Sleep problems that affect breathing, such as obstructive sleep apnea (OSA), are also common, especially in men, older people, and fat people [9]. The number of people with OSA is increasing over time, and some things like neck size, where you come from, head shape, and genes can make people more likely to have this problem [10]. Other sleep problems include snoring, restless legs, and sleep paralysis [11]. The number of people with sleep problems varies among different groups of people, and some studies have reported different rates of breathing problems and short sleep [12].

OSA is a common sleep problem in Pakistan, and many studies show that it affects a significant portion of the population. One study conducted in a village in Punjab found that more than 40% of the people were at high risk of OSA [13]. Another study in the same area found that older women were more likely to have OSA than younger women [14]. A study in Chitral found that about 13% of the people there had a high risk of OSA and that OSA was related to other health problems like being overweight, having heart disease, high cholesterol, and high blood pressure [15]. Additionally, a study in Karachi found that people with larger neck circumferences had more severe OSA, especially men [16]. The number of people with OSA varies between countries, and some estimates range from 4% to 22.8% in different regions [12]. Sleep problems can cause many health issues. They can damage your heart, blood pressure, and chance of survival [17]. They can also cause a condition called obstructive sleep apnea syndrome (OSAS), which makes you stop breathing while sleeping. This can lead to many other problems, such as stroke, diabetes, liver disease, kidney disease, mental problems, and road traffic accidents [18]. Your eyes can also suffer from sleep problems, especially from OSAS. You may have eye problems like floppy eyelid syndrome, optic nerve damage, swelling in the retina, changes in the blood vessels of the eye, and maybe glaucoma [19]. Not sleeping enough or having poor quality sleep can also make you feel sleepy, moody, tired, angry, anxious, depressed, forgetful, and less focused. You may also get sick more often, gain weight, and have higher blood sugar and blood pressure [20]. Moreover, sleep problems can harm your metabolism, which is how your body uses energy. You may become obese, resistant to insulin, and have type 2 diabetes. This can raise your risk of heart disease and death [21]. OSA treatment in Pakistan is not good and more people need to know about it and learn how to treat it. Studies have shown that OSA is not taken seriously in most parts of the country, and there is not much information on the problem [22]. A survey done among medical and dental professionals in Karachi showed that only a few of them knew enough about OSA and how it affects daily life [23]. Another study done in a rural area of Punjab found a lot of people with OSA, especially men, older people, and those with less education [24].

In the past decades, countries like India and Bangladesh have taken steps to create awareness and treat sleep problems by creating sleep medicine centers and labs, even though OSA is the cause behind stroke and heart diseases that often happen in people with high blood pressure, diabetes, high cholesterol, and smoking, which are common risk factors. Surprisingly, even though these conditions are likely to happen together, doctors often miss screening for OSA in these patients. This leads to the possible underdiagnosis of OSA, as doctors usually focus on high blood pressure, diabetes, high cholesterol, and heart problems, and forget to check for OSA symptoms.

This problem is worse because Pakistan does not have a good sleep service or specialty, and there is no formal training program for sleep problems. Creating such programs would not only increase the number of trained professionals but also increase research activity in the field, and make young doctors more aware. Also, there is a lack of trained people who can provide cognitive behavioral therapies for people who have trouble sleeping. It is important to address the importance of sleep at the school level, promote healthy sleep habits, screen for sleep-related symptoms in medical schools and colleges, do awareness programs for the public and doctors, and start formal training programs to improve sleep health and research in Pakistan. Also, a collaborative approach involving public-private health industry partnerships and working together with different experts is important. Cooperation is needed to increase awareness, create comprehensive training programs, and provide high-quality care to patients who struggle with sleep problems. By working together, Pakistan can improve its efforts to improve sleep health and deal with the challenges of sleep problems.