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Thu, Nov. 21

Berlin Sleep Questionnaire a highly accurate test for sleep apnea

Dear Dr. Rosenberg,

My husband was hospitalized last month for chest pain. It turned out to be coronary disease and now he is on medication and a strict cardiac diet. He was administered a written questionnaire called the Berlin Sleep Questionnaire. It was positive and now based on that his doctor wants him to have a sleep study. Does this make sense?

A: What you are describing is a very accurate screening test for those with sleep apnea. In a recent study, 88 percent of those with positive questionnaires had sleep apnea. More importantly, this study was performed on cardiac patients. Those with a positive questionnaire and coronary disease had poorer outcomes such as heart failure, progressive disease and death when not treated. So in answer to your question, it makes good sense.

Dear Dr. Rosenberg,

I was diagnosed with narcolepsy 10 years ago. Despite being on Ritalin and antidepressants, I'm still sleepy and have cataplectic attacks regularly. I understand there is a medication called Xyrem that might help. Do you know anything about this drug?

A: Yes, I use it in many of my patients with narcolepsy. It is not only effective in improving cataplectic attacks (attacks of sudden muscle weakness in response to emotions), but it also improves daytime sleepiness. It is a tightly controlled medication, as it is also known on the street as the "date rape drug." It is available through only one pharmaceutical company in the United States. However, it is well worth the time and effort to get it. It has significantly improved the treatment of narcolepsy.

Dear Dr. Rosenberg,

Whenever I travel abroad I have terrible jet lag. It takes me several days to get back to feeling normal. We will be traveling to Spain this year. Do you have any ideas?

A: Yes, jet lag results from a lack of synchronization between your internal biological clock and your new environmental clock. This results in fatigue, irritability, headaches and sometimes constipation or nausea. Taking Melatonin, 2 to 3 mg. a half-hour before bedtime at your new destination can help. Exposure to light late in the afternoon and avoidance of bright light in the morning the first day of arrival can also be beneficial when traveling to the East. Finally, try to eat your meals such as lunch or dinner at times appropriate for your new time zone.

Dear Dr. Rosenberg,

I was diagnosed with sleep apnea. When I was placed on CPAP I developed what I was told were a lot of central apneas. I have been on CPAP for six weeks and I do not feel any better. In fact, I wake up several times a night feeling short of breath. When they gave me the CPAP I was told that the central events would go away. Is it possible that the central events have not gone away and that is why I am not feeling better?

A: Yes, what you are describing is called complex sleep apnea. It means that in response to the CPAP, your brain is periodically failing to send a signal to your respiratory system to breathe. Unfortunately, the most recent studies show that 50 percent of those with this form of sleep apnea do not change. Therefore if this continues I would advise you see a sleep specialist. You will probably need a completely different type of machine, one that treats both the obstructive and central events. Most insurance companies now cover these more expensive machines.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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