Wednesday, August 16, 2017  

Good Night and Good Health


In my medical practice I see a number of health issues that can sneak up on you with virtually no symptoms or with only very vague symptoms. For the most part, obstructive sleep apnea (OSA) isn’t one of them.

Sleep apnea is accompanied by loud and persistent snoring as well as pauses in breathing and subsequent gasping that may or may not result in waking up. As you might imagine, these symptoms are most often reported by a bed partner. If you don’t have someone nearby when you sleep to notice the signs, your indication of a problem is more likely to revolve around morning headaches, daytime drowsiness and an overall sense of fatigue.

The reason for concern regarding obstructive sleep apnea is that fact that it can also lead to some very serious health problems. The good news about OSA is that there are effective ways to treat it. Before taking a closer look, it’s helpful 
to get a little more information on 
the condition.

What sleep apnea is and why it’s important to treat it

Obstructive sleep apnea is a sleep-related breathing disorder that takes place when muscles in the back of our throat aren’t able to keep our upper airway adequately open. While this situation isn’t a problem when we’re upright and awake, it results in brief and repeated interruptions of breathing during sleep.

There are some anatomical features that can increase the risk of OSA, things like large tonsils, a small jaw, a large neck size, and a larger than average tongue. With a growing number of patients that I see, however, the problem likely to be related to obesity.

Obstructive sleep apnea would be bad enough if the only results were symptoms related to not getting a restful night’s sleep. But in fact, there are a number of serious health conditions associated with OSA including high blood pressure, higher risk for heart attack and stroke, congestive heart failure and heart rhythm problems, along with depression and mood and memory problems. That’s why accurate diagnosis and treatment are critical.

The Gold Standards for Sleep Apnea Testing and Treatment

The Centers for Disease Control and Prevention estimate that around 18 million Americans experience sleep apnea, though many of them don’t address the symptoms. One of the most common and effective methods to diagnose OSA and determine its severity is a sleep study. We carry out these studies in a specialized area at Riverside Tappahannock Hospital where we can monitor a number of sleep related functions like eye movement, respiratory effort, airflow, muscle activities, heart activity and blood oxygen levels.On the other hand, when the frequency (daily or several times a week) or the amount of reflux is significant, that’s a good indication that GERD is at work. The result can 
be severe and chronic heartburn, hoarseness, chest pain and damage to 
the tissue lining of the esophagus that 
may be related to a number of serious conditions and complications.

If the results of the sleep study indicate OSA, the most common treatment is a continuous positive airway pressure (CPAP) device. Medical equipment vendors supply them in slightly different forms but all CPAPs consist of an air flow generator box, a mask that fits over part of the face and a hose that connects the two – and all are designed to blow air into the nose at a designated pressure to help keep your airway open while still making it possible to sleep.

If your sleep study indicates you could be helped by a CPAP, we repeat the study using the device to make sure the equipment fits properly and that the device is providing the maximum health benefit. In some cases we might split a single night’s study into a “before and after” to help determine the effectiveness of the treatment.

As an added resource that’s growing in importance, the sleep studies we conduct here in Tappahannock can be monitored and interpreted by physician sleep specialists, usually pulmonologists or occasionally neurologists, at Riverside Regional Medical Center through our telemedicine program. This communications technology means that patients and physicians here can interact with specialists at a remote site without having to leave the community.
What You Can Do About 
a Getting Enough 
Quality Sleep

When it comes to getting a good night’s sleep, there are a lot of recommendations out there including keeping your room dark and cool, limiting computer and other screen time, making sure you don’t exercise too close to bed time, keeping a regular sleep schedule, avoiding caffeine, and that’s just a few of them. What I want to stay focused on, however, are strategies related to sleep apnea.

As a primary care physician I’m on the front lines of identifying people at risk for OSA, and it’s gratifying to know that there are effective ways to treat it. But a big part of improving the situation and reducing the risks for serious health problems involves managing your own health.

Lifestyle changes are highly effective in improving sleep apnea symptoms and weight loss can even eliminate the condition in many overweight or obese people. Alcohol, which makes the muscles in the upper airway relax, is also a concern. And if there weren’t already enough other reasons to quit smoking, it causes swelling in the airway that adds to the “obstruction” in obstructive sleep apnea.

If you suspect you may have sleep apnea, the first thing you should do is see your doctor. When you do please keep in mind that a physician has the skills to identify the condition, but only you can provide the motivation and make the lifestyle adjustments needed to successfully manage it. 

To schedule an appointment with 
Dr. Cleary, call Riverside Tappahannock Family Practice at (804) 443-6063.

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