Pascualy - Snoring and sleep apnea: sleep well, feel better

FOURTH EDITION

FOURTH EDITION

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2008 Ralph A. Pascualy. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Illustrations: Robert Holmberg, University of Washington, Health Sciences Center for Educational Resources.

Photographs: The following images were used with permission from ResMed Corporation, 2007: S8 Elite with humidifier, S8 Escape, and C-Series Tango.

Library of Congress Cataloging-in-Publication Data

Pascualy, Ralph A., 1951

Snoring and sleep apnea: sleep well, feel better / Ralph A. Pascualy. 4th ed.

p. cm.

ISBN-13: 978-1-932603-26-2 (pbk. : alk. paper)

ISBN-10: 1-932603-26-3 (pbk. : alk. paper)

1. Sleep apnea syndromesPopular works. 2. SnoringPopular works. I.Title.

RC737.5.P37 2008

616.209dc22

2007047889

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Contents

Sleep apnea syndrome is number one among the hundred-plus sleep disorders recognized today. Why?

1. Sleep apnea is common: it affects one in ten middle-aged men. It is slightly less common in women.
2. Sleep apnea, untreated, can be deadly.
3. Sleep apnea patients are poorly diagnosed and treated because of the lack of trained sleep experts.

Sleep apnea robs people of vitality, health, and sometimes life itself. Loss of vitality will be familiar to many readers of this book. People suffering from sleep apnea fall asleep anywhere and everywhere, even while driving. Their heavy snoring disrupts their own sleep and often that of their family. They drag themselves to work despite exhaustion, doze at their desks, stumble home completely drained, and fall asleep on the sofa. They lack the energy to enjoy family life or the company of friends.

The health consequences of sleep apnea are even more grave. Untreated sleep apnea puts people at high risk for driving accidents, high blood pressure, stroke, irregular heart rhythms, and other life-threatening complications.

Treatment is available and dramatically effective. Formerly sick, sleepy people quickly regain their vigor, resume their cherished activities, and thrive. Life is restored.

Accurate diagnosis is the major problem. Eighty to ninety percent of sleep apnea victims are undiagnosed. The National Commission on Sleep Disorders Research has heard countless testimonies of patients suffering for 10 years or more before sleep apnea was correctly diagnosed and treated.

My primary mission in life today is to lift the shroud of darkness surrounding sleep disorders, and with it years of prolonged and needless suffering. Education is the key public education, patient education, and medical education.

This new edition of Snoring and Seep Apnea answers all three of those educational needs. It educates the sleep apnea sufferer and the public alike. Further, this book is an authoritative survey of sleep apnea diagnosis and treatment for the primary care physician.

This book is an excellent guide for people who suspect they have sleep apnea, for people who have been diagnosed, and for those undertaking lifelong treatment.

I recommend this book to all those with sleep apnea and their friends and families. Use it as a pathfinder. Let it point the way out of the twilight of sleep apnea to timely diagnosis, appropriate treatment, and a bright future.

William C. Dement, MD, PhD
Lowell W. and Josephine Q. Berry
Professor of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Division Chief
Stanford University
Division of Sleep
Palo Alto, California

Sleep apnea is now recognized as a common and major medical disorder that can significantly impact cardiovascular and mental health, driving safety, and day-to-day functions at home and work. There are over 4,000 sleep centers across the United States and sleep medicine has been recently recognized by organized medicine as a real sub-specialty. Yet millions of individuals continue to suffer without care for their sleep disorder or receive sub-standard treatment and feel dejected that their condition has not improved.

The Main Challenge

This book will help you choose the most appropriate treatment for your problem whether it be surgical, dental, or medical intervention rather than using a CPAP machine. Nevertheless, we know that CPAP therapy continues to be the most common and effective long-term therapy. Why is it then that perhaps half of all patients prescribed a CPAP device are not using it effectively? The current model of care for sleep apnea is focused around the diagnosis and the initial treatment. But for most patients sleep apnea is a chronic and life-long problem that requires a chronic disease model of long-term care. Unfortunately, the health care system provides incentives for the initial diagnosis and treatment, but very little to assist patients in staying compliant with necessary care. This is the great challenge facing the field today and until effective care systems are in place individual patients will face significant challenges obtaining the care they need.

What This Book Will Do for You

More than ever, patients need to be well-informed consumers and ready to be assertive about receiving the appropriate diagnostic tests and the most effective treatments. The information in this book will enable you to become an effective consumer and find relief from snoring and sleep apnea.

The beginning of the book describes the causes and consequences of sleep apnea, the tests for diagnosing sleep apnea, and pros and cons of current treatments.

Chapter 12 tells how to find a qualified sleep specialist and the nearest accredited sleep testing center.

Chapters 13 through 15 contain suggestions about living with sleep apnea and dealing with the treatment process, plus information on products and services for people who are being treated for sleep apnea.

The names of patients have been changed to preserve their privacy. In the interest of simplicity and because sleep apnea is more common among males, patients usually have been referred to as he and their partners as she. This should not be interpreted to imply any disregard for the many women who have sleep apnea and are under diagnosed for the very reason that this problem has incorrectly been considered a male disorder.

You can free yourself from the twilight world of lifeless days and broken nights.

Ralph A. Pascualy, MD

I am grateful to three of my colleagues in the practice of sleep disorders medicine for their time, expertise, and cogent suggestions for this Fourth Edition: