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Hi Ms. Aultman-Morris,
Despite the classic description of a sleep apnea patient being an older overweight snoring male with a big neck, it's been shown in the past few decades that even young, thin women who don't snore can have significant sleep apnea. Unfortunately, most doctors still think the former. I have many very petite, thin women in my practice who don't snore and have significant obstructive sleep apnea. Ultimately, it's a jaw narrowing problem with obesity coming later. If you're chronically tired, no matter how much you sleep, and if you prefer to sleep on your side or stomach, almost invariably, the area behind your tongue when lying flat on your back will be very narrow. Because of the narrowing, when the tongue relaxes during deep sleep, one goes straight to obstruction without snoring, leading to an arousal. This is why many people with these issues don't like to sleep on their backs. If your jaws start off normal and you gain weight, then the partial narrowing will lead to snoring and later apneas. I am an otolaryngologist, in private practice in New York City. About 80-90% of my practice is related to sleep-breathing disorders.
Since I work closely with my area sleep doctors, I don't usually prescribe masks. However, I counsel patients extensively on CPAP usage, and try to do everything to optimize compliance and patient satisfaction. Most of my patients do very well on CPAP, but some do not due to various reasons.
To determine whether or not someone has central vs. obstructive sleep apnea, one needs a formal polysomnogram. It's a relatively simple finding related to the sleep stage EEG, along with nasal airflow, chest and abdominal movements.
Up until recently, sleep medicine was under the auspices of neurology. Anyone who did a one year fellowship and passed an exam could be certified in sleep medicine. Now, sleep medicine is an independent specialty recognized by the American Board of Medical Specialties, cosponsored by the following five specialties: pulmonology, psychiatry, otolaryngology, neurology, and pediatrics. It really doesn't matter who treats someone with central sleep apnea, as long as he or she is certified in sleep medicine. Central sleep apnea is thought to be a neurologic disorder, with a possible obstructive component, as well as a cardiac component. This is why sleep medicine has to be an interdisciplinary field.
Your servoadaptive ventilation machine is the most current way of treating central sleep apnea. Since you also have emphysema and COPD, it's a good thing that your sleep doctor is also a pulmonologist.
Hope this answers your questions.
Steven Park
http://www.doctorstevenpark.com
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