Comment-Chrismene

Discussion: Sleep Wake Disorder

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Sleep/Wake Disorders: Central Sleep Apnea

Sleep/wake disorders are common yet they remain underdiagnosed and undertreated. Many people live with different forms of sleep/wake disorder yet they fail to realize that this is a problem that needs to be addressed. Hey either ignore that this is a problem that needs the attention of a health provider or they simply lack the knowledge that it is a problem in the first place. Sleep/wake disorders, when untreated, affect the quality of life of a person and they also are associated with serious other health issues that require medical attention (Walia & Mehra, 2016). In this discussion, the focus shall be on one disorder referred to as central sleep apnea.

Diagnosing Criteria

Central sleep apnea is associated with the repetitive stoppage or decrease in ventilatory effort as well as airflow while an individual is asleep (Safwan, 2017). It should be noted that this disorder can either be primary or secondary as shall be noted in the manner in which the disorder is specified. According to the DSM-5, central sleep apnea is diagnosed when using polysomnography, there is evidence to the effect that there have been 5 or more instances of central apneas in an hour of sleep. In addition, the disorder should not be explained better using a different sleep disorder that the patient has been diagnosed with (APA,2013). The specifications include idiopathic central sleep apnea which falls under primary as well as Cheyne-Stokes breathing and apnea comorbid with opioid use which fall under secondary central sleep apnea. Ideally, Cheyne-stokes breathing is specified when there is a pattern of periodic crescendo-decrescendo variation in tidal volume leading to the central sleep apneas as well as hypopneas in at least 5 cooccurrences in one hour followed by an arousal (APA,2013). The central sleep apnea that is associated with opioid use is caused by the effects of such drugs on the medulla leading to variations in respiratory rhythm. With primary central sleep apnea, there should be no evidence of airway obstruction (APA, 2013). That said, it is prudent to look into the treatment modalities for central sleep apnea.

Interventions

Treatment of central sleep apnea may be through non-invasive positive pressure ventilation interventions such as bilevel positive airway pressure, adaptive servo-ventilation and continuous positive airway pressure among others. However, evidence shows that these interventions may not always be as effective as desired and they may lead to residual apnea hypopnea index. Therefore, this is why medications such as zolpidem, acetazolamide, triazolam as well as theophylline are used and they are known to be effective. These medications help with the problem of central sleep apnea through dissimilar mechanism of actions such as respiratory stimulation as well as stabilization of sleep (Riera et al., 2018). There is scarcity of evidence regarding the use of psychotherapy in the treatment of central sleep apnea. A different intervention that is not pharmacological that has shown to have significant impact on the CSA is the stimulation of the phrenic nerve. This is a neurostimulation therapy that has been studied by scholars and seen to have positive effects on central sleep apnea (Abraham, Pleister & Germany, 2018).

Referral

The referral to the primary provider for purposes of additional referrals should be considered if the problem persists for long even after the use of the known interventions that have been listed above. Referral should also be necessary if the patient starts to develop sone complications such as cardiovascular problems as well as excessive fatigue especially during the day leading to daytime sleeping which could be very dangerous due to accidents.

References

Abraham, W. T., Pleister, A., & Germany, R. (2018). Identification and treatment of central sleep apnoea: beyond SERVE-HF. Cardiac failure review, 4(1), 50

Badr, M. S. (2017). Central sleep apnea: Treatment. UpToDate, Retrieved from https://www.uptodate.com/contents/central-sleep-apnea-treatment

Riera, R., Latorraca, C. O., Martimbianco, A. L. C., Pacheco, R. L., Drager, L. F., Lorenzi‐Filho, G., & Pachito, D. V. (2018). Pharmacological treatment for central sleep apnoea in adults. The Cochrane Database of Systematic Reviews, 2018(1).

Walia, H. K., & Mehra, R. (2016). Overview of common sleep disorders and intersection with dermatologic conditions. International journal of molecular sciences, 17(5), 654