Tuesday, 20th February 2018


To Sleep… Perchance to Die! (The Bangungot Horror)

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To Sleep… Perchance to Die! (The Bangungot Horror)

Part 1 of 2

Dr. Cesar Yap


Dr. Cesar Yap




Spooky Halloween night? It could be deadly! They call it Nightmare Death Syndrome, Brugada Syndrome, Rico Yan Syndrome, and other names. Usual victims are young, males, Asian, with relatively bigger hearts on autopsy. Discovered dead on bed, Pancreatitis could be a reason; but many dispute it as ‘chicken or egg’: Pancreatitis could be the cause or could be the effect of a dying tissue. Heart abnormality could best define it as the heart beats irregularly causing sudden stoppage.


Beware: loud snorers
Wakeful Medicine has been with us since hundreds of years, but Sleep Medicine has come out only few decades ago. Sleep problems like Obstructive sleep Apnea, Excessive sleepiness, Insomnia, Restless leg syndrome affect our daily lives. Do you snore like thunder? Then as you suddenly stop snoring… God forbid it could signal a deadly silence as your heart and breathing had finally stopped! You could have:


Obstructive Sleep Apnea:
Common among middle-aged overweight men, Sleep Apnea self-destroys men (or women) as they actually STOP BREATHING (breath stoppage for at least ten seconds = APNEA) due to airway obstruction during sleep. Breath stoppages, scattered between loud snores, occur from a dozen to a hundred times per night. During breath stoppage episodes (that may last up to more than 60 seconds) blood oxygen drops to dangerous levels. This causes the heart to beat irregularly and, in worst cases, stop suddenly.


Heart and Brain Attacked
The morning dip (a phenomenon when your blood pressure lowers during restful sleep) is gone with sleep apnea; BP even shoots up as the heart struggles during breathless episodes. Stroke is not far with this together with Heart Attack when the heart muscles are deprived of oxygen. Sleep apnea also links with Metabolic Syndrome (diabetes, heart diseases, obesity, and cholesterol problems) due to increase in body’s bad chemicals caused by low oxygen supply while you’re not breathing.


Daytime sleepiness
Patients wake up feeling tired with headaches. Memory suffers. At work, Sleep apnea patients always feel sleepy and sluggish. And at day end, they feel “Low-Batt” and needs recharging. Prolonged sitting (travels and boring meetings) induces uncontrolled sleepiness. Work related accidents (vehicular too) could be dangerous. Personality changes are common (irritability, over eating, depression) plus, more sadly, Erectile Dysfunction.


Sleepless, breathless, restless!
The obstructed airways from the nose to the mouth to the throat (anatomical abnormalities, allergic rhinitis, big tonsils, small jaw, and accumulated fat) causes ‘traffic’ of air flow to the lungs. How could they soundly sleep when, as they go deep, the mind commands them to panic? Being breathless for ten seconds makes the mind and heart suffer the pain. Patients regularly snort and gasp as they try to breathe “again”. And when breathing fails to regain, bangungot wins!


What To Do
By all means, lose some weight! No smoking. No alcohol before bedtime (avoid sedatives too) for they worsen the Apnea spells. Avoid lying at your back (upper roof of throat collapses); airways open somehow while lying at your side. Put a tennis ball inside a sock: sleeping at your sides may put breathing to the max when you pin it on your pajama’s back!
Sleep…and we'll do the rest!
Sleep labs doing Polysomnography confirms the diagnosis. Monitors are attached to the patient for respiratory efforts and flow studies. You are watched overnight as you sleep to study your sleep patterns and to document those breathless cycles. St. Paul’s Hospital has it. For privacy and comfort of a hotel room or your bedroom, you can have it with my good friend, Dr. Rolin Tabuena of Iloilo Mission Hospital.


CPAP-- not a dance step
But a portable machine that “blows” air regularly to a sleep-apneic patient. Once sleep apnea is confirmed, CPAP (continuous positive airway pressure) machine is attached while patient sleeps with same monitoring parameters.


Time bomb ticking!
We'll never know when stroke or heart attack strikes. It could be biblical like “A thief in the night”! So if you are obese, with 17 inches (16 for women) of neck diameter (grab your tape measure now), with big tongue, or small jaw, and snore like thunder, consult now! “Tis better to visit the cemetery this All Saints’ day than be visited upon. And Sleep test I did! I looked like an astronaut as I donned those wirings in the sleep lab in Manila a decade ago. Luckily, or unluckily, I was positive! The longest time that I stopped breathing was 69 (of all numbers) seconds. My lowest oxygen saturation was 67 % (normally: above 90%).


Thank God I’m back!
With my CPAP around I sleep like I never did before. I now have lots of sweet dreams. My memory improved. My blood pressure normalizes. I now manage my midlife crisis well (and Denise loves it). And my energy improved tenfold! Before, I can only manage one round in one setting. Now, I can easily make five! Five hospital rounds of course! You… you!!


(Doc Yap is a neophyte councillor of the sea foods capital of the Philippines Roxas City, a proud member of The Kapisanan ng Mga Brodkasters sa Pilipinas and a multi awarded physican. His book “Joyful Life and Sex- GO TO HEALTH!” is available at National Book Store outlets)

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