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Treating sleep problems can reduce fibromyalgia symptoms

Dear Dr. Rosenberg:

I have fibromyalgia. In addition to being in pain and fatigued, I feel like I don't get enough sleep, even when I have slept for nine hours. Is this unusual?

A: Part of the diagnosis of fibromyalgia is non-restorative sleep. People with fibromyalgia tend to have more light sleep and less deep sleep when studied. In addition, they frequently show an awake pattern superimposed on deep sleep called alpha delta. Interestingly, when sleep issues are properly addressed, pain and fatigue tend to improve.

Dear Dr. Rosenberg:

Recently I had a sleep study. There was no evidence of sleep apnea. However, my oxygen levels were low. Now my healthcare provider wants me to undergo testing in a breathing lab. My oxygen is perfectly normal during the day. What would the point of this be?

A: A number of diseases that affect the respiratory system will first manifest at night. Oxygen and carbon dioxide levels will be abnormal during sleep when our respirations become shallower. So I think it is a very good idea to undergo testing for what might be causing your low oxygen levels during sleep. Early diagnosis and treatment might prevent far more serious consequences later on.

Dear Dr. Rosenberg:

I have sleep apnea and have tried numerous masks for my CPAP machine. I cannot find one that I am comfortable using. In addition I have a lot of trouble with tolerating CPAP. I feel like I cannot breathe with it on. Any ideas as to what I might try? I know I need to wear it; I've already had two heart attacks.

A: Yes there is a technique called a PAP-NAP that we use for patients with the same issues. It is an abbreviated sleep test that lasts about two hours and is performed during the day. A trained sleep technician will apply various masks and expose the patient to various forms of pressure delivery while at the same time utilizing desensitization techniques. It has been found to be very successful. In fact, the average success rate is in the 85 percent range.

Dear Dr. Rosenberg:

I am a 24-year-old woman pregnant with my first child. I am 23 weeks pregnant and my blood pressure is above normal. I snore a little at night and I am very fatigued. Now my obstetrician thinks I might have sleep apnea and wants me tested. Do you think this is necessary? It seems to be a little extreme to me.

A: I agree with your doctor. Recent studies have shown that the incidence of sleep apnea in gestational hypertension may be six to seven times normal. The presence of snoring and fatigue would make me suspicious as well. Another predictor is neck circumference. We find that neck sizes of 16 inches or more may be predictive of sleep apnea during pregnancy. It is best to get it diagnosed and treated if you do have it. Being treated for sleep apnea can prevent the development of more severe forms of hypertension during pregnancy. In addition, the low oxygen levels that accompany the apneas may be harmful to the fetus.

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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