Cen­tral sleep ap­nea less com­mon than ob­struc­tive

Cape Breton Post - - Advice / Games - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am a 94-year-old man who was di­ag­nosed with cen­tral sleep ap­nea about six years ago by my pul­mo­nolo­gist. Try as I may, I have been un­able to ad­just to an as­sort­ment of ap­nea masks that are con­nected to a BiPAP ma­chine (which is at­tached to oxy­gen). I have threat­ened to give it up, but I have been warned by my doc­tors of the risk of stroke, heart prob­lems and more. The only symp­tom I ex­pe­ri­ence when I don’t use the mask is drowsi­ness. I’d like your opinion of my shed­ding the mask and ma­chine, and get­ting by just with oxy­gen. -- S.M.L.

AN­SWER: Ob­struc­tive sleep ap­nea is a com­mon enough con­di­tion that most peo­ple know it: The mus­cles of the air­way re­lax dur­ing sleep, and in some peo­ple, es­pe­cially those who are over­weight or just have the neck anatomy to per­mit it, the air­way can be­come com­pletely closed.

It is treated with a con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) mask, which uses pres­sure to keep the air­way open. The mask needs to fit very tightly on the face. It is un­com­fort­able, but most peo­ple even­tu­ally get ac­cus­tomed to it. Al­ter­na­tives to CPAP in­clude BiPAP, which has two dif­fer­ent set­tings of air­way pres­sure (for in­spi­ra­tion and ex­ha­la­tion), and ASV (adap­tive servo-ven­ti­la­tion), which varies the amount of pres­sure to the amount of res­pi­ra­tory ef­fort. All of th­ese op­tions re­quire masks.

By con­trast, cen­tral sleep ap­nea is much less com­mon or well-known. In most cases of cen­tral sleep ap­nea, the prob­lem starts in the brain, with ex­cess breath­ing. Low oxy­gen level is one root cause of this. The per­son re­sponds by breath­ing rapidly, which drives the car­bon diox­ide level down, which then causes a pe­riod of no breath­ing at all (ap­nea).

Treat­ment for cen­tral sleep ap­nea may use any of th­ese breath­ing masks. My ex­pe­ri­ence has been that it may take months to find a well-fitting mask, and a good res­pi­ra­tory ther­a­pist is an in­valu­able friend in find­ing this. How­ever, if you can’t get a good re­sult with a mask, then you can con­sider oxy­gen alone. It may be that sup­ple­men­tal oxy­gen pre­vents the ini­tial low oxy­gen level that trig­gers the rapid breath­ing. You need to speak with your pul­mo­nolo­gist, but if you have the usual kind of fast-breath­ing-trig­gered CSA, oxy­gen may be a rea­son­able treat­ment.

Oxy­gen alone (with­out CPAP) is po­ten­tially dan­ger­ous for peo­ple with ob­struc­tive sleep ap­nea.

DEAR DR. ROACH: My son is 51 years of age, and ap­par­ently in good health. He had chick­en­pox as a young child. My con­cern is whether he should get the shin­gles vac­ci­na­tion now, or wait un­til he is older. I have heard that the vac­cine wears off as you get older, and I won­der if he should wait un­til he is older and hope he does not get the shin­gles ear­lier. -- L.C.

AN­SWER: I rec­om­mend wait­ing un­til 60. The shin­gles vac­cine be­comes more im­por­tant as peo­ple get older, par­tially be­cause the vac­cine wears off, but mostly be­cause shin­gles is worse in older peo­ple. In par­tic­u­lar, the like­li­hood of get­ting se­vere post-her­petic neu­ral­gia, the pain syn­drome that can fol­low shin­gles, is higher, and when it does, it lasts longer in older peo­ple. That’s why ex­pert groups rec­om­mend get­ting the vac­cine at age 60. A new vac­cine in de­vel­op­ment hope­fully will be longer-last­ing and more ef­fec­tive.

READ­ERS: The arthri­tis book­let dis­cusses rheuma­toid arthri­tis, os­teoarthri­tis and lu­pus. Read­ers can or­der a copy by writ­ing: Dr. Roach, Book No. 301, 628 Vir­ginia Dr., Orlando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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