Treatment Options for OSA

In this fourth FAQ video in our series, Dr. Popper discusses several available treatment options for patients suffering from OSA. This series is designed to address frequently asked questions regarding obstructive sleep apnea and other sleep disorders. If your question has not been answered, come back soon as we’re continually adding more videos to this series. You can also subscribe to our YouTube channel to be alerted when a new FAQ video is posted. If you need information quickly, feel free to contact us here on the site or on our Facebook Page. We’ll get back to you as quickly as possible.

How is OSA Treated?

There are a variety of treatments available for obstructive sleep apnea syndrome. Weight loss is always encouraged for those patients who are overweight. In patients who’s sleep apnea occurs predominately on their back, they can be trained or taught to sleep on their sides and this is often effective in treating their obstructive sleep apnea syndrome.

In addition, various surgical procedures can be performed by either ear, nose and throat doctors, or dentists, to remove some of the obstructing tissues in the upper airway. Dentists also make what are known as oral appliances, which are devices that are placed within the mouth to either hold the tongue down or advance the lower jaw forward, bringing the tongue away from the back wall of the throat.

A newer device, known as Provent Therapy, provides positive airway pressure through the use of a small valve that is inserted through the nostrils and held in place by a bandage-type device.

The treatment of choice for most cases of obstructive sleep apnea syndrome is a device called Continuous Positive Airway Pressure (CPAP).

Dr. Ronald A. Popper is a Board Certified sleep specialist. The Southern California Pulmonary and Sleep Disorders Medical Center in Thousand Oaks, California, is a four bed, state of the art, fully accredited sleep disorders center. Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including obstructive sleep apnea, restless limb syndrome, insomnia, narcolepsy, and others.

Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of sleep apnea.

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Diagnosing the Presence of OSA

In this brief video explanation, Dr. Popper goes over the typical steps taken by physicians to determine whether or not a patient is suffering from OSA. This third video in the series to address frequently asked questions regarding sleep disorders is short and to the point. If this video doesn’t answer your question, come back soon as we’re continually adding more videos to this FAQ series. You can also subscribe to our YouTube channel to be alerted when a new FAQ video is posted. If you need information quickly, feel free to contact us here on the site or on our Facebook Page. We’ll get back to you as quickly as possible.

How is OSA Diagnosed?

The first step in the diagnosis of sleep apnea is to obtain a thorough history and physical examination with concentration on sleep related symptoms, which can be performed by your primary care physician or a board-certified sleep medicine specialist.

Once the suspicion of sleep apnea is made, a sleep study is the next step. There are two types of sleep studies. There is a screening version, known as a home sleep study, which monitors a few parameters pertaining to sleep. And there is the more comprehensive sleep study, known as a polysomnography examination, which is performed in a sleep center. There are advantages and disadvantages to both a home sleep study and an in-sleep-center polysomnographic evaluation.

Dr. Ronald A. Popper is a Board Certified sleep specialist. The Southern California Pulmonary and Sleep Disorders Medical Center in Thousand Oaks, California, is a four bed, state of the art, fully accredited sleep disorders center. Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including obstructive sleep apnea, restless limb syndrome, insomnia, narcolepsy, and others.

Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of sleep apnea.

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An Explanation of the Causes of OSA

This is the second video in a series designed to address some of the most frequently asked questions regarding sleep disorders. If this video doesn’t answer your question, visit again later because we’ll add more videos to this FAQ series. You can also subscribe to our YouTube channel to be alerted when a new FAQ video is posted. If you need information quickly, feel free to contact us here on the site or on our Facebook Page. We’ll get back to you as quickly as possible.

What Causes OSA?

Upper airway tissue obstruction can occur from a deviated nasal septum, which is the cartilage that runs up and down the middle of the nose, or from enlargement or hypertrophy of the turbinates, which are these ridges that occur within the nose. Some patients will have a droopy soft palate, which is the structure in the back of the throat. The uvula is often enlarged. That’s the little “punching bag” that occurs in the back of the throat. The tonsils can be enlarged. And the tongue is often enlarged.

When the tongue is enlarged, it may come up very close to the soft palate. The soft palate may droop down nearer the tongue, and you may have very little opening in the upper airway.

From the side view, this structure drops down, like so, creating blockage in your airway. In addition, in patients with an overbite where the lower jaw is set back, the tongue is then pushed into the airway, further compromising the obstruction of the airway. If you have lesions on the vocal cords, they may also obstruct the airway.

Dr. Ronald A. Popper is a Board Certified sleep specialist. The Southern California Pulmonary and Sleep Disorders Medical Center in Thousand Oaks, California, is a four bed, state of the art, fully accredited sleep disorders center. Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including obstructive sleep apnea, restless limb syndrome, insomnia, narcolepsy, and others.

Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of sleep apnea.

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Sleep Apnea – A Definition

With this video, we begin a series designed to answer the most frequently asked questions regarding all topics related to sleep disorders. If this video doesn’t answer your particular question, come back often as we’ll be adding more videos to the FAQ series. You can also subscribe to our YouTube channel to be alerted when a new FAQ video is posted. If you need information quickly, feel free to contact us here on the site or on our Facebook Page. We’ll get back to you as quickly as possible.

What is Sleep Apnea?

Sleep Apnea is a disorder manifest by snoring and holding of the breath. Patients are often unaware of the breath hold. They often will awaken with a snort, a gasp, or a grunt or choking sensation. They still may not be aware of this and these may only be brought to their attention by a bed mate or spouse.

We hope this video has been informative in helping you understand what sleep apnea is all about. If you have symptoms of sleep apnea, please visit your primary care physician or see a board certified sleep specialist at an accredited sleep center. And always remember, sleep well tonight for a better day tomorrow.

Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including obstructive sleep apnea, restless limb syndrome, insomnia, narcolepsy, and others.

Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of sleep apnea.

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Theravent May Be The Solution For Many

Theravent is a disposable nightly snoring device that is FDA approved to reduce or eliminate snoring. It has been proven to reduce snoring in separate clinical studies and is available without a prescription. On average, successful Theravent users reduced snoring by 76%, as measured using a decibel meter worn on the forehead. Theravent uses the same patented MicroValve Technology that was previously only available with a prescription.

Lisa Sigell of CBS2 news returned to Southern California Pulmonary and Sleep Disorders Medical Center for a second interview with me. This time the subject was severe and chronic snoring. Snoring is seen as a comical issue to many people, but it can disrupt a family’s rest and lead to more serious health problems. Snoring itself may be an indication of an already existing health issue that needs medical attention. I discussed some new treatments with Lisa.

LOS ANGELES (CBSLA) — It’s a problem that affects 60 percent of people at some point in their lives: snoring.

CBS2′s Lisa Sigell reports now there’s a new option for those seeking some silence – and you don’t have to see a doctor to get it.

Cheryl Belfer has lived with her husband Milt’s snoring for over three decades, but never showed him how bad until we asked her to take some video of his not-so-silent nights.

“It’s like a freight train coming throughout the bedroom,” said Cheryl. “It’s almost like…I can’t believe a human can produce those sounds.”

Milt said he has tried to stop snoring using various methods, including even getting a mouthpiece at one point – but nothing worked until recently when a new over-the-counter treatment became available.

It’s called Theravent, an FDA-approved treatment that sleep specialist Ron Popper says patients call a “miracle”.

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Narcolepsy Symptoms and Treatments

Today I’d like to talk to you about a sleep disorder called narcolepsy. Narcolepsy is manifest by a symptom complex consisting of excessive daytime sleepiness, cataplexy, sleep hallucinations and sleep paralysis. All of these symptoms do not need to be present to make a diagnosis of narcolepsy, but when excessive daytime sleepiness and cataplexy are present the diagnosis can be made clinically. In the absence of cataplexy a sleep study and another type of study called a multiple sleep latency test are required to confirm the diagnosis.

So what is narcolepsy? Let’s look at the components of narcolepsy. Daytime sleepiness can be found in many disorders such as sleep apnea, periodic limb movements during sleep, shift work, it could be the result of medication or other medical disorders so daytime sleepiness by itself is not a sufficient symptom to make a diagnosis of narcolepsy.

What is cataplexy? Cataplexy is the sudden and uncontrollable loss of muscle tone that can occur either out of the blue or in response to some kind of trigger. The two most common triggers being laughter and anger. But any strong emotion, be it joy, fear, being startled, getting into an argument, even during climax during sexual activity, any strong emotion can set off this sudden loss in muscle tone. This can be manifest by the complete dropping to the ground which is the classic textbook form of cataplexy, which is rarely seen to much more subtle manifestations such as the sudden shaking of a hand while holding a coffee cup, slurring of your speech, a little blurring of your vision.

If you’re working on a computer your fingers might not move quite as well as they ordinarily move. These symptoms can last, literally, from seconds to as long as 20 to 30 minutes. Patients come out of their cataplectic episodes often feeling drained but often they will also be as wide awake as they were just prior to the episode.

Sleep hallucinations or paralysis are just as the name implies. Patients will have a hallucination seeing or hearing or smelling an object or a sound or sensation that they know isn’t there as they are falling asleep or right as they are waking from sleep. More commonly are sleep paralysis episodes where, again, as the name implies, patients are paralyzed. They’re wide awake after they’ve awakened int he morning or just as their falling asleep. They are aware of their surroundings but are completely unable to move. These episodes can last for just a few seconds or even up to 10, maybe 20 minutes and the patient will come right out of it. These are completely benign but they may be very, very frightening to the patient.

Narcolepsy is not as rare as we once thought it was. Narcolepsy is more common in males, compared to females. The peak onset of symptoms occurs in the teenage years. We have seen symptoms occur as young as 5 or 6 year old children and patients who are well into their 30’s. Patients who first present with symptoms of narcolepsy after the age of 40 must rule out other sleep disorders first before considering a diagnosis of narcolepsy. And if one takes a very, very thorough history, retrospectively, most patients will demonstrate symptoms way back into their teenage years or into their 20’s.

In children who complain of daytime sleepiness, after ruling out other causes of daytime sleepiness, narcolepsy is the diagnosis until proven otherwise. In years past, stimulants were the only medications that were available to treat narcolepsy and they only treated the symptom of excessive daytime sleepiness. Today we have many choices in the treatment of narcolepsy. To treat the symptoms of inturrupted nighttime sleep and cataplexy, we have a drug known as sodium oxybate or Xyrem.

To treat the cataplexy, tricyclic antidepressants are also still used by some physicians. To treat symptoms of daytime sleepiness we will often use drugs known as provigil, modafinil, nuvigil also known as armodafinil and older medications such as dexadrine and ritalin and adderall are also available to treat symptoms of daytime sleepiness.

I hope this video has been informative in helping you understand what narcolepsy is all about. If you have symptoms that are suggestive of narcolepsy, please visit your primary care physician or see a board certified sleep specialist at an accredited sleep center. And always remember, sleep well tonight for a better day tomorrow.

Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including narcolepsy, OSA, restless limb syndrome, insomnia, and others.

Watch the video above, and then Click Here to schedule an appointment with Dr. Popper if you feel you exhibit symptoms of narcolepsy.

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Treatments for Restless Leg – Restless Limb Syndrome

In this session, I’d like to discuss some of the treatment options for restless limb syndrome. The primary treatment class of medications for this are known as dopamine agonists. This is a class of medication used primarily for the treatment of Parkinson’s Disease. When using these medications for the treatment of Restless Limb Syndrome we use them in a much smaller dose than we would use for Parkinson’s Disease and therefore the potential side-effects are much less

The most common drugs within this classification are Mirapex or pramipexole and ropinirole or Requip. The most common side-effects that occur when using these medications include headache or nausea, increased sleepiness or fatigue, and some patients feel drugged or have difficulties upon rising the next morning. There’s a black box warning that talks about a very uncommon side-effect which is sudden uncontrollable sleep attacks. This is almost never seen in patients with Restless Limb Syndrome and has primarily occurred in patients with Parkinson’s Disease who are taking vastly larger doses of this medication than patients with Restless Limb Syndrome would ever take.

In addition, there’s a small incidence of an increase in compulsive behaviors; compulsive gambling, compulsive shopping, compulsive lying, compulsive sexual activity, any compulsive behavior can occur within this class of medication.

When using these drugs, we are always striving to use the lowest effective dose, so we titrate, or gradually increase the dosage until we find that it’s effective with the least amount of side-effects or, hopefully, no side-effects.

The next class of medications that we use to treat restless limbs are a class of medications called anti-convulsives or neuroleptics. These drugs were initially used, as the name implies, for treating epilepsy. And just like with the dopamine agonists, if we compare it to aspirin and Tylenol, which are both used to treat fever and pain, we’ve found that these medications are often useful in treating other disorders, in this case, Restless Limb Syndrome. The drugs most commonly used in this class of medications include Neurontin, or gabapentin, and Lyrica, or pregabalin. More recently there has been a long acting version of gabapentin known as Horizant.

The third class of medication common in the use of Restless Limb Syndrome is a classification known as benzodiazapines. The most commonly used within this group is a medication known as Klonapin, or Clonazepam. This medication is also useful as a sleeping aid and as a treatment for anxiety. Patients with restless limbs often have insomnia and are anxious about their insomnia, and Clonazepam can be used as a supplement in the treatment of this disorder.

Another class of medication which can be useful are analgesics, in particular, opioids or narcotic medications. Many patients, and physicians as well, are reluctant to use these medications in the treatment of restless limb but they can be very effective if the dopamine agonists or neuroleptics are either not tolerated or were found to be ineffective. Sometimes we have to use multiple medications to adequately treat restless limbs including all classes that we’ve previously discussed.

Some patients prefer to use over-the-counter medications. While these are not always proven to be as effective, some patients will respond to simple measures such as over-the-counter analgesics like tylenol or advil. Sometimes supplements such as calcium or magnesium are also helpful and especially if we find that your blood iron levels are low or, in particular if your ferritin levels are low, the use of supplemental iron can be very effective in the treatment of restless limbs.

I hope this brief overview on the treatment of Restless Limb Syndrome has been helpful. For more information please browse this website or contact us directly for an appointment and evaluation. And always remember, sleep well tonight for a better day tomorrow.

Dr. Popper is available at (805) 557-9930 to answer any questions you have regarding diagnosis and treatment of all sleep disorders, including OSA, restless limb syndrome, insomnia, and others.

Watch the video above, and then Click Here to learn more about diagnosis and treatment of RLS.

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Obesity has long been associated with an increased risk for obstructive sleep apnea (OSA). Neck circumference guidelines (greater 17 inches for men and 16 inches for women) as a risk factor for OSA came out of several studies on NFL players. The University of Connecticut reported that the increase in body mass in football players since the 1970’s has occurred primarily in offensive and defensive linemen.

The University of North Carolina reported in 2005 that more than 25% of NFL players were obese. Scripps Howard newspapers reported that the heaviest NFL players were more than twice as likely to die before their 50th birthday. Probably the most famous NFL player to die from complications of untreated OSA is Reggie White, the hall of fame defensive end for the Philadelphia Eagles and the Green Bay Packers.

Given the high prevalence of OSA in the NFL, the NFL alumni association (NFLAA) and players associations (NFLPA) and the Pro Players Health Alliance (PPHA) have teamed together to raise the awareness of undiagnosed sleep apnea among their ranks. In addition, they are lending their star power to bring this awareness to the general public by creating a program of local meetings where diagnosed and undiagnosed sleep apnea patients can come and hear stories and testimonials from their gridiron heroes as well as receive an educational message from medical and dental professionals with special training in Sleep Medicine.

Preliminary reports on Merck’s experimental sleep drug Suvorexant indicate it helps insomniacs fall asleep faster and stay asleep longer. Suvorexant works differently from other sleeping pills. Current sleep medications work on brain receptors that increase sleepiness.

Suvorexant inhibits Orexin, a hormone that acts on the brain to increase wakefulness. Brain levels of Orexin are naturally lower during the night. An additional interesting use for Suvorexant is that it might be particularly helpful for shift workers, who need to sleep during the day when Orexin levels are high.  Merck is hoping to receive FDA approval for Suvorexant in the Summer of 2013.

Continuous positive airway pressure (CPAP) has long been the gold standard of treatment for severe obstructive sleep apnea (OSA). Newer data shows that CPAP is also effective in patients with mild to moderate OSA and daytime sleepiness.

A study recently published in the American Journal of Respiratory and Critical Care Medicine shows that CPAP treatment effectively reduces symptoms and improves quality of life in patients with mild to moderate OSA which represents the largest segment of the OSA population.

This study confirms what specialists have observed over many years of treating patients with OSA and daytime sleepiness. The use of CPAP results in reduced complaints of daytime sleepiness measured with the Epworth Sleepiness Scale.