| |
 |
|
| Medical Edge |
|
|
|
Medical Edge Newspaper Column from Mayo Clinic
SLEEP APNEA SUFFERER’S BREATHING MACHINE MAY NEED ADJUSTMENT
DEAR MAYO CLINIC: My husband has obstructive sleep apnea and, although
he uses a machine for it, he still has problems sleeping. He has also
been on Ambien (zolpidem) for several years, but this doesn’t help, either;
and I’m getting worried because I know he can’t continue to function without
enough sleep. The sleep specialist he has consulted seems to be stumped.
Do you have any suggestions? — Atlanta, Ga.
ANSWER: Obstructive sleep apnea, which affects some 2 to 4 percent
of the adult population in the United States, disturbs sleep because of
its starts and stops in breathing. Often associated with snoring and obesity,
it is especially troubling for the patient because of sleep deprivation’s
cumulative effects.
Several aspects of your question require careful consideration. The first
thing to be sure of is that everything has been done to optimize the comfort
and effectiveness of the breathing-aid device you mention, which is known
as a Continuous Positive Airway Pressure machine.
As you may know, the CPAP machine’s mask is designed to fit securely yet
comfortably over the patient’s nose. When it is adjusted and fitted properly,
the system eases breathing by blowing air into the nostrils to create
pressure that keeps the airways open. Because the sleep apnea patient
is consequently getting continuous airflow, he or she does not wake up
as frequently and can finally obtain some much-needed restful sleep.
However, the proper adjustments for one patient may not be at all proper
for another. So be sure to investigate the possibility that your husband’s
CPAP machine and mask are not optimally set for his particular condition;
this may require his spending a night in the sleep-observation laboratory.
Regarding the drug therapy you cite: The medication zolpidem is rarely
used successfully on a long-term basis because it loses its effectiveness
over time. Yet, like many other sleep aids, zolpidem can be habit-forming.
Thus the patient is left without relief from obstructive sleep apnea but
has become dependent on a now-useless drug.
Lastly, although your husband has seen a sleep specialist, that individual
may not have been as well trained for treating insomnia as for sleep apnea.
And it’s possible that your husband has a separate — and unrelated — insomnia
problem that requires independent assessment by a specialist trained in
that area.
Your next steps should therefore be getting away from the long-term use
of zolpidem, and obtaining a second opinion from someone with explicit
training and experience in treating insomnia.
— Peter Gay, M.D., Pulmonary and Critical Care, and Sleep Medicine, Mayo
Clinic, Rochester, Minn.
Additional Resources:
Treatment
of Sleep Apnea
Appointment
Information
More
Information on Sleep Apnea
DEAR MAYO CLINIC: I’ve been living and working in the far-flung
Republic of Georgia for the past year, where the incredibly hospitable
locals serve their guests copious amounts of “chacha,” a homemade distilled
liquor.
But I remember learning in college chemistry that if alcohol is not distilled
properly, it can contain methanol, a poisonous form of alcohol that causes
permanent optic nerve damage and, eventually, blindness.
I’d like to continue toasting chacha with the locals, but as a pilot and
photographer, my eyesight is extremely important to me. Is there some
kind of test that can be performed to determine if my eyes are being damaged
by methanol? — Eugene, Ore.
ANSWER: Methanol poisoning is more likely to occur with accidental
(or intentional) drinking of the wrong substance, and it is not produced
in significant quantities during the fermentation process.
So the risk that the chacha contains methanol is near zero. If you have
already partaken of this drink without any serious consequences, then
you should be able to continue doing so — in moderation, of course.
If you have been passing the vision tests for your Federal Aviation Administration
flying physical, as well as the color vision test, you are good to go.
You don’t need any other type of testing.
— Brian Younge, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn.
- - -
Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
|
|
