Altitude and Sleep Apnea

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DRUG MAY AID SLEEP APNEA AT ALTITUDE

(The following article may be of interest to those who have occasion to be at altitudes above 5000′)

People with sleep apnea can safely travel to high altitudes with the help of a diuretic and a commonly used breathing device, a new study from Switzerland suggests.

Researchers found acetazolamide (sold as Diamox), which is already used to treat mountain sickness, improved overnight oxygen levels among people with the sleep disorder who spent time above 5,000 feet. Because there is less oxygen in the air at high altitude, nighttime breathing symptoms may get worse far above sea level. However, there aren’t any standard recommendations for mountain travelers with sleep apnea, according to Dr. Konrad Bloch, who worked on the new study.

“Physicians had no scientific evidence to counsel the patients,” Bloch, from the University Hospital of Zurich, told Reuters Health.

To try to provide some guidance, his team sent 51 people with sleep apnea – all of whom lived at low altitude – to resorts in the Swiss Alps as high as 8,497 feet on two different trips.

Each time, the volunteers used a breathing device commonly prescribed to people with sleep apnea, called continuous positive airway pressure therapy, or CPAP, at night. On one trip, participants also took three 250- milligram doses of acetazolamide each day. On the other, they were given drug-free placebo pill.

Along with being a diuretic, acetazolamide also triggers more frequent breathing. Bloch and his colleagues found participants’ average oxygen saturation overnight – a measure of sleep apnea severity – was better among the acetazolamide group, at 91 percent versus 89 percent in the placebo group at the highest altitude. (Normal oxygen saturation is between 97 and 99 percent.)

People taking acetazolamide also stopped breathing fewer times during the night than those taking the placebo pills, the research team reported Tuesday in the Journal of the American Medical Association.

With the type of CPAP used here, called autoCPAP, a computer controls air pressure flowing through the breathing mask. For standard CPAP – which is more common in the United States – pressure is calibrated in a sleep lab and doesn’t change based on nightly variation.

Most of the study volunteers were moderately obese men. Any related conditions they had – such as diabetes or high blood pressure – were stable before the study.

WATCH OUT FOR SIDE EFFECTS
Bloch said acetazolamide, which requires a prescription, “is not a harmless drug” because it alters water and salt content in the body. Some people in the study had side effects such as burning, numbness or tingling – and others complained about the drug’s taste.

For patients with heart or kidney disease in addition to sleep apnea, acetazolamide could lead to more serious complications – by making them pee too much, said Dr. Seva Polotsky, a sleep apnea researcher from Johns Hopkins University School of Medicine in Baltimore.

“I think it’s really beneficial. Having said that, you have to be careful with this drug,” Polotsky, who wasn’t involved in the new study.

“I would definitely check with a doctor and approach it very carefully.”

The new research was partially funded by a grant from Philips Respironics, which markets sleep systems such as CPAP devices. Drs.Bloch and Polotsky both recommended anyone traveling at altitude ascend slowly and take time to acclimatize along the way. “This is a recommendation that is important for everyone, but especially those that have a breathing problem,” Bloch said.

SOURCE: Journal of the American Medical Association, online Dec 11, 2012

SHOULD YOU HAVE A BACK-UP CPAP MACHINE?

The answer is emphatically YES!

Here is why: By the time that your sleep apnea gets bad enough that you take action to correct it, you’ve probably been suffering from it for 20 or more years. Obstructive Sleep Apnea is insidiously slow. You think your are sleeping well but your bed partner can tell you different. Your friends and hunting buddies can tell you different. Snoring, not breathing for up to a minute, chocking, gasping for air, it doesn’t bother you but it bothers them. You sleep the night away but they don’t.

Even though you sleep the night away, you don’t get the rest your body needs to repair itself. CPAP therapy restores normal breathing while you sleep. It keeps your upper airway open allowing you to breath normally. It allows you to go into the deeper stages of sleep allowing your anatomical functions to slow down and do the necessary repair work. After using CPAP for a while, your system returns to it’s normal functioning. The stresses placed on the heart and lungs is eliminated. You get back to a near normal state.

Suddenly, your CPAP machine or your nasal interface quits or breaks. You can’t use your CPAP machine because it is showing SERVICE REQUIRED or and ER (error) code in the LED window. It won’t run.

Can you get along without it? Sure! All you need to do is sleep setting up. As you find out on night one, that doesn’t work out too well. The next night you sleep on your stomach. That doesn’t work out either because it is very uncomfortable.

The third night you keep jerking yourself awake because you are not breathing properly, the apnea is waking you up or your snoring is waking you up. You are not sleeping. The next day you are tired, sleepy, can’t concentrate, have a hard time staying awake while driving, watching television or trying to read the daily paper. Your apnea is back, full blown and trying to kill you. Suddenly the stresses that cause heart attacks and strokes is much higher because your system had acclimate to a near normal stress level, thanks to the CPAP therapy. With out the CPAP you are at a much If you had a back up CPAP machine setting in the closet, when the old machine quits, within 10 to 15 minutes you could be back to sleeping like a baby. You and everybody else would be happy. Get a back-up CPAP machine now. They are not that expensive. This is affordable insurance, even setting in the closet!

SOURCE: www.cpapman.com/newsletter

Alzheimerʼs Disease and Dementia

Alzheimer’s disease (AD) is a brain disorder that affects a person’s thoughts, memory, speech, and ability to carry out daily activities. There is a loss of brain tissue that leads to deterioration of mental abilities and may also disrupt the sleep/wake cycle, which may cause sleep problems, nighttime wandering, and agitation.

Symptoms of AD develop slowly, usually beginning with short term memory problems. Over time, patients gradually lose more and more of their mental capabilities. For example, they may have difficulty remembering people or events and then lose the ability to do everyday tasks such as cooking, cleaning, and bathing. Eventually, AD patients may not be able to recognize loved ones, speak, or think clearly. Additional symptoms of AD include: Incontinence; speech problems; an inability to dress, or groom oneself; wandering and getting lost; losing items; and depression.

Patients in the early stages of AD may sleep more than usual or wake up disoriented. As the disease progresses, patients may begin to sleep during the day and awaken frequently throughout the night. Patients with more advanced AD rarely sleep for long periods. Rather, they doze irregularly throughout the day and night. Because caregivers are likely to be asleep during the night when AD patients are active, sleep/wake disruptions can be a dangerous problem for AD sufferers. In addition, AD patients who do not get enough sleep are more likely to suffer from agitation.

A feature of AD is “sundowning,” a term used to describe an increase in agitated behavior that occurs in the evening. This increased agitation may be explained by sleepiness or it may be that agitated behavior is more troublesome to caregivers after sun down. Whatever their causes, agitation and sleep problems result in severe stress for caregivers and are among the top reasons AD patients are given care in nursing homes instead of at home.

Alzheimer’s disease is not a normal part of aging but the risk of developing it goes up with age. It usually begins after age 60 and the risk nearly doubles with every 5 years of age after age 60. The number of Alzheimer’s patients is expected to increase dramatically in the coming years.

There is no cure for AD, but there are behavioral and drug therapies that may slow its progression and treat its symptoms. For example, cholinesterase inhibitors are medications used to treat mild to moderate AD (Aricept). They work by blocking the action of an enzyme that breaks down acetylcholine, a chemical which is essential to brain function. In addition, a drug called memantine is used to treat moderate to severe AD (Namenda). It works by regulating glutamate, a chemical in the brain that is important to learning and memory. AD patients may also benefit from antidepressant, antipsychotic, and sedating medications.

The National Institute on Aging at the National Institutes of Health identifies many forms of dementia, all of which have many of the same effects as Alzheimer’s disease. AD is the most prevalent form of dementia, though the second leading cause of impaired cognitive function in older adults is multi-infarct dementia which is actually caused by a series of often imperceptible strokes. Some forms of dementia may be cured or managed if accurately diagnosed and treated. That is why it is important to actively seek out answers to signs of memory loss.

Coping with AD:
• Create an ideal sleep environment
• Keep a regular sleep/wake schedule
• Get into bright light soon after waking
• Keep lighting dim as bedtime approaches
• Create simple routines for accomplishing everyday tasks
• Create a safe environment – keep dangerous items out of reach
• Use labels and reminder notes to help accomplish daily tasks such as dressing and food preparations
• Get some form of exercise every day

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