Sleep Dynamic Therapy

Archive for the ‘Sleep Apnea’ Category

This is the one graph I’ve found about the cause of Russert’s death, “Russert’s internist, Michael A. Newman, told MSNBC that an autopsy showed the journalist had an enlarged heart and that cholesterol plaque ruptured an artery, causing coronary thrombosis. He said Russert had been diagnosed earlier with coronary artery disease, but that it was controlled with medication and exercise and Russert had performed well on a stress test in late April.” He was only 58 years-old. One can only speculate whether undiagnosed sleep apnea was another risk factor in this case.

Day in and day out, it is remarkable how many sleep apnea patients never achieve an optimal clinical response due to mouth breathing. The problem starts with the fact that so many people believe that mouth breathing is somehow normal and the problem ends with the fact that so many people are reluctant to use chinstraps. I went almost two years on an APAP device, imagining I was getting a fairly good response until I tried a chinstrap. Then, “all of a sudden,” I began waking up in the morning without a dry mouth and realized what I had been missing.

I too was one of those individuals that just couldn’t imagine putting yet another contraption around my face or head, yet once I effectively placed the chinstrap and obtained a much better clinical response, I was very grateful that so many different styles of chinstraps were on the market.

The biggest barrier to the use of the chinstrap, I believe, is psychological comfort, because when you first use one, it really feels confining. But, I think this physical sensation actually translates into a psychological feeling of discomfort, which is the more difficult sensation to overcome.

Currently, I use the Respironics Premium Chinstrap, which I personally believe is the best on the market for two reasons. First, it uses a behind the head strap to leverage the chinstrap in a snug but not too tight manner. Second, because of this design, the chinstrap component that goes under the chin and up over the head actually exerts force in a vertical fashion to pull the chin up. Whereas, you can find many chinstraps that are designed in a more compact way, these straps exert force on the chin in two directions, up and backward. This backward force occurs because the chinstrap imaterial runs in a diagonal from the chin towards the top portion of the back of the head. You can actually feel that it’s tugging your jaw backwards, which theoretically could worsen your breathing.

In sum, never sell short the potential value of a chinstrap in your efforts to achieve a great response to PAP therapy. If you awaken in the morning with a dry mouth, chances are high you need one.

Today, I spoke at the Montebello Senior Center in Albuquerque on a variety of topics on sleep. In these types of discussions, the topic of aging always emerges as the most likely explanation for why someone’s sleep would deteriorate. While certainly aging has an impact, I always point out that there’s just as much chance that a sleep disorder ages a persons mind and body faster than aging itself. In particular, we know that sleep breathing problems cause sleep fragmentation and inconsistent delivery of oxygenation to the blood and blood vessels, and both of these problems clearly make us age faster.

A useful study has shown that death rates are a bit higher than anticipated following bariatric surgery, and in the short commentary that was written up in JAMA about the article, it merely states that the deaths in the first few months were largely due to coronary artery disease. Yet, no mention is made about the likely contribution of untreated sleep apnea in many of these cases. Even today, it is not clear whether all bariatric centers require pre-op sleep testing in obese patients to determine whether they suffer from sleep apnea.

This media piece on recent research about UPPP fails to make note of the frequent side-effects induced by this procedure. The technique sometimes worsens sleep breathing problems in patients, but more importantly, UPPP sometimes makes it more diifficult to use CPAP in the future. A simple Google search provides many links discussing these problems and more.