Rx for Readers: A tractor in bed

As people get older, the amount of fat in the neck increases, causing snoring and apnea to be more common.

Sleep disorder (photo credit: INGIMAGE)
Sleep disorder
(photo credit: INGIMAGE)
 My husband is 64 and about 15 kilos overweight (although he is trying hard to lose these kilos). For the last five years, he has been suffering from obstructive sleep apnea – snoring loudly and stopping breathing for some 20 seconds every minute during his sleep without his being aware of it. His general practitioner told him he is at much higher risk for a heart attack or stroke because of this. He was advised by a sleep medicine expert to wear a CPAP (continuous positive airway pressure) mask attached to a device that forces air into his lungs. It helps a lot but is cumbersome during sleep.
I heard recently about a flexible plastic “dental splint” worn in the mouth during sleep that keeps the mouth somewhat open and supposedly prevents or eases sleep apnea. Does such a device really help?
-N.T., Netanya
Dr. Efraim Winocur of the department of prosthetic dentistry at Tel Aviv University’s School of Dental Medicine and Dr. Hagay Slutzky of the Hebrew University’s School of Dental Medicine (both of whom work in Clalit Health Services’ dental clinics) answer:
Sleep apnea is the result of a partial obstruction of the airways that, in mild cases, causes loud snoring that disturbs anyone nearby; in serious cases, it causes a halt in breathing for a relatively long time before the brain reacts to the lack of oxygen and restarts respiration.
This is a medical condition that must be treated, as it can raise the risk of falling asleep at the wheel of a car, heart attacks and/or strokes. In the US, for example, every professional driver must undergo a sleep lab examination to rule out sleep apnea. The obstruction is very often the result of overweight or obesity, causing the deposition of fat in the walls of the pharynx when the sleeper is in the supine position. The fat puts pressure on the neck region, and the pharynx “drops” onto the base of the tongue.
The structure of the upper and lower jaws, enlarged tonsils (especially in children) or genetic factors can cause the obstruction of air while sleeping. In any case, this really harms the quality of sleep and even endangers life.
The oral appliance pushes the lower jaw a few millimeters forward, pulls the tongue backwards and prevents the muscles that make up the walls of the throat from dropping, leaving the airways open without disturbing sleep. After a short period of getting used to it, the apnea patient doesn’t understand how he managed without it in the past. The quality of life improves drastically.
Those who think that only men snore and suffer from apnea are wrong. Studies have shown that 30 percent to 40% of men and 20% of women snore to some extent.
As people get older, the amount of fat in the neck increases, causing snoring and apnea to be more common.
Prof. Giora Pillar, head of the sleep lab at Rambam Medical Center and chief of pediatrics at Carmel Medical Center in Haifa, adds: There are plenty of [research] papers indicating oral appliances have beneficial effects in obstructive sleep apnea. I don’t know which specific appliance the reader is talking about, but generally [such an appliance] has a role in treating this condition. Speak to a sleep expert and/or dentist with expertise in the field to make sure it will help.
Part of the problem is that it’s difficult to predict which dental device will work for each apnea patient.
Prof. Jonathan Mann, head of community dentistry at the Hebrew University- Hadassah School of Dental Medicine, comments: The oral device seems to be a good solution, but it is not the perfect one – which is CPAP.
Three months ago I started a new job that involves intensive use of a computer and my smartphone. My previous work did not require this. Since I started, I have been getting frequent headaches. I went for an eye exam and was told that my glasses are suitable. How does one cope with “overuse” of the eyes? -M.A., Ariel
Prof. Avi Solomon, an ophthalmologist at Hadassah-University Medical Center in Jerusalem’s Ein Kerem, replies:
Almost everyone today is “addicted” to smartphones, tablets and computers at work, at school, at leisure and even, unfortunately, while driving. We hardly raise our eyes from electronic screens. This often causes discomfort, dryness and pain in the eyes, fuzzy or double vision, headaches and pain in the neck and back.
Studies in the US show that 90% of the 70 million Americans who work more than three hours daily at a computer screen suffer from some eye problem. The difficulty results from the eyes getting tired from having to focus on a nearby target and from reduced blinking as a result of concentration on the screen. (Reading books by looking down causes many fewer problems than looking straight ahead at a screen.) Neck and shoulder problems come from the incorrect position of the screen. But one can take measures to reduce these problems.
First, minimize illumination that causes glare and reflections on the screen. Place the screen 50 to 70 centimeters away from your eyes and 10 to 20 degrees below your line of vision. The chair should be positioned so your feet lie comfortably on the floor, and armrests are strongly recommended to support your elbows. Use “warm” (yellow) lightbulbs in the room instead of white ones.
Take breaks from the screen every 20 minutes or so and look into the distance for 20 seconds each time to rest your eyes. Try to blink more, spreading tears on your eyes and reducing dryness. If this isn’t enough, artificial tears without preservatives can be used. Go to an eye doctor periodically, especially if you are older, to check vision and need for eyeglasses.
Limit children in the amount of time they use computer and smartphone screens.
And, by the way, wearing contact lenses and heavy use of screens can make your problems worse.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to [email protected], giving your initials, age and place of residence.