4/21/2012 9:58:00 PM Smoking during pregnancy increases SIDS risk
DR. ROBERT ROSENBERG Courier Columnist askthesleepdoc@yahoo.com
Dear Dr. Rosenberg:
My daughter is pregnant and continues to smoke. I have heard that smoking increases the risk of Sudden Infant Death Syndrome (SIDS). Is that true? I'm trying to get her to quit.
A: Yes, it does. Nicotine exposure during pregnancy blunts the development of the carotid body in infants. The carotid body senses low oxygen and high carbon dioxide and promotes breathing. Because of its blunted development in the babies of smokers, we believe that may be one of the causes of SIDS. The infant does not respond to drops in oxygen appropriately.
Dear Dr. Rosenberg:
I have been on antidepressants for several years. Unfortunately, they haven't done much to improve my mood or fatigue. I'm seeing a new therapist and mentioned that I snore loudly. I'm also overweight. She suggested I see a sleep specialist and look into sleep apnea. She said, that might be the reason I have not responded to medication. What do you think?
A: I think your therapist is making a valid point. Several studies have shown that the incidence of depression in sleep apnea is significantly above normal. In addition, treatment of sleep apnea has resulted in a significant improvement in depressive symptoms in those patients. In fact, results suggest that in patients with depressive symptoms despite pharma-
cotherapy who also have symptoms of suspected sleep apnea, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography. They need to be treated with an appropriate treatment such as CPAP, which may result in a significant improvement of residual depressive symptoms.
Dear Dr. Rosenberg:
My daughter takes two Midol tablets at night for menstrual cramps. She has a hard time getting to sleep and then getting up for school when she takes it. Does this make any sense?
A: Yes. Each Midol contains 60mg of caffeine. So basically, she is taking a little over the equivalent of one strong cup of coffee. I would advise her to take it earlier in the day, or try some other remedy.
Dear Dr. Rosenberg:
My wife has GERD (gastro-esophageal reflux disease). It occurs mainly during the night after she's gone to sleep. She keeps a bottle of Tums by the bedside. She snores like a freight train. Could the two be related? I can't get her to discuss this with her doctor.
A: Yes, she probably has sleep apnea. The negative pressure created by trying to breathe in against a closed airway can literally suck the gastric contents up into the chest. She should bring this to the attention of her doctor for two reasons. First, if she does have sleep apnea, treatment could put an end to the problem. Second, treating nighttime GERD with Tums is a very inefficient method. There are many excellent medications that are preventive.
Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.
