Evidence of Sleep Breathing Disorder

The more a medical practitioner learns about sleep-disordered breathing.  The more her or she has to learn about the effects of this disorder.  It is the effects of this disorder that is often the clue that the problem exists at all.  Most of the sleep-disordered breathing is very subtle and difficult to diagnose.  Therefore, it is incumbent upon the investigator to look at all the effects of sleep-disordered breathing and accumulate the evidence.  The evidence will come from multisystem examination and history.  Because each of the systems investigated has its own possibility of pathology; however, it is the complete picture that will bring to bear upon the sleep-disordered breathing problem.

 For example, sleep-disordered breathing can cause an increase in high blood pressure, nocturia (going to the bathroom at night), type 2 diabetes or blood sugars problems, TIAs, hyperactivity, fatigue, drowsiness, weight gain, GERD, and other pulmonary disorders.  When asking the history of a patient, he can explain that each of these problems he has, has its own clause within its own system; however, when stacking up the evidence it is apparent that the sleep-disordered breathing is affecting all the systems or many different systems, then the evidence starts to pile up that there is a sleep-disordered breathing problem.

The issue is that often times this sleep-disordered breathing is very subtle and not apparent.  The patient does not know this is occurring because he does not actually wake up.  It occurs in the sleep stages of deep sleep and light sleep; however, the arousals from the deep sleep and the light sleep is causing many of these problems as is the pressures in the thoracic cavity due to the closing of the airway.  Therefore, it is incumbent upon the investigating medical practitioner to learn as many of the effects of sleep-disordered breathing so that he can accumulate the evidence to provide a diagnosis or at least a clinical impression of a sleep-disordered breathing problem.  The actual problem cannot be diagnosed without a sleep study because it is a dynamic problem and not a static problem.  That is a subject of another blog.

Common cause of many medical problems

 

The more I learn of sleep disordered breathing and its consequences, the more I realize what a profound effect it has on all the systems of the body.  It affects the heart, the brain, the blood chemistry, the lungs, gastrointestinal, and urinary system.  It affects the general overall feeling of a person and the fatigue levels and it even puts a person in danger as the person’s ability to concentrate and stay focused is decreased with the sleep breathing disorders.  When a person goes to doctors for particular issues on an individual basis, it seems that each of the systems that could be explained the way as its own pathology.  However, when you start putting the pieces together and accumulating the evidence, there seems to be a common cause and that is sleeping disordered breathing.

When I talk to patients about their medical conditions, they all seem to explain away the medical problems they have by saying that it is either age-related or natural causes, but when we start accumulating evidence and checking out different systems, it seems to have a common causative factor and that can very well be sleep disordered breathing.

Therefore, it is imperative for a medical practitioner involved in sleep medicine to learn the effects of sleep on all the systems of the body so that he or she can start putting together the evidence of this problem.  This would allow the medical practitioner to not only convince the patient of this problem by presenting the evidence, but also to help the practitioner to actually treat these patients at a much more profound and life saving level.

Sleep breathing is a dynamic problem

When starting to understand sleep-disordered breathing, it is imperative that the medical practitioner understands that this is a dynamic problem.  The collapsing of the airway at night is a problem that occurs with changes in the pressures of the esophagus.  This is not something that can be imaged, although imaging does suggest a narrow airway and the possibility of this happening.  There is no exam for this problem that can be done without invasive techniques.  The medical problem can be brought to light by history and examination of the various effects of sleep-disordered breathing.  Once the case has been made, then the only way to diagnose this dynamic situation is with a nocturnal polysomnograph (NPSG).  This sleep study would then measure the various parameters of sleep-disordered breathing such as airflow and effort to come up with a proper diagnosis of sleep-disordered breathing.

Therefore, the examination process is basically good enough evidence that this problem exists to the point, which a NPSG will be ordered.  The goal-up of this evidence may have several purposes one of which might be to convince the patient that this problem actually exists.  The other purpose is to determine the severity.

It is impossible to guess the severity of sleep-disordered breathing by the examination history alone.

God bless,

Ron Prehn

Competency, Character, and Compassion – Part Three: Compassion

As I reflect on the third part of our core values of the practice compassion is a very easy concept to think about.  Compassion is what draws people into this business, and it is a compassion for others who are in pain.  The ability to help others and to make a difference in their lives is what satisfies people such as myself who are in this business.  My staff are all very compassionate people and most of the people that I teach and speak to are also very compassionate people.  It seems compassion is what brought people into the field of dentistry to begin with.

Compassion means to empathize with the person’s issues in their life and to help them intervene in these issues so that they are better off either their pain or in the effect of pain in their lives.  This pain of course can be more than just physical pain as we address the spiritual and emotional pain as well.  We try to address all those features in a practice such as this in order to be compassionate with them.  It means to connect with them on a personal level not just as a patient.

Dr. Mayo once said medicine is about knowing the person who has a disease and not the disease that the person has.