qwertyuiopasdfghjklzxcvbnmqwe rtyuiopasdfghjklzxcvbnmqwertyui opasdfghjklzxcvbnmqwertyuiopa sdfghjklzxcvbnmqwertyuiopasdfg hjklzxcvbnmqwertyuiopasdfghjklz xcvbnmqwertyuiopasdfghjklzxcv bnmqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmqwe rtyuiopasdfghjklzxcvbnmqwertyui opasdfghjklzxcvbnmqwertyuiopa sdfghjklzxcvbnmqwertyuiopasdfg hjklzxcvbnmqwertyuiopasdfghjklz xcvbnmqwertyuiopasdfghjklzxcv bnmqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmqwe rtyuiopasdfghjklzxcvbnmrtyuiopa Sleeping Disorder Problems And Feasible Solutions Available In Today’s Hospitality Industry Project done by Sohong Chakraborty Final year student, Batch 2009-11 Jyotirmoy School of Business, Kolkata Under guidance from Mr. Pankaj Sabharwal Asst. Vice President-Healthcare, BOC India Ltd, Kolkata And Mr. Krishna B Senior Manager, Marketing, Healthcare, BOC India Ltd, Kolkata
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8/7/2019 Sleeping Disorder Problem and Feasible Solutions Available in Today's Hospital Industry_final
The success of any business entirely depends on research and marketing strategies applied by the organization
to understand the preferences, market scope and attitude towards the product or services. I have tried to makethe study realistic. The project will give a complete view of sleeping disorder and feasible solutions available in
the hospital industry in the city of Kolkata.
Marketing plays a vital role in a business to make it a success. It is such a topic which cannot be learned
through books only. It needs to be learned through practical exposure. In this project I have tried to find out the
way the company like BOC India Ltd, a member of The Linde Group uses marketing as a key to success. I have
put my best effort to complete this task on the basis of the skill that I have achieved during my one month live
project in BOC India Ltd, Kolkata.
I have done the work independently under guidance from Mr. Pankaj Sabharwal, Asst. Vice President-
Healthcare, BOC India Ltd, Mr. Krishna B. and Senior Manager, Healthcare, BOC India Ltd. I am equally
grateful to Mr Sandeep Bhattacharya, Vice president, Human Resource, BOC India Ltd and Mr Sitangshu
Khatua, Associate Dean and Examination Controller Head of Jyotirmoy School of e Business, Sonarpur,
Kolkata for giving me a chance to work with BOC India Ltd and make this live project possible..
However, I would appreciate if any mistakes are brought to my notice by the readers.
Sohong Chakraborty
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abnormally low breathing event is called ahypopnea. Sleep apnea is diagnosed with an overnight sleep test
called a polysomnogram, or "sleep study".
There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e.
a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively. In CSA,
breathing is interrupted by a lack of respiratory effort; in OSA, breathing is interrupted by a physical block to
airflow despite respiratory effort and snoring is common.
Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon
awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is
suspected because of its effects on the body (sequelae). Symptoms may be present for years (or even decades)
without identification, during which time the sufferer may become conditioned to the daytime sleepiness
and fatigue associated with significant levels of sleep disturbance.
Sleep apnea is a common and potentially devastating sleep disorder. It is the most common reason that patients
are referred to sleep centers around the country. Patients with the usual form of sleep apnea actually close off
their airway at night.
This airway closure occurs either behind the tongue or behind the nose. Patients continue to make efforts to
breathe. Then after 10 to 120 seconds, the brain, realizing it is not getting any oxygen, actually "wakes up." The
brain then tells the upper airway to open to let some air in.
This is associated with loud bothersome snoring, often described as snorting and gasping. Patients may take a
few breaths of air, the brain goes to sleep again and the cycle may repeat itself several hundred times a night.Patients are often not even aware that they are doing this (although the bed partner is).
Sleep apnea is dangerous, common, relative easy to diagnose, and treatable . Patients with sleep apnea are at
great risk for heart disease, heart attacks, strokes and high blood pressure. In addition, since the sleep is poor
quality (remember the brain keeps waking up), patients are often sleepy during the day. Sleepiness is associated
with inability to concentrate, remember or think. There is also increased risk in falling asleep while doing vital
tasks such as driving or using heavy machinery.
Medical treatment involves weight loss if the patient is overweight, avoidance of drugs, which increase the risk
of apneas such as sleeping pills, alcohol and sedative medicines, and sometimes sleeping semi-upright
However, in most cases additional treatment is warranted.
In some cases, Continuous Positive Airway Pressure (CPAP for short) is used to treat patients. CPAP,
mechanical device worn while sleeping which provides continuous air pressure to keep the airway open, is the
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Self help treatments, like losing weight, elevating the head of the bed or sleeping on your side, can also be
effective remedies for mild to moderate sleep apnea. Dental appliances and surgery are other treatment options.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone ofthe body ordinarily relaxes during sleep, and at the level of the throat the human airway is composed of
collapsible walls of soft tissue which can obstruct breathing during sleep. Mild occasional sleep apnea, such as
many people experience during an upper respiratory infection, may not be important, but chronic severe
obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and
other complications. The most serious complication is a severe form of congestive heart failure called cor
pulmonale.
Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structuralfeatures that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more
likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children are,
though it is not uncommon in the latter two population groups.
The risk of OSA rises with increasing body weight, active smoking and age. In addition, patients with diabetes
or "borderline" diabetes have up to three times the risk of having OSA.
Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime. Diagnostic tests
include home oximetry or polysomnography in a sleep clinic.
Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quit
smoking. Many people benefit from sleeping at a 30-degree elevation of the upper body or higher, as if in
a recliner. Doing so helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side),
as opposed to supine positions (sleeping on the back), are also recommended as a treatment for sleep apnea,
largely because the gravitational component is smaller in the lateral position. Some people benefit from various
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Image shows a Patient connected for a sleep study to determine
degree of apnea. Sensors variously detect brain activity, snoring
sounds, etc. The white bands are to determine expansion and
contraction of chest and abdomen.
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kinds of oral appliances to keep the airway open during sleep. "Breathing machines" like the continuous
positive airway pressure (CPAP) may help. There are also surgical procedures to remove and tighten tissue and
widen the airway.
As already mentioned, snoring is a common finding in people with this syndrome. Snoring is the turbulent
sound of air moving through the back of the mouth, nose, and throat. Although not everyone who snores is
experiencing difficulty breathing, snoring in combination with other conditions such as overweight and obesity
has been found to be highly predictive of OSA risk. The loudness of the snoring is not indicative of the severity
of obstruction, however. If the upper airways are tremendously obstructed, there may not be enough air
movement to make much sound. Even the loudest snoring does not mean that an individual has sleep apnea
syndrome. The sign that is most suggestive of sleep apneas occurs when snoring stops. If both snoring and
breathing stop while the person's chest and body tries to breathe, that is literally a description of an event in
obstructive sleep apnea syndrome. When breathing starts again, there is typically a deep gasp and then the
resumption of snoring.
Other indicators include (but are not limited to): hypersomnolence, obesity BMI >30, large neck circumference
(16 in (410 mm) in women, 17 in (430 mm) in men), enlarged tonsils and large tongue volume, micrognathia
morning headaches, irritability/mood-swings/depression, learning and/or memory difficulties, and sexu
dysfunction.
The term "sleep-disordered breathing" is commonly used in the U.S. to describe the full range of breathing
problems during sleep in which not enough air reaches the lungs (hypopnea and apnea). Sleep-disordered
breathing is associated with an increased risk of cardiovascular disease, stroke,pressure, arrhythmias, diabetes, and sleep deprived driving accidents. When high blood pressure is caused by
OSA, it is distinctive in that, unlike most cases of high blood pressure (so-called essential hypertension), the
readings do not drop significantly when the individual is sleeping. Stroke is associated with obstructive sleep
apnea. Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those
unaffected.
In the June 27, 2008, edition of the journal Neuroscience Letters, researchers revealed that people with OSA
show tissue loss in brain regions that help store memory, thus linking OSA with memory loss. Using magneticresonance imaging (MRI), the scientists discovered that sleep apnea patients' mammillary bodies were nearly 20
percent smaller, particularly on the left side. One of the key investigators hypothesized that repeated drops in
oxygen lead to the brain injury.
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the obstructive component has been eliminated. This has long been seen in sleep laboratories and has
historically been managed either by CPAP or Bi-Level therapy. Adaptive servo-ventilation (ASV) modes of
therapy have been introduced to attempt to manage this complex sleep apnea. Studies have demonstrated
marginally superior performance of the adaptive servo ventilators in treating Cheyne-Stokes breathing
however, no longitudinal studies have yet been published, nor have any results been generated that suggest any
differential outcomes versus standard CPAP therapy. At the AARC 2006 in Las Vegas, NV, researchersreported successful treatment of hundreds of patients on ASV therapy; however, these results have not been
reported in peer-reviewed publications as of July 2007.
An important finding by Dernaika et al. suggests that transient central apnea produced during CPAP titration
(the so-called "complex sleep apnea") is "…transient and self-limited. The central apneas may in fact be
secondary to sleep fragmentation during the titration process. As of July 2007, there has been no alternate
convincing evidence produced that these central sleep apnea events associated with CPAP therapy for
obstructive sleep apnea are of any significant pathophysiologic importance.
Research is ongoing, however, at the Harvard Medical School, including adding dead space to positive airway
pressure for treatment of complex sleep-disordered breathing.
Snoring
Snoring, which is sometimes confused with sleep apnea, can be a significant obstacle to quality sleep both for
yourself and your partner.
Snoring is caused by a narrowing of your airway, either from poor sleep posture, excess weight or physical
abnormalities of your throat. A narrow airway gets in the way of smooth breathing and creates the sound of
snoring. The snoring noise doesn’t necessarily that the airway is obstructed, as it is in sleep apnea. Snoring may
accompany sleep apnea, but not always.
There are many self help remedies and cures for snoring. If you are a mild snorer, sleeping on your side,
elevating the head of your bed, or losing weight may stop the snoring. Consulting a doctor on the problem may
be ideal before trying self made remedies. Don’t give up trying to find a solution for your snoring – it wi
make you and your partner, sleep better and may also boost relationship.
Restless Legs Syndrome (RLS) and Periodic limb Movement Disorder (PLMD) in Sleep
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medications related to morphine and opium, can be also be used. In some cases, anti-seizure medications may
be effective.
Narcolepsy
Narcolepsy is a neurological disorder that causes extreme sleepiness and may even make a person fall asleepsuddenly and without warning. Specific causes of narcolepsy are not known but people with narcolepsy are
lacking hypocretin, a brain chemical which regulates sleep and wakefulness.
The “sleep attacks” experienced by people with narcolepsy occur even after getting enough sleep at night, and
make it difficult for people to live normal lives. Falling asleep during activities like walking, driving or working
can have dangerous results.
Symptoms of narcolepsy include:
Intermittent, uncontrollable episodes of falling asleep during the daytime
Excessive daytime sleepiness
Sudden, short-lived loss of muscle control during emotional situations (cataplexy)
Narcolepsy may be genetic, but it also appears to be influenced by environmental triggers. Treatment requires a
combination of medication, behavioral treatments, and counseling.
Narcolepsy is a chronic sleep disorder that commonly begins during adolescence and is characterized by
excessive daytime sleepiness with the occurrence of sleep attacks. Narcolepsy can run in families, but can occur
in the absence of any family history as well. There are several other characteristic symptoms that may or may
not be present, including cataplexy, sleep paralysis and hypnogogic hallucinations.
• Cataplexy is the sudden loss of muscle tone, commonly associated with strong emotions. It may
be a subtle sensation of weakness or a complete loss of strength with a fall to the ground.
• Sleep paralysis is a sensation of not being able to move on waking, usually for a few seconds.
• Hypnogogic hallucinations are very vivid and sometimes violent or bizarre sensations, almost
dreamlike, that occur on waking or falling asleep.
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fall asleep. This combined with treatment of any underlying disorders is often the best way to treat the
devastating symptom of insomnia.
Sleepwalking/Somnambulism
Sleepwalking, also referred to as somnambulism, is characterized by walking or other physical activities duringsleep. Sleepwalking is common in children -- up to 15 percent of children have had this problem -- but can
occur at any age. In children, it can be associated with sleep deprivation or anxiety. In adults, it is more
commonly associated with other medical disorders, medication use, or anxiety or depressive disorders.
Clinically, the person may simply sit up with their eyes open, appearing to be awake, or they may engage in a
complex task. Episodes can last from seconds to minutes. Contrary to popular belief, it is safe to wake a
sleepwalker, but they may be confused and disoriented on waking.
There is no specific treatment except to avoid triggers if known, or treat anxiety or depression. If severe, short-
term use of sedatives may be considered. Otherwise it is best to keep the person safe and out of harm's way. We
often advise families to make sure the windows are closed and that there is no possibility of sleepwalking
leading to danger for the patient.
Sleep Disorders in Medical Illnesses
Many medical illnesses are associated with disturbances of sleep. Patients with chronic lung disease may
experience low oxygen levels at night that disturb sleep. Patients with asthma may develop wheezing or
shortness of breath at night, usually in the early morning hours. Patients with heart failure may develop
abnormal breathing at night, which disturbs sleep much in the way that sleep apnea does. Patients with
Parkinson's or other neurological diseases may develop disturbed sleep.
Many people with mental illnesses, notably depression, anxiety, post-traumatic stress syndrome, and panic
attacks, develop profound sleep disturbances. Insomnia is a common symptom in many people with these
problems. Evaluation and treatment by a health care provider skilled in these disorders, usually in conjunction
with evaluation by a sleep specialist, often brings about great improvement.
General principles of treatment
Treatments for sleep disorders generally can be grouped into four categories:
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to insure proper treatment. Although CPAP therapy is extremely effective in reducing apneas and less expensive
than other treatments, some patients find it extremely uncomfortable. Many patients refuse to continue the
therapy or fail to use their CPAP machines on a nightly basis. The CPAP machine assists only inhaling, whereas
a Bi-PAP machine assists with both inhaling and exhaling and is used in more severe cases.
In addition to CPAP, dentists specializing in sleep disorders can prescribe Oral Appliance Therapy (OAT). The
oral appliance is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. OAT is
usually successful in patients with mild to moderate obstructive sleep apnea. OAT is a relatively new treatment
option for sleep apnea in the United States, but it is much more common in Canada and Europe. Its use has led
to increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA.
CPAP and OAT are generally effective only for obstructive and mixed sleep apnea which has a mechanica
rather than a neurological cause.
For patients who do not tolerate or fail nonsurgical measures, surgical treatment to anatomically alter the airway
is available. Several levels of obstruction may be addressed, including the nasal passage, throat (pharynx), base
of tongue, and facial skeleton. Surgical treatment for obstructive sleep apnea needs to be individualized in orderto address all anatomical areas of obstruction. Often, correction of the nasal passages needs to be performed in
addition to correction of the oropharynx passage. Septoplasty and turbinate surgery may improve the nasal
airway. Tonsillectomy and uvulo-palato-pharyngo-plasty (UPPP or UP3) is available to address pharyngeal
obstruction. Base-of-tongue advancement by means of advancing the genial tubercle of the mandible may help
with the lower pharynx. A myriad of other techniques are available, including hyoid bone myotomy and
suspension and various radiofrequency technologies. For patients who fail these operations, the facial skeletal
may be advanced by means of a technique called maxillamandibular advancement, or two-jaw surgery (upper
and lower jaws). Technically, this is accomplished by a surgery similar to orthognathic surgeries addressing an
abnormal bite. The surgery involves a Lefort type one osteotomy and bilateral sagittal split mandibular
osteotomies.
Sleep Medicine
Due to rapidly increasing knowledge about sleep in the 20th century, including the discovery of REM (Rapid
Eye Movement) sleep and sleep apnea, the medical importance of sleep was recognized. The medical
community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as wel
as the role and quality of sleep in other conditions. By the 1970s in the USA, clinics and laboratories devoted to
the study of sleep and sleep disorders had been founded, and a need for standards arose.
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gets it by other ways (i.e., outsourced). Desun Hospital receives less footfalls as they are a new in the
market. Fortis Hospital has a sleep lad but not under operation.
• The sleep study machines are manufactured by Siemens, Philips, GE, Somnomedics Wireless System
Viasys and other such companies which are generally not disclosed by health care institutes but have
been known by verbal discussions with lab technicians and other stuffs. Lab technicians generally
manage the sleep lab devices. Companies itself generally sets up the lab and provides services till the
warranty (1 yr) last.
• 41% of the hospitals have visiting consultants, 26% of the hospitals have full time consultants and 7% of
the hospital has both visiting and fulltime consultants for sleeping disorder problem. If these all are
added up, then 74% of the hospitals have consultants for sleeping disorder problem which means thatthe consultants are available and are good in number. Medicinal products for sleeping disorder can be
pushed in the market through consultants towards the targeted audience.
• With growing number of patients getting aware of sleeping disorder problem, the market potentiality
seems to be good in near future. Low cost treatment procedure can be a hit in the market. Cost of c-pap
which has to be bought by patients cost around Rs. 35000/-. Most of the patients avoid taking due to the
cost based affair but 10 out of 27 hospitals prefer c-pap first and then bi-pap if necessary looking at
treatment required as per patients treatment procedure and necessity. Other treatm
Mardibular Advancement Splint, Surgery(Laser radio frequency or hyoid suspension)
• The average age of patients facing sleep disorder problem are between 41-50 yrs and face chronic
sleeping disorder problems. Transient and short term sleeping disorder problems are still over looked by
patients.
• 11 out of 18 nursing homes/health care institute refer patients to other hospitals where sleep monitoring
system is available which means that with tactful dealing these hospitals can be tapped for treating
sleeping disorder problems. 4 hospitals which refused to give details regarding refer of patients to other
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hospitals and 5 hospitals which already has their own sleep study labs are eliminated from 27 to get the
number 18. This means 61 % of the hospitals refer cases to other health care centers.
•
Treatment of sleeping disorder is mostly done by Pulmonologist under ENT department. Propetreatment of OSA is taken care by the pulmonologist where as General Physician recommend sleeping
pills to any sleeping disorder patients. Patients suffering from CSA are rare. Among 27 hospitals, 8
hospitals specialize in Pulmonologist (ENT) for treatment of sleeping disorder where as 4 hospitals
specialize in Neurology for treatment of sleeping disorder. 2 hospitals say it depends on both the
department of ENT and Neurology for treatment of sleeping disorder. 2 hospitals say it depends on
General Physician. 1 hospital says it depends on both the department of Cardiology and Neurology for
treatment of sleeping disorder. 1 hospital says it depends on both the department of Cardiology and ENT
for treatment of sleeping disorder and 1 hospital depends on Cardiologist for treatment of sleeping
disorder problem. Neurologist deals with patient with chronic insomnia.
• The pressure prescribed for various sleep disorder patients is between the 5cm of water to 15 cm of
water which depends on the individual patient anatomy of airway. The pressure also depends on the
Body Mass Index (BMI) of patients and hypothyroidism,
CONCLUSION
At the end of the LIVE Project the ultimate understanding what I got during this one month, treatment of
sleeping disorder has a huge market potentiality. In the near future, the size of the market will literally grow
keeping the fast pace life and ever changing habits and routines of human being, in mind in this 21
st
centuryThis has been a life time opportunity and a great learning experience for me regarding the study of health care
institutes in Kolkata. Regarding the report, after all the data analysis work I understood that the sleeping
disorder problem and feasible solutions available in today’s hospital industry which is discussed in the repor
has a significant impact on the market for treatment. The procedure of the treatment and available remedies are
very costly affair and can’t be afforded by the middle class, lower middle class people and below poverty line
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