Do You Find Yourself Falling Asleep on The Job?

You May Have Sleep Apnea!

Dr. Paul Donahue explains Sleep Apnea in the article below:

 Dear Dr. Donohue: I was recently diagnosed with sleep apnea.  I have a very difficult time with the mask and air intake.  I think I sleep less now, from fighting the hose from the machine and from the pressure of the mask on my face.  No one tells me how to handle these problems.  Any information you give will be appreciated.

ANSWER: Apnea is a Greek word meaning "no breathing."  Sleep apnea is repeated episodes of no breathing during the night.  Those episodes might be as few as five in an hour to as many as 15 or more.  The usual story involves a snorer whose snoring increases in loudness until there's an abrupt silence.  The silence marks the onset of no breathing.  Finally, the affected person grunts, and breathing resumes, as does the snoring.

Sleep apnea has significant health consequences.  It raises the blood pressure.  It causes daytime sleepiness in dangerous situations, like driving.  It promotes heart attacks and strokes.

The standard treatment is CPAP, continuous positive airway pressure.  It's a machine that delivers pressurized air through a mask to keep the throat open so air can enter the lungs.  Apnea spells are eliminated.

You're not the only one to complain about the machine and mask.  Many different delivery machines and many different masks are available.  If you were tested in a sleep clinic, the people there can put you on to other equipment. 

I know of no medicine to control sleep apnea.  Other appliances might be helpful.  One is a mandibular advancement splint that fits into the mouth to pull the lower jaw forward.  That position of the jaw opens the throat so that air can pass through it easily.

Tyler Morning Telegraph, June 3, 2010

We held a seminar on Thursday, January 21st.

Click on the link below to view the invitation.

 

Some Symptoms of Sleep Apnea

  • Snoring 
  • Fatigue
  • Lack of Energy
  • Morning Headache
  • High Blood Pressure
  • Depression

If you think you may have sleep apnea, you need to ask your doctor for a referral to a sleep clinic since it is considered a medical problem.  Once you have been diagnosed, there are various treatment options available including the CPAP machine or oral appliance therapy.

Here are a couple of highlights on treatments from a report issued by The American Academy of Sleep Medicine, February 2006:

  • Oral appliances are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP.
  • Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering oral applicances. 

If you would like more information about oral appliance therapy for mild to moderate sleep apnea in Tyler, TX, please call our office during business hours at (903) 581-1777 or send us a message on our "contact us" form.

While you're here, be sure and sign up for Dr. Coker's monthly e-zine.  It's a great way for us to "keep in touch."


An article from the Fort Worth Star Telegram does a nice job of explaining snoring, sleep apnea, testing and treatments.

 "Here's How the Snorers Amoung Us Can Get Help" 
Ft. Worth Star Telegram, February 2008

The typical patient at a sleep clinic is older than 35, weighs about 235, is on medication for high blood pressure, is more irritable and moody than usual and may have a history of heart disease.  He finally makes an appointment with a sleep specialist at the urging of his wife who said all his snorting, whistling and rattling may not be keeping him awake at night, but it's playing havoc with her sanity.

Sleep apnea is a serious sleep disorder that occurs when tissues in the upper throat collapse and block the airway. It increases the risk of heart attack, angina, stroke and hypertension.  "Sleep disorders can wreak havoc on people's lives. Poor sleep not only affects performance and behavior at school, work and home, but it also has been tied to health issues such as obesity and high blood pressure," said Dr. Nilesh Dave, medical director of UT Southwestern Medical Center's new Sleep and Breathing Disorders Center in Dallas. "There is a growing body of research that shows if you have been snoring for a long time, it tends to cause memory problems; patients feel they can't think clearly. Even without sleep apnea, snoring can cause chronic sleep deprivation, which can make it difficult to go about your daily business. You can't focus, can't remember things," Dave said.

And a study published in the January 2008 issue of Journal of the American Geriatrics Society found that older women with sleep apnea are more likely to show cognitive impairment. The greater the severity of apnea in these otherwise healthy older women living at home, the greater the likelihood of impairment.

We asked the sleep experts about snoring:

What is snoring?
Snoring is a rough and hoarse breathing sound made in the upper airway of your throat as you sleep. Air enters through the mouth and nose and causes vibrations and noise as it flows over relaxed throat muscles, adenoids, uvula (the soft flap of tissue hanging from the back of the mouth), soft palate and other tissue in the throat, on its way to the lungs.

Who snores?
At least 30 percent of adults snore on a regular basis; up to 50 percent snore at least occasionally. Men out-snore women by about 2 to1, and the risk of snoring increases with age and weight. Allergies, asthma, colds and sinus infections increase the risk, as does smoking, alcohol, sleeping flat on your back and taking certain medications, including muscle relaxers.

What can I do to stop snoring?
Anything that increases airway resistance can provoke snoring, so anything that decreases resistance can help. First, try clearing your nasal passages by blowing your nose, taking a decongestant or using saline nose nasal spray just before falling asleep.

Also, lose weight (excess tissue in the mouth, nose and throat increases with weight gain), stop smoking and sleep on your side. (Try the tennis ball trick where you safety pin a sock containing a tennis ball to the back of your pajamas so that it is uncomfortable to sleep on your back.). Some experts suggest elevating the head of your bed about four 4 inches and sleeping without a pillow.

Breathe Right external nasal dilators, spring-loaded strips that hold the nasal passages open, work for some people. (To test, look in the mirror, inhale through your nose and watch what happens inside. If the walls of your nose collapse and the air passages narrow, nasal strips probably will likely help.)

What are the medical treatments?
Mandibular advancement devices, which look like mouth guards worn by athletes, are the best accepted and most often used devices to treat snoring that disrupts sleep but is not linked to apnea. These "oral appliances" are fitted by a dentist or orthodontist and can be very effective in reducing snoring, Watenpaugh said. The advantage is they are simple devices that are not connected to any machine and do not require a mask over the face. They help open airways by bringing your lower jaw or tongue forward during sleep. Most dental devices are acrylic and cost between $500 and $1,000.

Pressurized masks, designed to treat obstructive sleep apnea, also keep your airway open and can be used to relieve snoring, although insurance usually will not pay for them except to treat apnea. A Continuous Positive Airway Pressure (CPAP) mask worn over the nose and mouth delivers pressurized air from a machine at the bedside. (Think of your nose, mouth and throat as a deflated balloon. The positive airway pressure reinflates the balloon and prevents it from collapsing on itself.) The machines cost between $200 and $400, and masks with replaceable cushions average $50 to $60.

Surgery can increase the size of your airway by removing tissue or correcting abnormalities. Surgeons remove polyps, tonsils, adenoids, and excess tissue at the back of the throat or inside the nose or reconstruct the jaw in severe cases. Laser surgery and thermal ablation are sometimes used. Surgery costs vary widely.

Also the "Pillar Procedure," minimally invasive surgery to implant small plastic rods into the soft palate using a syringe-like instrument, is sometimes used to stiffen the soft palate and prevent snoring. The rods are implanted in a doctor's office under local anesthesia in a procedure that takes 20 to 30 minutes and costs $1,500 to $2,000.

TESTING COSTS
Specialists in pulmonary medicine, otolaryngology and dentistry are most involved in the treatment of sleep disorders, including snoring, sleep apnea, insomnia, restless leg syndrome, narcolepsy and other sleep problems, but most insurers, including Medicare, require diagnosis through an over-night test at a sleep lab, which costs about $1,500.

Now Medicare is considering a change in regulations to allow payment for diagnosing and treating obstructive sleep apnea through at-home testing, which costs about $500. Final approval is expected in March, and if Medicare begins paying for treatment based on the at-home test, private insurance is expected to follow suit.

WHERE TO FIND HELP
Most patients see a medical or dental sleep specialist at the suggestion of their primary care physician after first trying home remedies and over-the-counter antihistamines and decongestants to relieve snoring. Most insurance will not pay over for treatment for snoring unless sleep apnea is diagnosed through an over-night "polysomnography" (PSG) test at a sleep clinic.


A landmark study finds that sleep apnea can increase the chances of dying as much as 46 percent.
 

 Common Sleeping Disorder Ups Chances of Dying : Study Is the First to Quantify Death Rates for Sleep Apnea, Especially in People Who Snore
AScribe News

08-18-09

BALTIMORE, Aug 17, 2009 (ASCRIBE NEWS via COMTEX) -- Nightly bouts of interrupted, oxygen-deprived sleep from a collapsed airway in the upper neck raises the chances of dying in middle-aged to elderly people by as much as 46 percent in the most severe cases, according to a landmark study on sleep apnea by lung experts at Johns Hopkins and six other U.S. medical centers.

Even in people with moderate forms of the sleeping disorder, with anywhere from 15 to 30 episodes of interrupted breathing during each hour of supposed rest, risk of death jumps 17 percent.

The ongoing study is believed to be the largest ever conducted into sleep and related illnesses, with the latest report taking more than a decade to complete. The study involves some 6,441 men and women between ages 40 and 70, with mild to severe forms of sleep apnea or none at all. Many are self-described snorers; snoring is a key symptom of sleep apnea.

Though anecdotal reports and medical record searches have long hinted at the connection between sleep problems and death, especially from heart disease, the latest study is the first to define death from sleep apnea by monitoring a large number of people with or without the sleeping condition, including a high proportion of snorers, to see who dies and who does not. Some 1,047 deaths occurred among study participants since the clinical investigation began. It is estimated that 24 percent of American men and 9percent of women have irregular breathing patterns during sleep, with four in five unaware that they have a problem.

As part of the so-called Sleep Heart Health Study, researchers at Johns Hopkins Bayview Medical Center monitored study participants' sleep patterns at home for at least one full night's sleep, which averaged about seven hours. More than 50 study technicians were needed to handle the nearly 10,000 detailed recordings of participants' breathing patterns, heart rhythms and brain activity made to date. About half of all participants had moderate to severe sleep apnea. They were then tracked through annual clinic visits to gauge any sickness or death from high blood pressure, heart disease or stroke.

Reporting it the Public Library of Science, Medicine online Aug. 18, researchers found that as little as 11 minutes a night - just 2 percent of an average night's sleep of seven hours - spent in severe sleep apnea and subsequent oxygen deprivation, in which blood oxygen levels drop below 90 percent, doubled the death rate in men.

Women in the study who died and had severe sleep apnea were too few for researchers to draw a similar conclusion at this stage in the study, but researchers suspect that further research will bear the same results.

"Our study results really raise concern about the potentially harmful effects of sleep apnea," says pulmonologist and study site principal investigator Naresh Punjabi, M.D., Ph.D., an associate professor at the Johns Hopkins University School of Medicine. He adds that low blood oxygen levels during sleep are "a particularly worrisome sign," citing the factor as the single biggest predictor of death in people with sleeping disorders.

"Such an increased risk of death warrants screening for sleep apnea as part of routine health care, in which all physicians should inquire about patients' sleeping habits, including symptoms of feeling tired or drowsy during the daytime, poor nighttime sleep quality, recurrent awakenings from sleep, and reports from your bed partner that you snore loudly or intermittently stop breathing during the night," says Punjabi.

He says that given how widespread sleep apnea is, acquiring this information is relatively easy and essential for medical scientists to identify which, if any, particular treatments work at curing the illness by ultimately lowering the number of chronic medical conditions and premature deaths caused by it.

Key among such treatments is use of overnight sleeping aids, such as the CPAP (continuous positive airway pressure) device. The device, which resembles a typical oxygen mask, is worn over the nose and connected by a thin tube to a machine that forces air into the nasal passages, preventing the airways from collapsing.

"Our goal is to achieve normal breathing patterns during sleep and maintain blood oxygen levels as close to normal as possible," says Punjabi, who points out that the medical standard is to always maintain blood oxygen levels in the range of 95 percent or above.

Punjabi says the study team's next steps are to separate causes of death due to sleep apnea, in particular, defining the added risk from heart disease or stroke.

Funding support for the study was provided by the National Heart, Lung and Blood Institute, a member of the National Institutes of Health.

Besides Punjabi, other Johns Hopkins researchers involved in the study were Brian Caffo, Ph.D.; Philip Smith, M.D.; Moyses Szkio, M.D., Ph.D.; and Melissa Minotti. Johns Hopkins was also the data coordinating center for the Sleep Heart Health Study, with additional research assistance provided by Marie Diener-West, Ph.D.; John Dodge; Michele Donithan, M.H.S.; Charlene Levine, B.S.; Curtis Meinhart, Ph.D.; Nancy Min, M.H.S., M.P.H., Ph.D.; Michael Smith, B.S.; Andrea Tibbs, B.S.; James Tonascia, Ph.D.; Linda Roberts, M.H.S.; and Jill Meinert.

Other study co-investigators involved in writing the report were James Goodwin and Eyal Shahar at the University of Arizona, Daniel Gottlieb and George O'Connor at Boston University, Anne Newman and David Unruh at the University of Pittsburgh, David Rapaport at New York University, Susan Redline at Case Western Reserve University, Helaine Resnick at the American Association of Homes and Services for the Aging, and David Samet at the University of Southern California. 

 
An article from the Dallas Morning News.

An Amazing New Blood Pressure Treatment:
Formula ZZZZZZ

Dallas Morning News
11/28/2006

The brain controls a lot, but the ever-beating heart needs sleep, too.  During the night, the heart gets a break.  Most people experience a 20 percent to 30 percent reduction in blood pressure, and a 10 percent to 20 percent drop in heart rate when they're asleep, according to 24-hour blood pressure studies of more than 5,000 people by Dr. William White at the University of Connecticut Health Center.

Sleep is so important for the heart that one researcher suggests that a good night's sleep should be tested as a treatment in managing high blood pressure.  In a study published in the Aug. 2 issue of the journal, Sleep, Dr. Daniel J. Gottlieb of the Boston University School of Medicine questioned men and women ages 40 to 100 on their sleep habits.  He found that people sleeping less than six hours had as much as a 66 percent greater prevalence of hypertension.

Those most at risk for heart disease because of sleep problems are people with apnea, a disorder in which airways are obstructed and the person wakes up, sometimes hundreds of times a night, snoring and gasping for air.  Sleep apnea puts people at higher risk of heart attack and stroke, in part because their cardiovascular system doesn't get its nightly dose of an easier workload.
Los Angeles Times


The article below is from Dr. Paul Donohue who writes a medical column for many newspapers.  He does a nice job of explaining sleep apnea, but failed to mention that oral appliance therapy can be a godsend for those people who absolutely can't wear the CPAP with any mask.
 


Hole in Heart Won't Cause Sleep Apnea
By Dr. Paul Donohue

08/29/2006

Dear Dr. Donohue:

I am 64 and in good condition.  Unfortunately, I have a hole in my heart, sleep apnea, chronic obstructive pulmonary disease and an enlarged prostate gland. I've tried using CPAP for sleep apnea, but it doesn't work for me. I had surgery to remove tissue from my soft palate and throat, but it didn't help my sleep apnea.  Is it possible that the hole in my heart is causing the sleep apnea?  I would have surgery to close it if I knew it would help. - J.W.

Dear J.W.,

Neither the hole in your heart nor COPD (chronic obstructive pulmonary disease) nor the enlarged prostate gland causes sleep apnea. The more common kind of sleep apnea is the obstructive variety. Redundant tissue in the throat and the back of the mouth so narrows the air passageway to the lungs that it obstructs air- flow. During the night, those tissues sag even more, and people with the condition stop breathing in episodes lasting from 10 seconds to as long as a few minutes. Then the body rouses itself, the person partially wakens with a grunt and airflow resumes. Snoring is often a sign of sleep apnea.

This disorder has many complications. One is daytime sleepiness because of the many interruptions in sleep. It's also a strain on the heart. It can increase blood pressure in the lungs and in the body.

Don't drink any alcohol or take any sedatives in the evening. They increase the laxity of throat tissues. If you are overweight, you must lose some pounds.

CPAP, continuous positive airway pressure, is a mask attached to a machine that increases air pressure so that it can get past the obstructions in the mouth and throat. It usually works. Is it the mask that makes it impossible for you to use? If so, there are other models.

Write Dr. Donohue at P.O.Box 536475, Orlando, Fla. 328553-6475.

We have more comprehensive information about sleep apnea on our sister website:

http://www.tylersleep.com

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