Stop Sleep Apnea Naturally
Descriptions of sleep apnea associated with obesity also date from Roman times. Dionysius, the tyrant of Heracleia of Pontius, who reigned ca 360 BC, is one of the first historical figures afflicted with obesity and somnolence. This enormously fat man frequently fell asleep. His servants used long needles inserted through his skin and fat to awaken him when he fell asleep. Kryger cites a second case of Magas, King of Cyrene, who died in 258 BC. He was a man ''weighted down
The frequency of congenital myasthenic syndromes varies from 8 to 21 in reported series of childhood myasthenia gravis, reportedly higher where consanguineous marriages are frequent.18,340 In the fetal period, decreased fetal movements have been reported, resulting in arthrogryposis multiplex congenital, congenital flexures, and contractures of multiple joints.498 Affected patients are born to mothers without myasthenia and may demonstrate ptosis and ophthalmoparesis during infancy. Severe generalized weakness may also present in the postnatal period with frequent apneic episodes, recurrent aspiration, failure to thrive, and poor sucking. Other patients may present during the first or second year of life with ocular signs and only mild systemic signs. Although ptosis was reported to be present in all of seven patients in one series,340 it was generally mild and not incapacitating.
The clinician or therapist who sees an overweight patient needs to obtain certain basic information which is relevant to assessing its risk (Table 9) (100-108). This includes an understanding of the events that led to the development of obesity, what patients have done to deal with the problem, and how successful and unsuccessful they were in these efforts. Several of these items are listed in Table 10. The family constellation is important for identifying attitudes about obesity and the possibility of finding rare genetic causes. Information about the amount of weight gain ( 20 lb or 10 kg) since age 18-20 and the rate of weight gain is important because this is related to the risk of developing complications from obesity (109). The type and regularity of physical activity are also important since physical inactivity increases cardiovascular risk, particularly in overweight individuals (110). Information about comorbid conditions such as diabetes, hypertension, heart disease, sleep...
The treatment of choice for RBD is clonazepam, a benzodiazepine, although the mechanism is unknown and there are no controlled trials (13). Other drugs thought to be helpful for RBD include pramipexole, levodopa, carbamazepine, donepezil, and melatonin (64,89-91). Caution needs to be exercised with the use of clonazepam, as in some cases, RBD may be confused with sleep apnea, which can be worsened by clonazepam. Nighttime dosing with drugs such as selegiline may aggravate RBD. Others have reported a paradoxical worsening of RBD with deep brain stimulation (DBS) of the subthalamic nucleus (STN) (92).
Injectable amphetamines are class A, and oral amphetamines class B drugs. They used to be widely prescribed for depression (in the 1950s and 1960s) and for obesity (until quite recently). They are stimulants, and are thus related to cocaine (see below). They are now only licensed for treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents as part of a comprehensive treatment programme, and for narcolepsy or obstructive sleep apnoea syndrome. Inappropriate private prescription by 'slimming clinics' still occurs occasionally, and patients sometimes get supplies over the Internet. Easy chemical synthesis also makes for continued widespread availability.
Treatment of laryngospasm initial treatment includes 100 oxygen, anterior mandibular displacement, and gentle CPAP (may be applied by face mask). If laryngospasm persists and hypoxia develops, succinylcholine (0.25-1.0 mg kg 10-20 mg) should be given in order to paralyze the laryngeal muscles and allow controlled ventilation.
A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goals and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.
In untreated acromegalic patients without sleep apnea, standard polysomnography revealed a reduction in REM sleep as well as a reduction in amount of SW sleep as compared to control subjects (92). However, a more complex picture emerged when power spectral analysis of the EEG was performed (92). Indeed, though the minutes of REM and SW were decreased, the spectral energy per min spent in both REM and SW was increased, indicating that the amplitude of the EEG waves during both SW and REM sleep is higher in acromegalics than in control subjects (92). The amplitude of the EEG is the sum of the post-synaptic potentials of the cerebral cortex, and thus a higher energy presumably reflects an increased neuronal activity in the cerebral cortex. One year after adenomectomy, an important increase in REM time was observed, resulting in normal values for this age group (92). A moderate increase in SW sleep was also observed. Treatment normalized the EEG energy per minute in both SW and REM stages...
A few studies have examined nocturnal GH secretion in patients with obstructive apnea before and after treatment (82-84). As expected, nocturnal GH release is decreased in untreated apneic subjects. Because adult patients with this pathology are frequently obese, the low overnight GH levels could reflect the hyposomatotropism of obesity, rather than result from the shallow and fragmented nature of their sleep. However, two studies that have examined the nocturnal GH profile before and after treatment with continuous positive airway pressure (CPAP) have demonstrated that treatment of the sleep disorder resulted in a clear increase in the amount of GH secreted during the first few hours of sleep (83,84). An example is illustrated in Fig. 7. In children, surgical correction of obstructive sleep apnea may restore GH secretion and normal growth rate (82). In obese subjects who do not have sleep apnea, a normal relationship between the first SW episode and GH release may be observed both...
Arrhythmias, congestive heart failure, and obstructive sleep apnea. Blood glucose control in patients with diabetes and lowering of fibrinogen and lipids should be beneficial. Food supplementation with folic acid has been recently implemented in an effort to reduce effects of hyperhomocysteine-mia on vascular disease. Other preventable factors should be determined in an effort to decrease the risk of dementia and disabling stroke with appropriate preventive treatment (Rom n, 2002b).
Are suffering from the complications of obesity. Surgical interventions commonly used include gastroplasty, gastric partitioning, and gastric bypass. Treatment of clinically severe obesity involves an effort to create a caloric deficit sufficient to result in weight loss and reduction of weight-associated risk factors or comorbidities. Surgical approaches can result in substantial weight loss, i.e., from 50 kg (110 lb) to as much as 100 kg (220 lb) over a period of 6 months to 1 year. Compared to other interventions available, surgery has produced the longest period of sustained weight loss. Assessing both perioperative risk and long-term complications is important and requires assessing the risk benefit ratio in each case. Patients whose BMI is 40 kg m2 are potential candidates for surgery because obesity severely impairs the quality of their lives. Less severely obese patients (BMIs between 35 and 39.9 kg m2) may also be considered for surgery if they have comorbid conditions (e.g.,...
Sleep architecture can be studied using PSG, and MSLT provides measures of alertness. These studies are not routinely required for the assessment of sleep in PD. However, in cases where obstructive sleep apnea or severe PLM is suspected, PSG is essential. In cases of severe RBD or other parasomnias, PSG is useful for confirmation of diagnosis. A pathological MSLT result (sleep latency
Although clinical history may suggest a diagnosis, in some situations such as when there is a high risk of physical injury or loud snoring suggestive of obstructive sleep apnea, confirmation of diagnosis should be obtained by a single night of polysomnography (PSG) with video telemetry. PSG would show an increased electromyographic (EMG) activity during REM sleep. Symptoms of RBD may predate the diagnosis of PD. Schenck et al. (37) reported that in 1l of 29 men (38 ), 50 years or older in whom idiopathic RBD was diagnosed, a parkinsonian disorder was identified after a mean interval of 3.7 years following the diagnosis of RBD and 12.7 years after the onset of RBD. One study (41) suggested an increased risk of developing PD in individuals who have RBD and olfactory disturbance. This concept is consistent with the recent hypothesis of Braak et al. (21) who suggest that the preclinical stages 1 and 2 of PD start at the olfactory and medullary area of the brainstem. Although the...
Figure 1 Recommendations for weight goals. Patients with acute complications, such as pseudotumor cerebri, sleep apnea, obesity hypoventilation syndrome, or orthopedic problems, should be referred to a pediatric obesity center. *Children younger than 2 years should be referred to a pediatric obesity center for treatment. Complications such as mild hypertension, dyslipidemias, and insulin resistance. (From Ref. 37.) Figure 1 Recommendations for weight goals. Patients with acute complications, such as pseudotumor cerebri, sleep apnea, obesity hypoventilation syndrome, or orthopedic problems, should be referred to a pediatric obesity center. *Children younger than 2 years should be referred to a pediatric obesity center for treatment. Complications such as mild hypertension, dyslipidemias, and insulin resistance. (From Ref. 37.)
Treatment includes nebulized racemic epinephrine and systemic corticosteroids. If edema is minimal and early intubation is not required, conservative care to maintain airflow consists of positive pressure breathing (BIPAP or CPAP) or a mixture of helium oxygen gas that due to its lower density can improve upper-airway flow dynamics by reducing turbulence. However, in the presence of edema not immediately requiring intubation, conservative care should only be done if frequent monitoring to assess edema progression and emergent intubation is possible.
Apnea is a frequently cited extraesophageal manifestation of reflux in infants, but the causal relationship is controversial, despite being examined by multiple investigators. Most episodes of apnea of prematurity occur in the post-prandial period, and likely follow bouts of regurgitation, and yet studies using impedance and monitoring cardiorespiratory events have been contradictory 52 , 53 . In 21 infants with a history of intermittent reflux and apnea, 81 of apneic events did not follow episodes of reflux 52 . However, using pH and impedance testing in 22 infants with a history of irregular breathing and reflux, 29.7 (49 of 165) apneic episodes were associated with reflux, though only 22.4 of these were related to acid reflux 53 , (Fig. 1) 54 . Apnea related to reflux has been explained on the basis of a
The overexpression of EPO occurs in a number of adaptive and pathologic conditions. In response to acute hypoxic stress, such as severe blood loss or severe anemia, EPO production can increase 100- to 1000-fold, although the maximal bone marrow response to such stimulation is only a 4- to 6-fold increase in RBC production (46). Overproduction of EPO with accompanying erythrocytosis may be an adaptive response to conditions that produce chronic tissue hypoxia, such as living at high altitude, chronic respiratory diseases, cyanotic heart disease, sleep apnea, smoking, localized renal hypoxia, or hemoglobinopathies with increased oxygen affinity (21). Paraneoplastic production of EPO from tumors and cysts, including renal carcinomas, benign renal tumors, Wilms' tumors, hepatomas, liver carcinomas, cerebellar hemangioblastomas, adrenal gland tumors, and leiomyomas, can also result in high plasma concentrations of the hormone.
Risk assessment may involve identification of existing patient physiological risk factors, such as sleep apnea, obesity, and cardiopulmonary compromise such as emphysema or chronic obstructive pulmonary disease. Patients with these risk factors are at much higher risk for developing opioid-induced respiratory depression (128-135). If opioid analgesics will be used, then these patients will require much closer monitoring than comparable patients without these preexisting risks. For all high-risk patients, the best approach is to start low and go slow. However, if aggressive pain management is necessary, such as immediately postop-eratively, then these patients should be placed under constant monitoring for apnea and oxygen saturation, and resuscitation equipment should be readily available.
From an economic standpoint childhood obesity is related to the large increase in the percentage of hospital discharges with obesity related diseases. These include hypertension, diabetes gallbladder disease, sleep apnea, and asthma. Obesity associated hospital costs increased by threefold from 35 million in the late 1970s and early 1980s to 127 million in the late 1990s (Wang and Dietz, 2002).
No study summarises the clinical significance of claustrophobia but instances of life-threatening incapacity are described fear and intolerance of radiological examination in an MRI scanner (McIsaac et al., 1998), of an airway mask for sleep apnoea (Edinger & Rodney, 1993), of gas masks in military personnel (Ritchie, 2002) and hyperbaric delivery of oxygen (Hillard, 1990).
Patients who have a condition known as sleep apnea should not use quazepam. This condition involves episodes of breathing difficulty and oxygen deficiency that occur throughout the night. Patients who are pregnant or who had an allergic reaction to quazepam should not take quazepam
GERD can be found in relation to obstructive sleep apnea (OSA) syndrome in the elderly. Many older patients with OSA complain of sleep-related heartburn and regurgitation of gastric contents into the pharynx. Teramoto and Ouchi noted that nighttime treatment with CPAP can correct the sleep apnea related reflux in patients with OSA 24 .
Treatment should be initiated immediately if there is clinical suspicion. In cases of mild PCP (BGA PO2 70-80 mm Hg), ambulatory treatment can be attempted oral medication can even be administered in very mild forms. This may well be possible in cooperation with a competent HIV nursing service. If such monitoring is not possible, if respiratory deterioration occurs, and in every case with resting dyspnea, immediate hospitalization is advised. If ventilation becomes necessary, patients have a poor prognosis, even today. Non-invasive methods (like CPAP) may be beneficial if used from an early stage. This helps particularly in prevention of pneumothoraces (Confalonieri 2002).
Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?