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Narcolepsy and Apnea Syndromes


Narcolepsy and apnea syndromes


Narcolepsy is a real sleep disorder, largely genetically marked, but also a symptomatic consequence of brain trauma or brain infection.It is characterized by an irresistible need to sleep during the day, which is repeated at different intervals, and inevitably ends with several minutes of sleep wherever the person is. In this disease, in addition to sleep attacks, cataplexy also occurs, ie a temporary loss of muscle tone with falling objects, kneeling, and in severe cases, falling, all with clear consciousness. Cataplexy is often caused by excitement, more often by joy than fear. Some of these patients have hallucinations before bed, as if they are dreaming while still awake, or they happen to wake up at night paralyzed for a short time. The disease is rare. It is specifically diagnosed, and the treatment is complex. For imperative sleep during the day, modafinil is undeniably effective. Cataplexy is treated with tricyclic antidepressants (amitriptyline, imipramine, clomipramine).

There are also some narcolepsy-like conditions, which occur in adolescence, last a short time and pass spontaneously.

Nocturnal apnea syndrome - sleep apnea

Sleep apnea can be due to two reasons. The first, less common, is due to the mismatch of the respiratory center with the stimulated need to breathe. Another, more common, form of sleep apnea is upper airway obstruction as a result of muscle relaxation of the surrounding tissue, which inevitably occurs in non-compromising measure in normal sleep, and all this is more pronounced the deeper sleep. In people with obstructive sleep apnea, this phenomenon leads to upper airway obstruction, stronger and longer in deep sleep and in REM. Therefore, these people can still sleep superficially, but they cannot achieve the highest quality, ie the most restorative, form of sleep, phases III and IV and REM phase.

Obstructive apnea syndrome - clinical aspect

It is more common in men, it is more common in old age, being overweight is crucial. These people have a hard time snoring, visibly stop breathing while sleeping, sleep restlessly, and are extremely sleepy during the day. Drowsiness becomes more severe over time, a typical external appearance occurs: obesity, cyanotic and puffy face, psychomotor retardation, with intrusive intellectual hesitation. They make mistakes at work, they are especially risky in traffic with an accident frequency five times higher than their peers. In more severe forms, they fall asleep as soon as they sit down.

The snoring of these patients wakes the sleepers, not only in the same room, but also in the same apartment. Over time, cardiovascular risks for stroke, heart arrhythmias, and right heart failure develop.

Is there any help for that?

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There are, and very effective ones. Small room appliances for individual, nightly use solve the problem of obstructive sleep apnea. These devices have been used by hundreds of thousands of patients around the world for the past ten years. These are devices with positive pressure, the so-called. CPAP (Continuous Positive Airway Pressure), which raises the pressure in the room air by 0.06-0.16% and in normal flow through a customized night mask for the nose (mouth remains free) completely normalizes breathing, which takes place automatically with a frequency independent of the device. Improvements are obvious, daytime sleepiness disappears, heart rate at night normalizes, no apnea and snoring, oxygenation, ie oxygen content in the blood, during sleep significantly improves, mostly normalizes. The subjective feeling of daily freshness with awake reactions is visible with the application of the device to the patient and the environment.

Does the device work on centrally induced sleep apnea?

It works, but not as well as for obstructive sleep apnea. Fortunately, centrally induced apneas are much less common. In them, drugs that stimulate the respiratory center are more important than the described device.

What are the options for surgical treatment of obstructive sleep apnea syndrome?

Significant. ENT procedures that reduce tissue mass in the upper respiratory tract correct congenital or acquired anomalies in the nose and throat can solve the problem on their own in rare cases, and certainly contribute to the effectiveness of CPAP-device, which improves function but can not affect pathological structures if have.

How long has the CPAP device been used?

The use of the device is permanent or at least long-term. Healing can be followed by a radical reduction in body weight, cessation of smoking, drinking, use of sedatives and / or relaxing drugs, all of which are very bad for sleep apnea. The fact is that obese patients with apnea often begin to lose weight radically after using the device. Obviously, some pathological interrelationships between drowsiness and hunger and an increased tendency to gain weight are broken.

Is snoring always a pathological sign?

It's not. Sleeping sleep is most often a normal occurrence due to the vibration of flabby structures in the pharynx, especially the soft palate and uvula, but also the vocal cords, in a naturally resonant environment. Apnea-free snoring therapy is more of a socio-cosmetic procedure than a medical necessity. Changing the sleeping position can reduce the problem - you should definitely avoid the back position.

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