Thursday, 13 March 2014

To sleep: perchance to cease from snoring.


I've been sleeping a lot this past year. I often have had 8 1/2 hours of uninterrupted sleep at night. But I have awakened feeling very tired, and have frequently taken two long naps during the day, falling to sleep within a minute or so of relaxing on a reclining chair.

My good primary care physician has tested me for any  blood conditions which may induce lethargy (e.g. diabetes), but all blood tests in every area come up good.

With all that in mind I took myself today to a medical Doctor who is Board Certified  by the American Board of Sleep Medicine.

For the first forty five minutes I had a consultation with a young medical student. He asked me a thousand and one questions, and also did a brief physical examination. This student was entirely thorough.

After his time with me he reported at length  to the M.D.,  who then talked with me, did some more physical exams, and declared that it's almost certain that I am experiencing sleep apnea. (This did not surprise me -  I have long thought that this might be the case).

It seems that the entrance to my wind pipe (I don't know the medical name) is about half the size it should be, ( and that there are medical issues with my tongue which I did not understand, but in my mind are associated with non-stop talking!)

Back to the windpipe entrance.  When I sleep the muscles relax causing this "entrance" to close. That means that I cannot breath (sometimes for as much as 45 seconds) until my brain reminds the muscles to do their job.

The chances are that I am sleeping a lot, but I am not sleeping well. That's why I always tired.

 So next Monday I will spend the night at the Sarasota Sleep Disorders Center, and be hooked up to monitors on many parts of my body (all of them mentionable). 

These monitors will enable all night reporting of just how I sleep - ain't modern medicine wonderful.

 The M.D. will see and analyze the date  before 6:00 a.m.  (He like me is an early riser). Depending on what he sees there might or might not be a second overnight stay with yet more tests.

The M.D. has a good bedside manner which leads me to trust his judgment. (I was also very pleased to see that he is using his skills to help train a medical student  -  that's so good).

He (the M.D.)  is almost certain that I have obstructive apnea (see below 1), and that I will benefit greatly by the use of a CPAP machine  (see below 2)

If all this pans out a great side effect will be that I will stop snoring.  My dog will be grateful.

I will report again next week.

I must add that I am very lucky to live in a part of the world where there are many, many doctors will all manner of specialties, and that I have superb health insurance. 

In this respect I am one of the world's one-percenters.

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From Wikepedia

(1) Sleep apnea (or sleep apnoea in British English; /æpˈnə/) is a type of sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last from at least ten seconds to several minutes, and may occur 5 to 30 times or more an hour.[1] Similarly, each abnormally shallow breathing event is called a hypopnea. Sleep apnea is often 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.[2] 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.

(2) For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device[32][33] which 'splints' the patient's airway open during sleep by means of a flow of pressurized air into the throat. The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.[34] The CPAP machine generates the required air pressure to keep the patient's airways open during sleep. While pure CPAP machines require one to input a desired pressure (usually determined in an overnight sleep study), an APAP machine will automatically titrate the air pressure as needed to minimize apneas and hypopneas. Advanced models may warm or humidify the air and monitor the patient's breathing to ensure 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, especially in the long term.[35] One way to ensure CPAP therapy remains comfortable and effective for patients is to carefully consider the right CPAP face mask to be used. CPAP masks come in different shapes, sizes and materials to ensure effective treatment for obstructive sleep apnea. It is important to select the right mask to fit each patient.
It is not clear that CPAP reduces hypertension or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to noncompliance with therapy.[36]

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