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Fleet News reports that the DVLA has produced a document highlighting the facts around driving and obstructive sleep apnoea syndrome.

The condition is particularly prevalent among HGV drivers, and excessive sleepiness is thought to be responsible for up to 20% of motorway traffic accidents. The document, which has been developed between the OSA Partnership Group and the DVLA, has taken into account input from clinicians and the haulage industry itself.

Professor John Stradling from the Oxford Sleep Clinic, who contributed to the document, said: “It is vital that we do not push the problem underground by making it difficult for commercial drivers to admit that they have symptoms. Therefore members of the OSA Partnership Group have worked closely with the DVLA to agree a consistent process that highlights the importance and the longer term benefits of seeking treatment quickly.”

Those most at risk of having the condition are overweight middle-aged men and HGV drivers seem to be at higher risk of OSAS. However, OSAS can be fully treated quickly and easily; when the symptoms are controlled, quality of life can improve considerably. However if left untreated OSAS is likely to impact on overall health and wellbeing, and can impact on life expectancy. Ian Gallagher, head of policy for DVLA Policy at FTA said: “We understand from talking to our members that many drivers have concerns about seeking medical advice for fear of losing their licence. However this document provides answers to many questions about OSAS and also offers advice on how to access treatment as quickly as possible.”

The OSA Partnership Group has been established to bring together organisations from the commercial vehicle sector, clinicians, patient groups and those interested in health and safety at work together to raise awareness of sleep apnoea and to address the road safety issues associated with the condition.

Jan Chandaman, acting head of medical licensing policy at the DVLA said: “Our medical team has worked closely with the OSA Partnership Group in order to provide answers that we hope will allay drivers’ concerns if they believe they have symptoms of OSAS, and to encourage early notification of the condition.

“Our concern, first and foremost, has to be the safety of road users – both drivers and others and we want drivers to come forward straight away if they have any symptoms of the condition. Once they are receiving treatment and their symptoms are brought under control, driving can resume without jeopardising their safety and that of other road users. There is a European Working Group in progress on OSA and OSAS which DVLA is a member of and we are awaiting their recommendations on European standards for this condition.”

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A new surgical treatment used to treat sleep apnoea has cured 70 per cent of patients involved in a Flinders Medical Centre study. It is the first time the technique, developed in China, has been properly evaluated.

FMC head of ear, nose and throat surgery, Professor Simon Carney, said the procedure was twice as effective as previous types of surgery.

“Our study of 48 sleep apnoea patients has shown that the technique has significant benefits, with the symptoms of every patient in the study improving,” Prof Carney said.

“The number of pauses in between the breathing of people involved in the study was reduced by 76 per cent and daytime sleepiness reduced by half.”

The hospital was the first in Australia to use the technique after the late Dr Sam Robinson brought it to Australia. The study also involved patients from the Illawarra ENT Head and Neck Clinic in New South Wales. The new technique, which requires only one night in hospital, involves repositioning tissue in the throat with a treatment that creates channels in the tongue.

The older technique was more painful and included the removal of a wedge in the tongue, before sewing it back together. “Often the patient wouldn’t be able to be guaranteed to talk or swallow completely normally afterwards and not surprisingly a lot of patients declined to have the surgery,” Prof Carney said.

“The results weren’t very good for a lot of these patients … only about 30 per cent of these patients got better.”

Prof Carney said the new technique took about 45 minutes and was much more successful.

“The technique is incredibly safe, easily taught and has long term benefits for the management of sleep apnoea within the health system.”

He said about five patients were now undergoing the procedure each month at Flinders and it was becoming available at other SA hospitals. But, he warned the technique was not a replacement for continuous positive airway pressure – a mask worn while sleeping – but an alternative for those where CPAP does not work, or was too intrusive.

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A new 10-point charter outlining the diagnosis and treatment that people living with obstructive sleep apnoea (OSA) should have access to has been launched today by the British Lung Foundation.

The BLF’s OSA charter also calls for improved screening, and more comprehensive and consistent access to sleep clinic diagnosis and appropriate treatment throughout the UK. The charter also calls on governments across the UK to make OSA a national priority. This reflects the need to improve the current levels of awareness of the symptoms and dangers of untreated OSA across a broad a range of people, from the public through to healthcare professionals.

Chris Mulholland, head of the British Lung Foundation Wales, said: “The BLF’s OSA charter reflects the need for earlier diagnosis, better access to treatment and increased awareness – both among the wider public and medical community.

“The range of health and lifestyle impacts of OSA mean these recommendations not only have the potential to save lives, but to make considerable savings to the NHS at a time of great financial pressure.”

Dr Keir Lewis, respiratory consultant at Hywel Dda Health Board, and an expert in obstructive sleep apnoea, said: “Sleep apnoea can take a huge toll on an individual’s health and wellbeing. Those with undiagnosed sleep apnoea are very extensive hospital users before they are diagnosed, and visit hospitals and their GPs less when they are on the correct treatment.

“Moreover, undiagnosed people are at between four and seven times greater risk of having road traffic accidents than the rest of the population. And yet it really can be completely treated. For some patients it may simply be changes to lifestyle, for others it may be using a machine to help them breathe at night.”

The British Lung Foundation…

Believes that people with OSA and their families have a right to:
1. OSA screening, through primary care wherever possible;
2. a speedy and accurate diagnosis in a sleep clinic, wherever they live in the UK;
3. access to appropriate treatment and to a comprehensive specialist sleep service if needed, wherever they live in the UK;
4. appropriate information and ongoing support for the management of the condition, according to agreed national standards and provided by suitably qualified and trained staff; and
5.timely and relevant information on the implications of an OSA diagnosis for vigilance-critical job roles, and fast-tracking for diagnosis and treatment if people with OSA drive for a living.

Calls on governments across the UK to:

6. make OSA a national priority;
7. increase awareness of the symptoms and dangers of, and issues that surround, OSA among medical professionals, employers, the general public and those at greatest risk;
8. ensure collection of comprehensive data to enable commissioners and service planners to provide effective services; and
9. encourage investment in research, including clinical trials, recognising the potential cost savings and improvements to quality of life that could be made.

And encourages employers to:

10. arrange for all staff who are employed as drivers or in other vigilance-critical roles to be screened for OSA.

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It is possible that pregnant women can develop sleep apnoea during pregnancy. In studies of non-pregnant populations, a 20 % weight gain has a very significant impact on the development of OSA. Since pregnant women often have similar weight gains it is theoretically possible that many will develop breathing problems that can affect the developing fetus.

Snoring is the lowest level of sleep disordered breathing. Only 4% of healthy young women snore; the fact that reports of snoring increase to 25% of pregnant women by the third trimester, points to other possible negative side-effects of compromised breathing. The more overweight a woman is before she gets pregnant, the more likely there will be alterations in her breathing at night. Studies of pregnant women show that snorers have higher blood pressure than non-snorers.

Sleep apnoea is known to increase blood pressure in patients, in the beginning this is seen only during sleep and could be missed at a medical appointment. There is a pregnancy-induced hypertension that can develop after the 20th week of pregnancy and can cause many problems with the developing baby and the mother’s health. When this gets out of control, it is called preeclampsia or, worse yet, eclampsia and can be fatal. Known risk factors for preeclampsia include family history, advancing maternal age, obesity, chronic hypertension and kidney disease.

As of now, no one knows if sleep apnoea, and the intermittent lack of oxygen it causes at night, causes the blood vessel breakdown in the placenta seen with preeclampsia or if the retention of fluid from the preeclampsia causes the breathing problems due to tissue swelling all over the mother’s body. Obstetricians are always on the lookout for this condition and will treat it aggressively.

Treatment of Sleep Apnoea during pregnancy:

Who should be treated?

Any woman who is diagnosed with severe sleep apnoea or who has drops in her blood oxygen level below 90% must be treated as quickly as possible. If the mother is not breathing properly at night, the fetus can suffer growth retardation which impacts the baby’s survival after delivery.

How should she be treated?

CPAP (Continuous Positive Air Pressure): There is no other option that will be as helpful for the fetus. It is not sexy, or comfortable, but it is only required during the remainder of the pregnancy and will help protect the baby. Oral appliances, though effective, require time to fabricate and up to three months to be maximally effective. By the time effective oral appliance therapy is instituted, the pregnancy will be over.

Surgery: is less effective than any other therapy for sleep apnea and not an approach to be taken during pregnancy.

What to do after delivery?

Women who develop sleep apnoea during pregnancy should have a follow-up sleep study after regaining her normal weight (2-3 months after delivery) This will verify if the sleep apnea has resolved. Some women take longer to shed the extra weight of pregnancy and may continue to have sleep apnea. Since sleep apnea makes people feel sleepy, and a new baby also disrupts a mother’s sleep, treatment is necessary to keep the new mother from experiencing severe sleep deprivation. Some researchers have wondered if this loss of sleep may be part of the cause of “post-partum depression”.

Source: Pien GW; Schwab RJ. Sleep disorders during pregnancy. SLEEP 2004;27(7):1405-17.

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Its been 4 months to the day exactly that I have been using CPAP. You can backtrack on my initial stages on previous blogs, but though it was time for another update…
Reading or I should say listening to the blog Post with the BBC Breakfast Clip about SA during Stop Snoring week. It really got me thinking of how lucky I have been. The clip from the show hardly highlighted the potential dangers of SA. Shame really… I would have thought the BBC could have done a better story.
I consider myself very lucky indeed, like the chap on the TV Clip, I went to my GP ”just about snoring”.  I was referred to Mr Oko’s Sleep Clinic. Unlike it appeared from the clip, I had a thorough examination of my nose and throat, blood tests and a Sleep Study. It was then that it was diagnosed that I didn’t just have the problem of snoring! I did in fact have Severe Obstructive Sleep Apnoea with an AHI of 62.
I wasn’t ‘just given’ (like it appeared on the TV Clip) a CPAP machine -as initially by my own choice I didn’t want to use one- but after much research online I changed my mind and with the utmost care and patience from Mr Oko and his Team I have successfully got through the last 4 months. A few hiccups on the way, but that was mainly due to not being able to find a mask that I felt comfortable with. There were many tears and many fears, but I think we have got there now 🙂
When I initially didn’t want to use the CPAP therapy I was offered an alternative that may not fully help the OSA but would help the snoring. This was an Mandibular Advancement Device. Initial use of this wasn’t as successful as hoped for, but after an adjustment to extend it, it successfully stopped the snoring. So now, on Mr Oko’s advice, I am using this along with the CPAP machine as it will help bring my receded jaw forward as I sleep, as well as having the constant air blowing through my nose.
After trying several masks I think I have now found the right one for me…. its the Philips Respironics True Blue Nasal Mask and I can happily recommend it. Its so much softer and doesn’t leak air as you move due to the new technology of the concertina part of the mask. They make this one in a petite size which seems to be a better fit for me too.
Although mentally I am still coming to terms with having this condition, with a little help from my GP too, I am very proud to say that over the past 4 months I have been 100% complaint and my AHI readings have gone down to around a ‘normal’ 3….. It must be a first in my life… I’ve always been anything but normal!! lol
Sadly unlike many CPAP users I haven’t had that feeling of waking up feeling refreshed in the morning. Maybe one day I will, but having Fibromyalgia doesn’t really help the situation as that zaps all my energy away.
On a recent clinic appointment to see Mr Oko, I was so pleased that he is very happy with my progress and he is confident that I am in control of the therapy, he has now suggested my next appointment can be a telephone consultation. Such a brilliant idea as I wont have to leave the house and have to travel 15 miles to the Hospital (or 25 to the other Clinic in Spalding). I know that I can contact them at any time and arrange a face to face appointment, plus I have the support from Philips Respironics who are also excellent and offer first class support for OSA and their products.
Within 2 or 3 days of my appointment I had a letter through confirming my ‘next’ appointment…by phone. That way I know when to be by the phone ready and have any questions written down that I may need to ask…so all in all a bit of a success story 🙂 The best will be yet to come when I have finally accepted the whole issue of having this condition and having it for life…. I am aware that if I were to stop using the CPAP Therapy the apnoeas would go back up. So its definitely in my own interest to continue with it.
I am confident about using the CPAP therapy but I don’t think I would be had I just been given a machine and ‘any’ mask and just told it will stop the snoring….. Mr Oko has helped me understand the condition and given me the confidence to continue with the therapy. I couldn’t have done it without him…..or his team.
I now find myself ‘spreading the word’. I am not worried or self conscious about telling anyone about my OSA and CPAP therapy, however I don’t like the idea of showing it to anyone….. Mind you, I haven’t had to as yet. But I do get frustrated though, when someone mentions to me about theirs or their OH’s snoring but they wont do anything about it.
Thanks again for all the help and support you have given me… I do hope this serves as a reassurance to anyone else going through the same.

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Life longevity specialist Dr Dick Richards blogs on Breathing Relief about the dangers of lack of sleep to health, and side effects of sleep apnoea:

“The bad news is that this [sleep deprivation] causes a rapid fall in the ability of the metabolism to conduct its requisite routines of anti-oxidation and other tissue repairing processes. If repeated several times , as is usually the case, there can be significant falls in oxygenation levels in the blood leading to a recognisable state of what is called oxygen desaturation. The serious consequences over this were such that over thirty years ago there was a careful medical study [*] into the relationship between sleep loss and these unwelcome side effects. It was clearly shown that symptoms of the obstructive sleep apneoa [OSA] syndrome include excessive daytime sleepiness, nocturnal awakenings, reduced sexual inclination and performance, and morning headaches. A number of other mortality studies have suggested decreased survival statistics in persons with the OSA syndrome, possibly due to this causing vascular-related disease.”

We know sleep apnoea leads to greater incidence of hypertension and atherosclerosis related diseases such as stroke, angina, and acute myocardial infarct. In addition to shortened longevity in patients with untreated or inadequately treated OSA there are also other factors which could account for this early mortality, for example sudden death during sleep (arrhythmia) or even fatalities from sleep related automobile or other accidents.

 

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Helen Gilbert reports in the Sun that scientists in the US have found that people who don’t sleep much are far more likely to pile on the pounds:

“Diane MacLean, 42, had always struggled with her weight. Tipping the scales at 28st, she was so heavy she struggled to take part in activities with children Bethany, 16, Louise, 14, Callum, nine and her roofer husband Callum, 38.

But then the mental health nurse from Dumfries was diagnosed with a disorder called sleep apnoea. The condition stopped her breathing during her sleep and would regularly wake her up in the night, leaving her feeling tired and grumpy.

After her diagnosis, Diane had the impetus to change her life and the weight fell off. She shed an amazing 15 STONE in a year.”

Read the full article here

 

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A very interesting post on CNN by Lisa Shives MD:

“The thin child with OSA does not usually act sleepy in the daytime. On the contrary, they often act hyperactive or inattentive. In fact, their symptoms can mimic attention deficit hyperactivity disorder. Large tonsils and adenoids are the primary cause of OSA in thin children because these and surrounding tissues can relax during sleep and block the airflow to the lungs. In fact, 80 to 90% of such cases of pediatric OSA are cured by surgically removing the tonsils and adenoids.

“Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep.

“Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA. The others are encouraged to try continuous positive airway pressure (CPAP) which is the most common treatment for severe OSA.”

Read full post…

 

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I am very thankful for the help I have been given by Mr Oko and the time taken up to listen to me to help me overcome my fears. This is the first step in a huge hurdle for me and with your help I know i will get there. I hope my experience will help others too.

I havent actually started treatment as yet, but thats my own fault really….. I first went to see Mr Oko back in November 2011 and within no time he arranged a Visilab Sleep Study for me. I had envisaged my problem to just be ‘snoring’, so when i went back a couple of week’s later for the results of the Visilab test I was rather alarmed to find I did in fact have Severe Obstructive Sleep Apnoea!

Not expecting this and not really knowing that much about the CPAP treatment I was too scared to give it a go. I opted for a Mandibular Advancement Device to at least help the situation instead. So whilst waiting for this to  be made up, I did plenty of research on the internet and over the Christmas period wrote out many questions.

Today I have been back to see Mr Oko saying that I have changed my mind and would like to give the treatment a try. He couldn’t have been more helpful. He never rushed me and never pressured me. He answered all my concerns and has sorted out a suitable mask for me to try….all I need to do now is wait for my machine to arrive.

Ok, I know I haven’t actually got any CPAP experience to share with everyone as yet, but my experience of nerves after the initial diagnosis will hopefully help others who may be feeling the same, come forward. I will update as my treatment continues as I would like to help and hopefully others will do the same and I can also gain from their experiences of the condition.

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This is an article I have written for You and Your family, who send out the baby book to all expectant mothers:

Pregnancy and then a new baby can make getting enough sleep difficult, especially if your partner suffers from Sleep Apnoea…

When your baby arrives you will want to be on top form in order to give him or her all the care and attention they need, day or night. The chances are that you will also be among the three quarters of women who have difficulty getting enough sleep during pregnancy.

Leg cramps, heartburn, frequent toilet trips, can all make sleep difficult. So when you have the opportunity for sleep you need to make the most of it. Good practices to avoid insomnia include taking daily exercise, not smoking or drinking alcohol, avoiding caffeine in the evenings, and not eating a big meal too close to bedtime.

However, it could be your partner that is giving you sleepless nights if he has a snoring problem; and it could be due to a medical condition. The most common sleep disorder is called Obstructive Sleep Apnoea, and men are twice as likely to suffer from this than women.

The problem itself is a disrupted breathing pattern during sleep caused by a closing of the upper airways of the lungs when you relax and a period of time when your body stops breathing. Common indicators of Sleep Apnoea are loud snoring, daytime fatigue, memory loss, frequent urination, and loss of interest in sex.

Sleep Apnoea also carries significant health risks, increasing the risk of high blood pressure, heart attack, stroke, type 2 diabetes, and obesity.

Sleep Apnoea can usually be treated by making small lifestyle changes, but moderate or severe Sleep Apnoea may require wearing a CPAP machine while you sleep. This is a mask attached to a machine that helps you to breathe at night by providing a steady supply of air.

If you are concerned that you or your partner may be suffering from Sleep Apnoea it is advisable to consult your GP, who can then refer you to specialist for diagnosis and treatment.

When your new baby arrives you will need all the rest you can get, so it makes sense to get a sleeping disorder treated in plenty of time for the birth.


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