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Ask the Medical Expert Archives 2000-2004

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Central Sleep Apnea
July 2000

Q. I have been diagnosed with central sleep apnea. I wake up each morning feeling worse than when I went to bed. I also suffer severe stomach problems. At times I endure heartburn, severe stomach bloating, diarrhea, and sometimes frequent urinating. My ribs get especially sore, sometimes even sensitive to touch. All these symptoms can come and go. I have seen several specialists and had various tests done, but no one can find a problem. Could the two problems be related? Can you offer me some advice please?

A. It sounds like you have some complex issues. However, I'll do my best to try to help. I'm going to focus more on the sleep apnea, as this seems to be your chief concern. Sleep apnea is defined as an intermittent cessation of airflow at the nose and mouth during sleep. The duration is usually greater than 20 seconds per episode and usually one with this disorder has at least 10 episodes per hour. Because of this, sleep is interrupted, often hundreds of times per night. This leads to the chief symptoms of sleep apnea, including daytime sleepiness and fatigue. Morning headache is also common as is snoring.

There are 3 kinds of sleep apnea: Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Mixed (combination of OSA and CSA). The chief risk factor for OSA is Obesity and Alcohol use. In OSA the upper airway is occluded so although the brain instructs the respiratory muscles to contract, the airway collapses. In CSA, which is what you said you have, there is a problem with the brain instructing the respiratory muscles to contract, therefore, there is not even an attempt to breath intermittently. The cause is often unknown, but certain defects in metabolic control systems or instabilities in central respiratory drive, such as congestive heart failure can cause CSA. Also, esophageal reflux of acid may cause CSA. Due to your complaints of heartburn and stomach problems, it is possible that these two conditions may be related.

There are several possible treatments for sleep apnea, such as CPAP (Continuous Positive Airway Pressure) mask device and Acetazolamide (medication), and sometimes night time oxygen. It would be wise for you to follow up with a pulmonologist that specializes in sleep apnea, as well as a gastroenterologist for further evaluation and possible more aggressive acid reflux treatment.

Hope this helps with some good ZZZZZZZZ's.

Ref: http://www.sleepapnea.org/

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