Slumber Party

Poor Sleep Can Kill Your Libido, Your Marriage, And Even You

This is what keeps Dr Kenny Pang, the brains behind a revolutionary sleep apnoea surgery technique, awake at night.

Poor Sleep Can Kill Your Libido, Your Marriage, And Even You
Dr Kenny Pang wears silk and wool jacket, cotton shirt, and silk and wool trousers, all from Ermenegildo Zegna; Leather sneakers (worn throughout), from Common Projects at Pedder On Scotts.

Dr Kenny Pang is a sleep doctor. But there’s nothing soporific about him.

Instead, he is full of energy, talks animatedly, smiles a lot and has an endearing manner of apologising for being long-winded while peppering this two-hour-plus interview with enthusiastic thank-yous whenever this writer asks him about something close to his heart.

The 50-year-old is truly a study in contrasts. His field of work is filled with big, intimidating, multi-syllabic terms like hypnagogic hallucinations, pharyngoplasty and otorhinolaryngology, but he speaks simply and uses easy-to-understand analogies to distill what he does into an insightful conversation for the layman.

But first, what exactly is a sleep doctor?

It’s as straightforward as it sounds. Pang, who’s also an ear, nose and throat (ENT) consultant (or an otorhinolaryngologist) at Asia Sleep Centre, helps patients sleep better.

The 26-year veteran chose to specialise in ENT medicine — even though it may not be as high profile as something like brain surgery or plastic surgery — because he was intrigued by how the head and neck anatomy “is a small but challenging area”.

But he has always been even more fascinated with the concept of sleep and likes how ENT medicine and sleep medicine are a symbiotic “lock and key situation”.

“We spend one-third of our day sleeping — that’s a third of our lives. If you live till 88 years, that would mean you spend about 29 years sleeping. But we take sleep for granted and don’t really understand it,” he enthuses.

The father of five — his two elder kids are studying medicine at University of Glasgow, Scotland, and at National University of Singapore — isn’t one to take his sleep for granted.

By 11.30pm on most days, he’s in bed so that he can wake up at 6.30am to fetch his younger children to school before starting work at 7.30am.

Being well-rested is important to him because he has a jam-packed schedule.

Wool jacket, from Paul Smith; Cotton and linen knit top, from Z Zegna.

Besides seeing patients and doing surgeries, Pang has authored and edited a few books, the latest being the fourth edition of Sleep & Snoring Matters. He is also the founder of the ASEAN Sleep Surgical Society and International Sleep Academy.

But what has made him a celebrity of sorts here and overseas is Pang’s Expansion Pharyngoplasty, a sleep apnoea procedure that he started and pioneered in 2006 before having it published in an American peer-review journal in 2007.

Sleep apnoea causes a person’s airway to narrow or collapse repetitively during sleep. When this happens, oxygen levels fall and breathing may stop for 10 seconds or longer.

This process triggers the brain to wake the person briefly to reopen the airway. In severe cases, he or she may stop breathing as often as once every minute. As a result of this disrupted sleep pattern, the sleep apnoea patient feels more tired upon waking, suffers from headaches, loses concentration and feels moody throughout the day.

Sudden death during sleep is also a possibility.

Sleep apnoea doesn’t just affect adults. Young children — those with big tonsils, small jaws or sinus problems — make up a third of Pang’s patients. Besides attention-deficit issues, poor quality sleep can also lead to stunted growth because the growth hormone phase, which emerges only during the deeper sleep stages, doesn’t get to take place.

In adults, snoring is one of the major issues and signs linked to sleep apnoea. In a social context, it can mean anguished bed partners and relationship problems; but there are medical implications too. A narrowed or collapsed airway places stress on organs like the heart and brain, which can then result in hypertension, a stroke or heart attack.

According to Pang, Singapore has one of the highest sleep apnoea rates in the world. The good news is, more of us are seeking help for the condition instead of assuming that “snoring is normal”.

“Fourteen years ago, people couldn’t even pronounce sleep apnoea. Now they come to my clinic to discuss it with me,” he says. “Some of my male patients had low libido and were irritable because they weren’t sleeping well, and their wives were very unhappy. After I treated them, their lives changed and they became healthier and happier.”

Silk and wool jacket, cotton shirt, and silk and wool trousers, all from Ermenegildo Zegna. Watch, Kenny’s own.

Not Sleeping On His Success

There are a few ways to treat sleep apnoea and the many problems that arise from it. A doctor may advise a patient to use a continuous positive airway pressure (CPAP) mask. This helps prevent the airway from narrowing by blowing air into the throat and increasing the air pressure there.

The downside? A CPAP mask is uncomfortable to wear throughout the night. Plus, it doesn’t cure the disorder but only curbs its effects.

The alternative, albeit more invasive, is surgery. One surgical method, uvulopalatopharyngoplasty, opens the upper airway by cutting out tissue like the tonsils and uvula, the teardrop-shaped soft tissue that hangs down the back of the throat.

Despite this method being hailed as the gold standard, the success rate is only 50 percent, which wasn’t good enough for Pang. So he spent four years doing research before coming up with Pang’s Expansion Pharyngoplasty.

“I’ve been very driven and motivated all my life and mediocrity isn’t for me, especially when it comes to sleep surgery, as I always want to better myself and better my patients’ lives.”

His research led him all the way back to medical literature from 1959 that addressed the treatment of babies with cleft palates. For this, doctors would close off the cleft palate by stitching the palatopharyngeus muscle.

Inspired by this, Pang thought of a method to rotate this muscle upwards and forward, and open it up instead. By doing so, he would be able to expand the upper airway.

“Sometimes, I release more tissue, sometimes I stitch more. It’s like plastic surgery in the mouth. I tailor my surgery to every patient’s oral cavity.”

He says that with Pang’s Expansion Pharyngoplasty, the success rate is at a much higher 80 percent.

“I revolutionised sleep surgery in the world. If you ask any sleep surgeon about my technique, they will know it.”

But the watch collector (who wore his own tourbillion for this shoot) wasn’t satisfied with just treating patients at his clinic in Singapore. He wanted more surgeons and sleep apnoea patients worldwide to benefit from his research and innovation.

“I want to teach so that I’m not limited to treating a fixed number of patients,” he explains. Four times a year, he travels overseas to countries like the US, India and South Korea, where he passes on his skills and findings to other sleep surgeons.

As he chose not to patent Pang’s Expansion Pharyngoplasty, Dr Pang doesn’t earn royalties. He also teaches for free and, in some instances, pays for his own airfare and accommodation. Some doctors visit him in Singapore to learn from him too.

Why does he bother spending his time and energy on something that doesn’t have any monetary gains?

“It’s about altruism. I’m already 50. Money is not the end-all and I’ve never looked up to it.”

Instead, he finds it enjoyable when younger ENT and sleep surgeons, as well as his contemporaries, seek his advice and opinion on their work.

On the other end of the spectrum are patients who’ve kept in touch with him over the years, even after being cured of sleep apnoea. He has no qualms sharing his handphone number with his patients, some of whom send him photos of their meals to ask if they are eating right.

After all, Pang is a strong advocate of a healthy lifestyle.

“I’m very into nutrition because I need to stay healthy as an example to my patients,” he says.

Cotton shirt, from Hugo Boss. Jacket, Kenny’s own.

“There’s the keto diet but mine is almost paleo. I eat minimal fat and a lot of vegetables, fish and soup. I also haven’t had a proper rice meal in 10 years. If I must have rice, I’ll share just a small bowl of it with my wife.”

He’s also very disciplined about exercise, following a strict fitness routine four days a week. His three sons and two daughters help him with this; the devoted father plays tennis or soccer, swims and goes on runs with them at different times, depending on what each child likes.

On his own, he hops onto his stationary bike or plays golf with his wife. That level of dedication extends to his hobby: collecting Lego Minifigures for more than 20 years. He now has more than 1,000 pieces, including prized Star Wars models, that are meticulously displayed on acrylic shelves.

When You Encounter Teething Issues

And just when you think that Pang has enough on his plate, he tells you about his ongoing project: working with and coaching dentists. But what’s the link between sleep issues and dentistry, you wonder aloud.

Bruxism or teeth grinding in one’s sleep is actually a common sleep disorder (and not primarily a dental problem). In his work, Pang has come across many young female patients with bruxism.

“They grind their teeth when sleeping and become very moody, tired and emotional. They have jaw and neck aches and their teeth are worn out. Sixty-eight percent of them have depression. But when I do sleep tests on them, they do not have sleep apnoea.”

He worked with a dentist who saw a similar demographic among his patients. The duo collected and analysed data on 86 of them, and published their findings in an American medical journal on sleep disorders in young Asian women.

Pang discovered too that if he helped open up their airways and “laser their noses”, they could breathe better in their sleep and not have to clench their jaws so hard.

“They no longer had jaw pain, they were no longer anxious or depressed, their lives changed, and it’s amazing.”

From this, Pang saw an opportunity to pass on his knowledge to dentists and has since become “very active” in dental sleep medicine conferences.

With a child-like grin, he says: “I’ve not only come up with Pang’s Expansion Pharyngoplasty for sleep apnoea but I’ve also discovered its association with bruxism!”

Wool-blend jacket and wool-blend trousers, both from Paul Smith; Cotton knit top, from Hugo Boss.

Besides teeth grinding, there are other common sleep disorders which many of us may have experienced. For instance, hypnagogic hallucinations are brief periods of dreaming between the stages of consciousness and sleep. These dreams can cause the person to feel that he or she is falling, and jolt awake suddenly.

There’s also sleep paralysis, a feeling of not being able to move when one is awake. This is a scary experience that more superstitious individuals have attributed to supernatural forces sitting on their bodies.

While it’s hard to avoid sleep issues altogether, Pang says there are some general rules to having a good night’s rest. And they don’t include counting sheep or burning essential oils, although he’s open-minded enough to say, “if it works for you, it works for you”.

What he suggests instead: avoid stimulants like caffeine before bedtime, keep your room cool and avoid exercising at least four hours before bed.

And in this era of mobile devices, he has seen a two- to three-fold increase in patients suffering from what he likes to call “sleeplessness” — because there is a stigma to insomnia and patients don’t like to be seen as insomniacs.

“I remind all my patients, ‘no light-emitting devices in your face two hours before you sleep’. No iPad, no smartphones, no laptops, no television. Some people are sensitive to light, especially white light, so I tell them to turn on yellow light, like a lamp. Oh, and read a book.”

This story first appeared in the April 2020 issue of A Magazine.

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