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Sat, Dec. 07

Untreated sleep apnea can thwart weight loss efforts

Dear Dr. Rosenberg:

I am very overweight and snore. My doctor has asked me to get a sleep study, but I have not wanted to do it. Now he tells me that if I have sleep apnea, it may be contributing to my inability to lose weight. Is that possible? If so, I might have to reconsider the sleep study.

A: Yes, your physician is most likely correct. We now know that sleep apnea leads to a condition called insulin resistance. As a result, people with sleep apnea have higher than normal levels of insulin. Please be aware that insulin increases appetite and fat storage. In addition, people with sleep apnea are fatigued and less likely to exercise. Therefore, if you have sleep apnea, treating it usually reverses the insulin resistance and fatigue. Food for thought - no pun intended!

Dear Dr. Rosenberg:

My dentist showed me a snoring prevention device called SilentNite. It has upper and lower retainers held together with special connectors that position the lower jaw slightly forward to keep the airway open. The manufacturer of SilentNite states it is more than 85 percent effective at eliminating snoring. Are you familiar with this device? Does it work?

A: SilentNite is a type of appliance referred to as a MAD (Mandibular Advancement Device). These devices bring the lower jaw forward while you are asleep. The tongue is thus moved forward and out of the airway. There are several of these types of devices on the market and all are excellent in the appropriate circumstances. However, before you do this, you should have a sleep study done. It is a common and unfortunate mistake to assume snoring is the only problem. You may actually have sleep apnea and, if it is severe, the Mandibular Advancement Devices may not be effective.

Dear Dr. Rosenberg:

I have severe fibromyalgia. I read on a fibromyalgia website that there is a sleep medication used for narcolepsy that may soon be used for fibromyalgia. What do you know about this?

A: The medication is Xyrem (sodium oxybate) and is now undergoing final trials for use in fibromyalgia. The results are very encouraging. In a randomized trial, those reporting reduction of pain were significantly higher in the Xyrem group - the reason being that fibromyalgia may be more a sleep problem than just a pain problem. Surveys of fibromyalgia patients show pain lags behind sleep disturbances, fatigue and cognitive dysfunction. So we know fibromyalgia is much more than just a pain problem. Xyrem acts by promoting deep sleep, which is lacking in fibromyalgia patients. It looks like it may soon be available for patients who are not responding to other forms of treatment.

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.

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