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From: Carl Cadwell <CarlC@cadwell.com>
Subject: Sleep Apnea screening
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Wondering if you have sleep apnea?  BMI is not a reliable screener by itsel=
f.  One of the effective screeners for sleep apnea is the STOP BANG questio=
nnaire developed by the American Sleep Apnea Association.  There are 8 ques=
tions and one can screen one self. =20
http://www.sleepapnea.org/assets/files/pdf/STOP-BANG%20Questionnaire.pdf =20
Or http://www.westfieldhospital.com/uploads/STOP.BANG_1_.pdf =20
Each one has a slight variance on the interpretation of the results. =20

What are the risks associated with sleep apnea?  The obvious one is not hav=
ing restorative sleep so there is excessive daytime sleepiness/tiredness/dr=
owsiness.  The less obvious risks result in high blood pressure, stroke, he=
art attack, diabetes and GERD (gastric esophageal reflux).   Much of this i=
s caused because of our lowered blood oxygen levels from our breathing bein=
g blocked by our tongue falling back obstructing our airway.  The body resp=
onds by pumping more blood at higher pressures to deliver what oxygen is av=
ailable.  The GERD is caused from our abdominal and chest muscles straining=
 hard to get the air down into our lungs and forces the acid from our stoma=
ch into the esophagus.  (The real docs out there can do a better job of exp=
laining all of this.)

What to do next? =20
A sleep study will determine whether you have sleep apnea or other related =
sleep disorders.  These can be done at home or in a sleep laboratory. =20

If it is determined that you have sleep apnea, what are the treatment optio=
ns?
Sleep docs place almost all patients on CPAP devices which forces air into =
nose and forces open the airway using an air pump and mask.  About 50% of t=
he patients fail to use this after one year.
Another, less used treatment is the use of an oral appliance which is simil=
ar to a football mouth guard.  It is effective in treating about 90% of all=
 sleep apnea patients and is a recommended treatment by the American Associ=
ation of Sleep Medicine as first line treatment for mild and moderate sleep=
 apnea and a secondary treatment choice after CPAP for severe apnea.  Most =
sleep doctors want you to fail on CPAP before going to the oral appliance a=
lthough this is not what the guidelines say.  Most of the oral appliances a=
dvertised on TV have poor results based on our experience and putting the b=
oiling hot appliance in the mouth really hurts.
Weight loss certainly helps with sleep apnea as well as all the comorbiditi=
es.
Surgeries (UPPP) and pillar implants have mixed results. =20
Maxillary/Mandibular advancement surgeries also are effective and rarely do=
ne. =20
Trach tubes work but is really a drastic solution.  (No one that I know doe=
s this.)

This is a chronic disease and you will be on lifelong treatment. =20

Carl Cadwell
Former IVP=20