I saw today that the World Congress on Sleep Apnea is holding it’s tenth congress in Rome. They only meet every 3 years, so don’t look for one next year. The last one was in Seoul, Korea, but that web site is no longer active.

I am not going, as I am not a physician, and do not work in the sleep apnea world – I just live in it as a patient. I was particularly interested in a couple of items on the agenda for discussion on Rodshealth.

1. Philips Respironics is organizing a symposium on CPAP compliance. Participants are going to be hearing about the rationale for using CPAP, with the question of how much is enough being asked. They are also going to hear about interventions that will improve CPAP compliance from a PR person, then something about the role of behavioral interventions in improving CPAP compliance.

   I wonder if they will address what seems to be a frequent mantra of those who work in this area that the straps should be pulled as tight as possible? Getting the patient set up right at the start of their treatment is extremely important for improving adherence to the treatment program (I prefer adherence to compliance because I choose to follow the treatment). 
    

2. In the introduction to the Congress, Dr. Christian Guilleminault notes that sleep disordered breathing is responsible for many health-related problems, especially cardiovascular diseases. There will be no arguments from those who have sleep apnea that inattention, daytime sleepiness, systemic inflammation, and grinding of the teeth are associated with sleep apnea – they were in my case.

   Dr. Guilleminault goes on to note that sleep apnea “is induced or enhanced by obesity leading to fat deposition within the tongue and neck.” As pointed out, which comes first is not easy to identify.

The last point raises a question that I have often seen in the forums – will my sleep apnea be cured if I lose weight? My own opinion is that it all depends on which came first. I am not obese, although I am overweight. As a child I was definitely not overweight – almost the opposite, in fact. Yet I had symptoms that I now recognize as being possibly related to sleep apnea. There is no way to confirm that I had sleep apnea that long (50+ years!), but the possibility of being able to stop using the CPAP through weight loss is intriguing.

This looks like a scientifically very interesting meeting, and I hope I will be able to go through the abstract book over the next few months and highlight some of the interesting studies. Meantime, I will continue to work on my exercise program, my diet, and taking good quality vitamins to support my diet and exercise program.

As those who have been following my blog for a little while know, I have sleep apnea. Recently, I have started getting it under better control by adjusting a few things that don’t need a doctor’s permission. For example, I turned off the humidifier, using just the fan part of the CPAP machine. The first night I did that, I disconnected the humidifier and attached the hose directly to the part that contains the fan.

I kept waking up during the night because the fan had seemed to become very noisy. I could understand why people complain about the noise of CPAP machines. My wife also commented that it was noisier than usual. So the next night, I reattached the humidifier, but did not put any water in it. When I turned the machine on that night, I made sure the humidifier was turned to zero, allowing the air to pass straight through without being moistened.

My apnea/hypopnea index (AHI) was coming down closer to 1 event per hour, but then I had a night where I couldn’t sleep. The next day I saw somewhere that a low dose of melatonin might help with getting to sleep. I was able to pick up some 1.5 mg tablets at Walmart. I took one that night – out like a light, and slept well. Apparently, there were some strong thunderstorms during the night. I vaguely remember hearing something, but turned over and went back to sleep. Obviously, the melatonin worked for me! However, it is not something I want to take every night. It makes me feel too sleepy the next day!

I was interested to know what had happened to my AHI, so first thing in the morning I took the data card from my CPAP machine and read it into my computer (it is a standard card, so there was no difficulty there). The software told me that my AHI was 0.9 – the lowest it has been for several months. Of course, this was only one night, and I have to continue for several more nights before I can claim I have found the fix that helps my machine get my apnea under control. You certainly have to be persistent with these darned machines, but it is still better than the alternatives.

With my apnea under better control, I am feeling like I want a nap less and less during the day, and I am even starting to exercise more. I am starting to look forward to getting on my bicycle again – it has been a while since I did that. When I lived in New Zealand a few years ago I cycled around Lake Taupo – it took me all of a very long day, but the feeling when I finished was absolutely amazing. I wasn’t racing, but I also wasn’t last ! Nothing like that planned for now, but may be tomorrow I will go out and do 15 to 20 miles – just for fun. Here is a pic of Lake Taupo – it looks huge …

Cycling around here took all day ...

Recent research from the University of Pennsylvania shows that if you listen to what your doctor tells you, it may help you have a better outcome. The study, which is published in the Journal of Cardiovascular Nursing in the July/August issue, looked at several markers of cardiac stress and general inflammation. Patients with heart failure who took their medications as directed, ate a low sodium diet, and exercised, as well as monitoring their symptoms, had low levels of cardiac stress and general inflammation.

This is important information because lower levels of cardiac stress and inflammation markers have been shown to be associated with a lower risk of death, less need for insertion of a device to help the heart beat, and less need for heart transplantation. the heart failure is a difficult disease to treat, so something as easy as doing what the doc tells you is going to be very helpful.

Source: University of Pennsylvania School of Nursing press release.

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.