Rod's Health

I recently saw an article on PubMed that suggested that acupuncture may help improve some of the symptoms of sleep apnea. The study, published in Chinese, suggests that the apnea-hypopnea index (AHI), and the oxygen desaturation index (ODI) were reduced, and oxygen saturation of the blood were both improved after 3 to 5 sessions of acupuncture each week until 30 sessions had been completed. Unfortunately, there were only 30 patients enrolled in this study, so the evidence that acupuncture may be beneficial for sleep apnea is not very strong.

Unfortunately, when I searched PubMed for other studies that looked at acupuncture and apnea, there was only one other study, conducted by the same group, in which 12 patients were actually treated with acupuncture. In this study, the patients were treated once a week for 10 weeks. As in the more recent study, the AHI improved in patients who got acupuncture. There was also a control group who got no treatment – in these patients the AHI deteriorated.

These two studies in people with sleep apnea suggest that it may be worth trying acupuncture to reduce the effect of sleep apnea. However, the number of patients is small, and you need to have at least 10 and up to 30 sessions to show the kind of effects that were seen in these studies. Clearly, more research will be needed before acupuncture can be used to treat sleep apnea. If I was able to find an acupuncturist who could do this, I would want to have another sleep study after the treatment session before I turned off my CPAP machine. Also, I would want to have a follow-up study 6-12 months after the course of acupuncture to make sure that the apnea had not become worse.

Do you or someone you know have sleep apnea? There is a stereotype that says that you have to be overweight, over 40, and a guy. However, the reality is that apnea can affect anyone. The usual symptoms include daytime sleepiness, waking up in the middle of the night gasping for breath or needing to use the bathroom. Snoring is often a sign that people think is associated with sleep apnea, but not everyone with apnea does snore, and not everyone who snores has sleep apnea. The only way to accurately measure apnea is with a painless sleep study. You are wired up with various recording systems, but once you are asleep you don’t notice. The standard indicator of severity of apnea is the apnea-hypopnea index (the AHI that I mentioned above).

The AHI is simply a measure of the number of times each hour that you stop breathing for more than 10-20 seconds (apnea) or have restricted breathing where your airway is not completely obstructed (hypopnea). My AHI was 31 times per hour before I got treated with CPAP. After more than 18 months of wearing a mask every night, it is now 2 times per hour (sometimes less, sometimes more).

I have just realized that it has been  9 months since I last posted. Far too long, and I know I will need to post more frequently on Rod’sHealth in the future. A lot has been happening, so here is a brief summary:

I am continuing with the challenges of CPAP treatment – nobody should ever say it is easy! There is so much to learn. I have struggled a bit with insurance companies, DMEs, not to mention masks and machines! I have learned that probably because I have a beard a full face mask does not work for me. I have tried a couple, and end up leaking all around the mask, particularly where it sits on my beard.

I have tried various solutions to the mask question over the last 18 months, and have come to the conclusion that for me, a Silent Nite dental device works well – used in combination with a chin strap and the CPAP machine. More information on that later, but please note you need to find a dentist who is experienced in the treatment of sleep apnea or who can work with your sleep medicine professional. I am neither, so I can’t tell you if it will work for you. Also, I have learned about the importance of regular cleaning of the interface and the humidifier chamber – not doing this regularly has a serious impact on the ability of the machine to keep my AHI under control.

My mother-in-law was diagnosed with advanced cancer last year. She had a surgical procedure, then was put on treatment with hyperthermia. It is still experimental in the US, and requires careful medical supervision. It is being used more frequently in Japan. However, you can read more about it here. As I learn more about it I will post more information here.

I was forced to change my daytime job earlier this year – despite my working very hard (including long hours) my previous company was not doing well. In fact, after I left, they laid off a large number of my former colleagues. It seems like I escaped just in time! My new company has required the dedication of longer hours than I wished for, but I am now well established and able to focus on a few things other than just work!

Just a short post this time. I promise I will post more regularly in the future!

Vitamin D is found everywhere in the body. It is essential for many body functions. It has been shown to be important in helping to

• Avoid complications of pregnancy
• Avoid Parkinson’s disease
• Maintain cognition (this may help reduce the effects of Alzheimer’s disease)
• Prevent cancer of several types
• Prevent type 1 diabetes, especially in babies
• Increase the risk of heart attacks and stroke
• Increase the body’s ability to fight Clostridium difficile infections (that is a nasty infection that is resistant to many antibiotics. Help avoid it by making sure you wash your hands frequently when visiting someone in hospital)
• Increase your response to exercise
• Increase the chances of migraine (possibly)
• Increased risk of fibromyalgia (a painful condition that has sometimes been linked to chronic fatigue syndrome)

There are probably many other health problems possibly associated with not enough vitamin D in the body. Autism has been suggested by some experts as being related to lack of vitamin D, but there needs to be a lot more research done to confirm the link – it might be that the lack of vitamin D is actually the result of something else.

The problem with all of these possible ill effects of not enough vitamin D is that it takes a long time to show the effects of supplementation with vitamin D on the health problem. There is also disagreement over the type of vitamin that should be used for supplementation.

So, how much vitamin D do I need?

Unfortunately, that is not possible to answer in a post – it all depends. How much vitamin D do you actually have in your body? How much sun to you allow to reach your skin (without sun blocker or clothes)? How dark is your skin? How far north (or south) of the equator do you live (the higher the latitude, the less effective sun exposure is in increasing vitamin D levels). How old are you (older people make less vitamin D)? How much vitamin D do you get in your food?

The answer to the last question is actually easy – not much. The only way to know how much vitamin D you need is to have a health care provider request a lab test for you. Once you know the levels, then you can plan for getting more vitamin D. The majority of people in the higher latitudes do not have enough vitamin D, so I can be fairly certain that you will need more.

Options for increasing vitamin D levels

Really, there are only two ways to increase vitamin D levels:

• More sun exposure
• Supplementation

The sun exposure can be difficult – you need about 15-20 minutes of full sun exposure every day during. As I write this post there has been no sun all day! In doing this, you have to be careful to avoid burning your skin. You may need to increase the time if you are dark skinned, and as you get older. See how difficult it is? The amount of vitamin D you can get from food is limited. Maybe a bit from calcium and vitamin D that is added to some orange juice or milk, but that is not a reliable amount.

Supplementation is easier, but you need to work with your health care provider to determine the dose. You don’t need to use a prescription form of vitamin D. What you can buy at the health food store is usually enough. Just make sure you buy a good brand, and have your vitamin D levels checked. Probably at the beginning and end of winter.

Blood levels of vitamin D

Blood levels should ideally be kept above 15 ng/ml (37.5 nmol/L), but less than 200 ng/ml (500 nmol/L) according to the Office of Dietary Supplements. My physician recommends keeping my levels closer to the lower level to avoid side effects. I take 1000 units per day, but some people may need 10,000 units/day, at least for a short time. It is important to work with your health care provider to determine YOUR correct level of supplements.

I often see questions on various forums and in news articles questioning the value of multivitamins.  There is a lot of evidence in the literature that in some cases individual vitamins have been shown to have this or that effect. Often, there is no effect, although in some cases it another vitamin is beneficial. Other times we read that a combination may show some benefit. Calcium and vitamin D is one example. Why should this be?

There are a couple of reasons why we need to look closely at what vitamins we are taking. Firstly, we need to make sure that they are high quality, that they undergo some kind of testing where the results are publicized, so that we can depend on actually getting what the label says we are getting. The FDA does not routinely inspect the places where vitamins are manufactured. They are concerned with whether those herbal remedies contain some form of the drug contained in Viagra, but under the Dietary Supplement Health and Education Act (DSHEA) of 1994, there is no prelaunch approval process for supplements similar to the process for pharmaceutical drugs. FDA will only act if there are problems reported with a supplement; and usually only if there are a lot of problems reported. Particularly if people have died.

The second reason we need to look closely at the vitamins we are taking is that some of them will only work if they are taken together. Like calcium and vitamin D, that I mentioned above. Several of the B vitamins work best if they are taken with other B vitamins. This is a problem with clinical trials – if the trial is of a single vitamin taken alone, how do we know that it will be used effectively by the body? We don’t.

Good combinations of vitamins are quite ‘expensive’ in money terms. However, we can read that the food that we eat is of lower nutritional quality than it was 30 years ago (I did a few weeks ago). This means that we have to replace some of that quality with a good nutritional supplement. Also known as multivitamins. These are different from the herbal ‘dietary supplements’. The manufacturing quality can be controlled to ensure that the amount of each vitamin is close to the amount stated on the label. Did you know that there are manufacturing tolerances for pharmaceutical drugs as well?

So, to ensure that we are getting ‘good’ vitamins, we should pick a company that carries out research into the optimal combinations of vitamins, and manufactures the resulting combinations with as much care as a pharmaceutical company does. That way, we can be sure we are getting value for money.

Do I take vitamin and mineral supplements? Yes. As a result, my blood pressure is lower than the ‘standard’ pressure for my age, I do not have diabetes, and I only rarely visit a doctor other than for check-ups. Could this be the result of eating a healthy diet and exercising? Yes, it probably could. Could it be something in my genes? Sure, but unless I get genetic testing, I am not going to know for sure. Could it be luck? Maybe, but don’t we all create our own ‘luck’ by working hard and eating right? I just prefer the additional insurance that taking vitamins gives me, maintaining Rodshealth at an excellent level.

Think about it.

I posted before that I have sleep apnea. Since the diagnosis, I have learned a lot about the disorder – both from reading about it, and from living with it.

My wife tells me that my snoring scared her when we got married (nearly 16 years ago). At that time she knew nothing about sleep apnea, and there were probably not many doctors that knew much about it, either. So she put up with it. I didn’t know that I snored that much, but I did find that I was getting very tired during the day. I thought that was normal for the kind of work I was doing – sedentary, office-type work. I would try and do some exercise, but then I found I was getting even more tired. Weight was becoming a big problem.

There are many effects of sleep apnea – none of them nice. They include  high blood pressure; greater risk of heart attack and stroke; heart rhythm changes; waking up in the night to use the bathroom (I was lucky, only once a night); headaches (including migraine); daytime sleepiness, even after a ‘good’ night’s sleep; memory and concentration problems; weight gain;  possibly seizures; possibly diabetes; gastric reflux disease; sweating during the night; depression; anxiety; pain; impotence; relationship and job issues; and so on. Enough already? The real danger is that some people fall asleep during the day – the person not moving when the traffic signal has changed to green may have sleep apnea. They need sympathy and education, not an angry blast on the horn.

I have been using my CPAP machine for nearly a year now  and have seen a lot of improvement in my health. I don’t snore, and I am no longer needing to nap during the afternoon at work (a very good thing when the boss is around). I still get tired, but I don’t have the ‘brain fog’ that I used to have. I wake up before the alarm some mornings, and I no longer want to sleep late (after 7-8 AM) on a Sunday morning. I do find that I need to go to bed a little after 9:30 PM, but that is because I get up at 5:00 AM on days when I have to go to work.

The CPAP machine is amazing technology. It is just a little fan that blows air through a hose and into my nose through a mask. These masks are often called interfaces because they can cover the whole face (think Darth Vader), just the nose (a little bit like the masks that come down if there is a loss of cabin pressure in a plane), or just sit under the nose so that there is very little contact with your nose (called nasal pillows).

My personal favorite mask is the nasal pillows. They don’t make my nose sore, and are normally very quiet. They do get a bit noisy when they are not adjusted properly and air is leaking out of the sides.

The air pressure is something people get worried about. It is measured in centimeters of water. Why, I don’t know. If they talked about pounds per square inch (in the US, where I live), the numbers would be very small. Nothing that would blow up a balloon. I got used to the pressure I was prescribed very quickly – it was only 8, although I did have to have it increased to 10 after a couple of months because I was still snoring a bit.

So, sleep apnea is a scary thing – the treatment is not.