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Fri, April 26

Sleep Well: Have CPAP machines checked every six months

Dear Dr. Rosenberg:

My husband read your column and would like some information. He is 62 years of age. He was diagnosed with sleep apnea in 1991 and has been using a CPAP machine ever since. How often should his condition be evaluated, and when should the airflow level of his CPAP machine be checked?

Answer: This is a great question. The American Academy of Sleep Medicine recommends that patients be followed at a minimum of once a year. At our sleep clinic we like see our patients with sleep apnea every six months. We check for compliance using a computerized card that most machines possess. We can detect leaks and the actual time on CPAP per night. The machine should be checked every six months.

I recommend re-evaluating the correct pressure setting only if:

1) The patient is experiencing a return of prior symptoms, such as sleepiness

2) The patient's bed partner notices snoring while on CPAP

3) There has been a significant weight gain or weight loss since the original study.

In these circumstances a return to the lab for an overnight re-evaluation may be advisable.

Dear Dr. Rosenberg:

I had a sleep study done a couple of weeks ago. They called with the results and told me I stopped breathing 53.6 times within an hour. Now they want me to go back for another sleep study so they can put a CPAP machine on me. I did use one of the machines for one month prior to having surgery on my throat and tongue a couple of years ago. Will I need a CPAP machine for the rest of my life? I am only 53 years old and feel it's not romantic to use this machine.

Answer: Yes, you will need to wear CPAP for the rest of your life. Based on your study, you have severe sleep apnea. Apparently, from your description, the surgery did not work. Sleep apnea, especially as severe as yours, can lead to serious cardiac, cerebrovascular and metabolic complications. The incidence of heart attack, stroke, hypertension and diabetes is significantly increased in untreated sleep apnea. I agree it may not be romantic, but it beats the alternative. I would strongly urge you to follow through and return to the sleep lab.

Dear Dr. Rosenberg:

On our seventh wedding anniversary, my husband was diagnosed with dementia, Alzheimer's, paranoid schizophrenia, and depression. I cared for him at home, before he went to a nursing home. After his death, I had to sell our home and move into a senior living apartment. I had to find a home for our dog and was forced to part with our cherished belongings. Shortly afterwards, I was diagnosed with leukemia. Now I am having trouble sleeping and experiencing terrible nightmares about some very dark times of my life.

These nightmares are happening every night. I have seen psychologists, neurologists and physical therapists, and have been on both anti-depressants and sleep medications. I don't smoke or drink, and live a healthy style. What is going on here?

Answer: Nightmares are dreams that are so disturbing as to awaken the person from REM, also known as dream sleep. Most people experience nightmares from time to time. It is abnormal if nightmares interfere with daytime functioning or cause difficulty falling and/or staying asleep.

Let's consider a couple of possible causes in your situation. First is the post-traumatic cause, which is characterized by the same or similar disturbing dream experience each time. This may be due to inability to resolve emotional conflicts. Secondly, many medications can cause nightmares, including anti-depressants, sleeping pills, blood pressure medications called beta blockers and amphetamines, as well as late-night alcohol.

We have found a technique called Imagery Rehearsal Therapy (IRT) to be most useful. Basically, you write down the nightmare, but alter the story line to something more pleasant. You rehearse this in your mind before bedtime. It may take some time, but it is an effective technique.

Dear Dr. Rosenberg:

My 7-year-old son sleepwalks. Lately, it's happening three to four times a week. It's become disruptive to the entire family's sleep, because we are worried about him. I have noticed that he is snoring quite loudly. Is there a relationship between sleepwalking and snoring?

Answer: A study done at Stanford University reported 61 percent of frequent sleepwalking children were found to have an associated sleep disorder. The majority had sleep apnea, but several had restless leg syndrome. Even more impressive was the resolution of sleepwalking when the underlying sleep disorder was corrected. In light of your son's associated snoring, I would have him evaluated for sleep apnea.

Dear Dr. Rosenberg:

I have been experiencing nightmares for the first time in my life. This started around the time when I was placed on the antidepressant Welbutrin. Do you think this medication is causing my nightmares?

Answer: Several antidepressants such as Prozac and Paxil have been associated with nightmares. Welbutrin, also known as Buproprion, has had the highest incidence of nightmares. This is probably due to its ability to increase REM, also known as dream sleep. If these nightmares continue to be a problem, you should talk to your doctor about discontinuing the medication. Please be advised anti-depressants should never be stopped abruptly without medical supervision.

Contact Dr. Rosenberg at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley AZ 86314.


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