by James Hubbard, M.D., M.P.H.

Emergency rooms are busy places, sometimes to the breaking point,  as anyone who has been there can attest.  The CDC has new data on medical care visits, in the U.S., from 1996-2006.  The report that is getting the most buzz is the National Hospital Ambulatory Care Survey: 2006 Emergency Department Summary stating that visits to emergency rooms  have risen 32 percent  (no surprise) at the same time that several hundred ER’s around the country have closed, mostly due to money problems.  This report raises concern that facilities are getting stretched to their limit in treating true emergencies in a timely fashion.  Their information answers some questions while raising others.

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by James Hubbard, M.D., M.P.H.

A new study reiterates common medical knowledge that sleep apnea increases your risk of death. The study in the Journal Sleep monitored 1,522 people, aged 30 to 60, over an 18-year time period and found that the worse the “sleep disordered breathing,” as they call it, the higher the risk. The worst breathers had an increased risk of 3.8 times those with no problems breathing while asleep.

The authors took into consideration age, sex and weights of the participants. Increased risk of cardiovascular-related deaths was a major contributing factor for the increase in death. It did not matter if the participants complained of daytime drowsiness. The causative factor was whether the person was stopping his/her breathing for a few seconds anywhere from five to more that 30 times a minute. This led to a drop in the blood oxygen level.

If sleep apnea is potentially deadly, then how do you know if you have it, and is current treatment effective?

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by James Hubbard, M.D., M.P.H.

I hope you enjoy our video. We have worked long and hard to create and edit this. My managing editor, Leigh Ann Hubbard, and director of photography, Gary Otte, have done most of the work.

After going through the experience myself, I wanted to give people a feeling of what it is really like. I put the test off for a while because I thought I would miss a day’s work before and after and be exhausted due to lack of sleep that night. That just was not the case at all. Sure, there are a lot of wires, but they are bunched up out of the way. It was really worth it for me.

Has anyone else experienced a sleep lab?

by James Hubbard, M.D., M.P.H.

Periodically, people come to my office because they’ve looked in the back of their mouth, for whatever reason, and seen large bumps. Freaked out and thinking they have some awful disease, they come to await the dire diagnosis. So what do I tell them?

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by James Hubbard, M.D., M.P.H.

Having a good family doctor whom you trust is an efficient way to fight high health costs. You can go for most of your family’s medical treatment. They will know you, answer questions and refer you when needed. In addition, your medical information can be kept in one place, you will have someone to keep up with your tests (less likely to be redundant and drugs (potentially less interactions of meds).

But will there be enough family doctors to treat us in the future?

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by James Hubbard, M.D., M.P.H.

The last time I posted about my sleep apnea diagnosis, I was just starting to use the cpap machine. It blows air through the mask while the mask forms a seal around my nose. This keeps my airways open during my sleep.

The first week was pretty bad. It wore my patience thin. I woke up about 6-8 times a night just getting used to the mask. Wearing it made me feel like was about 10 feet under water due to the pressure. My ears popped, and I felt just as fatigued as without it. Knowledge did help. I knew that it might take several weeks of getting used to, and that not treating the sleep apnea increased my risk of heart disease and stroke significantly.

Finally, on about day 8, I actually saw improvement. I slept through the night, and felt a little better the following day. Now I am encouraged. I think I may be getting used to this, and it might help.

By James Hubbard, M.D., M.P.H.

I went to get my sleep lab test results from my pulmonologist (lung doctor) but only the preliminary report was available. My AHI (apnea-hypopnea index) score was 68. This is how many episodes of apnea (stop breathing) and hypopnea (decreased air movement to the lungs) I had per hour. An AHI over 30 is considered severe.

He ordered a cpap (continuous positive airways pressure) machine. It keeps my airways open while I am asleep so that I breathe properly. Within 2 days the company had called and I went in to be fitted. I would suggest you do this rather than just having the cpap mailed to you.

At the oxygen supply company I tried on several types of masks to see which one I liked. There were masks that covered the mouth and nose along with nasal biprongs that just seal your two nostrils. I chose a mask that covers the nose with a gel foam seal. It has a connector that rotates 360 degrees that then connects to airway tubing. The tubing consists to the main machine, which measures 8 1/2 inches wide, 8 1/2 inches long and 4 inches tall. Everything is portable enough for travel.

The main machine plugs in to a wall outlet and is quiet. It has a filter, heater and humidifier. The company programmed it to the proper amount of room air pressure (found during my sleep study) that blows into my nose (to keep my airways open). She said it may take a few weeks to get used to this pressure. I tried it. The air pressure stops blowing when i breathe out. It will take a little getting used to that aspect because I note some initial resistance to the initial part of my expiration. I will need to clean the tubing every few days and the filter every month.

In a week or two I will let you know how it is going.

By James Hubbard, M.D., M.P.H.

I forgot to mention some more hookups. There was a small microphone taped to the front of my neck to monitor snoring and a wire attached to both lower legs to watch for leg movements.

I took a sleeping pill (Ambien) that I had brought with me. They said it was ok to do. They wanted me to get some sleep or the testing was useless. I had very little trouble getting to sleep. The attached wires were not uncomfortable but it did take a little effort to make sure the wires to the portable device did not get tangled when I turned over.

During the night the nurse came in to hook me up to a CPAP (Continuous Positive Airway Pressure) machine. She said her tests were showing that I was having some sleep apnea. Apparently my breathing would slow or stop. This lowered my blood oxygen content. The reason for this was my airway would relax to the point of obstruction. After a few seconds my body would realize this and I would wake up a bit to correct it. Since this happens many times during the night I don’t get a good night’s rest and I wake up tired (also bad for the heart). The CPAP seals over my nose and emits enough air pressure to keep my airway open at all times. She had demonstrated this to me before bedtime and told me she would use it if she detected trouble.

With the CPAP on it was a little hard to get back to sleep, and I woke up a few times to adjust it. She actually fine-tuned the air pressure in her office.

At 6:15 AM she came in, unhooked me and brought in breakfast. I was welcome to shower. She said I was a very busy man at night with a lot of leg jerking, snoring and apneic episodes.

The only residual from my ordeal was some spots of gel in my hair. The physician will go read the reports, and we will go from there.

I will let you know.

By James Hubbard, M.D., M.P.H.

I am back from my overnight sleep study and it was pretty easy.

I arrived at 7:30PM and the nurse put me in the sleep room. It looked a lot like a nice motel room. It was large with a comfortable king-size bed, table and chairs, large leather chair, television with cable and a large bathroom with a shower, sink and toiletries. There was also an adjustable climate control and a closet.

I had to fill out a little paperwork and get my sleep clothes on, then the nurse came in to hook me up. This took about 30 minutes. I watched a video on sleep apnea while she was doing this. She scrubbed some spots to get off the body oil so the tape would stick. She taped a few wires to my scalp and forehead (to measure brain waves), to my jaw areas (to measure teeth grinding and gerd), to my temple areas (to measure eye activity) and to my upper chest (to measure heart activity). Then she put a strap around my upper chest and one around my abdomen (to measure breathing effort). These wires (20 of them) were then hooked to an portable apparatus about the size of an iPod. Next I was told to watch tv or read until I was ready for bed.

I called her to my room around 10:00 to tell her I was ready for bed. She hooked up the “iPod” to another machine. She also taped a leather strap to my index fingertip, and taped some nasal biprongs to go inside my nose. She said that this looked liked an oxygen hookup, but was really to monitor my breathing. I was told to call her if I needed to get up to go to the bathroom. The whole room was wired for sound and there was a small infrared camera on the wall to moniter me during the sleep. She turned out the light and left.\

(to be continued)

by James Hubbard, M.D., M.P.H.

I am having a sleep study done tonight. I will tell you how in went from a patient perspective.

I have been having feeling sleepy in the daytime after a good night of snoozing, and my wife says I snore very loudly (probably exaggerating). The test will look for signs of sleep apnea.

A lab employee called today to ask if I had any questions. She says I should be there by 7:30 PM to do the paperwork and get hooked up to all of the wires. I should eat dinner beforehand, bring bed-clothes and be in bed around 10:00 or 11:00. Apparently they will kick me out around 6:30 AM.

I asked if people have trouble fallling asleep with all of the wires and she said I could take a sleeping pill, such as Ambien, if I wish.

Will follow up tomorrow.