Posted on: Saturday, July 2, 2005
PRESCRIPTIONS
Sleep apnea hard to diagnose, sometimes fatal
By Landis Lum
Q. My husband snores so badly. Is there anything to worry about?
A. Does he has even one of these: daytime sleepiness, awakening with snorting/gasping, stopping of breathing, overnight awakenings, or awakening to urinate?
If so, his snoring may actually lead to strokes, heart failure, high blood pressure and car accidents.
Your husband may have sleep apnea, where people stop breathing repeatedly throughout the night (for 10 seconds to three minutes), causing repeated near-awakenings and low oxygen levels. Have his doctor order a sleep study. Women may not snore, and may have daytime fatigue rather than outright sleepiness.
If he does have sleep apnea, his best bet is to sleep with a small nose or face mask connected to a device which allows one to breath against some air pressure (called continuous positive airway pressure, or CPAP) to improve sleep and reduce day drowsiness and car crashes. (Those nose-clip devices you see advertised don't really work.)
If he feels claustrophobic, keep practicing to get used to it. Or use it for one hour at a time and gradually increase the time. Some machines have a "ramp" feature that improves comfort by slowly raising the pressure during the first 30 minutes of sleep.
If the feel of air pressure when breathing out is bothersome, try a bilevel machine that reduces pressure when exhaling. With nasal pillows, air is blown directly into the nostrils. If there's excessive irritation from the CPAP mask, try using the mask one night and nasal pillows the next.
The cold, dry air of the CPAP mask may increase nasal congestion, and a room-temperature humidifier attached to the CPAP machine often helps with nasal drying or congestion. Heated humidification is more expensive but may do the trick. Nasal irritation and congestion may respond to inhaled steroids, ipratropium, or antihistamines.
If CPAP fails, try an oral device that pulls the lower jaw forward (mandibular advancement).
Such mandibular positioning devices need to fitted by a dentist working with a sleep physician, as the jaw needs to be moved forward gradually over weeks to months to avoid pain in the jaw joint.
When done in all comers, surgery works less than 50 percent of the time and can cause pain, bleeding, excessive narrowing of the upper throat, voice changes and occasionally death. Losing weight, treating nasal stuffiness, and avoiding alcohol, sleeping pills and tranquilizers within four hours of bedtime can help reduce sleep apnea.
We doctors aren't very good at diagnosing sleep apnea, so bring symptoms to our attention — or go ahead and tattle on your bed partner!
It may save a life or two.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
