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Suggest treatment for sleep apnea

Answered by
Dr. Neel Kudchadkar

General & Family Physician

Practicing since :2004

Answered : 531 Questions

Posted on Sat, 11 Jul 2015 in Lung and Chest disorders
Question: I've been diagnosed with sleep apnea. I believe my condition (although not proven yet by a professional) is due to smoking for many years. If this is true is it likely that there are burns around the vicinity of my upper airway? And if so what are the chances I need to get a tracheotomy as opposed to a cpap? Whenever I read the reasoning's why people who are diagnosed with sleep apnea the articles never mentions burns to the upper airway from smoking.
Again, am I a likely candidate to get a tracheotomy? I'm a 56 year old male; 5'11" and weigh around 180. What are the typical tracheotomy candidates?
Thank you, XXXXXXX
Answered by Dr. Neel Kudchadkar 1 hour later
Brief Answer:

Detailed Answer:
Dear XXXX,

1. Smoking produces an inflammation of the airways. Inflammation? Reddening. That's all. No burns.
2. CPAP is better than tracheostomy. I am sure you prefer it. CPAP that is.
3. Sleep apnea has many causes. Smoking might be a trigger to events in the lung substance, like destruction of the bronchioles, and lowering of lung volume, these lead to many issues.
4. A single article, or a pack of websites cannot describe sleep apnea in totality. Let me inform you, that bookshelves have been written on this subject.
5. Tracheostomy is performed when---
A. There is an obstruction (choking) of the tubes. (mucous secretions and plugs)
B. There is radical surgery as in cancer.
C. There is a foreign body, say a small coin, swallowed and stuck in the windpipe,
and it has to be removed.

I hope you get the seriousness of situations, involved.

Sleep apnea is not lethal. You cannot die in your sleep, or stop breathing permanently, or something sinister like that.

Lie down, close your eyes, pretend you are asleep, and try this now.

Stop breathing. Pretend you have a sleep apnea attack. When CO2 levels build up
in your blood stream, you'll automatically start breathing. Nobody can kill himself or herself by cessation of voluntary breathing. It is a mid brain function. you'll breathe.

1. You are not a candidate for tracheostomy.
2. CPAP is the better option, obviously.
3. I need to know if you are taking any medications. These can cause sleep apnea.
For example, propranolol.

Kindly write back to me as regards your opinions on the above true statements.

In Confidence,
Dr. Neel Kudchadkar

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
Follow up: Dr. Neel Kudchadkar 26 minutes later
Thank you for your in-depth response. Your response makes me feel better so thank you for that.
It's not just sleep apnea that I'm dealing with but insomnia as well. I'm currently taking Zolpidem (5 to 10 mg) for the past 2 or 3 years. It mostly doesn't work but because it has worked at times, I continue to take it regardless. Not sure what else to do as far as getting myself to sleep.
It looks as though I won't be fitted for my oral appliance until my implant is finished (another 6 months).
My uvula looks to be irritated (redness) and limp as well. There definitely is dryness sensation in my upper airway.
I'm thinking this waiting period is making my sleep apnea worse. Wondering if the oral appliance will work. I realize no one will know until I try it. Any idea what the success rate for an oral appliance is?

I'm thinking this waiting period (upon receiving an oral appliance) is making my sleep apnea worse. Wondering if the oral appliance will work. I realize no one will know until I try it. Any idea what the success rate for an oral appliance is?

I just can't sleep. The minute I do fall asleep I'm awake in an instant.
Answered by Dr. Neel Kudchadkar 46 hours later
Brief Answer:
Yes. It works.

Detailed Answer:
Dear XXXX,

1. The success rate for an oral appliance depends really on how patient you are and how determined you are to make it succeed. It's as simple as that.
2. There is no such thing as a fixed number of people for whom it works out for.
3. I had mentioned in the last answer that your sleeping issues were due to medication problems, mismanagement rather and smoking. This makes perfect sense.
4. Finally, it seems a bit contradictory to yourself, don't you think? You mention that you waken as soon as you fall asleep... It would be very difficult to get sleep apnea in this state of being that you are in. Isn't it? To get sleep apnea to the point of which devices have to be acquired, for it, and tracheostomy considered, YOU HAVE TO BE ABLE TO FALL ASLEEP IN THE THE FIRST PLACE, DON'T YOU?

5. See, you can get any number of devices. The point is that you need to be relaxed enough to get a good night's sleep. I feel that in your state of mind, I would stop zolpidem and give you some fluoxetine 10mg at night. I know, it
is a rather low dose, but it makes people sleep well... and less bothersome.

6. I really suggest you try it. You can also try Melleril tablets.

In your best interests,
Dr. Neel Kudchadkar

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

The User accepted the expert's answer

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