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SLEEP APNEA

Apnea means cessation of breathing. People with sleep apnea stop breathing during sleep for more than 10 seconds at a time. These short events can happen many times per hour, sometimes disrupting sleep noticeably. Othertimes simply by keeping one out of good, quality sleep. If you are waking up all night long or feeling unrefreshed during the day, you may have sleep apnea.

Sleep apnea is quite common. 12 million Americans are thought to have sleep apnea. There are two kinds of sleep apnea. Obstructive and central sleep apnea.

Most people have obstructive sleep apnea. If you have this type, something is blocking the air passage when you sleep. Often snoring, as well as apnea, is observed. Your windpipe can be blocked by your tongue, uvula, soft palate, or all of these combined. This type of sleep apnea is often genetic, and or associated with excessive body weight, medicines or medical conditions. However, sleep apnea can develop in anyone.

Central sleep apnea is rare. This type happens because of abnormalities in the central nervous system. Either the brain doesn't send the correct signal, or the signal gets interrupted.

Sleep apnea can be dangerous if it goes untreated. It is associated with serious medical problems. Sleep apnea causes the amount of oxygen in your blood to drop during episodes of obstructed breathing.

You are more likely to have heart conditions (such as rhythm problems, heart attack and heart failure), as well as stroke if the sleep apnea is ignored. Also daytime sleepiness may lead to poor performance at work, troubles driving your car or emotional alterations.

What can you do to help your sleep apnea?

1) Stop using alcohol and sleep medicines. These relax the muscles in the back of your throat making it harder to breathe at night.

2) If you are overweight, weight loss may help to some degree.

3) Sleep on your side instead of your back.

4) Contact your physician to check for hormonal conditions that can contribute to this condition.

Your doctor may prescribe a treatment for your sleep apnea. CPAP (continuous positive airway pressure) is the most effective and most commonly prescribed treatment. CPAP is simply airflow given by mask or nasal devise to keep the airway open while you sleep. In some, specific surgery can be performed to remove excessive tissue from the throat. Others may benefit from a dental appliance designed to keep the jaw and tongue forward during sleep. Your doctor will recommend treatment.

How soon will it get better? Most people begin to notice benefits of a good night sleep right away.

RESTLESS LEG SYNDROME

Restless leg syndrome describes symptoms of aching, twitching, burning or prickling sensations in the lower leg muscles. If this happens during the day while you are sitting, rubbing legs, getting up and walking around may help. If this happens during night, sleep is disrupted. The leg movements cause frequent awakenings, or simply brainwave alterations that affect sleep quality. You may feel tired during the day either way.

Restless leg syndrome happens in persons over age 65, but can happen to anyone. Diagnosis is made by sleep study. Treatment is to look for underlying factors such as iron or calcium deficiency. Medications such as benzodiazepines (medication used for anxiety and muscle relaxation) or Parkinson's medications may help.

PERIODIC LIMB MOVEMENTS

Periodic limb movement disorder affects people during sleep, but can be seen as well in those with restless leg syndrome. Continual movement of legs, ankles or toes during sleep characterizes this condition. It can be shallow continual movement or wild flaring of legs or even arms. Movement typically occurs for 0.5 to 1 second in intervals separated by 5-90 seconds. These limb movements are associated with arousals and sleep disruption, causing problems with insomnia or even daytime sleepiness.

Symptoms tend to worsen with age. Diagnosis is made by sleep study and a careful history by your physician. Treatment is similar to that used for restless leg syndrome and includes Parkinson's medicines or benzodiazepines (medication used for anxiety and muscle relaxation). This condition is associated with iron deficiency anemia.

INSOMNIA

Insomnia means that you have difficulty falling or staying asleep. This may result in daytime sleepiness. Episodes may be acute or chronic and affect 1/3 adults per year.

Causes of insomnia may be situational, related to stress, medical problems, or it may be secondary to medicines (either prescription or over the counter). Poor sleep habits may cause insomnia; particularly working in bed before sleeping or changes in sleep patterns (changes in bedtime).

Treatment involves determining the underlying problems that are causing the insomnia. Finding good sleep habits, such as a scheduled bedtime and awakening can be helpful. Avoiding caffeine and decongestants, which are stimulants which causes you to stay awake, and avoiding alcohol and other sedatives that cause you to relax but disrupt sleep patterns can be helpful.

Your physician may recommend relaxation techniques, daily exercise and a healthy lifestyle. If your physician feels appropriate, he may prescribe some medicine for the short term to help you sleep. Some sleep medicine can be addictive and may not be appropriate for everyone.

Other suggestions:

1) Establish a regular bedtime and wake up time even on the weekends. Avoid taking naps.

2) Keep the bedroom dark at a cool temperature.

3) Go to bed when you are drowsy. If not asleep within 20 minutes, leave the bed and return when sleepy again.

4) Meditate or relax before bed. Try to reduce stress in your life.

NARCOLEPSY/CATAPLEXY

Narcolepsy is characterized by attacks of extreme fatigue and sleepiness. These are usually during the day. REM (rapid eye movement) sleep is abnormal, and there is a loss of boundaries between sleep and wakefulness.

Persons with narcolepsy may have microsleep episodes, where they behave automatically without conscious awareness. They may have atonia (a sense of paralysis, which occurs between wakefulness and sleep). Hypnagognic hallucinations are dream like states between waking and sleeping. Periodic limb movements may also occur.

Cataplexy, sudden loss of muscle tone, happens in 2/3s of people with narcolepsy. These are brought on by intense emotional episodes. The loss of muscle tone is not accompanied by sleep. The person may slump to the ground while completely awake.

Narcolepsy is thought to be caused by both genetic and environmental factors. Autoimmune disease has also been linked to narcolepsy. Most persons are diagnosed after age 40.

Treatment includes scheduled sleep patterns, including scheduled sleep naps. Stimulants or antidepressants may be used for treatment if prescribed by your doctor.

Recognizing risk factors and implementing measures to prevent blood clots from developing are important. After pulmonary embolism has been identified, treatment consists of minimizing the damage caused by clots and preventing recurrance. Blood thinners such as heparin or Lovenox may be prescribed. Long-term treatment with warfarin will be necessary. Blood tests to check the protime and INR will be done at frequent intervals to determine the dose of warfarin needed.

PULMONARY VASCULITIS

Inflammation of the blood vessels in the lungs is termed pulmonary vasculitis. Pulmonary vasculitis is not usually a primary disease, but a development associated with another illness. Other conditions associated with the development of pulmonary vasculitis include Wegener's granulomatosis, Kawasaki's disease, Goodpasture's syndrome, and Churg-Strauss syndrome, as well as some auto-immune and collagen vascular disorders.

Pulmonary vasculitis may involve the smaller and medium sized blood vessels in the lungs. Inflammation of the blood vessels may progress to necrosis of the blood vessel walls.

General symptoms for patients with pulmonary vasculitis include cough, shortness of breath, and coughing up blood (hemoptysis). Diagnosis is established by correlating symptoms, physical exam, radiological studies, and blood tests. Pulmonary vasculitis is generally treated with corticosteriods taken over a period of months. Most patients have resolution of their condition, however relapses are not uncommon. There is no known method to prevent pulmonary vasculitis.