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5:44 AM Wed, Oct. 17th

Older sleep medications can worsen sleep apnea

Dear Dr. Rosenberg:

Is it true that sleeping pills make sleep apnea worse?

A: Yes, this is the case with some medications. The older sleeping pills called Benzodiazapenes definitely have this effect. They not only induce sleep, but also serve as muscle relaxants. This tends to cause the airway to collapse more easily. Examples of older sleep aids include Diazepam (Valium), Temazepam (Restoril) and Lorazepam (Ativan). The newer sleep aids such as Lunesta (Eszopiclone) and Ambien (Zolpidem) act specifically on the sleep center of the brain and do not have muscle-relaxing properties, and therefore do not worsen sleep apnea.

Dear Dr. Rosenberg:

I was diagnosed with sleep apnea seven years ago. I was told that, if untreated, my chances of a heart attack or stroke were very high. I have been faithfully wearing the CPAP for years; however I am still as sleepy as the day I was diagnosed. Does this mean my chances of heart attack and stroke are still high?

A: No, it does not. Anywhere from 10 to 15 percent of patients may not see an improvement in their sleepiness with CPAP therapy. A recent study published in the Journal of Clinical Sleep Medicine showed that if patients wore their CPAP, the risk of heart attack and stroke was no higher than the treated group without residual sleepiness. So, although your sleepiness remains, your risk for vascular disease is back to that of the normal population.

Dear Dr. Rosenberg:

I have had insomnia since I was 14 years old, and have been unable to fall asleep until 2 or 3 am. If left alone, I usually sleep until 11 a.m. and feel fine upon awakening. Unfortunately, now I have to be up for work at 7 a.m. I am miserable all day long. I really look forward to the weekends, when I can sleep late. Any idea as to what is wrong me?

A: It sounds like you have a circadian disorder called delayed sleep phase syndrome. Basically, your biologic time clock is set to a different sleep/wake cycle than the rest of us. It is not uncommon and occurs in up to 2 percent of the population. Many folks with this disorder gravitate to night-shift work, when they are most alert. If you're unable to do that, then maintaining a strict sleep/wake schedule, exposing one's self to bright sunlight in the morning and taking melatonin two hours before bedtime can be very helpful. If the problem continues, you might want to consult with a sleep medicine specialist.

Dear Dr. Rosenberg:

My 6-year-old son is autistic. He snores and has large tonsils. My pediatrician thinks it might be a good idea to have them removed. What do you think?

A: I would agree, but only if your son is first tested for sleep apnea. In the absence of this disorder, there might be little benefit. However, if your child has gone beyond snoring to intermittent upper airway obstructions, it would be an appropriate procedure. Several studies have shown that when autistic children are treated for sleep apnea, there is an improvement in both social skills and the ability to focus.

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.