Ask the Sleep Doctor

Ask the Sleep Doctor – Topics: Sleep Apnea and Diabetes, Laser Treatment, Asthma, and Nicotine

Dear Dr. Rosenberg,

My husband has Type 2 Diabetes. He also has sleep apnea. He was told that treating his sleep apnea might improve his diabetes. He sleeps about seven hours a night, wears the CPAP for the first four to five, and then removes it. His recent blood sugars are not improving. Any thoughts?

Answer:

Yes, several recent studies have shown that it is the more severe episodes of sleep apnea during REM (dream sleep) that have the most effect on blood sugar. Most of these REM episodes occur in the early morning, closer to when we wake up. In fact, a recent study performed at the VA entitled the VAMONOS (Veterans Affairs’ Metabolism, Obstructed and Non-Obstructed Sleep) Study demonstrated improved diabetic control only in those who wore their CPAP for at least six hours a night. Therefore, I would encourage your husband to keep his mask on for a few more hours per night. I think that he will then see real improvement in his diabetes.

Dear Dr. Rosenberg,

My son has asthma and it has been very difficult to control. He is obese, snores, and stops breathing. I know he has sleep apnea but he refuses to get it checked out. Could the sleep apnea affect his asthma?

Answer:

Great and topical question. Several recent studies have shown that untreated sleep apnea can exacerbate asthma. In one study, the rate of decline in breathing capacity was much worse in asthmatics with untreated sleep apnea. They also demonstrated a return to normal rates with treatment of sleep apnea. Another study showed that trips to the ER were more frequent in asthmatics with untreated sleep apnea. Consequently, I hope this helps to convince your son that he should discuss this with his health care provider

Dear Dr. Rosenberg,

I was recently diagnosed with sleep apnea. A friend told me it could be cured with laser treatment. Does this work?

Answer:

LAUP (laser-assisted uvulopharyngoplasty) was just reviewed in a study published in the journal Sleep. Unfortunately, the results were dismal. Only 8% achieved cure and 23% had success. In fact, when followed over several years, 44% worsened. On top of that, there was no significant improvement in oxygen levels. The conclusion of the authors was that the procedure is not indicated for the treatment of sleep apnea.

Dear Dr. Rosenberg,

I am trying to quit smoking and am wearing a nicotine patch 24 hours a day. I am having trouble sleeping. I have never had this problem before. Can the nicotine patch be responsible?

Answer:

Yes, it can. Nicotine stimulates the production of acetylcholine, a wake-promoting neurotransmitter. Insomnia and vivid dreams are common side effects, especially when worn overnight. I would recommend you take it off at night. It takes 30 minutes to 3 hours to achieve substantial levels after application. If you wake up with severe cravings for nicotine, a short acting form such as the gum or lozenge will work until your morning patch kicks in.

Dr. Robert Rosenberg, D.O., FCCP, DABSM

Robert S. Rosenberg, DO, FCCP, is the medical director of the Sleep Disorders Center of Prescott Valley, Arizona and sleep medicine consultant for Mountain Heart Health Services in Flagstaff, Arizona. Dr. Rosenberg is board certified in sleep medicine, pulmonary medicine, and internal medicine. His book Sleep Soundly Every Night, Feel Fantastic Every Day  is a best seller. Dr Rosenberg’s latest book is The Doctor’s Guide to Sleep Solutions for Stress & Anxiety. Visit Dr Rosenberg’s website WWW.AnswersForSleep.com which is a wealth of information on sleep topics.

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One Reply to “Ask the Sleep Doctor – Topics: Sleep Apnea and Diabetes, Laser Treatment, Asthma, and Nicotine”

  1. hwaneey8

    I ask your opinion of this question that I got from my test.

    What is the essential diagnostic criterion for sleep bruxism?

    ① abnormal wear of teeth
    ② masticatory muscle hypertrophy when you clench
    ③ patient’s recognition of bruxism
    ④ feeling masticatory pain, discomfort or fatigue when you wake up
    ⑤ associated with neurological impairment during mastoid activation.

    Answer of prof. ; ③ Answer of students ; ① ② ③ ④

    I read diagnostic criteria of sleep bruxism in THE INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS, REVISED(Diagnostic and Coding Manual) produced by American Academy of Sleep Medicine(AASM).

    Diagnostic Criteria: Sleep Bruxism (306.8)
    A. The patient has a complaint of tooth-grinding or tooth-clenching during
    sleep.
    B. One or more of the following occurs:
    1. Abnormal wear of the teeth
    2. Sounds associated with the bruxism
    3. Jaw muscle discomfort
    C. Polysomnographic monitoring demonstrates both of the following:
    1. Jaw muscle activity during the sleep period
    2. Absence of associated epileptic activity
    D. No other medical or mental disorders (e.g., sleep-related epilepsy, accounts
    for the abnormal movements during sleep).
    E. Other sleep disorders (e.g., obstructive sleep apnea syndrome, can be present
    concurrently).
    Minimal Criteria: A plus B.

    This article said that minimal criteria of diagnostic criteria of sleep bruxism are A plus B.
    I think that ③ in my question means A and ①, ② and ④ in my question mean B.
    According to this article, any choices can’t be an answer independently. To diagnose sleep bruxism, both patient’s recognition and clinical symptom (abnormal wear, muscle hypertrophy, discomfort) should be considered.

    Thank you for reading and I’m looking forward to your serious discussion and answer.

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