Forty-six-year old Prasad came into the clinic accompanied by his wife who complained that he snored excessively and disturbed her sleep. The children had even threatened to record how vigorously the father snored and play it back to him.

Prasad, a spice vendor from Indra Chok, was reluctant to admit to any health problems but his wife was adamant that something must be done of her husband's relentless snoring. She also said that the snoring was much worse when he went to a bhoj in the evening and had a couple of drinks. At times she felt he was going to die when he snored very loudly and then suddenly stopped breathing for a few seconds and woke up trying to catch his breath.

Prasad did admit to being sleepy at work. His blood pressure was on the higher side and although his lungs were clear, he had a protuberant, obese belly. The rest of the examination was completely normal.

In all likelihood Prasad is suffering from a common ailment called obstructive sleep apnea. In this condition, when the patient draws his breath in while sleeping, there is excessive narrowing of his windpipe. The sudden narrowing of the airway causes snoring.

When this sleeping pattern continues for a large portion of the night, the patient wakes up unrefreshed and affects his quality of life including suffering from mood swings and daytime sleepiness. Increased blood pressure is also common.

Sophisticated sleep studies (polysomnogram) which would help diagnose the problem, are generally unavailable in Nepal. So in most instances a typical clinical history as in Prasad's case may be all that is available to arrive at the diagnosis of obstructive sleep apnea.

Treatment for sleep apnea consists of losing weight for obese people. In order to decrease calorie intake only one rice meal a day with chapattis at night and cutting down on sugary drinks and mithais may help. Avoiding alcohol is beneficial both for weight loss and unhampered breathing during sleep. Sleeping on the side rather than on the back is also useful to decrease snoring. There is no drug therapy for sleep apnea. Continuous positive airway pressure (CPAP) machine or a simple dental appliance which gently pulls the lower jaw forward (if you can believe that) while sleeping are other commonly prescribed therapies which actually work well. But these are expensive devices and require some testing before use, and sadly not readily available here for this common problem.