Sleep Apnea

Sleep apnea is a sleep disorder that is characterized by repetitive episodes of upper airway obstruction. While it can lead to daytime drowsiness and lethargy, it can be potentially life threatening if left untreated. Sleep apnea is a condition where the blockage of the airway prevents air from getting into the lungs. This leads to snoring at regular pace and short periods of time where the breathing ceases. Apnea is the lack of spontaneous breathing. The patient may become limp and lifeless, have a seizure or turn bluish.

This is followed by sudden attempts to breathe with a loud gasp and snort. Consequently this condition affects the sleep and the person is not well rested. Besides the oxygen levels remain low leading to drowsiness and tiredness. Severe sleep apnea is likely to cause pulmonary hypertension. A large neck or collar size can be one of the causes of obstructive sleep apnea. Sleep apnea can be potentially life threatening since it can cause heart attacks or strokes.

Prolonged apnea is called as respiratory arrest. In children, this can quickly lead to cardiac arrest in which the heart stops beating whereas in adults, cardiac arrest usually is the first to happen followed by respiratory arrest. In adults, common causes of apnea and respiratory arrest include choking, drug overdose, near-drowning, head injury and cardiac arrest. In children, the causes may be different - prematurity, swelling of the airways, choking on a foreign object, seizures, regurgitating food or near-drowning.

Obstructive sleep apnea: This is a condition where tissues of the body obstruct the airways during sleep. Obstructive Sleep apnea is common in obese men who sleep on their backs. Other factors include Smoking, heavy alcohol consumption, emphysema, and an inherited tendency toward a narrowed airway.

Diagnosis of sleep apnea

• ECG to show arrhythmia during sleep
  
  
• Echocardiogram to study the heart functioning
  
  
• Thyroid function tests
  
  
• Sleep studies
  
  

Sleep apnea treatment

Treatment for sleep apnea can range from lifestyle modification, medication to even surgery in some cases. Weight loss and avoiding smoking are some of the changes that may need to be introduced into the lifestyle to prevent episodes of sleep apnea.

The risk of obstructive sleep apnea choking can be reduced by avoiding alcohol, tobacco smoking, tranquilizers and sedatives before bed. There is a surgical procedure called as LAUP (Laser Assisted Uvula Palatoplasty) where removal of the offending tissue is done to allow for unobstructed airflow.

Sleep apnea is often treated with surgery that removes the cause of obstruction. Enlarged tonsils or adenoids are removed to cure sleep apnea. Another sleep apnea surgery is UPPP - Uvulopalatopharyngoplasty, which involves removal of excess tissue from the back of the throat. This is done to increase the size of the upper airway. Usually it involves removal of the soft palate that hangs down the back of the throat. Such sleep apnea surgery is performed under general anesthesia. These days it is done under local anesthesia with laser assistance. Nasal reconstruction surgery straightens the nasal septum and shrinks the nasal tissue, thereby improving nasal airway. Changing the bony structure in the upper airway allows air to move more freely, especially during sleep.

The CPAP (Continuous Positive Airway Pressure) mask uses air pressure to push the tongue forward. This opens the throat to air and reduces snoring and apnea. It does not cure sleep apnea but relieves the patient by preventing recurrent episodes. Personalized sleep apnea masks are created to fit exactly on your face, nose, cheeks, lips and forehead. The sleep apnea mask is secured well so that there are no leaks.

Sedatives

Antihistamines

Antihistamines are widely used for allergies and motion sickness. As they exhibit properties that can indirectly induce drowsiness, there is a class of antihistamines, sold as OTC sleeping pills. However, the American Academy of Sleep Medicine warns that such pills should be used only occasionally. Beware that there is a price to pay for buying OTC antihistamines. Some OTC sedatives combine antihistamines with pain relievers and some combine it with alcohol.

They can induce abnormal muscle spasms. Other side effects are blurred vision, constipation, diarrhea, nausea and vomiting, dry mouth and general dehydration. Therefore she needs to consume plenty of water if she is taking any antihistamine. In elders and children, antihistamines can cause nervousness and insomnia. Similarly, asthmatics should steer clear of antihistamines as these can aggravate their condition. They can affect the behavior of the fetus in the womb. Antihistamines also interfere with lactation. Be warned that OTC antihistamines should never be clubbed with alcohol or other sedatives.

Although it is construed that some antihistamines are non prescription sleep aids, and they are more sedating than prescription hypnotics, beware that their effectiveness may decrease over time. More importantly, OTC sedative is only meant for short-term insomnia and by and large the long term effectiveness and safety of the OTC drugs is questionable. However, for transient insomnia or insomnia based on illness or depression, antihistamines can be an effective OTC tool.

Sedative antihistamine list includes (the following list also contains suggested dosage for an adult. Always take the medications e.m.p (ex modo prescripto as directed by the physician):

• Chlorpheniramine (Chlor-Trimeton) 4 mg every 4 to 6 hrs; maximum dose: 24 mg/day
  
  
• Cyproheptadine (Periactin) , 4 mg at bedtime
  
  
• Clemastine (Tavist), 50-100 mg every 4-6 hours, not to exceed 400 mg/day and it is supplied in table form chewable
  
  
• Diphenhydramine (Benadryl), as a night sleep aid to be taken 30 minutes before bedtime, and the dosage is 50 mg for adults
  
  
• Promethazine (Phenergan) Sedation: 25-50 mg orally or 50 mg rectally
  
  
• Hydroxyzine (Atarax, Vistaril), oral sedation dosage 50-100 mg, IM 25-100 mg. Intravenous (IV), subcutaneous and intra-arterial administrations are not recommended as these can cause thrombosis and digital gangrene.
  
  

These come in various brand and trade names and they can be taken as tablets, syrups or nasal sprays. Droplet form for use in the eyes is also available. The effects of these antihistamines including drowsiness, dizziness, headache, loss of appetite, vision changes, irritability, dry mouth, stomach upset should subside, when the body begins to adjust with the medication. If these side effects continue, it is better to contact the medical practitioner. Sedative antihistamines may be taken with food and milk. Sustained release low acting tablets can be swallowed whole as chewing the sustained release long acting tablets may destroy the action and increase the side effects. Chewable tablets can be chewed thoroughly and swallowed. Suspensions should be shaken before food consumption.

Melatonin

This is a hormone produced by human body – by the pineal gland, a pea-sized structure at the center of the brain. This regulates sleep and wakefulness. Taken as a supplement, melatonin helps to reduce delayed sleep syndrome. This also improves sleep quality and lengthens the period of sleep. Day time alertness also seems to improve when this is taken. Melatonin can treat insomnia without altering the sleep pattern of the individual. It also does not impair any performance related skills.

This may help elders with insomnia as the amount of melatonin produced in the body seems to decrease as one gets older, although it is not recommended for chronic insomnia. Melatonin works on the circadian rhythm – the biological clock that regulates our sleep and wake cycles. Many become melatonin deficient due to age, work schedules and stress. Melatonin supplements are a quick way to adjust the lack of melatonin in the body and rebalance the sleep cycle. These are available OTC and when used in conjunction with herbs like chamomile and lemon balm, help lull the body to sleep acting as a true sedative.

Although Melatonin shows good effects for the treatment of insomnia, if used in excess, this sedative can produce side effects including sexual irregularities, mood swings and depression. Although by and large safe when used in moderation, it is unsafe for small children and pregnant women to use melatonin supplements. It is also not recommended for those with lymphoma, extreme allergies, depression, rheumatoid arthritis, auto immune diseases and for cancer patients. Some melatonin sedatives include:

• clonazepam (Klonopin)
  
  
• lorazepam (Ativan)
  
  
• phenobarbital (Donnatal)
  
  
• zolpidem (Ambien)
  
  

As such Melatonin can cause sleepiness and drowsiness, and if taken with sedatives that cause sleepiness, then too much of sleepiness can result. Research indicates that quick release Melatonin can be more effective than sustained-release formulations, especially when used as sedatives. Intramuscular injections of 20 mg of Melatonin are also available.

SAMe

This is also found naturally in the body. This OTC aid can not only help to sleep but also treats depression and chronic fatigue by promoting serotonin production in the body. Unless consumed in large quantities, SAMe has no known side effects.

Antidepressants used as sedatives

Although the FDA has not approved the use of antidepressants as sedatives, there are those who believe that insomnia is related to depression. As with any other medication for depression, there is a significant risk of suicidal thoughts particularly in adolescents and children. Approximate dosage of antidepressants s.o.s (si opus sit only if there is a need) :

Citalopram 20 mg
Escitalopram 5-10 mg
Fluvoxamine 100 mg
Fluoxetine 20 mg
Paroxetine 20 mg
Sertraline 50-75 mg
Venlafaxine 75 mg
Donormyl sleeping pills are available without prescription and they are approved by the FDA for non-prescription. They are used in the treatment of insomnia. 25 mg of Donormyl is the strongest non-prescription sleeping pill. Possible common side effects of antidepressant sedatives include diarrhea, dizziness, headache, insomnia, rash, vomiting, blurred vision, decreased appetite, cold symptoms, nervousness, cramps, hallucinations, hair loss and decreased coordination.

OTC sedatives side effects

Although OTC sedatives can be effective for an occasional sleepless night, the longer you take them, the less they are likely to make you sleepy. OTC sleep aids can leave you feeling groggy and unwell the next day. This is like the 'hangover' effect. Much remains unknown about the safety and effectiveness of OTC sleep aids.

Dizziness and forgetfulness, clumsiness, feeling off balance, dry mouth and throat are some common side effects. Serious risks of OTC sedatives include severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal tendencies, sleep-related complexities such as sleep-walking, sleep-driving, and sleep-eating. If any unusual sleep-related behavior is exhibited, consult the doctor immediately.

Over-the-counter sedative tips

• Consult the doctor before taking OTC sedative, although you do not need the doctor concurrence to buy an OTC drug. This is because your doctor can make sure that the sedative does not interfere with other underlying medications.
  
• Certain OTC drugs are not recommended for those with glaucoma, asthma, chronic pulmonary disorders, liver diseases and urinary retention.
  
• Remember that OTC sedatives are only a temporary solution for insomnia and they are not intended to be used for longer than about two weeks.
  
• Persistent insomnia is a symptom of an underlying medical or psychological problem. These cannot be cured with OTC sedatives. It is better to learn about safer and effective way of end sleepless nights.
  
• Never mix alcohol with sedatives and this can increase the sedative effects of the medication.
  
• Combining medications such as OTC sedatives and pain relievers and allergy medicines is very dangerous.
  
• Do not drive or attempt any other activity that may require alertness while taking a sedative.
  
• Over a period of time, you may build up intolerance to sedatives and this can in turn lead to more side effects.
  
• You may also come to rely on sedatives and will be unable to sleep without them.

Electrooculography

Oculomotor is associated with the movements of the eye. These eye movements are both efferent and afferent in nature as they are regulated by one of the significant cranial nerves called the oculomotor nerve. These movements are recorded by using a technique called electrooculography. In most cases, this instrument is used to detect the blink amplitude and also drowsiness associated conditions. The relationship between the electrode potentials of the instrument and eye movements was first discovered and explained in 1849 by Du Bios Reymond. Significant research on this concept lead to the discovery of potential differences that exist between the cornea and retina of the eye.

The electro-oculography technique plays a significant role in the determination of resting potential of the eye. Over the years this technique has been extensively applied to identify the cause of drowsiness which is responsible for many accidents. The movements of the eye such as left, right, up and down are related to signal transmission mechanism which is powered by the brain through the oculomotor nerve. The electrooculography method detects the depolarization and repolarization differences caused both in the retina and cornea as a sequence which looking at an image and responding to it subsequently. These mechanisms are used to create a human computer interface system.

The tracking system was developed by administering the electrooculography technique. This system evaluates the distance of the person's gaze. The eye tracking and blink examinations performed using this method are essential in the determination of efferent and afferent activity of the nerves associated with the brain. The mechanism and categorization of the eye blink is also performed as it determines the neuromuscular activity of the respective system. An important observation in this evaluation is the measure of spontaneous blink time period. Under normal conditions spontaneous blinks are quick and are related to the reflex response. The duration of this blink is measured by using electrooculography to identify the presence of underlying Neuromuscular conditions. The electrooculogram values with respect to the movements of the eyes are linear in nature and hence the detection of wave form is significant.

In some cases, the electrooculography technique is used to determine the extent of alertness in person pertaining to eye movements and response to external stimuli. Electrodes are placed on the forehead and facial areas of the person to detect the activity of the oculomotor response. The activity of the eye in relation to the graph displayed on the monitor varies in different movements of the eye.