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Sleep Apnea, Snoring, Narcolepsy,
Insomnia and Other Sleep Disorders.

THE SLEEP SITE

BRINGING SECRETS OF THE NIGHT TO THE LIGHT OF DAY...

Understanding the symptoms of sleep disorders.

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IDIOPATHIC HYPERSOMNIA - 2.

--IMPORTANT! There is one specific condition that is the underlying cause of sleepiness in many patients who are mistakenly diagnosed as having idiopathic hypersomnia: and this condition can be easily overlooked during sleep laboratory testing.

-This condition is extremely treatable: so it should always be looked for.

-It is called UPPER AIRWAY RESISTANCE SYNDROME. It refers to patients who may never stop breathing at night, and who may get every breath they attempt but at a high price. People with this syndrome have to work extremely hard to keep air moving through a narrowed upper airway.

In fact, in some cases, the resulting swings in pressure inside the chest have even caused collapse of the left side of the heart!

People with this have been found to be just as likely to fall asleep at the wheel as are people with full-blown sleep apnea.
 

-The reason that this condition is frequently missed relates to the way that breathing is traditionally monitored in sleep laboratories. Many sleep centers lack the equipment to go any further when indicated to confirm this diagnosis.

Normally, during a conventional sleep recording, one records air flow at the nose and mouth with a temperature sensor, and breathing effort is monitored with bands, strain gages or electrodes on the chest wall and abdomen.

Upper airway resistance syndrome tends to be missed because first, air flow at the mouth and nose are not interrupted (since the person does not actually quit breathing). Second, it is difficult to see increased effort with the type of monitoring just described: since those techniques are very qualitative and not quantitative. They give a rough idea of the breathing effort present without actually measuring it.

The definitive way to diagnose this problem is by monitoring pressure swings within the chest. This in turn is usually done by having the patient swallow a small balloon by which one measures pressure swings. Changes in pressure in the esophagus reflect changes of pressure within the chest, since the esophagus passes through the chest. It is a very simple and safe technique. Unfortunately, most sleep centers do not offer it at this point in time.


-Some individuals with upper airway resistance syndrome snore loudly: which can help to suggest this diagnosis. However, some patients with upper airway resistance syndrome are not loud snorers at all.

-If upper airway resistance syndrome is present and accounts for the patient's sleepiness, a rental trial of positive airway pressure (CPAP or bilevel PAP) can help confirm such.

Restoration of good alertness on PAP certainly does not favor either narcolepsy or idiopathic hypersomnia, since neither of the latter respond to administration of air under pressure!  

--If in fact, upper airway resistance syndrome is not present and if the diagnosis truly is idiopathic CNS hypersomnia, the treatment is very similar to that used for the sleepiness of narcolepsy. Both avoidance of aggravating factors and medications are needed.


In summary, the first step:

Ensure as firm a diagnosis as possible, with careful exclusion of alternative explanations for sleepiness--particularly upper airway resistance syndrome (UARS). Ensure that the sleep center that has evaluated you is capable of doing special monitoring for detection of UARS.

The second step:

Institute the most specific and safest treatment plan possible, utilizing common sense measures to render treatments optimally effective.

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Columbus, Ohio, Central Ohio, hospitalssleep, wake, insomnia, sleepiness 

COLUMBUS COMMUNITY HEALTH
REGIONAL SLEEP DISORDERS CENTER
Accredited by the American Academy of Sleep Medicine.

Robert W. Clark, M.D., Medical Director
1430 South High Street, Columbus OH 43207

Tel: [614] 443-7800
Fax: [614] 443-6960

e-mail: flamenco@netexp.net 

 © Copyright 2006 Robert W. Clark M.D. Inc.