Sleep Apnea & Epilepsy

Professor Terry O’Brien… Royal Melbourne Hospital says there has been some evidence from other studies that patients with epilepsy may have an increased incidence of sleep-disordered breathing…

Doctors recruited 87 patients with epilepsy and monitored them in a sleep unit. They found 25 per cent had significant sleep-disordered breathing that was severe enough to require treatment…

Thirty-six-year-old Daniel Goldstein had always had strange sleeping habits, which included rocking back and forth during the night while he slept. Eventually, he was diagnosed with epilepsy but it was hard to stop seizures…

Since being treated for sleep apnoea, Mr Goldstein has also been able to reduce his epilepsy medications. Mr Goldstein was also given a CPAP machine which he says helps him soundly throughout the night.

[Extract] Sophie Scott. (2 Jun 2013). Doctors find key link between epilepsy and obstructive sleep apnoea. http://www.abc.net.au/news/2013-06-02/link-between-epilepsy-and-obstructive-sleep-apnoea/4728076. [accessed 24 Jun 2018]

Lifestyle changes

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:

  • Lose weight if you’re overweight.
  • Exercise regularly.
  • Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
  • Quit smoking.
  • Use a nasal decongestant or allergy medications.
  • Don’t sleep on your back…

Therapies

 

  • Mouthpiece (oral device). Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life.

    These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.

    If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment.

 

Surgery or other Procedures

Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include:

  • Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.

    Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.

Lifestyle and home remedies

In many cases, self-care may be the most appropriate way for you to deal with obstructive sleep apnea…

  • Keep your nasal passages open while you sleep. If you have congestion, use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using nasal decongestants or antihistamines, because some medications may only be recommended for short-term use.

[Extract] Mayo Clinic Staff. (no date, accessed 24 Jun 2018). Obstructive sleep apnea. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090. Mayo Foundation for Medical Education and Research (MFMER).

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Infection control and risk

Reference: Why I refused to visit my friend… (in the hospital at the first invitation)

I return finally to this post… This post may sound mechanical. It is precisely so because I have resolved to wipe away traces of my trauma and trembling as I recall this event.

… My dear friend had then received his first child into this world. He was promptly warded into a public (‘restructured’) hospital for lung sepsis (… potentially life-threatening complication of an infection – https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214). The condition was not fully resolved after his discharge, and he was soon admitted to another restructured hospital. I was asked by the patient to make a visit. Reluctantly I went.

I knew I was unwell and infectious so I did the following:

  • wore a surgical face mask
  • used disposable wet wipes – 70% Isopropyl Alcohol solution (or non-alcoholic equivalent) to wipe my arms and hands as I took a seat at the ground floor before taking lift
  • rubbed my hands with the antiseptic solution gel/rub provided by the hospital before I entered the room
  • cleaned the chair I sat on with the abovementioned wet wipes when I left
  • to push open the door to the room, I believe I used my foot instead – to avoid hand contact

Why did I do these?

The risk of getting an infection while in hospital is low, but patients can be vulnerable as they are already in poor health…

Visitors can help by:

  • Not visiting if you are feeling unwell, have a cold or cough, or have had any symptoms of sickness or diarrhoea in the last 48 hours;
  • Washing hands and using the alcohol hand rub when entering and leaving the ward areas…
  • Where possible, don’t bring children aged 12 years and under onto the wards, as they can be susceptible to infection;
  • Not sitting on patients’ beds, please use the visitors’ chairs provided…

Germs can be spread by touch and so washing your hands is one of the easiest ways of reducing the spread of infection… It is essential to wash your hands:

– After going to the toilet

– Before touching food and eating

– If they look or feel dirty

– After coughing, sneezing, or blowing your nose

– Before and after handling medical devices such as catheter

Infection Prevention & Control. (accessed 27 May 2018). https://www.hdft.nhs.uk/services/infection-prevention-control/#hospital-infection-prevention-and-control-performance. Harrogate and District NHS Foundation Trust. North Yorkshire.

Coughing

“Dr. Sanders, I’m still sick”… It was strange, she told me; she was fine during the day — with maybe the occasional cough — but at night, when she lay down, it was unbearable. She slept in a chair the past two nights, because in bed she kept waking up to cough. And the day before, she had a strange pressure in her chest… Cough is the most common single reason for a visit to a primary-care doctor. Most of the time it’s caused by an upper-respiratory infection or a cold. But that type of cough usually resolves on its own. A persistent cough has many possible causes. The most likely is an allergy…  Now she was back, sicker than ever, and I was starting to get nervous. I had already referred her to an ear, nose and throat doctor and a gastroenterologist. If none of this panned out, I wasn’t sure what to do next.

Lisa Sanders. (4 Jun 2013). The Cough That Wouldn’t Stop. http://archive.nytimes.com/www.nytimes.com/interactive/2013/06/16/magazine/diagnosis-cough-that-wouldnt-stop.html?_r=0#/#abnormal. The New York Times.

 

On Thursday, we challenged Well readers to unravel the mystery of a 75-year-old woman with a cough that lasted for months. In addition, we asked you to tell us what kind of test you would order to clinch the diagnosis.

The correct diagnosis is…
Lady Windermere syndrome
And the necessary test is…
A culture of the patient’s sputum

… Lady Windermere syndrome is an infection of the lung caused by mycobacterium avium-intracellulare, a bacterium related to the bug that causes tuberculosis. This bug is ubiquitous and commonly found in dust and dirt, in households and farmyards.

Lisa Sanders. (7 Jun 2013). Think Like a Doctor: A Cough Solved. https://well.blogs.nytimes.com/2013/06/07/think-like-a-doctor-a-cough-solved/. Well Blog. The New York Times.

Related references

  • [… she writes the popular Diagnosis column for the New York Times Magazine and the Think Like a Doctor column featured in the New York Times blog, The Well. Her column was the inspiration for the Fox program House MD (2004-2012) and she served as a consultant to the show.] Lisa Sanders, MD, FACP. Associate Professor of Medicine (General Medicine). Biography. https://medicine.yale.edu/intmed/people/lisa_sanders.profile. Yale School of Medicine.
  • Rhinitis – 鼻炎 [post on condition affected by coughing]

Rhinitis – 鼻炎

Note – Chinese translation of ‘Rhinitis’ was checked against Google Translate and Cambridge Dictionary Translator [https://dictionary.cambridge.org/translate/]. This post is a record to help the author understand challenges and treatments for rhinitis sufferers. Sentences/parts shortened by the author are indicated with “…”

Rhinitis is inflammation of the nose.

Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose… common characteristics of chronic rhinitis is post-nasal drip… may lead to chronic sore throat, chronic cough, or throat clearing… can be caused by excessive or thick mucus secretions or impairment in the normal clearance of mucus from the nose and throat.

Forms of non-allergic rhinitis include:

  • Idiopathic rhinitis often does not have a specific cause… but commonly includes upper respiratory infections.
  • Vasomotor rhinitis is thought to occur because of abnormal regulation of nasal blood flow and may be induced by temperature fluctuations in the environment such as, cold or dry air, or irritants such as
    • Air pollution
    • Smog
    • Tobacco smoke
    • Car exhaust
    • Strong odors such as, detergents or fragrances
    • Weather conditions (such as the arrival of a weather front)

Other causes… :

… rhinitis may be related to other generalized medical conditions such as:

… primary reason for impaired clearance of nasal secretions within the nasal cavities is from smoking… impairs the movement of the cilia (microscopic hairs) and their ability to push the secretions out of the nasal cavity to be swallowed. Other conditions that can impact clearance of secretions in the nose include allergies and some genetic disorders. Swallowing problems can make it difficult to clear normal secretions from the back of the throat. This may result in the accumulation of material in the throat, which can spill into the voice box, causing hoarseness, throat clearing, or cough.

Irrigating the nose with salt water is a home remedy that is very useful therapy for non-allergic rhinitis, and especially beneficial for treatment and relief post-nasal drip.

Nasal irrigation utilizing a buffered isotonic saline solution (salt water) helps to reduce swollen and congested nasal and sinus tissues… it washes out thickened nasal secretions, irritants (smog, pollens, etc.), bacteria, and crusts from the nose and sinuses. Non-prescription nasal sprays (Ocean spray, Ayr, Nasal) can be used frequently, and are very convenient to use.

John P. Cunha. (Medically Reviewed on 1/10/2018 – this could mean Jan 2018 due to the US calendar order). Chronic Rhinitis and Post-Nasal Drip Symptoms, Causes, Treatment. https://www.medicinenet.com/chronic_rhinitis/article.htm#chronic_rhinitis_and_post-nasal_drip_definition_and_facts. MedicineNet, Inc. – Owned and Operated by WebMD and part of the WebMD Network. [MedicineNet is an online, healthcare media publishing company. Webster's New World Medical Dictionary - authored by MedicineNet  … The doctors of MedicineNet are also proud to author Webster’s New World™   Medical Dictionary First, Second and Third Editions (May, 2008) John Wiley & Sons, Inc.; ISBN-10: 0470189282.]

 

Alternative medicine

Some small studies.. shown repeated applications of capsaicin — the ingredient… in hot peppers — to the inside of the nose can ease nasal congestion… treatment is often given multiple times on the same day, and relief has been shown to last as long as 36 weeks. But larger studies are needed.

Nonallergic rhinitis. (4 Jan 2018). https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/diagnosis-treatment/drc-20351235. Mayo Clinic.

Chinese Medicine – Diabetes

Xiao-ke syndrome means “wasting and thirsting.” Diabetes… three types: upper, middle, and lower Xiao-ke… upper type is characterized by excessive thirst, the middle by excessive hunger, and the lower by excessive urination… associated with the lungs, stomach, and kidneys, respectively, and all… associated with Yin deficiency.

Some of the most commonly used herbal substances for diabetes in TCM include:

1. Panax ginseng (Korean ginseng)… long history… as a hypoglycemic agent. At least five constituents of this herb have been shown to exert hypoglycemic effects. In one study, treatment with ginseng lowered blood glucose levels and improved mood and psychological performance as compared with placebo. Recommended dosage is 100–200 mg/day. [Footnote 14 – Choate C: http://www.jcm.co.uk/SampleArticles/DIABETES1.html (accessed March 2001) “Diabetes: modern medicine and traditional Chinese medicine (Part One)]

2. Momodica charantia (balsam pear)… dried, powdered, and made into pills. A dosage of 18 g/day has been shown to reduce blood glucose. [Footnote 15 – Keji C: Understanding and treatment of diabetes mellitus by Traditional Chinese Medicine. Am J Chinese Med 9:93–94, 1981]

Maggie B. Covington. Traditional Chinese Medicine in the Treatment of Diabetes. Diabetes Spectrum 2001 Aug; 14(3): 154-159. http://spectrum.diabetesjournals.org/content/14/3/154. American Diabetes Association. [accessed 18 May 2018]

Cross checks

Memory weakness and epilepsy

William Barr, PhD, ABPP. Reviewed By: Joseph I. Sirven, MD (March 19, 2014). Types of Memory Problems. https://www.epilepsy.com/learn/challenges-epilepsy/thinking-and-memory/types-memory-problems. Epilepsy Foundation of America.

  • “Problems of attention and encoding” – information fails to become memory
  • “Problems of storage” – retention
  • “Problems of retrieval” – recall

Irene Elliott, RN, MHSc, ACNP and Janice Mulligan, MSW, RSW. How Epilepsy Affects Learning. (2/4/2010). http://www.aboutkidshealth.ca/En/ResourceCentres/Epilepsy/AtHomeandAtSchool/EpilepsyandSchool/Pages/How-Epilepsy-Affects-Learning.aspx. AboutKidsHealth, The Hospital for Sick Children. Canada.

memory: a child may study a topic many times, but not remember it the next day

 

Diet and Epilepsy

Modified Atkins Diet

Modified Atkins Diet Can Cut Epileptic Seizures in Adults. (28 Jan 2008). https://www.hopkinsmedicine.org/news/media/releases/Modified_Atkins_Diet_Can_Cut_Epileptic_Seizures_in_Adults. Johns Hopkins Medicine. [Bold words my addition]

In 2002, Johns Hopkins researchers began testing a modified version of the Atkins diet in children with epilepsy… modified diet… high-fat focus of the ketogenic diet, prompting the body to generate ketones… allows more carbohydrates and protein, doesn’t limit fluids and calories, and has no fasting period… began testing it for efficacy and ease of use in adults.

30 adults with epilepsy, ages 18 to 53 years, who had tried at least two anticonvulsant drugs without success and had an average of 10 seizures per week, were placed on the modified Atkins diet… restricted them to 15 grams of carbohydrates a day. “… a few strawberries, some vegetables, or a bit of bread,”… most of its calories from fat-eggs, meats, oils and heavy cream-with as much protein and no-carb beverages…

…about half the patients had experienced a 50 percent reduction in the frequency of their seizures by the first clinic visit. About a third of the patients halved the frequency of seizures by three months. Side effects linked with the diet, such as a rise in cholesterol or triglycerides, were mild. A third of the patients dropped out by the third month, unable to comply with the restrictions… diet won’t be a good fit for all patients

 

Katie Barwick, Senior Paediatric Dietitian, Mater Health Services, Mater Children’s Hospital. (Nov 2011). The Modified Atkins Diet. http://www.epilepsyqueensland.com.au/modified-atkins-diet. Epilepsy Queensland Inc.

…high-fat diet… for difficult to treat seizures. Heavy cream, butter and vegetable oils provide the necessary fat… allows all protein rich foods… meat, chicken, eggs and fish. It completely eliminates sweets… lollies, biscuits and desserts… carbohydrate rich foods… bread, potatoes, rice, pasta and cereals are not allowed in the first month… may be introduced later.

Children and teenagers with uncontrolled seizures may be helped by the diet.

Medications may act stronger with the Modified Atkins Diet therefore close medical monitoring is necessary.

The diet is generally used for a period of 2 years… If the diet is not helpful, it will be stopped within a few months.

Most children do not develop high cholesterol levels while on the diet. If a child develops high cholesterol or lipids, the diet can be modified to lower these.

This diet should not be started without medical and dietetic supervision.

See also:

David C. Spencer. (2017). Navigating Life with Epilepsy. New York. Oxford University Press. [Diet Therapy]