THE NEW FACE OF SLEEP
Forwarded by JohnW/MN: For the 18 million people with obstructive sleep apnea, the remedy is far from perfect: bulky and expensive masks that some compare to sleeping in scuba gear. As the number of people with sleep apnea is expected to rise, doctors and medical device makers are trying new treatments. New masks, while still bulky, aim to be more comfortable. Dentists have begun prescribing an appliance that draws the lower jaw forward to create more space in the airway. Some doctors recommend several types of surgery. And some try basic lifestyle changes, like sleeping in a different position. For patients who don't find relief from any of these, there's an odd recommendation: Learn to play the didgeridoo (more about that later).

Patients with sleep apnea stop breathing during sleep because the soft palate collapses and blocks the upper airway. A tell-tale symptom is chronic and loud snoring. The most common and effective treatment is "continuous positive airway pressure," or CPAP. The treatment involves wearing a breathing mask to sleep—which some people find impossible to do. As few as 50% of people who are prescribed a CPAP device actually use it regularly.

A variety of specialists, including pulmonologists, ear, nose and throat doctors, neurologists, surgeons and dentists, treat sleep apnea. The most accurate diagnoses are performed in a sleep lab, where the patient goes to sleep overnight while being monitored. The cost, about $1,000, is usually covered by insurance with a doctor's prescription. Sleep apnea is measured on an apnea-hypopnea index, combining the number of apneas, or pauses in breathing, with hypnopneas, or instances of excessively shallow breathing, in an hour. An index of 1 to 15 is considered mild, 16 to 30 is moderate, and over 30 is considered severe. Typically, patients are diagnosed with sleep apnea only if they stop breathing five or more times in an hour. First mentioned in medical literature in the 1960s, sleep apnea was at first treated with a tracheotomy, a breathing tube inserted into a surgical incision in the windpipe...today, 60% to 70% of patients are treated with CPAP, in which the breathing mask, connected by tube to an air pump, sends pressurized air through the patient's nose. The air flow keeps the upper airway open and prevents apneas. A patient is supposed to wear the mask while sleeping for eight hours a night for the rest of their life. Usually covered by insurance, the device costs from $500 to $4,000.

Sleep-apnea dental appliances, costing from $2,500 and $3,000, are often recommended for patients who can't tolerate the CPAP treatment; there are some indications that compliance with these appliances is higher. But there is a significant downside. They can cause a patient's teeth to move, and the patient risks developing a painful case of temporomandibular jaw syndrome, or TMJ.

Surgery is an extreme option, often recommended for people with complicating issues such as a deviated nasal septum, nasal polyps or enlarged tonsils. Some interventions involve actually surgically advancing the lower jaw—which can cost as much as $50,000 and require weeks of recovery. Less-invasive surgical treatments are becoming more common. Some involve removing soft tissue from the back of the throat and palate; in somnoplasty, radiofrequency energy is used to shrink tissue in the nasal passage. Other procedures create more space in the airway by shifting how the tongue is attached. Injection snoreplasty involves injecting a chemical into the soft palate to create scar tissue, which reduces snoring.

Simple lifestyle changes can add to the benefits of other treatments. Sleeping while lying on the side, instead of the back, can prevent the airway from closing, some studies show. Losing weight can help, and so can stopping smoking, since smoking leads to inflammation and fluid retention in the airway. Sufferers also should avoid alcohol and sedatives, which can further relax the airway during sleep.

If all else fails, there is always the didgeridoo, an indigenous Australian musical instrument. In a study published in the British Medical Journal, 25 patients with sleep apnea who practiced playing it for about 30 minutes a day, six days a week for four months, significantly reduced the number of apneas they had during sleep; daytime sleepiness also decreased. Scientist believe the breathing technique required to play the didgeridoo strengthens the upper airway and makes it less likely to collapse.
http://online.wsj.com/article/SB10001424052748704107204575039101390202576.html

Here's a link to Wikipedia's info on a Didgeridoo. http://en.wikipedia.org/wiki/Didgeridoo

I've seen them for sale at Amazon for approximately $15.00. The price can be as high as $200.00 for an authentic one from Australia.

DEAR DR. PAUL DONOHUE Bronchiectasis
Tell me something about bronchiectasis. I have had it for more than six months. Is it treatable? I use albuterol in a nebulizer. I am tired all the time and have no appetite. I have a cough with phlegm. Some nights I sweat. My doctor has me on ethambutol, clarithromycin and rifampin.- D.M.

A: The bronchi are the airways, the breathing tubes. Bronchiectasis (BRONG-key-EK-tuh-siss) is a condition where the airways are stretched way out of shape. They become the perfect place for collection of thick, pus-filled secretions that promote coughing of yellow sputum, sometimes containing blood. The airway problem often results from previous infections, and it fosters recurrent infections. Antibiotics are frequently called upon to clear the airways of infecting germs. Medicines that open up the airways so that their thick secretions can drain are prescribed. Your albuterol nebulizer is such a medicine.

If bronchiectasis is limited to one specific lung location, that section can be surgically removed, or removed through artery embolization. That's a procedure in which the artery serving the involved lung part is injected with material that forms a clot. Cut off from its blood supply, that section of lung dies and is absorbed. I believe, however, that you suffer from the more-widespread variety of bronchiectasis, where much of the lung is involved.

You are getting treatment. You are on three antibiotics: ethambutol, clarithromycin and rifampin. This combination of antibiotics is used for a germ called mycobacterium, a germ often associated with bronchiectasis. It's a distant relative of the TB germ. Let me emphasize that you do not have TB, and you won't spread the mycobacterium germ to others. It takes a long time to eliminate mycobacterium. If the germ succumbs to treatment, as it often does, you should be feeling much better. Your energy returns. You stop coughing. You don't have further night sweats.Bronchiectasis is somewhat like COPD, the two illnesses of emphysema and chronic bronchitis. This is a very common condition.

Dear Dr. Donohue: What can you tell me about sniffing or smoking incense? The teenagers are into this. Are there side effects? - F.C.

A: The only information I can find on this topic is a study that took place in Singapore on a large number of Chinese there. They lived in cramped quarters where incense was burning constantly. Those people had an increased incidence of cancers of the tongue, mouth, nasal passages and larynx (voice box). I have to admit, I was unaware of this fad. I thought it was my age, but I talked to many teens, and they had no knowledge of it. Maybe it's a regional thing.
http://tinyurl.com/yd9fcnw

HOW DO YOU FIT IN ON USING THE COMPUTER FOR HEALTH RESEARCH
A survey of 7,192 participants measured consumers' use of health information technology. Specifically, CDC researchers asked when participants had used a computer to store, retrieve, share, or use healthcare information to make decisions and communicate, to conduct research, and to communicate with healthcare and prescription providers and engage in other forms of Internet dialog.

-The study found 51% of adults 18 to 64 used the Internet to look up health information at some point over a 12-month period. Previous research had shown that over 60% of all adults in the U.S. had, at some point, used the Internet to search for health or medical information.
-Not surprisingly, 18- to 49-year-olds were more likely than older adults to use health information technology.
-Women were more likely than men to use the Internet for health information in all surveyed categories, including:
-Chatting online about health topics (2.5% of men versus 4.1% of women)
-Researching health information (43.4% versus 58%)
-Communicating with healthcare providers (4.2% versus 5.6%) or scheduling an appointment (1.8% versus 3.5%) by e-mail
-Refilling prescriptions online (5.3% versus 6.6%)
-The survey was conducted by the CDC and the National Center for Health Statistics.
http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/tb/18281

POLYPHARMACY AND GROWING HUMAN ORGANS
I was drawn to this page by the word Polypharmacy which according to the clip is a burgeoning problem for patients, especially as they are seen by an increasing number of doctors. Primary care doctors sometimes wonder whether they should stop drugs started by other specialists. In a guest post, cardiologist John Mandrola notes that "patients in their present conditions would benefit from less preventive medical therapy and more symptom and comfort control." Sometimes that means stopping medications that a patient may have been on for years. He cites several difficulties, including the fear of liability and the fact that the discussion need to modify a chronic drug regimen takes time -- which is in short supply.

The most interesting video clip on the page however is just below it. TEDMED is a fantastic series of lectures featuring a wide range of compelling topics. In this one, Anthony Atala’ discusses how his state-of-the-art lab grows human organs – from muscles to blood vessels to bladders. It's 18 minutes long so make sure you have the time.
http://www.medpagetoday.com/Blogs/18272

THINGS FORGOTTEN
Simple Lapse or Serious Problem? Chances are you’ve walked into a room and forgotten why you went there. And misplaced your keys or eyeglasses at least a few times. Many people worry about these memory lapses. They fear they’re heading toward a serious condition like Alzheimer’s disease, an irreversible brain illness. Occasional forgetfulness is a normal part of life that becomes more common as we grow older. In most cases, it’s no cause for alarm—unless it begins to hamper daily activities. Forgetting where you left the car keys is one thing; forgetting what they do is quite another.

No matter what your age, several underlying causes can bring about memory problems. Forgetfulness can arise from stress, depression, lack of sleep or thyroid problems. Other causes include side effects from certain medicines, an unhealthy diet or not having enough fluids in your body (dehydration). Taking care of these underlying causes may help resolve your memory problems.

For some older people, though, episodes of memory loss may be a sign of a more serious problem called dementia. Two of the most common forms of dementia in older people are Alzheimer’s disease and multi-infarct dementia (or vascular dementia). In Alzheimer’s disease, memory loss begins slowly and gets worse over time. People with Alzheimer’s disease have trouble thinking clearly. They find it hard to do everyday things like shopping, driving, cooking or having a conversation. Medications can help during the early or middle stages. As the illness progresses, though, patients may need someone to take care of all their needs (like feeding and bathing) at home or in a nursing home.

Vascular dementia also causes serious memory problems. But unlike Alzheimer’s disease, the signs of vascular dementia may appear suddenly. This is because the memory loss and confusion are caused by small strokes or changes in the blood supply to the brain. Further strokes can make the situation worse. Taking care of your high blood pressure can lower your chances of getting this illness. See your doctor if you’re concerned that you or someone you know has a memory problem. Your doctor may be able to diagnose the problem or refer you to an expert who specializes in memory problems.
http://newsinhealth.nih.gov/2010/February/feature2.htm


MORE PEOPLE BEING ADMITTED TO CANADIAN HOSPITALS EACH YEAR WITH COPD
A review of Canadian data by the nation's leading lung specialists has provided the factual evidence to support what respirologists across the country have been suspecting for some time...more people are being admitted to Canadian hospitals each year with COPD than any other major chronic illness (including heart attacks) and that number has been increasing dramatically in recent years.

A new report by the Canadian Thoracic Society (CTS), entitled The Human and Economic Burden of COPD: A Leading Cause of Hospital Admission in Canada, is timely given the annual spike in hospitalizations due to lung infections each winter. "Anecdotally, we've known for some time that we're seeing a lot of COPD patients being admitted to our hospitals," says Dr. Darcy Marciniuk, Chair, Canadian Thoracic Society COPD Committee and Respirologist at the University of Saskatchewan. "Perhaps what's most concerning, is that the report shows patients frequently being admitted more than once. In fact, 18 per cent were admitted twice, and a further 14 per cent were admitted at least three times within the same year."

Weighing the human and financial burden: Once someone is admitted to the hospital for a COPD lung attack, they spend an average of 10 days there, with an average cost of $10,000 per stay. In fact, COPD lung attacks are the most costly of all reasons for hospitalization, and COPD as a whole could cost the Canadian healthcare system as much as $1.5 billion per year, according to recent estimates. But the human toll of the disease far exceeds any financial cost, as Judith Farley knows all too well. "COPD is clearly a debilitating disease. Having to rely on several medications plus oxygen 24 hours per day does limit one's physical abilities. The psychological impact is very difficult to manage as well. It can be quite frightening when one is not able to breathe on the way to hospital by ambulance with a COPD lung attack. I've required hospitalization in the past and probably will again in the future."

"People can lead long, active lives with COPD if it's detected and treated," says Dr. Ronald Grossman, Respirologist and Chief of Medicine at Credit Valley Hospital, Mississauga, Ontario. "Patients can play a large role in taking control of their health by ensuring that they take medications as prescribed, follow their doctor's advice about vaccinations for flu and pneumonia, quit smoking, and engage in regular physical activity."
http://tinyurl.com/ydafmxc

AN ALTERNATIVE WAY OF THINKING
I have had many responses to my previous columns on alternative medicine, where people have argued I am wrong, and that thanks to their experience, they know that remedy X is effective, writes Skeptic Simon Perry. So, if I and the scientific community are saying the majority of alternative treatments do not work, how can we explain why so many people believe in their efficacy?

Very easily: I find the psychology behind what makes people believe in nonsense fascinating, and by getting to know the mistakes of reasoning that people typically make, you can protect yourself from being drawn into mumbo-jumbo healthcare. I will be detailing the most common errors that lead people to believe in quackery below.

When someone tells how they took X remedy and then got better, there is no way of you knowing if the improvement was caused by the remedy, by a conventional treatment they were also taking, or if they just happened to get better.

In addition, anecdotes are subject to massive reporting bias.Take 100 people with an illness with a 10% chance of clearing up by itself and give them a sugar pill. You can bet the 10 or so who got better after taking the sugar pill will be telling everyone, while the other 90 will have nothing interesting to report.

The biggest victims of reporting bias are alternative health practitioners. Those who don't get better after visiting a quack for the first time don't return. Those who happen to get better anyway go back with stories praising the quack's ability.

By the nature of the way quackery operates, the quack ensures they are fed a constant stream of heavily-biased anecdotes. It's no wonder they'll tell you they "know" it works.

I am not persuaded by an example cited by the British Chiropractic Association as evidence about the efficacy of chiropractic treatment in the treatment of infant colic. My understanding is that infant colic generally clears up by within a few weeks. If you take 316 children with colic then assess them a few weeks later, you are likely to find most would have got better. So a case study showing that 94% got better a few weeks after receiving spinal manipulation does not persuade me chiropractic is effective.

Another error of reasoning can come from what is called "regression to the mean". The symptoms of most diseases vary over time, sometimes feeling better and sometimes getting worse. We are drawn to seek help from a doctor or quack when these symptoms are at their worst. And when symptoms are at their worst, guess what happens next? They get better.

Homeopaths have a prepared excuse for when their patients don't visit them when it is exactly at its worst point. According to many homeopaths, after treatment your symptoms may get worse before they get better. Is there any scenario, other than the patient's death, that could not be taken to confirm the homeopath's hypothesis?

Once belief in an alternative remedy has been established, it will take significant evidence to shake this belief. Psychologists tell us our brains suffer from a problem called "confirmation bias". We place more importance, and are more likely to remember, evidence that confirms what we already believe. Someone I knew used an alternative therapy in place of conventional medicine to treat his bronchitis. It took months before it cleared up. When it got better, he credited the therapy. He ignored the fact it took significantly longer than normal to get better.

Homeopathy has been tested for different diseases in randomized controlled trials and collectively these trials show no effect.

The US Government has spent over $120m a year on training quack practitioners and testing everything from acupuncture for lower back pain (doesn't work) to Ginkgo Biloba for dementia (doesn't work) through funding body NCCAM (National Centre for Complementary and Alternative Medicine). NCCAM has wasted this money to find hardly anything beneficial. I say "wasted" because although it is of value to be aware that these treatments do not work, it's a huge waste if once you've discovered they don't work, the therapists keep selling the treatments anyway.

SIMON PERRY belongs to a group called Skeptics in the Pub which seeks to rigorously and openly apply the methods of science and reason to commonly held beliefs and claims.
http://www.thisisleicestershire.co.uk/news/alternative-way-thinking/article-1796519-detail/article.html

LESS TOXIC SHOWER/TUB CLEANERS
A Landlord's Cleaning Advice: As a landlord, I occasionally need to clean really grubby tubs and showers when prepping for the next tenant. I buy the cheapest hair shampoo I can find. Greasy hair formula works best. I just coat the surface with a thin film and let it sit for a couple hours. It usually cleans everything off with minimum effort and expense. John in Ohio/Dollar Stretcher.