My old experience as a physician seeing patients dealing with the various sleep apnea treatments including CPAP was not that good. It seemed that most sleep apnea equipment was similar to the use of hearing aids , a lot of people owned the equipment but few consistently used it.
Advances in technology has changed both hearing aids and sleep apnea equipment into comfortable useful tools that are a pleasure to use.
My new experience as a physician and a patient using new hearing aids and CPAP for for my obstructive sleep apnea is "Oh my goodness ! Why did I wait so long ? "
The diagnosis of sleep apnea and compliance to treatment recommendations have improved significantly in recent years. The new quite comfortable simple to use equipment coupled the expertise of doctors and respiratory therapist have had a big impact on the management of this problem.
There are various surgical procedures and different oral appliances that have had limited success .
I believe that the use of CPAP "continuous positive airway pressure" continues to be the most effective. These machines are quite and automatically adjust to deliver just the right amount of pressure needed to over come the airway obstruction. The humidity of the delivered air can be adjusted to your comfort. The face masks have improved along with the machines to deliver warmed humidified air comfortable to your nose and mouth. The delivery of air directly into a person's nose with something called Nasals Pillows has been a step in the right direction.
If you have been diagnosed with sleep apnea , I suggest that you Google CPAP and also Nasal Pillows. Read and learn much as you can about the available equipment before your doctors visit . Decide on the features you would prefer to have with your equipment and if possible talk to someone who has sleep apnea and get their opinion on their pros and cons on the equipment they are using . It is possible to talk with some one ,ME . You can use the comment section below.
Your doctor will make recommendations based on his or her experience and your test results . There is a lot of CPAP equipment with multiple options
If you have done your home work then you will be a better participant in the decision process .
Have fun, Take advantage of the new wonderful advances in medical care.
David Calder, MD
Friday, January 27, 2012
Wednesday, January 25, 2012
Sleep Apnea,You can't diagnosis it if you don't think of it
Sleep Apnea
You can't diagnosis it if you don't think of it
Obstructive Sleep Apnea is a contributor to :
* the development of Diabetes and hypertension
* to some of the management problems associated with diabetes and hypertension
( including hypoglycemia )
* To a variety of vague common every day symptoms discussed yesterday
The Diagnosis is easy and painless .
* Talk to your doctor about Sleep Apnea
* Ask for a consult to a sleep center and sleep specialist
Testing is easy and painless . No blood test involved.
* There is a simple unattended screening sleep study . This involves picking up a device that
measure pulse and oxygen saturation and a few other things at a sleep center.
This device is small and attaches to the tip of your ring finger You wear this all night
and return it to the sleep center the next morning. The results and recommendations on how to
proceed are reported to you in a few days.
Our 72 y/o patient , discussed a few days ago , had this test done. He slept 7 hours and had 99
episodes of oxygen desaturations with his oxygen (sp o2 levels) levels dropping down to
78%. ( normal is about 100 %). His study was reported as definitely abnormal and compatible
with having, Obstructive Sleep apnea. He was asked to return for a more complete study that
involved spending the night in the sleep center. The primary reason for this test was to
determine the pressure needed to overcome the obstruction to air flowing into his lungs.
CPAP was ordered and within 2 months his blood pressure was normal (<130/80 ) with no
medications, His nasal congestion and morning cough is gone and there is no snoring . His
wife is happier because she is now able to have a good nights sleep .
His A1c and lipid panel are pending.
More on CPAP and other treatments tomorrow.
Have fun , be smart and defeat Diabetes
David Calder,MD
You can't diagnosis it if you don't think of it
Obstructive Sleep Apnea is a contributor to :
* the development of Diabetes and hypertension
* to some of the management problems associated with diabetes and hypertension
( including hypoglycemia )
* To a variety of vague common every day symptoms discussed yesterday
The Diagnosis is easy and painless .
* Talk to your doctor about Sleep Apnea
* Ask for a consult to a sleep center and sleep specialist
Testing is easy and painless . No blood test involved.
* There is a simple unattended screening sleep study . This involves picking up a device that
measure pulse and oxygen saturation and a few other things at a sleep center.
This device is small and attaches to the tip of your ring finger You wear this all night
and return it to the sleep center the next morning. The results and recommendations on how to
proceed are reported to you in a few days.
Our 72 y/o patient , discussed a few days ago , had this test done. He slept 7 hours and had 99
episodes of oxygen desaturations with his oxygen (sp o2 levels) levels dropping down to
78%. ( normal is about 100 %). His study was reported as definitely abnormal and compatible
with having, Obstructive Sleep apnea. He was asked to return for a more complete study that
involved spending the night in the sleep center. The primary reason for this test was to
determine the pressure needed to overcome the obstruction to air flowing into his lungs.
CPAP was ordered and within 2 months his blood pressure was normal (<130/80 ) with no
medications, His nasal congestion and morning cough is gone and there is no snoring . His
wife is happier because she is now able to have a good nights sleep .
His A1c and lipid panel are pending.
More on CPAP and other treatments tomorrow.
Have fun , be smart and defeat Diabetes
David Calder,MD
Tuesday, January 24, 2012
Two sneaky diseases, Diabetes and Sleep apnea
Obstructive Sleep Apnea
Who is at risk of having sleep apnea ?
* Almost everyone regardless of age however it is more common as we mature and get thicker.
* It is estimated that 2% of women and 4% of men over the age of 50 have sleep apnea
* Loud snorers , 17% of men and15% of women have obstructive sleep apnea
* Adolescents with high blood pressure are at risk of sleep apnea
* 30 % of adults with hypertension may have sleep apnea
* two thirds of people with difficult to control blood pressure had sleep apnea in one study
* Obstructive sleep apnea is associated with a 2.7 fold increased risk of having diabetes
* anyone ignoring the vague symptoms listed below
What are the symptoms ?
The symptoms are often considered as normal every day problems that we all deal with from time to time in our lives.
The symptoms and findings may or may not include;
Snoring , snoring and lapses in breathing noticed by a spouse , large neck , daytime sleepiness, fatigue , nasal congestion , morning cough , high blood pressure , having the metabolic syndrome or diabetes , spells of nausea ,sweating and light headedness, sweating at night , unrefreshing sleep , impaired concentration , personality changes and more.
Making a diagnosis of sleep apnea is easy,
Not thinking of Sleep Apnea as a possible correctable cause for our symptoms is the difficult part.
Diagnosis and treatment tomorrow
Have fun , be smart and defeat diabetes.
David Calder,MD
Who is at risk of having sleep apnea ?
* Almost everyone regardless of age however it is more common as we mature and get thicker.
* It is estimated that 2% of women and 4% of men over the age of 50 have sleep apnea
* Loud snorers , 17% of men and15% of women have obstructive sleep apnea
* Adolescents with high blood pressure are at risk of sleep apnea
* 30 % of adults with hypertension may have sleep apnea
* two thirds of people with difficult to control blood pressure had sleep apnea in one study
* Obstructive sleep apnea is associated with a 2.7 fold increased risk of having diabetes
* anyone ignoring the vague symptoms listed below
What are the symptoms ?
The symptoms are often considered as normal every day problems that we all deal with from time to time in our lives.
The symptoms and findings may or may not include;
Snoring , snoring and lapses in breathing noticed by a spouse , large neck , daytime sleepiness, fatigue , nasal congestion , morning cough , high blood pressure , having the metabolic syndrome or diabetes , spells of nausea ,sweating and light headedness, sweating at night , unrefreshing sleep , impaired concentration , personality changes and more.
Making a diagnosis of sleep apnea is easy,
Not thinking of Sleep Apnea as a possible correctable cause for our symptoms is the difficult part.
Diagnosis and treatment tomorrow
Have fun , be smart and defeat diabetes.
David Calder,MD
Monday, January 23, 2012
For those of you who read the Jan. 19 discussion .
" You fail to achieve 100% of the goals you don't set "
Please click on the link below or the tab above for the continued discussion of :
"Simple and Specific Goals Empower each of us to do better "
Diabetes Office Visits- Simple and Specific Goals Empower each of us to do better
Have Fun , Be Smart and Defeat Diabetes. David Calder, MD
" You fail to achieve 100% of the goals you don't set "
Please click on the link below or the tab above for the continued discussion of :
"Simple and Specific Goals Empower each of us to do better "
Diabetes Office Visits- Simple and Specific Goals Empower each of us to do better
Have Fun , Be Smart and Defeat Diabetes. David Calder, MD
Bra-size , Snoring , Diabetes and hypertension
I saw an article the other day suggesting that larger Bra sizes increased the risk of developing diabetes. I immediately thought of news paper adds " Get your breast reduction TODAY and cure diabetes ". There may be more to this than meets the eye. We will just have to wait for more research to get the answer.
Snoring with intermittent lapses in breathing is no laughing matter . The National Commission on Sleep -
Disdisorder Research estimate that 7 to 18 million people in the United State have sleep disordered breathing .
Obstructive sleep apnea ( a condition in which the back of the throat collapses during sleep blocking the airway ) is the most common form of this condition. One study found , in a group of 379 women and 262 men between the ages 65 and 70 , that 57 % had obstructive sleep apnea . This condition becomes more common as we age but is not limited to older people.
Sleep Apnea is associated with an increased risk of Metabolic syndrome , Hypertension , Heart disease and Diabetes.
The symptoms of sleep apnea are often common vague things that occur in our every day life such as snoring, insomnia , falling asleep reading the newspaper , tiredness , anxiety and depression.
Making a diagnosis first requires thinking about sleep apnea as a cause for a group of vague symptoms.
I will present a case that outlines the problems and delays in making a diagnosis.
A 72 y/o male with pre-diabetes ,hypertension and a stout build ( 5ft 8 in and 186 # )developed vague symptoms of sudden strange nausea followed by mild forehead sweating and an intense desire to sit down.The symptoms lasted less than a minute and continued to occur in groups of 3 about once a month. The symptoms occurred sitting standing or even lying down. Initially they were mild and ignored until one day the symptoms occurred and he found himself on the ground. He saw his doctor and had an evaluation including blood test , chest X-ray and ECG. His medications included glucaphage , amlodipine , a diuretic, L- Arginine and aspirin. There was no clear cause for the symptoms and glucophage,L-arginine and the diuretic were stopped. The symptoms were milder until one day he had the symptoms while driving and went off of the road. This episode resulted in a cardiology visit and testing that revealed a mild transient electrical conduction problem during the episodes. A diagnosis of Vasovagal syndrome( basically fainting ) was made and amlodipine was discontinued. Exercises and better hydration was recommended and the symptoms improved but did not go away and his BP was staying elevated above 140 mmhg systolic.
The concerns about driving persisted and prompted another visit with his doctor. The doctor ask about snoring, looked at his neck and throat , and suggested seeing a sleep specialist. A diagnosis of obstructive sleep apnea was made and CPAP treatment was started resulting in completes resolution of all of the symptoms. His blood pressure is 123 -130 / 70 to 80 mmhg with no medications and his wife is now able to sleep through the night without the snoring serenade.
The time from the onset of symptoms and a diagnosis was about 18 months.
Remember :
Thinking of sleep apnea as a cause for your vague symptoms is the first step to making a diagnosis.
Another Hint , If your spouse can't sleep because of your snoring , think of sleep apnea.
The time from the onset of symptoms and a diagnosis was about 18 months.
Remember :
Thinking of sleep apnea as a cause for your vague symptoms is the first step to making a diagnosis.
More on symptoms , screening test , effects on diabetes and blood pressure . Stay tuned.
David Calder,MD
Saturday, January 21, 2012
Terminal illness to one doctor may be a moment to excel by another.
I will put a hold on my goal setting ideas for today to discuss the article below. I am also still having trouble moving charts and graphs from Pages to my blog page. They transfer initially and then disappear leaving a ? mark. Any ideas ?
I read an article and comments in Medscape Connect today discussing "How doctors die". After reading the article and many of the comments , I came away with the feeling that most of the doctors responding would chose to accept the diagnosis of terminal illness and slip comfortable into the beyond without a fight.
I would like to offer a different perspective based on my over 48 years experience as a physician.
The first lecture on my first day of medical school was given by an old family doctor. His best advise for us as hopeful new doctors was to " never tell someone when they going to die because that person will probable be kicking dirt in your face" . I have lived long enough to know that he was right. I have had the pleasure of watching people make amazing come backs from what seemed like hopeless circumstances. I have also learned that we doctors are not that good at defining terminal illness. Terminal illness to one doctor may be a moment to excel by another.
I have had a very personal experience that high lights my thoughts. In my wife's will she signed a form stating that she wanted no life support. I recall asking her at the time if she really meant that and she said yes. Fortunately I had forgotten about our wills when my wife became ill . About 8 years ago she developed flu like symptoms and within 36 hours was hospitalized with septic shock. Over the next 24 hours she was on total life support , unconscious, bleeding from every orifice , acute renal failure on dialysis, gangrene of both lower extremities ,requiring respiratory and BP support . She had multiple surgeries including bilateral below the knee amputations and was in ICU for 2 months.
I refused request to talk about end of life care. Thanks to the doctors who chose to excel rather than yield to the easy choice of death, my wife now is healthy and enjoying life ,walking up to 2 miles each day on her new titanium legs. She has sense told me that dying would have been easy because the has no recall of anything after getting in the ambulance. She also has a better understanding of "do not resuscitate "and has now changed her choice to; allowing family and her doctor to make the decision if she is unable do do so on her own.
She is thankful for being given the opportunity to spit in deaths face.
David Calder,MD
I read an article and comments in Medscape Connect today discussing "How doctors die". After reading the article and many of the comments , I came away with the feeling that most of the doctors responding would chose to accept the diagnosis of terminal illness and slip comfortable into the beyond without a fight.
I would like to offer a different perspective based on my over 48 years experience as a physician.
The first lecture on my first day of medical school was given by an old family doctor. His best advise for us as hopeful new doctors was to " never tell someone when they going to die because that person will probable be kicking dirt in your face" . I have lived long enough to know that he was right. I have had the pleasure of watching people make amazing come backs from what seemed like hopeless circumstances. I have also learned that we doctors are not that good at defining terminal illness. Terminal illness to one doctor may be a moment to excel by another.
I have had a very personal experience that high lights my thoughts. In my wife's will she signed a form stating that she wanted no life support. I recall asking her at the time if she really meant that and she said yes. Fortunately I had forgotten about our wills when my wife became ill . About 8 years ago she developed flu like symptoms and within 36 hours was hospitalized with septic shock. Over the next 24 hours she was on total life support , unconscious, bleeding from every orifice , acute renal failure on dialysis, gangrene of both lower extremities ,requiring respiratory and BP support . She had multiple surgeries including bilateral below the knee amputations and was in ICU for 2 months.
I refused request to talk about end of life care. Thanks to the doctors who chose to excel rather than yield to the easy choice of death, my wife now is healthy and enjoying life ,walking up to 2 miles each day on her new titanium legs. She has sense told me that dying would have been easy because the has no recall of anything after getting in the ambulance. She also has a better understanding of "do not resuscitate "and has now changed her choice to; allowing family and her doctor to make the decision if she is unable do do so on her own.
She is thankful for being given the opportunity to spit in deaths face.
David Calder,MD
Thursday, January 19, 2012
"You Fail to Achieve 100% of the Goals you don't set"
Chapter 2 Diabetes Office Visit
Setting Goals and talking to your doctor
Diabetes is a chronic disease with known correctable risk factors.
Preventing diabetes complication,
especially heart disease, is possible and it depends on you.You are your doctors number one assistant and correcting these risk is up to you.
"Fixing the nine" is a term I like and setting 9 treatment goals with your doctor is your first step to preserving your good health.
Remember;
"You fail to achieve 100% of the goals you don't set"
My A1c goal is < 6 because I have pre- diabetes and do not want to progress to diabetes. What is your A1c goal?
How you achieve those goals is the next question.
Have fun, be smart and defeat diabetes.
David Calder,
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