Advancing Care - May 2022

When being sleepy is a problem 

You’re exhausted, even though you turned in early. Your partner complains that you’ve been snoring. Should you call your doctor? 

While anything that interferes with a good night’s sleep is a problem to discuss with your doctor, it’s especially important to find out if you have sleep apnea, said Vivian Asare, MD, a sleep medicine specialist at Yale New Haven Hospital and associate medical director, Yale Centers for Sleep Medicine. 

What is sleep apnea?

Obstructive sleep apnea is a respiratory condition where airways narrow during sleep, causing short periods where you are not breathing. Whenever a person stops breathing, even for a moment, the brain wakes up. These repeated interruptions prevent the brain from dropping into the deepest, most restful sleep. As a result, people with sleep apnea get much lower quality sleep. They often wake up feeling very tired, even though the clock says they had a full night’s rest.

“Untreated sleep apnea can increase your risk of serious complications, including high blood pressure, type 2 diabetes, stroke and heart attack,” Dr. Asare said. “There’s a high association between sleep apnea and atrial fibrillation (known as AFib). It is a complicated process, but low oxygen levels and other physiologic changes during sleep caused by sleep apnea, can cause structural changes in heart muscles and eventually lead to abnormal heart rhythms.” 

What are the symptoms of sleep apnea? 

“The most common symptom that we see in patients with sleep apnea is being very sleepy," Dr. Asare said. She notes that it is important to distinguish fatigue (which is a lack of energy) from sleepiness (which is an inability to stay awake). People with sleep apnea may also snore or make wheezing, choking or gasping sounds during sleep, which can be frightening for parents, caregivers or bed partners. In some cases, people with sleep apnea may wake up with headaches or a dry mouth or throat.

What are the risk factors?

While medical experts see sleep apnea in all age groups, from infants to the elderly, the causes of the disorder may differ. Though obstructive sleep apnea affects men and women, men are at a much higher risk than women-- although the risks for women increase after menopause, according to Dr. Asare.

Being overweight is one of most common causes of obstructive sleep apnea in adults. Smoking also increases the risk of sleep apnea as it causes inflammation close to the airway. Other risk factors for developing sleep apnea may include age, use of narcotics, heart disease and/or a history of stroke. 

Treatments for sleep apnea

If you have been diagnosed with sleep apnea, your doctor may recommend lifestyle changes such as losing weight, quitting smoking and avoiding alcohol and heavy meals in the hours before you go to bed. Sleeping on your side instead of your back allows the airway to remain open, and elevating the head of your bed may also provide relief. 

Your doctor may also recommend use of the CPAP (continuous positive airway pressure) appliance, the “gold standard” for treating sleep apnea. This device consists of a blower that delivers a small amount of air pressure through a mask that fits over your nose to keep your airway open while you sleep. Despite its effectiveness, patients may struggle to get comfortable with wearing the mask for a variety of reasons and stop using a CPAP. 

“It takes time and effort to get used to using a CPAP,” said Dr. Asare, who facilitates a CPAP support group at Yale Sleep Center that is held via Zoom on the first Friday of every month at 3 pm. “Our support group meetings offer participants the opportunity to ask questions, trade helpful tips and share experiences that help people better understand and manage their sleep-related concerns.”  To attend the virtual group, call 203-432-9666 at the scheduled time and enter the meeting ID number (921 4861 3236) and passcode (463881) when prompted, or log into Zoom directly. 

Other nonsurgical treatment options include custom-fit dental appliances that move the lower jaw forward so that the tissues of the back of the throat relax and prevent the tongue from collapsing and blocking the airway. 

For patients who cannot tolerate CPAP or who have trouble with other treatments like oral appliances or weight loss, surgical treatment options now include the Inspire upper airway stimulation device. Inspire is a small, electrical device, and like a pacemaker, it is implanted in the patient’s chest. The device is connected wirelessly to a remote that, when activated, stimulates the airway muscles so they remain open during sleep. 

“Inspire is different than CPAP because it keeps airways open from inside the body,” Dr. Asare said. “It’s not appropriate for all sleep apnea sufferers, so you should talk to your doctor about whether it is right for you.” 

If you notice any of the signs of sleep apnea, it’s important to mention it to your doctor. “So many people don’t know what normal, refreshing sleep feels like,” she said. “Treating your sleep apnea truly can change your life for the better.” 

‘Tis the season for spring allergies

It’s May. Your eyes are itchy, your nose is runny and you can’t stop sneezing. Allergy season has begun. What’s the best way to find some relief? 

If you’re one of the 50 million Americans who suffers from allergies, your symptoms may bloom when the seasons shift. Seasonal allergic rhinitis (commonly known as hay fever) is usually triggered by outdoor allergens such as pollen and mold spores. When you have hay fever, your immune system identifies specific pollens as a threat and releases signals that lead to symptoms such as nasal congestion; itchy, watery eyes; runny nose; tickly throat; hoarse voice; coughing and sneezing. 

When does allergy season start?

The best way to treat your symptoms is to do so as soon as – and even before – they  start, said Florence Ida Hsu, MD, an allergist and immunologist with Yale Medicine and Yale New Haven Hospital. According to Dr. Hsu, seasonal allergies fall into several groups. Tree pollen season typically begins in early April, followed by grass pollen season in May - June, and then weed pollen season  in the late summer and fall months. 

“Obviously, these seasons are dependent on the weather and can extend in either direction,” she said. “This year has been a cold spring with a lot of rainfall, so the tree pollens were delayed until early May, a bit later than normal.” Dr. Hsu added that the late start on tree season this year is not likely to offer much relief to allergy sufferers. “The spring season is going to be condensed, which may make it more intense,” she warned. 

How can I get relief? 

If you suffer from hay fever symptoms, it’s best to start taking medications before your eyes itch and your nose begins to run. “You don’t want to wait until you’re miserable to address your symptoms, because then you’re behind and trying to catch up,” Dr. Hsu said. 

Over-the-counter medications can offer relief for many people struggling with allergies. Dr. Hsu recommends non-drowsy antihistamines (such as Allegra, Claritin, Xyzal, Zyrtec or their generic counterparts) during the day for itching, sneezing and runny nose. A steroid nasal spray (such as Flonase, Rhinocort, Nasacort and their equivalents) is a first-line treatment for nasal congestion. Antihistamine eye drops (including Pataday, Zaditor and Alaway) can provide relief to dry, scratchy eyes. 

Other ways to reduce allergy symptoms 

Dr. Hsu also recommends the following steps to minimize your exposure to seasonal allergies

• Stay in the house if you can, particularly on windy days. Keep the windows closed in the house and in the car. 
• If you need to spend time outdoors, the American Academy of Allergy Asthma & Immunology’s allergen tracker (AAAAI) can help you plan your day. 
• Wear a face mask when you go outside to prevent you from inhaling larger particles of pollen. Wash the mask after each use because it may have pollen on it.
• Wear a hat and sunglasses to avoid getting pollen in your hair and to protect your eyes.
• If grass or moldy leaves are your triggers, avoid mowing the lawn and raking leaves, if possible, or wear a mask when doing yard work.
• If you spend time outdoors, brush off any pollen once you go back inside. “If you are pollen-sensitive, it’s a good idea to take a bath, wash your hair, and change your clothes, especially before going to bed,” Dr. Hsu said. “Try to minimize the amount of pollen that goes from your head to your pillow, because otherwise you will be breathing it in all night.”

If over-the-counter medications aren’t helping or your symptoms are severe, you may want to contact an allergist who can provide more specialized care, Dr. Hsu said. “Your doctor may recommend allergy testing, prescription medication, or even allergen immunotherapy, which helps your immune system build up a tolerance to allergens by exposing you to them in small and then gradually increasing doses,” she said. 

Is it allergies or COVID-19?

For those who have battled allergy symptoms in the past, the COVID-19 pandemic has tossed an additional worry into the mix: Are your symptoms due to allergies or COVID-19? Dr. Hsu suggests that you look at your symptoms one at a time. If you can rule out fever, muscle aches, a loss of smell or taste, sore throat or shortness of breath – and you generally tend to experience seasonal allergies – your allergies are likely to blame, she said. 

“If you have a runny nose, sneezing and itching, and you’re someone who often has allergy symptoms in the spring, then allergies are the likely culprit,” she said. “However, it is still wise to get tested for COVID-19 with any new symptoms, if you’ve never had allergies before, if you’re getting sicker, or if you’ve had a potential exposure to COVID.” 

BE FAST at first signs of stroke

Stroke is the fifth-leading cause of death and a major cause of disability in the United States. Thanks to the acronym BE FAST, more people are aware of some of the classic signs of stroke, including face drooping, balance problems, speech difficulty and arm weakness.

What people might not know is that a person having a stroke doesn’t have to display all of the symptoms. Any one, or a combination, can indicate a life-threatening emergency. 

A stroke occurs when blood flow to the brain is reduced or interrupted. Deprived of adequate nutrients, brain cells can begin to die within minutes. Timely treatment is vital because it can help preserve brain function and potentially save a life. 
 
Remember: BE FAST 

• B: Balance – Is the person having sudden trouble with balance or coordination?
• E: Eyes – Does the person have sudden blurred or double vision, or loss of vision in one or both eyes without pain?
• F: Face drooping and/or numbness on one side. Ask the person to smile.
• A: Arm weakness – Is one arm weak or numb? Ask the person to raise both arms – does one arm drift downward?
• S: Speech difficulty – Is the person’s speech slurred? Ask them to repeat a simple sentence.
• T: Time to call 911

The most common risk factors for a stroke are high blood pressure, smoking and uncontrolled diabetes. Remember to have regular healthcare visits to check your blood pressure and blood sugar. Also avoid smoking and second-hand smoke.

From prevention to treatment and recovery, Yale New Haven Hospital provides the most experienced doctors and the latest diagnostic tools, techniques and treatments for exceptional stroke care, 24 hours a day. Yale New Haven Hospital’s York Street Campus is certified by The Joint Commission as an Advanced Comprehensive Stroke Center, and the Saint Raphael Campus is certified as an Advanced Primary Stroke Center. These national recognitions signify expertise in providing the highest level of care to stroke patients. Get more information about YNHH’s Stroke Center or call 203-737-1057.

Take a walk and chat with YNHH doctors

Take a walk and chat with local doctors as part of Yale New Haven Health’s Get Healthy Walk ‘N Talk with a Doc. Walks are each Saturday through September from 9 - 10:30 am along the Farmington Canal Greenway Trail in New Haven. Walks begin at the entrance on the corner of Shelton Avenue and Starr Street and last approximately one hour. Parking is available at New Freedom Missionary Baptist Church, 280 Starr St., New Haven. Please arrive by 8:45 am on each walk day. For more information, email Andy Orefice or call 203-688-5671. 

Questions about cancer? “Yale Cancer Answers”

“Yale Cancer Answers” is a weekly radio program produced by the Yale Cancer Center that provides listeners with the most up-to-date information on cancer screening, detection, treatment, and prevention. The program is hosted by Anees Chagpar, MD, professor, Department of Surgery, Yale School of Medicine. Each week guest cancer specialists talk about the most recent advances in cancer therapy, prevention and supportive care.

“Yale Cancer Answers” airs Sundays at 7:30 pm on WNPR. Tune in live online at wnpr.org, or browse the podcast episodes and listen to a specific topic. If you have a question for possible use during a show, email [email protected].

Find a Doc at YNHH

Are you looking for a physician? Call 888-700-6543 or visit our website’s Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience. 

Billing questions?

Yale New Haven Hospital offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.