What keeps Dhaka up at night? Sleep labs can tell
Sleep disorders heighten the chances of several diseases. Sleep labs help diagnose such disorders. A few hospitals in the country have them now
Nahid sat on the bed with his legs folded. He was connected to multiple wires, taped on to his head, chest, abdomen and elsewhere. A tape also ran over his jaw and head.
Do you feel at ease? "Not really, I don't know how one is supposed to sleep in this way," he replied. We were sitting inside a private sleep lab in Aftabnagar on a recent Wednesday night.
This is what it takes to detect and even gauge the seriousness of sleep disorders.
After the machines were connected, the sleep lab partitioned by a steel divider, turned dark. Lights were switched off, mobile phones put on silent and the only light was that of the desktop monitor. It showed undulating lines. Nahid's heart rate, leg movement, brain activity, breathing and even eye movements were shown in those lines.
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Technician Mehedi with his assistant Rubel would stay awake in front of the monitor. "We need to be able to record at least a few sleep cycles. Now, every patient is different. So the test can end after three hours or four after the patient has fallen asleep," explained Mehedi.
The results – which are detailed graphs of the patient's body activities in sleep – are sent to a doctor for a diagnosis. In Nahid's case, it will be Dr AKM Mosharaf Hossain, a pulmonologist and sleep specialist at LabAid hospital in the capital. Dr Hossain set up the private centre at Aftabnagar.
Currently, a handful of hospitals in the country have sleep labs. They are used to diagnose sleep disorders. One of the most common sleep disorders is sleep apnoea in Bangladesh, according to doctors. At the same time, other disorders also persist.
In the case of Dhaka, let alone other parts of the country, the idea of sleep labs remains unknown to most. For a population which is more preoccupied with life-threatening and non-communicable diseases while navigating through a dilapidated (public) or expensive (private) healthcare system, sleep disorders stay on the backburners.
Why do we not care about 'sleep architecture'
Dr Nahid Raihan hails from Lokkhipur. He came to know about the Dhaka Sleep Research Center online. "We called BSMMU and Popular [hospitals]. One said that the next available date for a sleep lab appointment is in February, and the other said January," said Nahid.
A doctor by profession, Nahid could not wait that long. He said he had been having trouble sleeping for six months to up to a year. "It worsened especially since July-August," he added. His primary complaints were disruptive sleep, waking up with headaches and not feeling fresh. This led to days which left him feeling groggy, unfocused and irritable — all things that are likely to hinder his work.
"This is extremely important for me. I cannot wait. Not being able to sleep for about a year takes a toll, both mentally and physically," said Nahid.
Nahid and his father, who was also in the lab with us as an attendant, travelled to Elephant Road from Lokkhipur to lodge a relative's house. Then they came to Aftabnagar to the sleep lab. "I met Dr Hossain [at LabAid] before coming here." Nahid took a leave from work for a sleep diagnosis.
Are people generally aware of sleep labs in the country? "Sleep labs? No. Even among doctors, in my professional field, if I were to ask or talk about polysomnography [sleep study conducted in a sleep lab], they look dumbfounded," he replied.
Nahid's sleep study ended around 2:30 AM. Afterwards, everyone (both technicians, Nahid and his father) stayed back at the lab till 8 AM before heading out.
"I could not sleep at ease with those things connected to me. The technicians told me they have what they need to make a diagnosis," Nahid said over a phone call.
Nahid paid Tk12,000 for the test after a 40% discount.
On the following day (21 November), Nahid went to see the doctor and was told he did not have sleep apnoea. He was prescribed Feel Fresh to improve sleep along with sleep hygiene recommendations. He recently said he has been sleeping better.
Much of the lack of awareness about sleep labs in the country stems from the lack of awareness about the importance of sleep, according to sleep specialists. Without treatment, prolonged sleep disorders are likely to incur cognitive effects including memory loss and decreased libido.
Additionally, based on well-documented studies, sleep disorders heighten the chances of a stroke, diabetes and kidney disease among other serious health problems. "[And] in the case of existing health issues, it can make it worse," explained Dr Hossain.
So, if the risks are so grave, what explains the lack of awareness? "I would say that the lack of awareness among doctors is more problematic," replied Dr Hossain, "We do not ask a patient about their sleep. Regardless of why the patient had come in, sleep is extremely important and telling, it can be associated with 90% of health problems."
"We do not ask a patient about their sleep. Regardless of why the patient had come in, sleep is extremely important and telling, it can be associated with 90% of health problems."
"Every doctor must ask this," he continued.
A sleep cycle can last anywhere between 60 to 90 minutes, and a healthy sleep time frame consists of six to seven such cycles. Out of which 80% is non-REM and 20% is REM cycle (this is when we dream). There are of course more breakdowns and stages within this, which makes up the sleep architecture.
The common sleep disorders are insomnia, narcolepsy (a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles) and sleep apnoea while disorders include parasomnia, sleep-related movement disorders (such as sleepwalking), etc.
The International Classification of Sleep Disorders (ICSD) is the premiere clinical text for the diagnosis of sleep disorders by the American Academy of Sleep Medicine has detected 100 sleep disorders — this includes excessive sleep as well.
Does sleep apnoea dominate diagnosis in the country?
Have you observed an increase in patients with sleep disorders? "Yes, this is also telling of better socio-economic status I would say," replied Dr Hossain, who was involved in setting up the country's first sleep lab at Japan Bangladesh Friendship Hospital in 2005.
According to Dr Sarder A Baki, a sleep medicine specialist at the Japan-Bangladesh Friendship Hospital, the majority of patients (an annual estimation of 200-250) there have sleep apnoea.
There are two kinds, one is obstructive sleep apnoea (when the pharynx closes up and the individual wakes up choking) and the other is central (related to neurological causes, which are likely indications of Parkinson's disease, etc).
Although in the minority, "we also have patients coming in with insomnia or narcolepsy," said Dr Baki, "those cases are generally treated with medication and lifestyle changes."
Evercare, Square and LabAid are some of the private hospitals which launched sleep labs after JBFH. The price for a sleep study varies in these sleep labs costing over Tk10,000. At JBFH, the cost is Tk15,000.
Among the public hospitals, BSMMU, NIDCH, and Dhaka Medical also have sleep labs, which cost less.
Studies also point to the Covid-19 pandemic as a significant contributor to the increase in sleep disorders seen in Bangladesh and elsewhere around the world. Reports also point to an increase in sleep apnoea and insomnia in recent years, citing Bangladeshi doctors.
When it comes to sleep studies at home, commonly known as the sleep apnoea test (HSAT), there are countless options. Several companies offer a service where technicians go home to conduct a sleep study and then prescribe sleep apnoea machines.
"I strongly oppose this, they are not trained medical professionals to make this diagnosis. One of the reasons why I started the centre (at Aftabnagar). Because there is so much malpractice I am aware of," said Dr Hossain.
