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Suggest Treatment For Circadian Desynchronization And Sleep Deprivation
Question: I have GERD w/ hiatal hernia and resultant frequent aspiration during sleep even when being well elevated. I also snore very loudly w/ reported pauses in breathing. I have eaten as much as 7 hours prior to sleep and still have the aspiration. I am on Nexium 40mg q d. have taken motillium with no apparent change in symptomatology. I am a 61 year old married white male weighing 220 lbs, and stand 6' tall. I have been scoped in the past 3 years both throat and colon w/ some diverticulum and precancerous polyps which were removed. I have borderline GFR numbers >60 w/ high normal creatine leading to a possible stage 2 CKD diagnosis. I also have slightly high alt/SGOT at times and an enlarged aortic base (43mm and stable for at least 5 years confirmed by echo cardiograms each year) and I have a bicuspid aortic valve w/ no reflux or subluxation noted. I have mild hypertension controlled by Toprol XL 50mg q d and Cozaar 25mg q d. I have BPH and have had holmium laser ablation of the prostate for that about 7 years ago which seem to be holding up very well. My PSA numbers are normal (>3) I have constant sinus and nasal congestion with a suspected continuous sinus infection which varies somewhat in severity but has not totally resolved in over at least 15 years. I suspect emesis from the reflux as a major contributing factor.
The frequent aspirations and possible sleep apnea seem to be leading to decreased lung productivity. I carry a pulse oximeter and have found my normal reading to be about 95% with pulse rate about 90-100 resting. I cannot take stairs without becoming quite winded and cough incessantly to try to clear the emesis I have aspirated. Also as a result of this, I believe I suffer from circadian rhythm desynchronizes, sleep deprivation, and resultant daytime sleepiness/ general fatigue.
The frequent aspirations and possible sleep apnea seem to be leading to decreased lung productivity. I carry a pulse oximeter and have found my normal reading to be about 95% with pulse rate about 90-100 resting. I cannot take stairs without becoming quite winded and cough incessantly to try to clear the emesis I have aspirated. Also as a result of this, I believe I suffer from circadian rhythm desynchronizes, sleep deprivation, and resultant daytime sleepiness/ general fatigue.
Brief Answer:
Need your input.
Detailed Answer:
Hi,
Welcome to Health Care Magic,
I am Dr.Muhammad Ahmad, I have read your message and will try to help you in best possible way.
I would like you to give me some more info in this regard.
Here i will ask you some questions to guide our conversation..
1) What is your main concern you sinuses and lungs?
2) Is it getting wrose?
3) Used any med for sinus and lung issues?
4) Did you ever get echicardiography done?
5) Ever visited a cardiologist?
6) Any cough or fever?
7) Any body swelling?
8) Do you use any diuretic?
9) Did this worsen with your kidney issues?
Waiting for your input.
Dr.Muhammad Ahmad
M.B.B.S
Resident M.D.
Need your input.
Detailed Answer:
Hi,
Welcome to Health Care Magic,
I am Dr.Muhammad Ahmad, I have read your message and will try to help you in best possible way.
I would like you to give me some more info in this regard.
Here i will ask you some questions to guide our conversation..
1) What is your main concern you sinuses and lungs?
2) Is it getting wrose?
3) Used any med for sinus and lung issues?
4) Did you ever get echicardiography done?
5) Ever visited a cardiologist?
6) Any cough or fever?
7) Any body swelling?
8) Do you use any diuretic?
9) Did this worsen with your kidney issues?
Waiting for your input.
Dr.Muhammad Ahmad
M.B.B.S
Resident M.D.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. Yes, my main concern here is sinuses and lungs. But everything really as I have specialists but they treat their part of what I have. I have no GP or Internist to coordinate treatments which I would think I should? Do you agree?
2. It does seem to be getting worse incrementally w/ time.
3. I use (12hr prn) Pseudoephedrine. I had an albuterol inhaler after an emerg. room visit but it is long gone.
4. I have echo-cardiograms every year. The aortic base is stable at 43mm since the diagnosis about 7 years ago.
5. I have a wonderful interventional cardiologist.
6. I cough a lot. I feel as if it is in order to try to clear the aspirated food.
7. Lower leg. Mostly right leg. Pitting edema. I use compression stockings. I have just ordered 20-30 mmHg as the ones I have are not strong enough.
8. No diuretic use at this time.
9. I can not say if the overall symptomatology got worse w/ the kidney issues. Maybe the swelling though as it has increased slowly as a factor of time.
Thank you.
I will be more than happy to answer anything else.
-XXXX
Please advise when possible.
This is very important to me of course.
Thank you.
XXXX
2. It does seem to be getting worse incrementally w/ time.
3. I use (12hr prn) Pseudoephedrine. I had an albuterol inhaler after an emerg. room visit but it is long gone.
4. I have echo-cardiograms every year. The aortic base is stable at 43mm since the diagnosis about 7 years ago.
5. I have a wonderful interventional cardiologist.
6. I cough a lot. I feel as if it is in order to try to clear the aspirated food.
7. Lower leg. Mostly right leg. Pitting edema. I use compression stockings. I have just ordered 20-30 mmHg as the ones I have are not strong enough.
8. No diuretic use at this time.
9. I can not say if the overall symptomatology got worse w/ the kidney issues. Maybe the swelling though as it has increased slowly as a factor of time.
Thank you.
I will be more than happy to answer anything else.
-XXXX
Please advise when possible.
This is very important to me of course.
Thank you.
XXXX
Brief Answer:
Few things can help.
Detailed Answer:
Hi Baxter,
Thanks for writing back ,
I really apologize for the delay ,and will thanks you for your bearing with me , you'v been so nice.
I have read your reply and i will try to get as comprehensive and helpful as i can be.
Starting with the fact that you want to coordinate all the different specialities dealing with your problems , you are very right in this , I had this patient once who
was taking oxycodone for body aches and his psychiatrist wrote him prozc for phsyc issue, when he came for my advice i suddenly realized that both drugs have severe
interactions and can not be used at the same time,
This is one reason , there are so many other reasons why every thing should be well organized and coordinated. I will definitely suggest you to get in contact with a
good GP for thios purpose. Then there are many issues which a GP can better manage, for example now you are having pulmonology issue, yes a doctor specialized in lungs
would be great to contact but specialist usually take more time to give you an appointment and they are hard to follow up with, and get in contat with.
A Gp is always there and you can have an appointment in a couple of days and they keep solving your minor issue. For instance you got 80mg of a blood pressure med
(antihypertensive) , your blood pressure fell too much, your GP can help you better in this instead of a hard to contact sepcialist.
So i would say you are perfectly right in this and I would second your opinion in this.
You want inter relations so here I will tell you what can inter relate in your case:
1) Your weight:
It can worsen gerd.
It can Worsen you leg swelling.
It can worsen your snoring.
It can worsen your sleep apnoe or breathlessness episodes druing sleep.(back of lung gets fatty narrowing breathing pathway)
It can worsen your shortness of breath.
It can worsen your hypertension.
Can worsen Pressure on bicuspid aorta.
Can worsen your liver enzymes because of fatty liver.
So reducing your weight by to less than 180 pounds is going to affect ALL of above mentioned things in one shot and this can really improve your quality of life.
2) Kidney problem:
***Can you please tell me your urea and creatinine ? and tell me if your have had proteins in your urine exa?**
Kidney issues can worsen your BP.
and BP in turn can worsen your kideny.
It can retin water in body worsening your leg edema.
Increased water in body can put pressure on heart too.
And increased water in body can cause water in lungs causing issues in respiration.
*****I would also like to ask does your breathing problem get worsened when you lie down?****
3) GERD:
It can worsen your breathing in night by irritating our bronchi and causing them to spasm...
Any spiration would also cause you have breathing issues.
It can irritate your pharynx causing issues to your sinuses and upper throat.
4) Sinus issues:
They can cause bad throat and bad lungs and cause youcan have issues with breathing.
5) Prostat :
It is fine now so it wouldnt have been playing much part i suppose.
6) Heart:
***I would like you to tell me ejection frection according to the echo and what are comments about systolic and dyastolic function of the heart***
Bicuspid aorta can cause high BP,
Heart hypertrophy , systolic dyastolic dysfunction but because your echo is fine so this wont be playing a part much in your issues.
***What are your blood pressure ranges these days???***
Usually high blood pressure puts pressure on heart and this may lead to lungs edema and gets short of breath but this seems to be less likely.
So this was inter relation in your conditions i tried to summarize for your better understanding, now i will come to your present condition.
MY OPINION:
In my opinion you are having a combo of sleep apnoea and lung irritation with aspiration that happens to you in night.
Plus you have sinus issues. Is it diagnosed?
***Do you feel pressure in cheeks?***
***If you bend down , like prostration position , does it puts pressure on forehead?***
**any x-ray sinuses done lately??**.
WHAT CAN YOU DO??
1) First try to get better control of GERD for that Reduce your weight.
2) You can discuss your doctor about having a pro-kinetic like motillium this will clear out foot from your stomach which will recude aspiration.
3) Contact a pulomonologist he might want to get an x-ray chest done and see what are possible issues there in the chest.
4) Keep a close look at your blood pressure.
5) Keep a check on your blood pressure.
6) Try to make a habit of sleeping on your side, don't sleep flat, sleeping on your side will reduce your aspiration episode plus your breathing stoppage and snoring
in night.
7) Walk a bit after dinner.
To control your Sinus and repsiration issues some more things can be helping , which you can do at home, here they are,
1-Steam inhalation.
2-Taking warm steamy shower helps sometimes.
3-Take green tea twice a day and keep drinking water it will help to thin out mucus clogged in your nose and this will help your sinuses and nose to get better draining.
4-Use warm compresses, place it at your forehead and cheek prominences.It will soften blockages in your sinuses.
5-Over the counter nasal decongestant can be used.
I hope conversation so far was a bit of help for you, I will wellcome any input , more queries or any feedback if you have. Plus I will like to apologize again for my delayed reply.
Regards.
Dr.Muhammad Ahmad
Few things can help.
Detailed Answer:
Hi Baxter,
Thanks for writing back ,
I really apologize for the delay ,and will thanks you for your bearing with me , you'v been so nice.
I have read your reply and i will try to get as comprehensive and helpful as i can be.
Starting with the fact that you want to coordinate all the different specialities dealing with your problems , you are very right in this , I had this patient once who
was taking oxycodone for body aches and his psychiatrist wrote him prozc for phsyc issue, when he came for my advice i suddenly realized that both drugs have severe
interactions and can not be used at the same time,
This is one reason , there are so many other reasons why every thing should be well organized and coordinated. I will definitely suggest you to get in contact with a
good GP for thios purpose. Then there are many issues which a GP can better manage, for example now you are having pulmonology issue, yes a doctor specialized in lungs
would be great to contact but specialist usually take more time to give you an appointment and they are hard to follow up with, and get in contat with.
A Gp is always there and you can have an appointment in a couple of days and they keep solving your minor issue. For instance you got 80mg of a blood pressure med
(antihypertensive) , your blood pressure fell too much, your GP can help you better in this instead of a hard to contact sepcialist.
So i would say you are perfectly right in this and I would second your opinion in this.
You want inter relations so here I will tell you what can inter relate in your case:
1) Your weight:
It can worsen gerd.
It can Worsen you leg swelling.
It can worsen your snoring.
It can worsen your sleep apnoe or breathlessness episodes druing sleep.(back of lung gets fatty narrowing breathing pathway)
It can worsen your shortness of breath.
It can worsen your hypertension.
Can worsen Pressure on bicuspid aorta.
Can worsen your liver enzymes because of fatty liver.
So reducing your weight by to less than 180 pounds is going to affect ALL of above mentioned things in one shot and this can really improve your quality of life.
2) Kidney problem:
***Can you please tell me your urea and creatinine ? and tell me if your have had proteins in your urine exa?**
Kidney issues can worsen your BP.
and BP in turn can worsen your kideny.
It can retin water in body worsening your leg edema.
Increased water in body can put pressure on heart too.
And increased water in body can cause water in lungs causing issues in respiration.
*****I would also like to ask does your breathing problem get worsened when you lie down?****
3) GERD:
It can worsen your breathing in night by irritating our bronchi and causing them to spasm...
Any spiration would also cause you have breathing issues.
It can irritate your pharynx causing issues to your sinuses and upper throat.
4) Sinus issues:
They can cause bad throat and bad lungs and cause youcan have issues with breathing.
5) Prostat :
It is fine now so it wouldnt have been playing much part i suppose.
6) Heart:
***I would like you to tell me ejection frection according to the echo and what are comments about systolic and dyastolic function of the heart***
Bicuspid aorta can cause high BP,
Heart hypertrophy , systolic dyastolic dysfunction but because your echo is fine so this wont be playing a part much in your issues.
***What are your blood pressure ranges these days???***
Usually high blood pressure puts pressure on heart and this may lead to lungs edema and gets short of breath but this seems to be less likely.
So this was inter relation in your conditions i tried to summarize for your better understanding, now i will come to your present condition.
MY OPINION:
In my opinion you are having a combo of sleep apnoea and lung irritation with aspiration that happens to you in night.
Plus you have sinus issues. Is it diagnosed?
***Do you feel pressure in cheeks?***
***If you bend down , like prostration position , does it puts pressure on forehead?***
**any x-ray sinuses done lately??**.
WHAT CAN YOU DO??
1) First try to get better control of GERD for that Reduce your weight.
2) You can discuss your doctor about having a pro-kinetic like motillium this will clear out foot from your stomach which will recude aspiration.
3) Contact a pulomonologist he might want to get an x-ray chest done and see what are possible issues there in the chest.
4) Keep a close look at your blood pressure.
5) Keep a check on your blood pressure.
6) Try to make a habit of sleeping on your side, don't sleep flat, sleeping on your side will reduce your aspiration episode plus your breathing stoppage and snoring
in night.
7) Walk a bit after dinner.
To control your Sinus and repsiration issues some more things can be helping , which you can do at home, here they are,
1-Steam inhalation.
2-Taking warm steamy shower helps sometimes.
3-Take green tea twice a day and keep drinking water it will help to thin out mucus clogged in your nose and this will help your sinuses and nose to get better draining.
4-Use warm compresses, place it at your forehead and cheek prominences.It will soften blockages in your sinuses.
5-Over the counter nasal decongestant can be used.
I hope conversation so far was a bit of help for you, I will wellcome any input , more queries or any feedback if you have. Plus I will like to apologize again for my delayed reply.
Regards.
Dr.Muhammad Ahmad
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. You have answered a lot of my concerns. I am out of my country now but will try to get the other information you request as soon as I can after I get back home.
It seems that primarily, getting on a diet to loose down to 180 lbs is mandatory. I will begin that immediately.
No problem on the delay. I understand there is a plethora of information contained in my question and that it could not be answered without considered thought.
-XXXX
It seems that primarily, getting on a diet to loose down to 180 lbs is mandatory. I will begin that immediately.
No problem on the delay. I understand there is a plethora of information contained in my question and that it could not be answered without considered thought.
-XXXX
Brief Answer:
Yes you should reduce your weight.
Detailed Answer:
Hi,
Thanks for writing back,
Yes reducing your weight is going to help you big time in my opinion.
Keep one principle in diet "It's not about eating less,it's more about eating smart and healthy"
Plus you can also work on other remedies i told you for sinus issues.
I will be waiting for more info from you when ever you get back home.
This will help me guide you in a better way.
Have a safe visit abroad.
Stay blessed.
Regards.
Dr.Muhammad Ahmad.
Yes you should reduce your weight.
Detailed Answer:
Hi,
Thanks for writing back,
Yes reducing your weight is going to help you big time in my opinion.
Keep one principle in diet "It's not about eating less,it's more about eating smart and healthy"
Plus you can also work on other remedies i told you for sinus issues.
I will be waiting for more info from you when ever you get back home.
This will help me guide you in a better way.
Have a safe visit abroad.
Stay blessed.
Regards.
Dr.Muhammad Ahmad.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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