improving airway stability in the retrolingual and hypopharyngeal airway (airway behind and below the base of tongue). In more severe cases, maxillomandibular advancement (MMA) with advancement genioplasty may be indicated. In this operation, the upper and lower jaws are surgically fractured, and both are moved forward to enlarge the airway. Hypoglossal Nerve
Obstructive Sleep Apnoea has a bi-directional relationship with Chronic Kidney Disease
ABSTRACT- Removing waste from life is important for breathing well. How do our kidney diseases also cause sleep disturbances? Let’s find out: The relationship between Obstructive sleep apnea (OSA), and cardiac and lung-related problems is renowned though the relationship between kidney disorder and OSA is not much known among us. “Why am I becoming breathless if I have been diagnosed with just kidney dysfunction?” is the question most CKD (chronic kidney disease) patients ask. OSA has a bi-directional relationship with CKD. That indicates that CKD worsens OSA and vice-versa. OSA- We now know how important the role of sleep is in maintaining normal body physiology. We also know that snoring isn’t very pleasant for you or your partner sleeping next to you. Sleep can be disturbed for a lot of reasons. Most common, underdiagnosed, and ignored is Obstructive Sleep Apnea (OSA). Cessation of breath for more than 10 seconds repeatedly during sleep causes frequent arousals, stress hormones release, gasping and choking sensation, and oxygen desaturation. It is associated with excessive daytime sleepiness, tiredness, mood swings, poor quality of life, and increased morbidity and mortality. OSA increases the risk of cardiac diseases, hypertension, stroke, and depression. It has been the major cause of death due to traffic accidents because drivers doze off. Because of the overall worsening of health by other major diseases associated with OSA. One among them is CKD (Chronic Kidney Disease). What is CKD? Chronic kidney disease or chronic kidney failure means that the kidneys do not perform their function of filtering waste and excess fluids from blood, causing excess accumulation of these electrolytes, fluids, and waste products in your body. Progress end-stage kidney failure is fatal without artificial filtering by dialysis or kidney transplant. CKD- Symptoms: Along with sleep problems, other symptoms associated with CKD are Nausea, Vomiting, Loss of appetite, Fatigue, and weakness, Urinating more or less, Decreased mental sharpness, Muscle cramps, Swelling of feet and ankles, Dry, itchy skin, High blood pressure (hypertension) that’s difficult to control, Shortness of breath if fluid builds up in the lungs and Chest pain if fluid builds up around the lining of the heart. [i] Triad of CKD, OSA, and Hypertension. [ii] The presence of OSA in CKD usually lacks the typical symptoms of OSA including loud snoring, apneic episodes, and daytime somnolence, which leads to the underdiagnoses of OSA in this patient population. Features associated with CKD such as chronic fatigue, uremia or side effects of medications, and the increased sympathetic activity in the setting of volume overload may overshadow the complaint of subjective sleepiness. Approximately 50% of the patients with ESRD have OSA, making it common among this patient group. Sakaguchi et al. reported a high prevalence of OSA in no dialysis CKD patients; they found moderate to severe OSA in these patients as compared to mild to moderate OSA in the control group. [iii] Shared risk factors of OSA and CKD: Diabetes Hypertension OSA is an independent predictor of proteinuria- important for analyzing CKD progression. OSA, CKD, and Hypertension share common pathophysiology including: Chronic volume overload- causes treatment-resistant hypertension and difficult to manage OSA in CKD and ESRD patients. When you lie down for resting or sleeping, the volume shifts from the lower extremities to the upper body causing the worsening in peripharyngeal edema (Abnormal accumulation of fluid leading to swelling of the pharynx) leading to the worsening of OSA. Hyper-aldosteronism (a corticosteroid hormone that stimulates the absorption of sodium by the kidneys and so regulates water and salt balance). A dysregulated renin-angiotensin-aldosterone system may contribute to excess sodium retention and hypertension. This may be activated in OSA. [iv] Increased sympathetic activity- Due to increased chemo reflex drive. OSA with hypoxia increases vasoconstriction, leading to resistant hypertension and reduced renal function. Endothelial dysfunction- Intermittent hypoxia from OSA during the night leads to the release of endothelin. It is a potent vasoconstrictor, which is another contributor to resistant hypertension in OSA. Increased inflammatory markers like elevated levels of plasma C-reactive protein, leukocyte superoxide, and soluble adhesion molecules suggest the presence of chronic systemic inflammation in OSA. [v] TREATMENT: Positive airway pressure therapy: OSA is often treated with CPAP (sometimes BIPAP), which gives pressurized air to keep the airway open during sleep thus preventing apneic spells and hypoxia. This, in turn, reduces the resistant hypertension which further slows down the process of CKD by reducing the GFR hyperfiltration, plasma brain natriuretic peptide, and urinary meta-adrenaline levels. CPAP improves baseline endothelial NO release and stimulates endothelium-dependent vasorelaxation in the systemic circulation thus improving systolic and diastolic BP and slowing the progression of CKD. Renal Replacement Therapy: In patients with ESRD on HD, intensive dialysis techniques have been shown to improve the severity of OSA. The conversion from conventional hemodialysis to nocturnal hemodialysis was associated with a reduction in the frequency of apnea and hypopnea from 25+/-25 to 8+/-8 episodes per hour of sleep (P=0.03). [vi] In a trial where a sleep study was performed before and after transplant, there was a significant decrease in AHI in OSA patients after transplant. [vii] Antihypertensive Therapy: Diuretic therapy helps in improving the OSA by displacing the fluid that moves from the lower body to the upper body during sleep. This helps in improving the leg fluid volume and reducing the neck circumference as well. In one study, the investigators evaluated the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone and found that with treatment, the AHI and hypoxic index, weight, and clinic and ambulatory BP were significantly reduced. [viii] CONCLUSION: OSA is more prevalent in CKD patients than in normal individuals. OSA shares many common risk factors (diabetes and hypertension) and pathophysiology. Some symptoms, of OSA like daytime sleepiness, may be overshadowed due to mechanisms like increased sympathetic activity in a volume overload setting. It may give the chance of missing out on the diagnosis of OSA. Thus, it’s recommended to book sleep studies for CKD patients when clinically suspected. Treatment of OSA with CPAP has markedly improved symptoms of CKD as
Learn Everything About the Science of Sleep
The sleep medicine field has grown up fast over the past few years. It has developed as a documented subspecialty in Western countries, but yet to be in developing markets. General Medical practitioners and professionals may encounter patients with sleep problems and may often initiate therapy. It would be significant to know sleep disorders initially and treat them to prevent complications. Failure of primary management or absence of transparency on the careful nature of the sleep disorder should prompt a recommendation to Sleep Medicine experts. In the present landscape there is an increasing demand for skilled physicians, technologists, and other personnel for accurate diagnosis, effective treatment and efficient management of sleep related problems and sleep disorders. This may be largely credited to the exponential increase in number of patients facing sleep related issues having a troublesome influence and impression on their day to day life. In order to satisfy to this increasing request, there are valuable few opportunities other than teaching and awareness upgradation of all worried connected to this field from physicians, technologists to patients. Active diagnosis and management is an result of the growth of information base of all allocated participants, who play an essential and pivotal role, in the diagnosis and action of sleep related problems and sleep disorders. Keeping this in view, a first of its kind sleep medicine concerned with online platform has been launched in 2020 by Dr. Manvir Bhatia for physicians, technicians, technologists, patients and to all those who wish to improve their awareness of sleep related problems and sleep disorders. Sleep Medicine Institute deals a wide change of educational chances. Our devoted faculty is committed to improving the information in a loyal, collective, and courteous environment. We aim to prepare our students with the skills to assimilate clearly into the ever-changing landscape of healthcare which helps them stay up to date in their industry. Sleep Medicine Institute, a division of Neurology & Sleep Centre is a one stop solution for treatment, training, teaching & community awareness for sleep related issues & neurological disorders. Started with Two Major Courses in 2020 – Basic courses in Sleep Medicine and Advance Modules in Sleep Medicine, the institute has trained more than 150 Doctors/Therapists and Technicians, majority of them rating the quality of course 5 star. Basic course in sleep medicine is intended to offer a complete state-of-the-art method to the diagnosis of sleep disorders. It aims to growth information and abilities in this exact, stimulating and energetic field of sleep medicine. This 3 month online course, covers all structures of sleep medicine and technology. Starting with base knowledge about normal respiratory and sleep physiology, it will also cover all sleep disorders and their treatment, including applied application of sleep disorders assessment and management. You will be trained about existing practice in sleep science, as well as introduced to new and sensational developments for the future. This course is an concentrated introduction to the ground of sleep medicine. It is significant for all those new to the field and mentioned for those who would like to revive their information base. Contributors will be able to review thoughts, obtain up-to-date systematic data and applied tips, to proficiently and truthfully analyze sleep disorders. What This Course Will Entail: Essentials of Sleep: Converses common sleep, why we sleep? And determinations of sleep. Part of a Sleep Technologist: Defines responsibilities of a sleep tech. The vocation path of a sleep and the concern and supplies for each pole. Organization and Means to a Patient with a Sleep Disorder: We will define the newest arrangement of sleep disorders, and history taking in a patient with sleep disorder. Dimension of Sleep: The particulars of Overnight sleep study – what is dignified? How it is measured? Levels of PSG. We will also include gathering on home sleep testing, the indications, contraindications, advantages and disadvantages will be underlined. PAP Titration: Basics of manual CPAP titration for OSA patient based on full night titration and split night study protocols. Learn how to start manual titration, how to score the results of manual titration and how to fixed pressure on fixed CPAP after manual titration Examination of PSG data & Report: Indication of Polysomnography sleep stage scoring. Features of EEG respiratory, limb and EKG waveforms. Review of AASM Practice Parameters for Polysomnography and home sleep tests. Apparatus Safety, Infection Control and Centre Difficulties: How to take maintenance of Equipment? Foundations of infection and how to switch infection will be described. The common problems in the center and how they should be handled. History of Patient: Role play, ask specific question regarding sleep like- name, age, problems, symptoms, case study. Preparing Patient for Sleep Test: Briefly describe about sleep test, provide information about do’s and don’ts before test, payment and address conformation, finalizing date for test. Demo Equipment / Sensor: Sensor / Sleep study device / level 1, level 2 and level 3. Hook Up: EOG, EEG, Electrode Placement, 10-20 system, respiratory sensor, and leg movement sensor. Calibration: EEG / EMG / Respiratory Sensor Performing the Study: After hookup recording of study, patient treatment during test. Titration: PAP device introduction, employed, how to choice device for patient. Mask: Outline with diverse types, how to choose best for patient. Trouble Shooting: How to handle issues faced by technician during sleep test, any case. Documentation: During test evidence noted by technician – diagnostic timing, titration timing, any kind uneven activity of patient, type of device and mask used. Completion of the Study: Data downloading from diagnostic device and titration device, cleaning of all sensors and device, handover all document to concerned person. Knowledge & Skills You Stand to Gain: Recognize the essentials of sleep functioning Assess a sleep patient Classify the main corresponding tests in sleep medicine Recognize the specific necessities for execution of sleep lab Be able to make a patient to complete a sleep study Gain involvement with polysomnography scoring Cover the basic applied skills required including wiring up, troubleshooting and report explanation – develop and improve these core practical skills Interaction with new research and developing knowledge in
Online ENT Sleep Medicine Course in India and Benefits
Sleep Medicine Institute is dedicated to providing well-rounded training experience in all aspects of ENT sleep medicine, as the Online ENT Sleep Medicine Course In India offered by us is unique, and covers many lectures in sleep medicine, an area (to overcome the most common roadblocks in sleep medicine practice for Comprehensive Management Of OSA) that is not usually a focus in other Courses In ENT Sleep Medicine and training. Serving as the best Academy Of Sleep Medicine, and a strong backbone to our enrollees, in helping them acquire intricate knowledge and development in the ENT sleep medicine space, with our Certification Course In ENT Sleep Medicine not only gets them started on an exciting journey into treating patients with Management of OSA but also makes them capable of prescribing oral appliances to patients. Benefits Learning from Experts Learn from the experts of the industry. Course imparted and backed by a team of Senior Specialists with 20 years of experience. Flexibility Can customize learning as the online course provides a flexible schedule and learning environment Doubt Clearing Join learning Community via Google Classroom, where you will get frequent updates and will be able to interact with each other. Case Studies Access to CASE STUDIES for better understanding of complex concepts More than 30 years of expertise in the field She has treated more than 5000 patients with sleep-related issues and neurological disorders during these years. Sleep Diagnosis and Treatment Sleep Medicine Institute started in 2008 as one of its kind in providing a comprehensive diagnosis and treatment for all kinds of sleep-related issues and neurological disorders. Training Students Dr. Manvir Bhatia initiated the Ace School of Sleep Medicine in 2011 in partnership with Dr. Preeti Devnani to provide training to students interested in Sleep Medicine. Premier Training Facility This is a premier training facility for physicians and other health care professionals in the field of Sleep Medicine. Dr.Manvir Bhatia has Successfully conducted 22 courses which include National and International Workshops and Conferences. Senior Technologists and Technicians Our team consists of Managers, Senior Technologists, and Technicians for whom regular training is provided to enhance their knowledge in sleep and keep them Up-to-Date. Practical Comprehensive Course The courses are designed to provide participants with a practical comprehensive overview and understanding of the pathophysiology, clinical symptomatology, and management of Sleep Disorders. How to Get Started with an Online Sleep Medicine Course in India We have a direct link to the courses present on our website where you can directly enroll in the course. Apart from this, we have a detailed summary of everything that will be covered in the course. The Importance of an Online ENT Sleep Medicine Course in India for Medical Professionals Since the COVID-19 outbreak, the number of people suffering from sleep disorders is increasing, and so they need for sleep specialists is increasing simultaneously. Since the number of problems is increasing, people are suffering more and more. As the number of young talents entering the medical field is increasing, this is surely going to help people fight their problems. There is a lot more to come after completing the sleep medicine course. Below mentioned are some of the topics that are going to get updated: Obstructive Sleep Apnea Central Disorders of Hypersomnolence Effects of chronic opioid therapy on sleep Rhythm Sleep-Wake Disorders Sleep-Related Movement Disorders In recent times, where the pandemic has hit almost all of us, certain things are going around us. Sleep disorders among people are increasing as people are facing tensions that are going around. Almost some years ago, sleep medicine started to develop, giving a wide aspect of sleep disorders and the medicines prescribed on them. There is a lack of awareness among people regarding this wherein people should be made aware of the topic. The scope of sleep medicine is that there can be online workshops regarding the same, online sessions, online training, and consulting, which makes it easy for both patient and the specialist. In today’s time, more than 7,000 have specialized in caring for sleep health which is an important element of our life. The scope of sleep medicine is not only in India but also Abroad as many people have sleep disorders and they need specialists there to make them better. It is very necessary to diagnose the problem and provide the treatment on it accordingly, which will help the patient get better at it.
Restless Leg Syndrome Is Difficult to Diagnose but Can Be Managed Well
Restless Legs Syndrome (RLS) Restless legs syndrome (RLS), also known as Willis-Ekbom Disease, is a movement disorder in which an individual experiences an irresistible compulsion to move his or her legs due to abnormal, non-painful sensations such as throbbing, crawling, itching, pulling etc., at bedtime, which are relieved on movement. Studies have shown that RLS has a prevalence of 3 to 10% in India with higher susceptibility in women. Diagnosis The diagnosis of RLS largely depends on doctor’s evaluation of the patients’ symptoms and family history as there is no proper test available for its diagnosis. A blood test may be performed to detect iron deficiency and other disorders associated with RLS. It is extremely difficult to diagnose RLS in children as it is difficult for them to find the right words to explain their discomfort and hence it can remain undiagnosed for a long time. Causes Restless-legs syndrome can be of primary or secondary type. In primary RLS, the cause can be genetic or unknown (idiopathic RLS), while secondary RLS occurs due to certain disorders like end stage renal disease, celiac disease, rheumatic disease etc. Though the exact cause of RLS is still unclear, it may occur due to any of the following reasons: Dysfunction of dopaminergic pathways: Dopamine is required for effective movement and dysfunction of any of dopamine pathways often results in involuntary movement. Parkinson’s patients have greater chances of developing RLS. Genetic component: Polymorphism in genes namely BTBD9 and MEIS1 have been shown to be associated with restless legs syndrome. Iron deficiency Peripheral nerve abnormalities Diabetes Mellitus Management of RLS The management of RLS depends on its severity. For patients with mild symptoms of RLS certain lifestyle changes such as avoiding tobacco, alcohol, eating meals rich in calcium, folate and iron can be helpful. Patients with severe RLS may require medications that improve the dopamine levels in the brain. Physical exercises like yoga, cycling, and swimming a few times a week can also help relieve symptoms. Iron supplements have also shown to be effective against RLS. Restless legs syndrome is of serious concern as it severely affects patients’ sleep, causes daytime sleepiness, and also influences their mental health and social life. RLS patients often find it difficult to concentrate and perform daily tasks. Hence, in case one notices any of the symptoms, one must not hesitate to consult a doctor who may prescribe suitable medications. To seek help or know more about Restless Leg Syndrome, you can visit the Neurology and Sleep Centre, the 1st sleep medicine center in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270, Or write to info@neurologysleepcentre.com
Sleep Plays a Major Role in Boosting Immunity. By Dr.Bhatia & Saunri
Does Sleep Improve Your Immunity? A study published in 2020 in the International Journal of Behavioural Medicine found that sleep plays a role in improving the efficacy of vaccination. It was reported that people who slept for shorter durations had fewer production of antibodies after immunization with trivalent influenza vaccine. Interestingly, they also found that those individuals who slept for a shorter duration two days prior to receiving the vaccination also produced fewer antibodies in response to it. The idea that sleep benefits your immune system is not new. Numerous studies have previously also shown the benefits of sleep in vaccination in various animal model systems, through the activation of various components of your immune system. When you suffer from a bacterial illness, your demand for sleep increase. The fatigue and sleepiness that you face during the illness promote less activity and hence conserve your energy for a faster recovery. Sleep acts as a booster to your natural immunity. During the deep sleep phase of your sleep, the efficiency of the transfer of immunogenic information to T cells increases. During sleep, the number of immune cells, such as T cells and APCs that circulate in your blood get reduced and redistributed to the lymph nodes. At these lymph nodes, these cells get accumulated and concentrated and allow for a greater chance of encountering a foreign pathogen that could potentially cause a disease. Hormones such as growth hormone and prolactin are also released during sleep that creates a suitable environment for the presentation of antigens by APCs, thus boosting your natural immunity. Studies have also shown that night shift workers have low immunity thus are more susceptible and prone to upper respiratory tract infections such as cold and flu caused by viruses. Some studies have found that sleep deprivation and short sleep duration also lead to low immunity and increase the risk of respiratory illnesses such as pneumonia. Such studies give us important insights into how our immune systems can get compromised and how we can be more susceptible to illnesses, in times such as the COVID-19 pandemic, where there has been a drastic change in work/school schedules and sleeping patterns among people. Sleep should not be compromised and those suffering from persistent sleep issues must seek professional help. For more information on sleep and immunity, you can visit the Neurology and Sleep Centre, the 1st Sleep Medicine Institute in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270, Or write to info@neurologysleepcentre.com
Why Teenagers Should Really Sleep Well And Why They May Face Sleep Issues
Why is Sleep Important for Teenagers? Sleep helps to restore and repair the rapidly developing bodies of teenagers. Sleep helps the brain process information it has received during the day, making some memories stronger while fading away unwanted memories. Sleep also helps us regulate emotions. Sleep issues such as sleeping problems at night and poor sleep cause physical and emotional problems. Research has found that social isolation is a risk factor for depression and anxiety in teenagers and good sleep can protect them whereas sleep issues and sleeping problems at night can make them more vulnerable to these ill effects. In a time like the COVID-19 pandemic, where social distancing and isolation is the norm, it is important for teenagers to get good sleep. How Many Hours of Sleep Do Teenagers Require? The recommended number of hours of sleep that teenagers should get every night is 8 to 10 hours. However, many surveys, including a survey by the National Sleep Foundation in 2006, found that adolescents do not get the required amount of sleep and face sleep issues and sleeping problems at night. Why Do Teenagers Face Sleep Issues? During puberty, the shift in the timing of production of melatonin, leads to sleep onset by 10 or 11 pm instead of 8 or 9 pm as during childhood, leading to sleeping problems at night. The excessive time spent on electronic devices and the subsequent bright light exposure inhibits melatonin production leading to sleeping problems at night and shorter sleep durations. Teenagers don’t give enough importance to sleep and think that it is ‘cool’ to pull out all-nighters or go by as little sleep as they can. The habit of catching up on sleep on weekends, only adds to sleep issues and sleeping problems at night. Teenagers can also suffer from sleep issues such as Obstructive sleep apnea, narcolepsy, circadian rhythm sleep disorders that make it difficult to get good sleep. What Is the Impact of Poor Sleep on Teenagers? Day time sleepiness can affect the concentration of teenagers during their regular classes. Lack of sleep can also induce unhealthy behaviors such as overeating and eating at wrong times during the day, resulting in weight gain, feeling of bloating, and sleeping problems at night. Lack of sleep can make teenagers more irritable and aggressive, causing the rash behavior we see amongst teenagers. Poor sleep due to sleep issues and sleeping problems at night has also been linked to an increase in the use of the substance, smoking, etc. Solutions for Sleep Issues in Teenagers Parents should develop a better relationship with their teenage children, understand their sleep issues, and help them. Teenagers themselves should develop a good attitude towards sleep. Teenagers should also: Limit their screen time and not use electronic gadgets that emit bright light at least half an hour before sleep time to avoid sleeping problems at night. Have a fixed bedtime and wake up time on weekdays as well as weekends. Avoid eating too close to bedtime, so that they don’t feel bloated, to reduce sleeping problems at night. Avoid drinking tea, coffee, chocolate drinks that contain caffeine after about 12 noon. Exercise regularly for about 60 minutes. To seek help or know more about teenagers and sleep issues you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270, Or write to info@neurologysleepcentre.com