Two and a half years after children with sleep-related breathing disorders had surgery to remove their tonsils and adenoids (glands in the back of the throat), they appear to sleep better than they did before the procedure but not as well as they did six months after, according to a report in the July issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals. Initial improvements in their behavior were maintained except when measured by an index of attention-deficit/hyperactivity disorder (ADHD) symptoms.

“Since the publication of our previous report demonstrating improvements in both sleep and behavior at six months after adenotonsillectomy for children with sleep-disordered breathing, there have been several articles that continue to support the impact of sleep-disordered breathing on neurocognitive development, behavior and quality of life,” the authors write as background information in the article. “Specifically, ADHD, hyperactivity and behavior have been shown to improve at six or 12 months after adenotonsillectomy in correlation with improved postoperative polysomnography [sleep monitoring] parameters regardless of which instruments were used to evaluate behavior.”

Julie L. Wei, M.D., of the University of Kansas School of Medicine, Kansas City, and colleagues analyzed long-term (2.4 to 3.6 years) follow-up data from 44 of 71 children with sleep-disordered breathing who initially participated in the six-month study. Before surgery, six months afterward and again at least two years afterward, parents completed a questionnaire assessing their child’s sleep and a multi-part parent rating scale with sections about ADHD symptoms, cognitive problems or inattention, hyperactivity and oppositional behavior.

“Our longitudinal study demonstrates that improvements in sleep and behavior may not be exactly maintained over time, but at 2.5 years after the surgical intervention, all parameters reported in this study except the ADHD index remained below baseline values,” the authors write. “Although speculative and based on extrapolation, this longitudinal model shows that even if the sleep-related breathing disorder subscale scores increase by 7 percent per year for many consecutive years, which is a statistically significant increase compared with baseline values, it would take nine or 10 years before the values could climb back to baseline values, if indeed a return to baseline values were likely.”

Because it is not a randomized controlled trial, the results do not prove the relationship between adenotonsillectomy and changes in sleep and behavior. However, the findings do support an association between the intervention and improvements in theses outcomes, the authors note.

Arch Otolaryngol Head Neck Surg. 2009;135[7]:642-646.

Source
Archives of Otolaryngology-Head & Neck Surgery

When you have sleep apnea, your doctor will prescribe a continuous positive airway pressure (CPAP) machine at some point to relieve the symptoms of the disorder. You have to use it all night, every night! Doing otherwise will only serve to make the symptoms come back, thus, worsening your condition.

Admittedly, this is easier said than done especially with the initially unwieldy CPAP mask. Fortunately, there are some things that you can do to live, maybe even love, it. After all, a good night’s sleep for everybody after months of the worst of sleep apnea symptoms is good!

Use it Outside the Bedroom

You have to gradually adapt to the feeling of having a CPAP mask on. Thus, wear it around the house as much as you possibly can - while watching television, reading books and newspapers, even writing your letters. This way, you accustom yourself to the feeling of the mask hugging your face albeit without the forced air pressure.

Don’t worry if it makes you look like an alien from the far reaches of the universe. It will only ad to your worries if you worry too much about your vanity. The important thing is that you will be relieved of your sleep apnea, which will also bring relief to your family and friends. Yes, it’s not just you who is suffering - the people who care about you do, too.

Use it During Naps

Slowly but surely, you must wear the mask with air pressure blowing through it especially during your naps. This way, you get accustomed to the whole setup of the CPAP machine. Of course, the machine itself is relatively quiet so you won’t have much difficulty living with it. The CPAP mask is harder to live with because it is plastered unto your face!

When you have gotten used to the mask during short naps, it will be easier to translate it into longer sleep periods at night. Soon, you might even sleep with the mask on as if there’s almost nothing there! Emphasis is, of course, on almost.

Use the Right Size and the Right Mask

Some sufferers complain that their masks are either too tight or too loose. This is a minor problem considering that there are many types and sizes of masks available in the market today. The trick is in finding the CPAP that you can live with. Or at least, sleep comfortably with.

Mask styles range from full-face masks to masks with nasal pillows. Each one has its advantages and disadvantages so it’s advisable to experiment with the different styles under the guidance of your doctor.

Mask size is very important, too. Often, problems arise not so much from the style of the CPAP mask but from the size of it. As much as possible, fit the mask before purchasing it just to be sure. Or better yet, opt for one with adjustable straps in a size that you know will fit you.

Indeed, living with a CPAP mask can be easy with the right style and size, not to mention the right attitude and approach to its use. Besides, it’s better to be alive and breathing with a CPAP machine than being alive but breathing through a respirator, right?

Sleep apnea is a disorder characterized by breathing interruptions during sleep. Basically, if you have this condition, you are - in a way - forgetting to breathe.

The causes of types of sleep apnea are clearly structural in nature. This means that an abnormality in one of your body parts will cause you to have this condition. In Obstructive Sleep Apnea (OSA), it is the collapse of your throat muscles (and the inability of the dilating muscles to keep the airway clear) that causes you to skip a breath. In Central Sleep Apnea, it’s a misfiring in your brain that causes it. Simply put, your central nervous system forgets to tell you to breathe.

The usual approach to treat sleep apnea - in Toronto and elsewhere - is the use of a CPAP machine. This introduces a special kind of pressure in your airway to keep your muscles from collapsing. This pressure is called the continuous positive airway pressure, or in short, CPAP.

How do you prevent sleep apnea? You may ask. Well, there a number of prevention strategies on the list, but since this kind of condition is largely structural, efforts need to be doubled for you to truly stay away from a CPAP machine.

There are a number of risk factors associated with it. Meaning, you are more at risk to developing this condition if you satisfy any of the following conditions:

a. You are male.

Studies reveal that sleep apnea occurs more often in men than in women. Statistics in the United States shows that 4% in men but just 2% in women display the symptoms of OSA. With this, you can infer (albeit loosely) that men are in need of a CPAP machine more. They would even need CPAP replacement parts - in Toronto or elsewhere - more.

b. You are between ages 40-60.

It is more common among individuals who are aged between 40 and 60. This does not discount the fact, however, that also occurs in children and infants. Thus, it’s not safe to say that those aged below 40 would never ever be in need of a CPAP machine.

c. You are obese.

If you are obese, you are more likely to develop sleep apnea - and consequently to need a CPAP machine. This is especially true if fatty tissues are deposited around the abdomen.

d. You have these physical characteristics: a large neck, a narrow upper jaw, a receding chin, or a larger tongue, among others. All these “structural abnormalities” disturb the natural flow of air, and the normal functioning of your airways.

Remember however, that risk factors are not causes. A large neck, for instance, does not necessarily cause sleep apnea. You cannot go pointing to an overweight male and tell him that his size will cause substantial disturbance in his sleep. You cannot tell a 60-year old man that his age will cause him to develop it.

Risk factors merely state a correlation - a relationship between two factors. Risk factors only increase a person’s chances of getting this condition. No more, no less.