We're all guilty of making fun of snorers, but sometimes this snoring can be a symptom of sleep apnea. Sleep apnea is a condition where breathing is not continuous and may start and stop many times while asleep. This affects the quality of your sleep and in turn can affect many aspects of your health including your cardiovascular health. Here's how:

High blood pressure
When a sleep apnea patient's breathing stops, the oxygen levels in the blood also suddenly fall. This can increase your blood pressure. High blood pressure means that the heart muscles need to work harder to pump blood through the body.

Cardiomyopathy
As a result of high blood pressure, the heart walls may become thicker and the heart muscles become stiffer. This is known as cardiomyopathy. As this condition worsens, the heart becomes weaker and is unable to maintain a regular rhythm. This can eventually lead to heart failure.

Arrhythmia
An irregular heartbeat is also known as arrhythmia. This may also be related to the changes in the heart's structure that follow the drop in blood oxygen levels. In many cases, arrhythmia has no visible symptoms and can often go undiagnosed. This can result in the formation of blood clots in the atria which can lead to a stroke.

Sleep apnea is easy to diagnose. If the doctor feels that you show symptoms of sleep apnea, you may be asked to stay on the hospital overnight and undergo a sleep evaluation. This tests a variety of body functions including brain activity, eye movements, heart rate, breathing patterns and blood oxygen levels.

Treatment for sleep apnea depends on the causes for this condition. If you are overweight, regular exercise and a change in diet can help you lose the excess weight and cure sleep apnea. Similarly, if your sleep apnea is triggered by an allergy, treating the allergy can help cure the sleep apnea. Other forms of treatment for sleep apnea may include:

Continuous positive airway pressure (cpap)
This is a machine which pumps air into the body through a nasal mask. By keeping the pressure in the machine higher than normal air pressure the upper airway passages are kept open and hence the quality of your sleep is improved. An auto cpap machine can modulate the air pressure such that it is higher when you inhale and lower when you exhale.;

Oral devices
Your doctor may suggest oral devices that allow you to keep your mouth open while you sleep. This is easier to use than cpap machine but less effective. Surgery is the last resort when it comes to treatment for sleep apnea.

Sleep Apnea and Its Link to Heart Failure

Pilonidal Sinus is the small channel in your skin near the tailbone that may sometimes be filled with pus or fluid. This accumulated pus leads to the formation of abscess or cyst. Pilonidal cysts occur near the coccyx or tailbone, right at the top of the buttock crease. Pilonidal sinus consists of dirt, hair and debris that penetrates your skin, becomes embedded and thereby causes infection. Once the cyst gets infected, you may see blood or pus oozing out of the channel, which causes severe pain.
Pilonidal sinus usually affects men and young adults (after puberty). This type of skin disease is mostly observed in people who sit for a prolonged period, such as desk-job workers, truck drivers etc.

What are the causes and symptoms? 
Doctors suggest pilonidal sinus or cysts is caused due to factors such as - hormonal changes during puberty, friction resulting from wearing tight clothes, prolonged sitting, hair growth etc. The hair growing in the region is forced to burrow back beneath your skin. In certain cases, the patient may develop multiple sinuses which connect under the skin.

The signs and symptoms of pilonidal sinus include-

  Pain when standing or sitting for long
  Swelling of the cyst
  Redness and soreness around the affected skin
  Formation of multiple holes (sinus tracts) in the skin
  Foul odor
  Blood or pus oozing out of the abscess
  Hair sticking out of the lesion
Pilonidal sinus can be embarrassing and painful if left untreated for long.

What is the treatment for this condition?
Pilonidal sinus usually goes away on its own, without medical intervention. However, if the cyst becomes infected, it may have to be operated or drained. The commonly used treatment procedures are-

  Conservative treatment - if the condition is diagnosed at an early stage, your doctor will prescribe a broad-spectrum antibiotic to treat a broad range of bacterial infection. This will relieve you from the pain and discomfort resulting from infection.

  Lancing - this procedure involves using a scalpel to open the abscess. Your doctor will give you an anaesthetic prior to the operation. The channel is then cleaned properly to drain out blood, pus or hair. The wound is packed with a sterile dressing and left to heal. It usually takes about a month for the wound to heal, after which no further treatment is required.

  Phenol injections - for this procedure, first and foremost, your doctor will give you anaesthetic so that you don t feel any pain. A chemical compound known as Phenol is injected into the cyst. Phenol acts as an antiseptic and is used to harden and eventually close the lesion. This procedure needs to be repeated multiple times to achieve the desired result.

  Surgery - if the pilonidal sinus tends to recur, or if you develop multiple sinus tracts, the most preferred choice of treatment is surgery. The surgeon will open the lesion, remove the debris and pus, and then suture the wound. You will be given an anaesthetic prior to the surgery, and once the treatment is done, you will need to change the dressing more often.
If you suffer from pilonidal sinus, you will also need to maintain good hygiene. Make sure you clean and wash the area with a mild soap, and rinse properly. If your job requires you to sit for a prolonged period, take a break in between your work. Avoid wearing skin tight clothes. Adopting these measures will help prevent the occurrence of pilonidal sinus.

Treatment For Pilonidal Sinus!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Pain related sleep disruption has affected a large number of people around the globe. Statistics has it that, in India, about 25% of the population suffers from pain-related sleep deprivation. Studies call it  the vicious cycle of pain and sleep  as pain affects your ability to sleep and lack of sleep makes the pain even worse.

Back pain and arthritis are examples of some common pain-related medical disorders. People with these types of chronic pains have reported persistent sleeplessness or have had immense trouble falling asleep.

The following are the primary sleep disorders associated with chronic pain:

Insomnia: It is a medical condition that is characterized by an inability to fall asleep no matter how physically exhausted you are. Insomnia can be acute (lasting for one night to a week) or chronic (that lasts for more than 3 weeks).
Hypersomnia: It is a condition wherein you tend to sleep excessively; in this condition, you will have trouble being awake throughout the day or can fall asleep at any point of time.
Sleep Apnoea: This is a sleep disorder wherein breathing pauses and resumes repeatedly. Risk factors include obesity, age and gender; it is more commonly observed in men. This condition can be chronic with symptoms such as snoring loudly or feeling very tired even after one has had a night s sleep.
Restless leg syndrome: It is a sleep disorder wherein you continuously move your legs while sleeping. However, this condition can also cause you to move your legs even if you aren t sleeping.
Some of the causes of sleep disorders due to chronic pain are:

Pain
Worry and anxiety
Sweating at night
Depression and other mental disorders
Treatment

A pain and sleep disorder should be simultaneous as both the components of it, pain and sleep, are interrelated. Some of the ways people with chronic pain can still have a good night s sleep are:

Limiting caffeine intake
Abstaining from alcohol and smoking, as these disrupt the sleep cycles, thus aggravating the existing pain.
Practicing meditation and other relaxation techniques
Pain killers or sleeping pills can be administered, but only with the doctor s advice.
Hot water fomentation over painful area during night, for better sleep.

Back Pain and Bad Sleep

Sleep apnea is a potentially dangerous sleep disorder in which you stop and start breathing frequently while you are sleeping. Symptoms of sleep apnea often include loud snoring and fatigue even if you sleep uninterrupted through the night. Obesity and age are the common risk factors of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea, in which the throat muscles contract and relax while you are asleep. The other type of sleep apnea, called central sleep apnea, usually occurs in people who have been diagnosed with brain tumors, infections or heart failure, or have had a stroke.

Treatment of sleep apnea includes:

CPAP: The Continuous Positive Airway Pressure (CPAP) device is generally recommended in the treatment of sleep apnea. CPAP is a breathing machine that stops your airways from getting blocked when you are sleeping. The CPAP device is normally the size of a tissue box. It comes with a mask that you put over your mouth and nose. The machine attached to the mask pumps a continuous flow of air that keeps your airways clear as you sleep.
BPAP: The Bilevel Positive Airway Pressure (BPAP) device is used as an alternative to the CPAP device, if you find it hard to adjust to the CPAP. If you have a weak pattern of breathing, the BPAP can be helpful.
ASV: The Adaptive Servo-ventilation (ASV) device is used to treat both central and obstructive sleep apnea.
Treatment for other medical conditions: Sometimes sleep apnea can be caused by underlying health conditions. Problems such as rhinitis (nasal passage inflammation) and hypothyroidism (underactive thyroid gland) can cause sleep apnea. In such cases, your doctor needs to diagnose these conditions first before treating your sleep apnea.
Lifestyle changes: Excessive weight sometimes can cause sleep apnea; so losing excessive weight should be a priority. Also, alcohol and tobacco can contribute to your symptoms, so try avoiding those.
Medication: Usually, doctors do not prescribe any medicine, since sedatives and sleeping pills actually worsen sleep apnea. But, in case of sleep apnea in children, doctors typically suggest intra nasal corticosteroid medicine to treat the symptoms.
Surgery: Surgeries to increase the size of your airway or to remove your adenoids, tonsils or extra tissues in the rear of your throat or your nose can prove helpful.

Sleep Apnea - 7 Ways it Can Be Treated!

We all look forward to a good night s sleep after a long day at work. Sleep is one of the most blissful habits and is very essential as well. When one has not had a good night s sleep, the following day s productivity takes a toll for sure. It is therefore very essential to get good rest for at least 8 hours. Take the suggested therapy for any disease and it would include 8 hours of rest.

However, when you look closer, the poor sleep is due to some patterns that are our habits. This could include our food patterns, the side we sleep, the pillow we use, etc. Read on to know more!

Food habits: Eating very close to bedtime is one of the worst things to do, especially if it is a greasy meal that you have had. Lying down after a heavy meal gets the acid coming up to the throat and causing further irritation. Keep the dinner light if you really are late for it.
Smoking: Smoking up just before you hit the bed is another habit you should kick (even if you can t kick the habit of smoking itself), the chemicals released keep you awake and stimulated and do not let you sleep.
Alcohol: Though the general belief is that alcohol induces a good amount of sleep, it requires extra metabolism and so does not give a good night s sleep. Think of hangover the next morning! There is no one who has a hangover without feeling groggy.
Irregular sleeping pattern: While this is difficult with the changing times, it is very important to stick to a schedule. This helps in the body getting a good, restful sleep and not confusing it as to when to sleep and when to wake up.
Lack of exercise: One of the many side effects of lack of sleep is the lack of a good sleep.
Sleep environment: Keep a pillow and blanket that is comfortable, not too cosy. The room temperature should neither be too warm or cold.
Technology: Keep technology (TV, mobile, tablet, etc.) out of your room and see how your sleep will improve. You can always catch up later on what is happening around you.
If you thought it was just about some hours of sleep, think again. In the long run, there are multiple effects of poor sleep including.

Irritated, moody, angry
Lack of focus and concentration
Loss of productivity
Memory loss
Relationship issues
Poor habits like binge eating and drinking (caffeine and coke) and excessive smoking and drinking
So, sleep for the prescribed 8 hours and see your quality of life improve.

Sleeping Habits - 7 Things That Can Help You Improve It!

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