What do you want to read in this newsletter? I welcome your ideas.
I'd like to involve you, my readers, in selecting the subjects for forthcoming in-depth articles. There are many developments in apnea research and treatment, so there is no lack of interesting material, and the topics below are just a sample. So I will outline some new, important, and interesting topics and ask you to help choose the ones that are of interest to you. Please let me know your own ideas and suggestions, too. Your issues and questions can be at least as important as ideas published in a medical journal.
Apnea and the benefits of treatment
What benefits of treatment have been demonstrated by research? For example, what is the risk of death from apnea, and does treatment reduce that additional risk?
This refers to a condition affecting a significant number of people diagnosed with obstructive sleep apnea. CPAP treatment uses air pressure to keep the airway open so the patient can sleep. But the treatment seems to make things worse! The patient develops "central" apneas--the signal to breathe is not coming so, although the airway is not obstructed, the patient stops breathing. This paradoxical reaction is just beginning to be recognized and studied, and effective treatments are being developed. Is this really a new condition or are the doctors finally starting to understand and treat it? If you're interested, I will try to make this "complex" subject easy to understand so you can see if you might be affected by complex sleep apnea, and if so, to learn your options for better treatment.
In most areas of medicine, treatment goes by levels.
- There is the first level, the "primary" care doctor. Primary care doctors can handle most problems and identify issues that need a specialist or special facilities.
- The secondary level is the specialist, so if your primary care doctor isn't sure of the diagnosis or treatment, he or she will send you on to a specialist.
- Finally, there is the third level, represented by a professor and/or a department in a hospital or a teaching hospital.
This system of levels is reasonably efficient, since most problems don't require the experts--experts are reserved to help in the most difficult cases. But in sleep medicine, a small number of the most intensely trained specialists, usually in a hospital setting, do the diagnosis, trial treatment, and prescription. What is good about that is if you go to an accredited sleep center, you are pretty likely to be cared for by highly trained, experienced people. What is bad about that is that there is a tremendous backlog of untreated people with sleep disorders. There aren't enough sleep centers or sleep experts to go around. And it may be hard to get continuing advice and care from these experts for the problems that arise during treatment. Although some centers have recognized the importance of patient education, troubleshooting and support, unfortunately this is not a universal practice.
For years people have been proposing the use of studies in the home, using a simplified method of testing. Proponents of home testing have advocated this as a way to treat more people, and believe that sleep apnea is easy to diagnose and treat with such new procedures. Opponents have seen this as a lowering of standards and risking that people with other sleep problems would be misdiagnosed and mistreated. Recently the use of home studies has started to be accepted by insurers and professionals. In the sleep industry, home studies is a very hot topic; according to a survey by a publication for respiratory therapists, 62% of those replying considered home testing the most important topic at the 2008 sleep society meetings.
Are home studies good for the person with sleep apnea? When should they be used? Who is qualified to do such studies? And when should the sleep lab be used? What do you, as a person living with sleep apnea, need to know about these choices?
Overlap disease: COPD and sleep apnea
The condition of Chronic Obstructive Pulmonary Disease has a major impact on a person's breathing. Treatment can involve the use of inhaled oxygen to assure that the person receives enough oxygen despite damage to the lungs.
Sleep apnea involves stoppages of breathing during sleep, which are often treated by applying air pressure to help keep the airway open. Treating someone who has both COPD and sleep apnea requires real care and expertise. This is because of the impact that oxygen has on the control of breathing. If there is plenty of oxygen in the blood, the body will stop or slow the rate of breathing. This would create more problems for the person with apnea.
Therefore, people who have both COPD and sleep apnea might want to know more about how your doctor and respiratory therapist will balance your treatments.
Stroke and apnea
If a person has had a stroke, and they have apnea, will they have a higher risk of death? And if they treat the apnea, will it help prolong their life?
Apnea and heart disease, diabetes, and other medical conditions
Several diseases and conditions tend to be found in the same patients: heart failure, hypertension, diabetes, obesity, and sleep disordered breathing (snoring, apnea, etc.). We don't know in every case which of the conditions are primary, or if some underlying cause might be responsible for them.
Research has shown that many people with apnea are likely to have a heart condition or diabetes; and that people with heart disease or diabetes are likely to have apnea. A number of industry partnerships have been announced, with manufacturers from two different fields collaborating to identify, diagnose, and treat more patients who would otherwise be overlooked. Their efforts are directed at the professional community: physicians and other care givers. What does this mean for us as people living with these conditions? Would it be good for the manufacturers to reach out to us--people living with sleep apnea and/or other chronic conditions--in addition?
When you drive, can you tell if you are about to fall asleep?
Are you sure? Would you like to know how well drivers were actually able to predict falling asleep? If a person has sleep apnea, when is it safe to drive and how can this be tested? Crashes caused by drowsy driving are all too frequent, and people with untreated apnea are at risk. How can you know if your treatment has made you alert enough to drive safely? What is the situation for drivers of personal vehicles, truck drivers, airline pilots, train crews, and pilots or ship captains?
Sleep apnea and erectile dysfunction
Can a sleep disorder lead to erectile dysfunction? Does treating the sleep condition improve erectile function?
Elderly sleep: is it different?
Are poor sleep, restless nights, and daytime fatigue inevitable for the older person? What are the normal changes in sleep patterns as we age? What are the causes of poor sleep in the elderly? Apnea in the elderly? And what can be done about the sleep of elders?
Please use the email contact form or post your ideas as a comment. And please include your email or other contact information so I can follow up with questions. Some submitted comments may be used in edited form in the newsletter or blog.