Curious About Your Childs Potential To Have Osa
If you suspect that your child may be living with obstructive sleep apnea, BEARS is a great screening tool you can use at home. It stands for:
B Bedtime. Does your child have trouble falling asleep or even going to bed?
E Excessive Daytime Sleepiness. Do you find that you have difficulty waking your child? Does he or she appear groggy or tired throughout the day?
A Awakening During the Night. Does your child awaken during the night and experience difficulty returning to sleep? Are other factors disrupting your childs sleep?
R Regularity and Duration of Sleep. How many hours of sleep should your child be getting at his age? What time does he go to bed and wake up during the week and on weekends? Does your child get adequate sleep each day?
S Snoring. Does your child snore? How loud? Is it every night? Does he stop breathing or making gasping and choking sounds while sleeping?
If your answer to any of these questions is yes, then you should contact us here at Houston ENT & Allergy Services today to discuss screening and potential treatment options for obstructive sleep apnea in children. The risks to your childs health are too great to ignore or put off.
Liver Disease And Sleep
Sleep changes in patients with cirrhosis complicated by hepatic encephalopathy have been well studied. Although explored less, sleep changes can also be seen in patients with chronic liver disease without hepatic encephalopathy. Abnormalities in the circadian rhythm are thought to be responsible for sleep abnormalities seen in chronic liver disease. There are multiple factors that contribute to these changes in the circadian process. First, cirrhotic patients may have changes in the function of the SCN, leading to dysfunction in the sleep-wake cycle. There may also be changes in melatonin secretion with delayed melatonin peak during the night, leading to sleep disruption., Impaired hepatic metabolism of melatonin in cirrhosis has also been described leading to elevated daytime levels of melatonin and sleep disruption.
OSA affects approximately 3% to 7% of adult men and 2% to 5% of adult women in the general population. OSA plays a role in many gastrointestinal diseases. Multiple studies have shown that hypoxia secondary to OSA may lead to an increase in fat accumulation in the liver causing nonalcoholic fatty liver disease and/or hepatic inflammation leading to nonalcoholic steatohepatitis. Additionally, studies have shown that OSA may lead to sleep disturbances in cirrhosis and further confuse the interpretation of sleep changes often seen in cirrhotic patients. Obesity is a well-studied risk factor for both sleep apnea and NAFLD.,-
Bilevel Positive Airway Pressure
Bilevel positive airway pressure machines are sometimes used for the treatment of OSA if CPAP therapy is not effective.
BPAP machines, sometimes called BiPAP machines, have settings that deliver two pressures in response to your breathing: inhaled pressure and exhaled pressure. This means the pressure changes during inhaling versus exhaling.
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Adjust Your Sleep Position
Sleeping at an incline may help. This position should prevent a “kink” in the esophagus that may ease the passage of air into the stomach.
Many people find it helpful to sleep with their head up at an angle of about 30 degrees. A wedge pillow can help. It can be placed on top of or under the mattress, depending on its design.
Some people opt for an adjustable bed, but this option can be expensive. Another idea: Raise the head of the bed with blocks.
Whatever you do, make sure to fully support your head, neck, shoulders, and upper body.
How Do I Avoid Red Marks
Similar to nasal sores and other skin irritation, red marks can be caused by over-tightening your CPAP mask. Your mask should only be tightened enough to create a seal. To avoid over-tightening your mask, work clockwise to make small adjustments to the headgear until the mask is secure but not overly tight. Cleaning your mask cushion, nasal pillows, and nasal prongs on a daily basis helps you achieve a better seal, too.
If you know your mask fits and you are routinely cleaning it, consider adding mask strap padsa soft covering for the headgear strapsto your CPAP set-up.
Red marks from your CPAP mask can be upsetting, but there are several products designed to target and minimize red marks and other skin irritation, including:
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Dry Mouth When Using Cpap
You may be wondering How can I prevent dry mouth with CPAP? if youre waking up with a dry mouth. One of the most common causes of dry mouth is simply that the mouth falls open during sleep, which can inhibit the effectiveness of your CPAP treatment. Fortunately, there are three quick solutions for CPAP dry mouth that you can try right nowincluding checking for leaks, trying a chinstrap, or adding a heated humidifier.
Leaking masks over six months old should be replaced soon, but if your mask is brand new and showing signs of leaking, you may need to adjust the fit. If you use a full-face CPAP mask and havent observed signs of leaking, consider using a heated humidifier the added moisture can help relieve CPAP dry mouth. If you have a nasal mask instead, you may benefit from a chin strap to prevent your mouth from dropping open as you sleep.
Are you still experiencing dry mouth after trying these solutions? Try a mask designed for mouth breathing.
Causes Of Swallowing Air With Cpap
Some causes of aerophagia may include:
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Tips For Preventing Cpap Side Effects
Unwanted side effects can be discouraging, but dont give up on your sleep apnea treatment just yet. The following recommendations may reduce or completely eliminate some of the issues youre experiencing:
- Ensure You Have the Proper Mask Fit
- Double-Check The Straps Are Secured
- Clean Your CPAP Equipment Regularly
- Avoid Using Oil-Based Cleaning Products
- Add Humidification or Mask Barrier Products
- Consider Sinus Medication or Heated Tubing
- Use Water-Soluble Saline Gel on Nostrils
You may also find it helpful to wear your CPAP mask during the day while fully awake to get more comfortable wearing it. You should use this time to also make any adjustments to your mask fit and seal quality to reduce the overall irritation and the number of sores you may experience.
Chest Pain And Cardiac Arrhythmias
Chest pain is one of the most common occurrences in patients receiving CPAP therapy. One case report shows that some sleep apnea patients have coronary artery disease, heart block, or chest pain. Obstructive sleep apnea seems to have caused such issues due to transient nocturnal hypoxia or oxygen saturation known to occur in sleep apnea patients.
Furthermore, the case report stated that chest pain and cardiac arrhythmias tend to occur in sleep apnea patients who receive CPAP therapy but are also obese.
In sleep apnea patients that have a BMI of 30 and higher, the chance of cardiac issues is significantly higher than in sleep apnea patients with a normal BMI.
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Dental Oral Appliances Can Improve Sleep Breathing And Bruxism Problems
Corrective treatments for obstructive sleep apnea that do not involve surgery or a CPAP device do exist. One such example is Vivos DNA appliance therapy. The DNA promotes new bone growth in the mouth and nasal passageways to allow for better airflow through the mouth and improved night time breathing. The DNA works for adults by expanding the palate and surrounding jaw structure. Other adult anterior growth appliances exist such as the AGGA device and the Homeoblock appliance.
Other Possible Reasons For Excess Gas Formation In Your Stomach
Even if youre using a CPAP machine, the cause for increased gassiness may be different from that of the CPAP therapy. It is often associated with food, especially if you eat too fast.
Also, if you drink carbonated beverages such as soft drinks containing carbon dioxide, your stomach can fill with air. Other causes could be chewing gum or smoking.
Excess gas in your stomach can also occur with hyperventilation from anxiety, from chewing gum, smoking cigarettes, during strenuous exercising, and even when talking too fast.
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How Do Cpap Machines Cause Aerophagia
Continuous positive airway pressure devices deliver a constant stream of pressurized air designed to keep the airway open for people with obstructive sleep apnea . As muscles relax during sleep, the separation between the windpipe and the esophagus becomes weaker, allowing air to pass more easily into the esophagus. This air then travels down the esophagus into the stomach and sometimes the intestines.
An estimated 16% to 50% of CPAP users experience aerophagia symptoms, including both children and adults. Some researchers have also linked aerophagia from CPAP to symptoms of gastroesophageal reflux, or heartburn. The theory is that as swallowed air causes the stomach to bloat, the stomach pushes upwards, making it easier for stomach acid to rise up into the esophagus.
Clean Your Cpap Regularly
Make sure that your CPAP mask and machine are clean. It is important to make cleaning your mask, tubing, and water chamber a regular habit to avoid any bacteria or fungi buildup. The CPAP mask and humidifier chamber should be cleaned daily with mild soap and water. On top of this, you should soak all of the parts in vinegar and water, using one part vinegar to three parts water. Follow this routine once a week. There are also sanitizing machines, like a CPAP cleaner, that you can purchase if you are having trouble keeping up with this cleaning schedule.
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Helping Your Patients Sleep Better
- If your patients report sleep complains, assess for obstructive sleep apnea or other sleep disorders
- Explain that sleep in combination with moderate physical activity may promote remission and help prevent relapse
- Keep CSCC brochures and forms in your office to help foster awareness of sleep disorders in your patients
- If your patient screens positive for OSA and has a supportive clinical history, please refer them to Comprehensive Sleep Care Center for an evaluation
What Happens During Sleep Apnea
During sleep apnea, your breathing process gets disrupted or stops and then re-starts. The whole process is repeated again and again during sleeping hours. Snoring may or may not occur in conjunction with sleep apnea. Shallow Breathing is interrupted at frequent intervals during sleep. Multiple breathing pauses measured around 10-20 seconds occur during this time for over 100 times adversely affecting the sleep cycle.
Deep and uninterrupted sleep is required for regaining energy. Energy is not regained and re-filled when sufficient rest is not achieved. Light and interrupted sleep does not fulfill the requirements of human body.
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The Immune System And Gastrointestinal Diseases
Cytokines are key mediators of the immune system and work to induce and control inflammation. Research shows that the sleep-wake cycle is affected by the release of cytokines, specifically interleukin -1, IL-6, and tumor necrosis factor , which increase fatigue and promote sleep. Conversely, sleep loss has been shown to activate IL-1 and TNF.
There is a strong body of evidence that supports changes in cytokine release, specifically an increase in proinflammatory cytokines, in most gastrointestinal disorders. Changes in serum cytokine levels with these underlying diseases will affect sleep, as cytokines are major modulators of the sleep-wake cycle.- Vgontzas and colleagues studied 25 young healthy subjects and restricted their sleep from 8 hours per night to 6 hours per night for 1 week. The 24-hour secretion of IL-6 increased in men and women and TNF increased in men. This study supports the key role that cytokines play in the modulation of the sleep-wake cycle.
Serum levels of multiple cytokines, including TNF, IL-6, and IL-8, as well as levels of vascular endothelial growth factor have been shown to be elevated in patients with colorectal cancer. Cytokines are not only produced by tumor cells, but also produced by surrounding cells such as macrophages and mast cells, which are recruited by the tumor. Additionally, IL-6 is a growth factor for colon cancer and promotes tumor cell growth and survival.
When To See A Doctor
Children with secondary bedwetting should have complete physical examination with a pediatrician . A simple urine test will be done. In these tests, urine is examined for signs of a disease like diabetes. In most children with nocturnal enuresis, these test results come back completely normal. X-rays are usually not needed.
In addition to doing a physical examination, the doctor should take a complete medical history. This involves asking your child if he or she has any concerns, allergies, is taking any medications, has urinary symptoms , or other issues. The physician should also ask about sleep patterns, bowel habits, past health, and family health. Finally, the doctor may discuss any stressful situations that could be contributing to the problem.
There Are Many Possible Causes The Following Are Provided:
1. Your CPAP pressure may be higher than you require. The extra air has nowhere else to go thus, it is directed in to the esophagus and on to the belly.
2. Your pressure may be too low and inadequate to resolve your apnea event. In your effort to get more air into your lungs, you gulp air in quickly and it is forced into the esophagus instead.
3. You may have nasal congestion from a cold, flu or allergies. When your nose is stuffy, you may not be able to receive the CPAP air pressure you need, so you gulp air by mouth and down into the esophagus it goes.
4. You may be a mouth breather, who is wearing a traditional nasal mask. As your mouth falls open during sleep, the air that is delivered by CPAP and intended to enter the lungs may instead, escape via your mouth. Your apnea events are not being resolved and in your unconscious panic to breathe, you may suddenly have a choking sensation and gulp air in quickly, forcing it into the esophagus.
Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
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Kids Oral Appliances Are Available
Expanders and growth appliances will cure pediatric sleep apnea with proper attention to other conditions such as tongue tie and lip frenums. Appliances for children include Schwarz, ALF and Crozat. No one appliance is the best appliance. It depends on the growth needs of the child, what the child can tolerate and what appliance the dentist knows how to use.
Irritable Bowel Syndrome Functional Dyspepsia And Sleep
IBS is defined as abdominal discomfort associated with changes in bowel habits. Emerging research on the pathophysiology of IBS has included bowel dysmotility, small bowel bacterial overgrowth, autonomic dysfunction, visceral hyperalgesia, and microscopic inflammation. Functional dyspepsia refers to discomfort in the upper abdomen that may be described as postprandial heaviness, early satiety, bloating, nausea, and/or epigastric pain. Emerging insight into the pathophysiology of functional dyspepsia suggests that dysmotility, visceral hypersensitivity, and the immune system all play a role in the pathogenesis of the condition. IBS is a common disorder that affects a significant percentage of the general population. It is likely that patients with IBS and functional dyspepsia have increased nocturnal autonomic arousal, which may result in poor sleep. It has also been postulated that patients with IBS spend more time in REM sleep, which is characterized by arousals and stimulatory effects on colonic motility, which may lead to sleep disturbance.
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Nasal Dryness With Cpap
Waking up with a dry nose or congestion is common and usually indicates a lack of humidification. You may be wondering, Why am I congested from CPAP use?
The air from your CPAP blows through your nasal passages, which can cause irritation ranging from dry nose to nosebleeds. On the other hand, your nasal passages may be trying to create a barrier of protection by producing excess mucus, which causes you to become congested.
Whether your nose is dry or full of mucus, a heated humidifier can add the moisture your nasal passages need to reduce or eliminate the irritation. Already using a heated humidifier? Try a higher setting, an insulating cover for the hose, heated tubing, or add a soothing nasal spray to your care routine. Its important to correct this issue since dry, cracked, or bleeding nasal passages make you susceptible to infection.
If youre asking, What can I do for sinus and congestion relief? and looking for suggestions, try these items which may help dry nasal passages:
If youre still experiencing issues after trying these recommendations, you may need to visit your ENT for guidance.