Friday, August 3, 2018

Obstructive Sleep Apnea

The Greek word "apnea" means "without breath".  In sleep apnea, there is an involuntary cessation of breathing that occurs while sleeping.  These pauses in breathing can last anywhere from 10 seconds to as much as a minute.  Snoring is also a common feature of sleep apnea.  While snoring can just be a nuisance, snoring associated with sleep apnea can signal a serious medical condition. If left untreated, sleep apnea can lead to the development of high blood pressure, heart failure, memory problems, and can increase the chance of having driving accidents due to excessive fatigue.

How does OSA develop?  The most common type of sleep apnea is called Obstructive Sleep Apnea (OSA).  This occurs when soft tissue in the back of the throat collapses during sleep, blocking off the airway. OSA is usually seen in overweight individuals.  Other risk factors for the development of OSA include: a large neck, a recessed chin, smoking, and alcohol use.  A typical patient with OSA will snore loudly after falling asleep. The snoring is then interrupted by silent periods during which no breathing takes place (apnea).  These apneic episodes are then followed by sudden efforts to breathe. The result is disturbed sleep, leading to excessive daytime drowsiness.

How is OSA diagnosed?    Most people with OSA will be unaware of their snoring or episodes of apnea. The predominant symptom will be excessive daytime drowsiness.  The snoring and apnea episodes are usually reported by a family member. The American Sleep Apnea Association has published a questionnaire known as the Snore Score.  A positive response to any one of the following questions points to the possibility of someone having obstructive sleep apnea:
  1. Are you a loud and/or regular snorer?
  2. Have you ever been observed to gasp or stop breathing during sleep?
  3. Do you feel tired or groggy upon awakening, or do you awaken with a headache?
  4. Are you often tired or fatigued during the waking hours?
  5. Do you fall asleep sitting, reading, watching TV or driving?
  6. Do you often have problems with memory or concentration? 
Other symptoms that can be associated with OSA include morning headaches, weight gain, attention deficits and memory loss. The diagnosis is usually confirmed after monitoring for apneic episodes in a sleep laboratory.

How is OSA treated?     Fortunately, there are a number of treatments available for OSA, depending on the severity and underlying causes.  These treatment options include:
  • Avoidance of alcohol and medications that relax the airway and/or reduce respiratory drive.
  • Weight loss is highly effective in obese individuals by reducing excess fat around the neck which is constricting the airway.
  • Positional therapy, i.e., avoiding sleeping on the back (for adults)
  • Oral appliances designed to keep the airway open.
  • Surgery (the most common procedure is called uvulopalatopharyngoplasty which removes excess tissue that is blocking the airway). 
  • Continuous positive airway pressure (CPAP)
The American Academy of Sleep Medicine recommends the use of an oral appliance as a first line treatment for patients with mild to moderate OSA.  In many patients, however, CPAP is the most effective treatment method.  It works by blowing pressurized air into the person's airway at a high enough pressure to keep the airway from collapsing.  A relatively new surgical procedure known as the Pillar Procedure has been found to be helpful in mild-to-moderate OSA. This procedure involves the placement of flexible implants into the soft palate to keep it from relaxing and blocking the airway.  For more on Obstructive Sleep Apnea, visit the American Sleep Apnea Association.

Sources for article: 

What Is Sleep Apnea? from the National Heart, Lung, and Blood Institute
Test Yourself from the American Sleep Apnea Association
Pillar Procedure from the Mayo Foundation for Medical Education and Research

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Monday, July 30, 2018

Getting a Good Night's Sleep

We spend approximately one-third of our lives asleep, but sometimes sleep can be elusive.
Almost everyone has experienced transient insomnia--the occasional inability to fall asleep, or waking up feeling unrefreshed. Thankfully, it's usually short-lived, lasting only a few days.

Chronic insomnia, however, lasts much longer. A common condition, it may be brought on by medical or psychiatric causes, such as colds, pain, or depression. But 10 percent of all insomnia occurs in the absence of any medical or psychiatric disorder and is called primary insomnia.

Primary insomnia seems to have a life of its own and often begins after someone has experienced a significant stressful event that may disrupt his or her sleeping pattern. To make up for lost sleep during this stressful period, the individual may develop poor sleep habits that perpetuate the insomnia long after the problem has passed.

Sticking to the following good sleep habits help most people sleep well:
  • Keep a regular schedule. Regular times for getting up, eating meals, taking medicines, doing chores, or other activities help to keep your inner clock running smoothly.
  • Establish a relaxing pre-sleep ritual. Activities such as taking a warm bath, reading for ten minutes, or having a light snack let your body know that bedtime is near.
  • Go to bed only when sleepy and get out of bed if you're not sleeping. By spending long periods awake in bed, your body learns that it's OK to be awake in bed.
  • Exercise regularly. It's best to exercise in the late afternoon about six hours before bedtime.
  • Avoid caffeine, alcohol, and smoking around bedtime. In fact, don't drink caffeinated beverages within six hours of bedtime.
  • In general, don't nap. If you must, it's best to take naps during the mid-afternoon.
If establishing these habits is either difficult for you or doesn't seem to be working, let your doctor know. Further assessment and treatment may be required.

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Monday, July 23, 2018

What does it mean when your stomach 'growls'?

Stomach "growling" is typically associated with hunger or an absence of food in the stomach.  The medical term for intestinal rumbling is borborygmus (bor-boh-RIG-mus).  If you say this out loud, you may find that pronouncing the word mimics the sound produced when your stomach growls.  In fact, the word borborygmus is an example of onomatopoeia, a word that imitates a sound. It comes from a Greek word that translates as "rumbling".
Sounds heard in the abdomen involve activity of the smooth muscle that lines the stomach and small intestine.  This muscle produces peristalsis, a progressive wave of contraction and relaxation that forces food, gas, and liquids through the stomach and intestines.  Peristalsis, like the beating of the heart, is under the control of the autonomic nervous system, occurring on a regular basis without requiring conscious effort.

After eating, peristalsis increases to move food through the digestive tract.  If one hasn't eaten in a while, peristalsis also increases and produces the rumbling noise associated with hunger.  This rumbling is more commonly associated with hunger than satiety because it is louder when the stomach and intestines have no food in them to muffle the sound.  So while stomach growling is most commonly associated with hunger, it can also occur after eating when the stomach is full.  And the sound does not just come from the stomach, but can be generated by the small intestines also.

In some cases, as with viral gastroenteritis ("stomach flu"), the sounds can be accentuated due to an increase in peristalsis. Increased amounts of gas in the intestinal tract may also bring about excessive abdominal rumbling.  One cause for this is lactose intolerance, a condition that occurs when the body does not make enough of an enzyme called lactase. With insufficient lactase in the intestine, lactose sugar, commonly found in dairy products, is instead broken down by gas-producing bacteria in the bowel.

Bowel sounds can be reduced when intestinal peristalsis is slowed down. This could be due to taking an opiate medication, receiving general anesthesia or undergoing bowel surgery.  A more serious situation may exist when bowel sounds stop altogether. This could indicate a problem such as bowel obstruction or an abdominal infection.

In general, the sounds produced in the abdomen, including growling, are not a sign of disease.  Stomach growling may be socially embarrassing, but in most cases is just a sign that the gastrointestinal tract is doing its job.

Sources for article: 
Abdominal sounds from Medline Plus
Why does your stomach growl when you are hungry? from Scientific America
Why does my stomach growl and make noises? from Tufts Now

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