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Thu, Nov. 14

Congestive heart failure and apnea

DR. ROBERT ROSENBERG

DR. ROBERT ROSENBERG

Dear Dr. Rosenberg,

My husband was recently discharged from our local hospital after being treated for congestive heart failure. During his hospitalization, the nurses had a hard time keeping his oxygen levels up while asleep. They said he seemed to stop breathing but there was no snoring. His cardiologist wants a sleep test. In the absence of snoring, is that really necessary?

A: I suspect your husband probably has a form of sleep apnea called Cheyne-Stokes Central Sleep Apnea. This is very common in patients with congestive heart failure. In this form of sleep apnea, the person will hyperventilate while sleeping. This is then followed by long pauses in which no effort is made to breathe. During these pauses, oxygen levels tend to drop. Untreated, this form of sleep apnea is very damaging to the heart and will result in further deterioration and hasten death. I would strongly recommend that you have this checked out. There are excellent treatments available.

Dear Dr. Rosenberg,

My son has high blood pressure. He needs three medications to control it and even then it tends to run high. His doctor is now suggesting a sleep study. He lives alone so he does not know if he snores. Why the sleep study?

A: Your son has resistant hypertension. This is defined as poorly controlled blood pressure on three or more medications. Studies have shown that 70% of people with resistant hypertension have sleep apnea and that with treatment of the sleep disorder, blood pressure becomes much easier to control. In fact, a recent study published by Ohio State's Wexner Medical Center showed that treating sleep apnea resulted in close to a 10-point drop in blood pressure in those with resistant hypertension. Many physicians are including the possibility of sleep apnea as a cause of this form of high blood pressure.

Dear Dr. Rosenberg,

I have nightmares every month or two. I am 50 years old and am wondering if I should be worried. Is this abnormal?

A: No, it is not. Nightmare disorder is defined as having at least one nightmare per week. It is especially common in people who suffer from depression, anxiety or insomnia. It can also be related to medications such as some of the antidepressants and the beta blockers used in high blood pressure and cardiovascular disease. Bottom line is that having an occasional nightmare is perfectly normal.

Dear Dr. Rosenberg,

I am a night owl. I go to bed between 1 and 2 a.m. and wake up at 10 a.m.. Can this have negative effects on my health? My doctor tells me my blood work is showing signs of what he called the metabolic syndrome.

A: Actually, a recent study from Korea published in the Journal of Clinical Endocrinology and Metabolism demonstrated just that. They found in a study of 1,620 people that night owls had higher blood sugar, higher levels of triglycerides and lower levels of muscle mass. This may be due to several factors such as staying up later at night causing sleep loss, poor sleep quality, and eating at inappropriate times, which might eventually lead to metabolic changes.

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

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