Obstructive Sleep Apnea (OSA), where the tongue falls backwards to block the airway passage during sleep, resulting in breath-holding for 30 seconds or so, and for up to 1 to 2 minutes in severe cases. Normally, we breathe every 3 to 5 seconds. The prolonged apnea (not breathing) in OSA, which can happen even more than 100 times per night, leads to an oxygen deficit for the brain, heart, liver, kidneys, and other vital organs. Some OSA cases developed stroke or heart attack during sleep due to prolonged oxygen deprivation. Untreated, OSA increases the risk for cardiovascular and metabolic diseases, Alzheimer’s, and even cancer. Around one billion people globally have Sleep Apnea. Around 80 percent of OSA remains undiagnosed and untreated.
Those who wake up feeling fatigued and become sleepy by the late morning or early afternoon, whether they snore or not, are suspects for OSA and need a Sleep Study for confirmation of diagnosis. If positive, Continuous Positive Airway Pressure (CPAP) therapy is initiated. CPAP has been the gold standard treatment for Obstructive Sleep Apnea since its introduction in 1981, and the younger the age at diagnosis and the age at which CPAP started, the healthier the person becomes.
The CPAP (computerized) machine delivers prescribed pressurized air through a face mask, a nasal pillow, or a nasal cushion into the oropharyngeal (throat) area, inflating it and pushing the tongue down, preventing it from falling backward, keeping the airway open during sleep. CPAP, considered a lifesaver, is covered by Medicare.
CPAP masks might sound uncomfortable to sleep with, but 10 million Americans find using CPAP to be quite tolerable, even soothing, and CPAP also provides security and peace of mind. Most users could not sleep without CPAP, even while traveling abroad. Restful sleep is vital to health and longevity.
Confusion
The advertisement about Inspire as treatment for Obstructive Sleep Apnea, which was introduced in April 2014, has confused the public with its wording: “No mask. No Hose. Just sleep.” The TV Ad message is not transparent and honest enough to point out that CPAP is the gold standard medical care for OSA, and that Inspire is only an alternative for those who cannot tolerate CPAP therapy, and that Inspire requires surgery. While the use of Inspire is only 12 years old (about 125,000 implants so far), CPAP has 41 years of proven effectiveness, safety, benefit, and value, as a non-invasive treatment, now being used by 10 million. Longer experience with Inspire in the years ahead will show what potential long-term complications this treatment might cause, if any.
Surgical Inspire
For those who are claustrophobic or uncomfortable with the mask and unable to tolerate masks, Inspire is an option. This requires surgery to implant a lead with a stimulation cuff at the base of the tongue, connected to an Inspire Implant (a pacemaker-like device) that senses breathing and delivers the impulse to stimulate the tongue when needed to prevent it from falling backward. The Inspire implant device needs to be changed every 10-11 years. Up to about 8 percent of patients required surgical revision due to lead malfunction, and about 4.6 percent due to intolerable discomfort. More than 90 percent report satisfaction.
Side-effects and complications
Minor complications of CPAP therapy include dryness of nose and mouth, skin irritation from the mask, nasal congestion, aerophagia (air swallowing), eye irritation, headache, and ear pressure.
As for the Inspire implantation, since it is an operation, it carries risks associated with the surgery and the actual stimulation therapy. Serious complications are rare, less than 2 percent. Potential side-effects include tongue soreness and tingling, throat discomfort, dry mouth, swallowing and speech changes, and tongue abrasion. Infrequent possible surgical complications include infection, bleeding/hematoma, nerve damage, pain-scarring, pneumothorax (air-leak into chest cavity – rare).
Garlic wonder
While garlic breath may be repulsive to people and to vampires, a new meta-analysis randomized clinical data from 180 randomized controlled trials among 7,000 adults showed “that consuming raw, cooked, or supplemental garlic improved cardiovascular risk factors like LDL cholesterol, triglycerides, and blood pressure — especially in those with elevated cardiovascular risk.”
In Asia and in the Mediterranean, garlic is indispensable in cooking. Worldwide, over 29 million metric tons of garlic are produced, 73 percent from China, with an average consumption of 31.5 pounds of garlic per person each year. The Philippines (117.5 million in population) uses about 143,000 tons of garlic a year. The Middle East (about 700 million in population) consumes about 375 tons of garlic in 2024, about 8-10 pounds per person (highest in Qatar) annually.
It is always best to ingest garlic in food. Natural garlic is superior and preferred to pills.
Meds and dementia
There are roughly 40,000 different prescription medications and about 300,000 over-the-counter drugs available around the world. While some of them are so familiar and commonly used, a few of them could have adverse side effects on our brain health. Some of the popular medications increase the risk for cognitive decline and dementia. They include those with strong anticholinergic effects, like over-the-counter diphenhydramine (Benadryl), Advil PM, Tylenol PM, Zzzz Quil, Aleve PM, etc., sleep aids and decongestants. Drugs for control of overactive bladder, GI meds, like scopolamine, PPI drugs (Esomeprazole, etc.), anxiety/anti-depressant meds (Valium, Ativan, Doxepin, etc.). Never start or stop medications on your own. Always consult your physician.
The fewer medications we take, the better. Prescribed drugs are essential to health and must be taken as ordered by physicians. Not taking them as prescribed could be dangerous, like a patient who developed a stroke because he forgot to take his blood pressure meds. Poor adherence to medications is linked to a nearly 4-fold risk of dying from stroke.
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The opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of the Asian Journal, its management, editorial board and staff.
Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, Health Advocate, medical missionary, newspaper columnist, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. He is a decorated recipient of the Indiana Sagamore of the Wabash Award in 1995, presented by then Indiana Governor, US senator, and later a presidential candidate, Evan Bayh. Other Sagamore past awardees include President Harry S. Truman, President George HW Bush, Astronaut Gus Grissom, pugilist Muhammad Ali, distinguished educators, renowned scientists, etc. (Wikipedia). Websites: FUN8888.com, Today.SPSAtoday.com, and philipSchua.com. On Amazon.com, search for “Where is My America?” Email: scalpelpen@gmail.com
