Don’t ignore the snore

Juma Mrashani, a 48-year-old businessman based in Dar es Salaam works almost 16 to 17 hours a day, hustling between his two liquor stores. With his busy, tiring schedule, Mrashani had ticked off his snoring problem of seven years as stress and fatigue.

He never knew snoring was a problem until he fell so sick that he was admitted to Amana Hospital a year ago.

“My wife and other family members have been complaining on the annoying noise I make when I’m asleep. I never took it seriously because it never affected my sleep. The doctors told me to consult an Ear, Nose and Throat (ENT) specialist for a further check-up,” says Mrashani.

Mrashani isn’t the only one in the pool of snorers who think that snoring isn’t an issue. A brief survey done by Your Health reveals that majority of snorers think that snoring is normal and cannot lead to serious health complications. 8 out of 10 people responded saying that snoring is due to fatigue and 2 out of 10 people said they didn’t know.

Why do we snore?

Here’s a wake-up call for Mrashani and his fellow snorers. Snoring is very dangerous and may put you at a greater risk than those who are overweight, smoke or have high cholesterol, reveals Dr Khuzema Rangwala, an ENT Specialist based at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT).

“Don’t ignore snoring, it is a disorder that needs immediate attention,” Dr Rangwala tells Your Health. He explains that snoring is a sound either from the nose or mouth and occurs when breathing system is blocked when one is asleep.

The sound is harsh and can disturb a person sleeping in the same room. Basically, anything that narrows your breathing passages can cause snoring.

“Generally, snoring and obstructive sleep apnea (OSA), are part of other sleeping disorders that are among the silent killers as they can damage every system of body over time,” says Dr Rangwala.

Not everyone who snores has apnea, but it is a key symptom. The difference is that, with obstructive sleep apnea, the snoring is accompanied by pauses where you literally stop breathing because your airway collapses or is blocked.

These pauses, which can last from a few seconds to minutes, are followed by choking, snorting or gasping, Dr Rangwala further explains.

“Most people who snore are not aware of the condition. The condition is often detected by the bed partner who witnesses the symptoms. 60 per cent of people who snore have OSA,” says Dr Rangwala.

According to a research conducted in 2015 titled ‘Prevalence and risk factors for obstructive sleep apnoea in Dar es Salaam, Tanzania’, a total of 1,249 people were involved in the study. Of these, 65.2 per cent were females. Night snoring was reported by 9.3 per cent of the respondents.

The prevalence of OSA was 11.5 per cent (144/1249). OSA was significantly more common among females, the study further revealed.

Poor sleep because of snoring condition that is not being treated in return will end up with several effects including excessive daytime sleeping, morning headaches, irritability, depression, workplace performance impairment etc.

Snoring, according to Dr Rangwala, is caused by different lifestyle factors but obesity seems to me the major reason. Alcohol consumption, allergies and cold also contribute to snoring.

Health consequences of snoring

Untreated snoring can result to threatening conditions like hypertension, diabetes, obesity, stroke, heart diseases and attacks, metabolic syndrome, liver problems etc.

Dr Rangwala says that early screening can prevent serious complications. As soon as one is diagnosed with health problems, a treatment process has to immediately start.

A study done at Henry Ford Hospital in Detroit, researchers have pointed out that ‘Snoring may be early sign of future health risks.’ The study reveals changes in the carotid artery with snorers -- even for those without sleep apnea -- likely due to the trauma and subsequent inflammation caused by the vibrations of snoring.

Obstructive sleep apnea has long been linked to cardiovascular disease, along with a host of other serious health issues.

But the study reveals that the risk for cardiovascular disease may actually begin with snoring, long before it becomes OSA. Until now, there was little evidence in humans to show a similar connection between snoring and cardiovascular risk.

Why Mrashani is still not treated?

Treating snoring depends on the kind of diagnosis. Monitoring your snoring for patterns can often help you pinpoint the reasons why you snore, what makes it worse, and how to go about stopping it.

Mrashani till to date has not been able to treat his condition because of the treatment cost he has to endure.

Upon attending an ENT clinic, Mrashani was asked to go for a specific kind of sleep test/study that cost anything between Sh400,000 to Sh600,000, of which he never went back as he is still struggling to raise enough money to support his treatment as he currently isn’t under any insurance schemes.

Dr Rangwala agrees that treating snoring comes with a cost here in Tanzania. As a way of raising awareness, CCBRT held a free screening camp for snorers. But out of 38 people who attended, only four people came back for further treatment. “One of the drawbacks to treating snoring is the costly tag it comes with it. Majority of the citizens cannot afford and it just paints a challenge in seeking further treatment,” Dr Rangwala explains.

Snoring is generally regarded as a cosmetic issue by health insurance, requiring significant out-of-pocket expenses by patients.

Adding that currently the ‘sleep study’ is only covered by AAR and Jubilee insurance schemes.

What does the treatment entail?

Albert Simeone, 40, started his ENT clinic soon after the screening. As part of his treatment he had to go through sleep test as one of the diagnostic tools for snoring and OSA.

A sleep test is a non-invasive, overnight exam that allows doctors to monitor you while you sleep to see what is happening in your body.

Commenting about the sleep test Dr Rangwala says, it is a test that costs Sh400,000 and requires the patient to spend an entire night at the hospital wearing a sleep test as it is easy to identify the possible disruptions in the pattern of ones sleep.

He says, a sleep study measures things like oxygen levels in your blood through a sensor, and breathing rates, snoring and body movements. The day from your sleep study will usually be taken by a technologist and later evaluated by your doctor.

Simeon went through that test and he is currently waiting for his results to be out for him to start his treatment. Results always determine the levels of damage has been done by snoring. Dr Rwangala says, with treatment there are people who are advised to do some exercise in addition to medication, some will be taken for a surgery while other will require continuous positive airway pressure (cpap) whenever they sleep to support them with breathing.

“The cpap machine is still a new technology in the country. It is not possible to get the machine here. For patients who are advised to use machine, they have to purchase it from Germany,” says Dr Rangwala.

The cpap machine ranges from Sh900,000 to Sh2,200,000 depending on the features of the machine. Dr Rangwala calls health stakeholders to supporting citizens who cannot afford the medical bills find a way that will help people access treatment easily.

“We’re hoping to change that thinking [from insurance to making treatment affordable] by calling upon health stakeholders, including the Ministry of Health, so that patients can get the early treatment they need, before more serious health issues arise,” says Dr Rangwala.

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