July 18, 2013
I know somebody who is a pilot. They can not be diagnosed with sleep or it is immediate disability and they can’t pilot the plane. MY question is have you ever done the MAD for this type of person without the diagnosis? What would the liability be if you said it was just for snoring?
This is one reason we have ambulatory (home) monitors, so we can rule out anything more severe. I would insist on at least this, and you can keep it away from insurance and any official diagnosis. The liability would be pretty heavy if he fell asleep at the controls, thinking he was cured, when in fact you had created a “silent apneic”, so you really need to get at least a Level 4 study done on this patient.
June 27, 2013
I have a patient who has opted to seek counsel with their physician regarding a sleep study. She has tremendous daytime drowsiness among other symptoms.
Originally, her doctor persuaded her to not visit a sleep center for reasons I can only imagine. In the meanwhile, at my prodding, she has visited her doctor again and he wrote a script for a PSG study at her local hospital. However, the doctor also prescribed Lexapro to ‘keep her alert’ during the day so that she would have a nice sleep the nite of the study. If I remember from your class, that class of drugs limits or reduces REM sleep. Do I recall correctly?
Lexapro and other anti-depressants will remove REM sleep, which indirectly improves the AHI, but at the expense of a valuable segment of sleep. They will sleep better if their anxieties are preventing sleep initiation, so it can be helpful, but will not give a true picture of the patient’s sleep architecture. That may or may not matter to the sleep physician, but I would ask the expert before deferring to the general MD.
June 20, 2013
I seem to have a couple of patients who complain of snoring and want me to make them a snoring appliance, but are reluctant to spend the time & effort to go to the sleep clinic for a baseline.
How would you feel about screening these patients with a home monitor to r/o significant apnea? If the screening is negative, I would go ahead and make the snoring appliance with some degree of confidence that I was not ignoring an apnea problem. If it is positive, then use the results of the screening to encourage them towards complete diagnosis for sleep apnea.
What monitor would you suggest for this? Also, would I need to be certified to read the results?
That’s an OK plan, as long as you follow them up with home monitoring to make sure the appliance is removing any events. That way, you can treat anyone up to about 30 events per hour, and even higher numbers if they have failed CPAP. There is no certification for reading the studies, but it does take some education. I love the Watch-PAT 200, but it’s more robust, and you may want to spend less. The ApneaLink is a “screener” at a lesser fee, but it all depends on what you want.
May 30, 2013
Q: What is it with men and snoring??!! I don’t know many men who can honestly say that they don’t snore. My father-in-law did it; my dad does it. And, now, I am double-whammied, because I have not only one man in my house who snores but two!
Prior to having kids, I was a pretty deep sleeper. My mom used to say that I could sleep through World War III and never even know it. Once kids came along, though, I started waking up at the drop of a hat. Now, I’m lucky to sleep throughout an entire night without someone or something disturbing my slumber.
It started out with my husband being the sole snorer in the family. It used to be just when he slept on his back. Now, it’s whether he’s on his back, his side, or standing on his head — it makes no difference. To give him credit, he has tried to rectify the situation by testing out the Breathe Right strips, the mouth sprays, etc., but, unfortunately, nothing seems to work. I, too, have tried to better the situation by nudging him, yelling at him, and even kicking him in the night, of course to absolutely no avail. I have finally resorted to wearing those stupid foam ear plugs each and every night to block out the noise.
And, wouldn’t you know, my other little man in the house has now followed in the footsteps of his father. Over the past couple of years, my son has become a mouth breather. Translation: the kid saws logs like nobody’s business at night. I can often hear him all the way down the hall even though his bedroom door is closed. My mom made me ask the pediatrician about it to see if he might have a problem with his adenoids. The doctor said that he really doesn’t recommend removing them unless sleep apnea is involved. He definitely doesn’t seem to stop breathing in his sleep — I’ve listened intently on many occasions. He’s got a steady and very excruciating rhythm going on with his snoring.
So, why is it that men are typically the ones who snore? My daughter doesn’t snore, and I certainly don’t either. Am I really doomed to stuff foam in my ears for the remainder of my nights? I don’t want to become like Lucy and Ricky and sleep in two different beds! I guess I just answered my own question — foam forever it is….
Dr. Smith: Don’t know where you live, but you should not take either your husband’s, nor your little man’s snoring lying down, and get some help. If your husband is now snoring regardless of sleep position, this has almost certainly elevated to obstructive sleep apnea, and if you don’t know the complications related to this, feel free to read all about them on my web site.
As far as your son, mouth breathing is not healthy, and can mean his adenoids are swollen. When this happens, he is forced to breathe through his mouth, which swells the tonsils even more. It also causes some structural changes in his mouth over time, as his upper arch begins to narrow, the roof of his mouth rises up, and before you realize it, there is even MORE constriction of the nasopharynx, and he becomes a permanent obligate mouth breather.
So, for your husband’s health, energy level, weight complications, etc.., get him some help. For your son’s future, get HIM some help. Let me know if I can help guide you somewhere.