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Archive for the ‘Surgery’ Category

brain-damage

Studies show that obstructive sleep apnea (OSA) affects much more than just your sleep. It can even damage your brain.

A recent brain imaging study from France involved 16 adults. Each of them had just been diagnosed with sleep apnea.

In numerous brain regions the study found a loss of “gray matter.” This is brain tissue that contains fibers and nerve cell  bodies. There also was a decrease in brain metabolism.

The authors suggest that these changes may explain some of the impairments that often occur in people with sleep apnea. Examples include attention lapses and memory loss. The study was published in March 2009 issue of the Journal of Sleep Research.

The results are similar to those found by a research team from UCLA. Their study was published in Neuroscience Letters in June 2008. They reported that people with sleep apnea have tissue loss in the “mammillary bodies.” These are brain regions that help store memory.

In July 2008 the UCLA team published another brain imaging study in the journal Sleep.It involved 41 people with moderate to severe sleep apnea. It also included 69 control subjects matched by age.

Results show that people with sleep apnea have extensive alterations in “white matter.” This is nerve tissue in the brain. It contains fibers that are insulated with myelin -a white, fatty sheath. The structural changes appear in brain regions that help control mood and memory. These regions also play a role in adjusting your blood pressure. Damage also was found in fiber pathways that connect these brain regions.

What causes the brain damage? The authors suggest that oxygen, blood flow and blood pressure may be involved. Sleep apnea involves breathing pauses that can occur hundreds of times a night of sleep. These pauses can produce drastic changes in oxygen levels.

These breathing pauses also reduce blood flow in the brain. People with sleep apnea also are at risk for high blood pressure. Both of these conditions create a potential for brain tissue damage.

Dr. Ronald Harper of UCLA said that the studies show how important it is for sleep apnea to be treated. CPAP is the most common treatment for sleep apnea. The findings make it all the more imperative that OSA be treated as soon as possible to prevent further injury. The long-term effects of OSA are terribly damaging to memory and thinking processes.

Can treatment reverse the brain damage caused by sleep apnea? The authors are uncertain if the changes are permanent.

But studies show that CPAP does help your heart, it may even save your life.

mind-racing

Insomnia can make you feel like your mind is racing out of control. A revealing new study explains why your brain may be unable to put the brakes on your thoughts. It links the problem to low levels of a brain chemical.

A new study shows that GABA levels are reduced by 30 percent in adults with chronic primary insomnia. The study was published in the Nov. 1 issue of the journal Sleep.

GABA is reduced in the brain of individuals with insomnia, suggesting over activity is present. It was explained that low GABA levels create an imbalance of brain activity. This may lead to an inability to shut down waking signals in the brain.

If your GABA levels are low, then your mind can’t slow down. It may race forward at full speed even when it is time to sleep. An over active mind is a key feature of psychophsicological insomnia. At bedtime you are unable to stop thinking and worrying. Your body may be ready for sleep, but your mind remains alert. This state of “hyperarousal” can make it hard for you to fall asleep.

Most with insomnia have “secondary” insomnia. It occurs along with another medical problem, mental illness or sleep disorder. It also may result from the use of a medication or substance. In contrast primary insomnia is unrelated to another health problem. Estimates that about 25 percent of people with insomnia have primary insomnia. The study only links low GABA levels to long lasting, primary insomnia.

All participants in the study had been suffering from primary insomnia for mor than six months. The average duration of their symptoms was about 10 years. The GABA connection affirms that primary insomnia is a legitimate disorder.

Recognition that insomnia has manifestations in the brain may increase the legitimacy of those who have insomnia and report substantial daytime  consequences. It was also explained that insomnia can affect your energy, concentration and mood. It also increases your risk of depression.

One solution for the problem of primary insomnia is the use of hypnotic medication. The short-term use of a sleeping pill can help break the cycle of sleepless nights. The study notes that many of the most effective sleeping pills increase activity at the GABA neurons.

Another treatment option is cognitive behavioral therapy. CBT helps you learn how to correct attitudes and habits that hinder your sleep. Many of these bad habits develop as people try to cope with chronic insomnia.

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Sleep disorders can be hard to identify, especially if their symptoms occure while you’re asleep. Amy Petrik, 40, spent three months and visited four doctors searching for the cause of her persistent laryngitis. Once she was diagnosed and treated for sleep apnea, she got back her voice -and reclaimed her health.

 It was about four years ago that I first began to wonder what exactly was wrong with me. I hadn’t felt well in quite some time, and my normally upbeat personality was dragging to the point where other people had started to notice.

I had memory problems, severe mood swings, and anxiety issues. I woke up every morning with headaches and a dry, swollen throat, and was getting up to use the bathroom several times a night.

I felt unhealthy and unhappy, but I work two jobs, so I just assumed I was overly tired. My days were filled with four-hour naps, and still occasionally nodded off. I mentioned my complaints to a few different doctors, but no one seemed to take them too seriously; even my elevated blood pressure and cholesterol level didn’t set off any alarms. And so I attributed it all to a mix of mild depression and extreme fatigue. (Only later did a sleep specailist tell me that depression, weight gain, and fatigue are all symptoms of obstructive sleep apnea.)

A wake-up call to get help
In early February, I lost my voice for three full weeks. I mean literally: Not like laryngitis or just a sore throat, but I actually couldn’t make any sound but squeaks. I was terrified. My family physician was on vacation, so I saw another doctor in his practice. She whipped me into her office and within minutes took my vitals and diagnosed my with strep throat. I tried whispering to her what was going on, but she didn’t pay too much attention to my concerns. Without even giving me any test, she prescribed some medication and told me to come back in a week if I didn’ t improve.

I was back in seven days. The doctor claimed she didn’t have time to see me (my regular physician was still out), but I complanied enough by writing notes back and forth to the nurse on duty and was finally allowed  back into an exam room. I again explained, through writing, that my throat had not improved and that I needed help. Her only solutions? Hot tea with honey and vitamin C.

At this point I turned to an ear, nose, and throat specialist at the advice of some friends. He immediately saw the warning signs that everyone else had missed and scheduled me for a sleep study.

A sleep test and a scary diagnosis
I went to the sleep lab in early April. Afterward my ENT told me that I had the most danerous case of sleep apnea he had ever seen: He told me that I stopped breathing 120 times per hour, I wasn’t getting enough oxygen to my lungs, and my cardiovascular system was steadily wearing dow. It was mind-blowing. I can only remember sitting in his office crying uncontrollably, my mom doing all the talking.

It sounds overdramatic, but I knew I was going down the same path my father had taken: He was overweight the majority of his life, had high blood pressure, and all kinds of medical problems, including untreated sleep apnea. He passed away at 67, and I was afraid I’d end up just like him, gone too soon, if I didn’t get assistance right away.

Slow but steady treatment
The doctor told me that I had to lose a significant amount of weight to cure my sleep apnea, either that, or get a tracheotomy. Of course I didn’t want a hole in my throat, but I was looking for any help I could get: Losing weight seemed impossible, since I was exhausted all the time. One other option, although my doctor warned me that results may be minimal, was to remove my tonsils and adenoids. I had the surgery later that month, followed by another sleep study. I was disappointed: The setting for my CPAP machine went from 13 (the hightest possible pressure) just down to 11.

As a naturally clasustrophobic person, learning to use the CPAP machine has been difficult. The first night I took it home, I made my mom stay overnight because I was so terrified to sleep with it. I had to try three different types before I found one -a small nasal mask -that I can actually tolerate. Even then it took me sometime to get comfortable with.

Now, I swear by my CPAP machine. I actually tell people that it’s time for me to go home to bed so that I can breathe in fresh air all night long! It has become a regular part of my bedtime ritual, and I don’t go anywhere without it. Until I am given the green light that I no longer need to wear this lifesaving device, it will always be with me.

Still room for improvement
My sleep patterns have improved, and I no longer have to take naps to play catch up in the afternoons. I don’t have sore throats in the morning. My blood pressure is back in the healthy range, and I’ve joined Weight Watchers and am finally starting to shed some pounds. I’m feeling a lot better, health-wise.

Getting the word out
I’ve become a spokesperson for my family and friends, letting others know about what can happen if you do not get treated. I’m sure some of my loved one also have sleep apnea, and some them tell me they’re just scared to hear the results. That’s pretty frustrating to hear, considering how much I suffered before I was diagnosed and how much better I feel now.

I try to tell people, please stop what you are doing and make an appointment today! If you are afraid of doctors, don’t be. If your afrais to go to the sleep lab, take along a friend, your mom, your wife or husband, or just take along something comforting to have by your side. This is your life we are talking about, and I promise you, you will not regret it.

-Amy Petrik
Recovering Sleep Apnea Patient.

 

DOT (Department of Transportation) proposal requires testing

The U.S. Department of Transportation has proposed new regulations that would require truck drivers at risk for sleep apnea to get tested and treated in order to obtain their licenses.

The move is aimed at reducing the number of truck crashes caused by driver fatigue, said Rex Patty, a nurse practitioner at WorkCare, a regional healthcare in Topka, Kan.  The Federal Motor Carrier Safety Administration estimates that approximately 141,000 large truck crashes that occurred during a 33-month study perios  18,000 or 13% were related to drivre fatigue.

Not all driver fatigue is the result of sleep apnea, but about 28% of truckers amy be at risk, compared to around 10% in the general population, said Patty.

Drivers with certain risk factors for OSA would be evaluated by a DOT provider and, if necessary, referred to their private physician for a sleep study.

It is estimated that 45% to 50% of (at risk) drivers will need additional evalation, and 70% of that outcome would need treatment known as the CPAP therapy; or Continouse Positive Airway Pressure.

Drivers diagnosed with OSA would need at least one week of treatment before they could get back behind the wheel. They would need to meet a minimym compliance of four hours or more each night 70% of the time, with periodic re-evaluations to maintain their license.

Trucking companies and independent drivers aren’t embracing the proposed rules. The most talked about is cost. On average, and depending on the severity of a persons OSA, CPAP machines and specific testings could cost up to $1,000.

  Cost concerns go well beyond intitial diagnosis and treatment.

DOT made is very clear that ‘If they are not compliant, they are disqualified to drive.’  Trucking companies can have a driver they depend on that can’t drive, and at this point, nobody knows how they get re-qualified. They are still under determination for what that may mean.

  It could be six months to a year before the proposal is finalized.

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  The intention of surgery is to open the airway sufficiently to eliminate or to reduce obstructions to a clinically insignificant level. In order to do so, surgical therapy in adults often must reconstruct the soft tissues (such as the uvula and the palate) or the bony tissues (the jaw) of the throat.

If you have been diagnosed with OSA and are considering surgery, talk to a sleep specialist and/or experienced surgeon about the different procedures, and the chances they will be effective to you, with your anatomy and why, and most of all the risks involved with surgery. Untreated sleep apnea can be harmful to your health, and surgery cannot always address all the points of obstruction. Eliminating the snoring does not necessarily eliminate the apneas. Sometimes surgery does not cure sleep apnea but reduces the number of apneas so that more treatment options are available to you and/or more comfortable. Yet in some circumstances, surgery may actually worsen the apnea.Insurance typically covers surgery for sleep apnea but not all surgical procedures. However, insurance companies that initially refuse to pay for a surgery may be convinced otherwise upon an appeal that demonstrates the efficacy and appropriateness of the surgery in your case. Throat pain from the major surgeries varies but is generally significant, often for one to two weeks. Most surgical procedures for sleep apnea are conducted in a hospital under general anesthetic. (People with sleep apnea must be cautious about general anesthesia–no matter for what medical condition the surgery is–because of the effects anesthesia has on the airway.)The most common surgery for sleep apnea is the uvulopalatopharyngoplasty, or UPPP procedure, which is intended to enlarge the airway by removing or shortening the uvula and removing the tonsils and adenoids, if present, as well as part of the soft palate or roof of the mouth. (The uvula is the tissue that hangs from the middle of the back of the roof of the mouth; the word comes from the Latin “uva” meaning “grapes.”) According to the “Practice Parameters for the Treatment of Obstructive Sleep Apnea: Surgical Modifications of the Upper Airway,” issued in 1996 by the American Academy of Sleep Medicine, the overall efficacy is 40.7%. A more recent surgery using a laser (laser-assisted uvulopalatoplasty or LAUP, a modification of the UPPP where the surgeon cuts the uvula with a laser) is performed for snoring. There is not yet enough information to say whether LAUP is effective for OSA. 

There are other surgical procedures where a part of the tongue is removed, and two which try to enlarge the airway by moving the jaw forward. These surgeries do have very high success rates but are long and involved (lasting several hours) with a significant recovery period and potential complications that patients may reject. As a rule, success rates for these complicated surgeries are higher when preformed by an experienced surgeon. You may have to undergo more than one procedure to eliminate the apneas sufficiently. In review, when weighing surgery, consider whether the safety and efficacy of the procedure have met the medical journals and cases studied are similar to yours. Surgery helps many, but effectiveness varies from person to person. It is also highly recommended that with surgery you have follow up sleep studies often, to evaluate your current conditions. If unsure about proceeding, you should seek a second opinion. Only a doctor who has examined you and your airways/complications can advise you on finding the correct surgery best for your needs.

 **Physicians who perform surgery for sleep apneas are most commonly otolaryngologists (specializing in the ears, nose, and throat) and oral and maxillofacial surgeons. If you are seeking a referral to a surgeon or a second opinion, you may find one through your physician or through a sleep center, and keep in mind that your insurance policy may require you to get a referral for a specialist and/or to see a specific provider.**

 

 

 

 

stroke.jpg  

  Moderate to severe cases of OSA (obstructive sleep apnea) significantly increases the risk of suffering a stroke. The study of 1,475 people found that those with moderate to sever sleep apnea at beginning of the study were 3 to 4 times more likely to have a stroke than a comparable group of patients without sleep apnea during the next four years. The study did not find any significant increase in the odds of having a stroke for people with mild sleep apnea compared with people without sleep apnea. The stroke risk we found for people with moderate to severe sleep apnea is quite significant- double the risk of other well -known risk factors for stroke, such as hypertension or diabetes. It was even found that the risk of stroke was significant even after other risk factors for stroke, such as high blood pressure and obesity, were taken into account.

   The patients in the study were defined as having moderate to sever obstruction sleep apnea in their breathing stopped or slowed at least 20 times per hour of sleep. People whose breathing stopped or slowed between 5 and 20 times per hour of sleep were considered to have mild sleep apnea. One reason obstructive sleep apnea may increase stroke risk is that it has been shown to cause high blood pressure, with this, it is the most common risk factor for stroke. Another possible reason is that when a person stops breathing, the lack of oxygen kick in the body’s “fight or flight” response. Part of that reaction is to make the blood more clottable, and blood clots in the brain can cause a stroke.    

    This study provides yet another reason why it’s so important to treat sleep apnea with all caution as possible. It also raises the question of weather people with sleep apnea should be put on aspirin therapy or given other anti-clotting drugs/medications, which is what is done for other people with stroke risk, but this is an issue that needs further research.

Sleep apnea increases risk of heart attack and/or death up by 30%.

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