Posted on January 18, 2012 at 12:01 AM in Dr. Boyce In The Media
Bariatric Times Article Features Knoxville Weight Loss Surgery Practice
Bariatric Times, a peer-reviewed journal intended for surgeons, physicians, nurses, and other professionals in the field of weight loss, recently featured Dr. Stephen Boyce’s center for bariatric surgery in Knoxville in its latest issue. The article spotlights patient care and services at the New Life Center for Bariatric Surgery in East Tennessee, highlighting Dr. Boyce’s staff and available procedures.
At the New Life Center for Bariatric Surgery, Dr. Stephen Boyce and his practice are featured in the latest issue of Bariatric Times. As a bariatric surgeon in Knoxville, Dr. Boyce focuses on weight loss procedures ranging from laparoscopic greater curve plication (LGCP) to vertical sleeve gastrectomy. The Bariatric Times article highlights Dr. Boyce’s practice by analyzing the inner workings of an American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Center of Excellence®, including the pre- and post-operative process, and available patient education services and life strategies program. Dr. Boyce says the article gives his office the opportunity to spotlight their attention to patient care and pursuit of the highest quality services and the safest, most effective results.
The New Life Center for Bariatric Surgery associates with Parkwest Hospital, a 300-bed hospital in Knoxville, and performs an average of 450 weight loss procedures each year. With a staff including registered bariatric nurse coordinators, psychologists, certified bariatric dietitians, physiologists, and a life strategies coach, Dr. Boyce says the New Life Center for Bariatric Surgery is well-equipped to facilitate the surgical process and get patients on the track to a healthier daily life. The spotlight article in Bariatric Times also outlines patient care at the Knoxville bariatric surgery practice as well as emerging trends in bariatric technology and innovative procedures such as LGCP.
Dr. Boyce says publication in the Bariatric Times offers him the chance to promote the well-being of his patients by staying active in seeking the latest techniques and technology. He adds that he hopes the article will encourage patients to thoroughly research the credentials and dedication of a bariatric practice before considering any procedure. “When evaluating a weight loss program, patients need to make sure it is a Center of Excellence dedicated to long term comprehensive care.”
About Stephen G. Boyce, MD
Dr. Stephen Boyce received both his Bachelor of Science and Masters of Science from Texas A&M University and his medical degree from the University of Texas Southwestern Medical School. He completed a surgical residency at the Parkland Memorial Hospital. Dr. Boyce has performed thousands of weight loss surgical procedures and has advanced training in laparoscopic surgery, in addition to completing a Masters Certification in Bariatric Surgery. Dr. Boyce’s practice, The New Life Center for Bariatric Surgery, is also the only ASMBS-designated Bariatric Surgery Center of Excellence® in East Tennessee to offer all approved Bariatric operations.
Located at 200 Ft. Sanders West Blvd MOB 1, Suite 200 in Knoxville, TN, the New Life Center for Bariatric Surgery can be contacted at (865) 694-9676. It can also be reached online through the website parkwestcwlc.com or facebook.com/newlifecenterbariatricsurgery.
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Posted on January 17, 2012 at 12:53 PM in Dr. Boyce In The Media
Weight loss surgeon and Director of the New Life Center for Bariatric Surgery Stephen Boyce, MD is the proud new occupant of Physician Spotlight, a regular article in the East Tennessee Medical News. The print and online publication recently profiled our own Dr. Boyce as part of their ongoing Physician Spotlight series, and covered topics including Dr. Boyce’s biographical history and his practice’s designation as a Center of Excellence® by the American Society for Metabolic and Bariatric Surgery (ASMBS). The New Life Center for Bariatric Surgery was one of the first in the nation to achieve that distinction.
The article also mentions Dr. Boyce’s recent selection to participate in an investigational bariatric surgery procedure called laparoscopic greater curvature placation (LGCP), a treatment designed to “shrink” the stomach without removing part of it or relying on implantable devices such as gastric bands. LGCP is also a reversible treatment. Dr. Boyce is one of only 45 surgeons in the nation trained to perform the procedure, and the New Life Center will shortly begin accepting qualified candidate patients into the study.
We are so proud of Dr. Boyce’s inclusion in Physician Spotlight, and we invite you to visit the East Tennessee Medical News website at the following link to read the full article: http://easttennessee.medicalnewsinc.com/news.php?viewStory=2158.
Please contact the New Life Center for Bariatric Surgery for more information, or to schedule an appointment with Dr. Boyce.
Posted on December 30, 2011 at 2:21 PM in Bariatric Surgery, Insurance, Weight Loss Surgery
It’s hard to believe 2011 has passed and we hope everyone has had a successful year. We have had a great year here at New Life Center for Bariatric Surgery by having the pleasure of scheduling many patients for surgery, and have also been fortunate to meet a lot of new faces who will be having surgery with us next year.
Just as a reminder for everyone who will have appointments at our office next year, please be prepared to fill out paperwork and bring your current insurance card(s) with you to your appointment. Even if your insurance provider remains the same, the information on your card will change and we need to make sure we get the correct information. We understand it can be frustrating completing paperwork every time you come in for an appointment, but it would be more frustrating if we could not reach you by mail or phone because there was a demographic change that was not updated.
We would also like for everyone to be mindful of their appointment dates and times. As our New Life family grows, we find the schedule fills faster and it can sometimes take a few weeks to get an opening in the schedule. For this reason, we would really appreciate patients giving us notice that you will not be able to keep your appointment. We keep a cancellation list for patients needing to be seen, but this list only works if we know ahead of time who will not be here. Unlike many other medical offices, we do not charge for missed appointments because we know that sometimes things happen beyond your control, but we would appreciate a phone call to let us know you will be unable to make it.
We always look forward to seeing patients when they come into the office to purchase vitamins and supplements, but for those of you who drive a distance to get here or have a hard time coming by during office hours, we have the online store available to you 24 hours a day. In fact, if you make a purchase over $50.00, it is shipped to you for free. You can reach our online store at www.newlifebariatricsurgery.com. In a day and time where most people are struggling with their time and finances, it is nice to have this service offered.
We wish everyone a Merry Christmas and Happy New Year. We are looking forward to seeing each and every one of you in 2012.
Posted on December 15, 2011 at 12:01 AM in Dr. Boyce In The Media, Nutrition
Bariatric Surgeon in Knoxville on Maintaining Nutrition Levels after Weight Loss Surgery
According to the latest study from the American Society for Metabolic and Bariatric Surgery (ASMBS), bariatric surgery may increase life expectancy for the morbidly obese by 89% and reduce the risk of premature death by 30 to 40% as compared to those who do not have surgery. Dr. Stephen Boyce, a bariatric surgeon in Knoxville, says that although weight loss surgery can offer the tools for effective relief of morbid obesity, patients must maintain a strict regimen of certain vitamins, minerals, and supplements to prevent nutritional deficiency.
Dr. Stephen Boyce of the New Life Center for Bariatric Surgery, a practice focused on weight loss surgery and nutrition bariatric supplements in Knoxville, says that while weight loss procedures can dramatically improve a person’s ability to lose weight and make healthy lifestyle changes, patients need to be aware of the effects of certain procedures on their nutrition. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), life expectancy may increase by 89% for patients whom undergo bariatric surgery. The ASMBS study also shows a reduction in the risk of premature death by 30 to 40% as compared to those who do not have surgery. However, Dr. Boyce says weight loss surgery procedures also reduce the intestine’s ability to absorb nutrients effectively, which can often cause deficiencies that result in poor hair, skin, and nail health. He adds that through vitamins and mineral supplements, patients are able to maintain their proper nutritional intake, preserving their well being, including hair, skin and nail health.
Because bariatric surgical procedures restrict food intake and can create malabsorption, the body cannot absorb as many nutrients through the gastrointestinal process as before. Therefore, weight loss surgery is often associated with hair loss, sagging skin, and poor nail health because of insufficient nutrient intake. Dr. Boyce says this insufficiency necessitates strict attention to dietary choices and vitamin and mineral supplementation. He says achieving safe and effective results following surgery depends on a patient’s ability to adhere to a daily regimen of nail, hair and skin vitamins and minerals. “If the patient wants to minimize their hair loss after weight loss surgery, they need to provide their body with the critical vitamins and minerals that it needs.”
Before undergoing a weight loss procedure, Dr. Boyce recommends patients find a bariatric surgical practice dedicated to providing post-surgery diet plans using a comprehensive range of nutritional vitamins, minerals, and supplements with continued nutritional education and follow up to minimize the risks of developing other serious medical complications associated with nutritional deficiency. He adds that patients should be sure to thoroughly research vitamin intake and their nutritional needs so as to achieve the safest and most effective results possible.
“It doesn’t make any sense to have weight loss surgery in order to cure diabetes, sleep apnea and hypertension only to develop serious medical conditions due to nutritional deficiencies. Patients who do not take adequate supplements are at risk for anemia, paralysis, osteoporosis, and fractures, as well as hair loss, excess skin and unhealthy nails. Hair health is known to rely on adequate iron, biotin, and high levels of Vitamin B and omega fatty acids. The New Life Hair Skin and Nails pack goes beyond the ASMBS’s recommendations in these vitamins and minerals in order to ensure optimal conditions for hair, skin and nail health.”
About Stephen G. Boyce, MD
Dr. Stephen Boyce graduated from Texas A&M University, obtaining his Bachelor of Science and Masters of Science, and received his medical degree at the University of Texas Southwestern Medical School. He completed a surgical residency at Parkland Memorial Hospital. Dr. Boyce has completed thousands of weight loss surgical procedures over the past twenty years and has received special training in advanced laparoscopic surgery. He is also a recipient of a Masters Certification in Bariatric Surgery and an Educator for Ethicon Endosurgery.
Located at 200 Ft. Sanders West Blvd MOB 1, Suite 200 in Knoxville, TN, The New Life Center for Bariatric Surgery can be reached at parkwestcwlc.com, newlifebariatricsupplements.com, or facebook.com/newlifecenterbariatricsurgery.
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Posted on November 17, 2011 at 4:01 PM in Bariatric Surgery, Nutrition, Weight Loss Surgery
Vitamins and minerals fall into a category called micronutrients. They function in our body as co-factors and enzymes that are necessary to complete every process in our bodies from our head to our toes. Unlike macronutrients (protein, carbohydrates and fats), they do not provide calories. Vitamins and minerals are necessary for healthy vision, cell growth and development, healthy skin, bones and teeth, immunity, wound healing, metabolism of nutrients, healthy brain and nerve function, normal heart rhythm and function, reproduction and much more! (1). Vitamins and minerals are found throughout all the food groups in a variety of foods and beverages. They are abundantly found in fruits and vegetables of all colors and sizes, protein sources like chicken, eggs and beans, dairy products like milk and cheese and in a variety of whole grains.
Vitamins and minerals play an important role in weight control and management! Micronutrients assist in many of the processes that regulate appetite and hunger hormones, metabolic rate, nutrient absorption and storage, glucose homeostasis and more! Therefor, adequate intake of vitamins and minerals is crucial for our body to appropriately use the nutrients we consume, a healthy and active metabolism, hunger control and ultimately optimal weight loss and long-term weight maintenance (1).
So how does vitamin and mineral supplementation affect the bariatric surgery patient? Before surgery vitamin and mineral supplementation is recommended to help boost your nutritional status. Your nutritional status prior to surgery is a good indicator of your healing process after surgery. The healthier you are prior to surgery the stronger your immune system and more efficient your wounds will heal and the shorter the recovery time (2).
After surgery, patients have an increased need for vitamin/mineral supplementation due to one of the three following procedural categories: restrictive, mal-absorptive or mixed procedures. Restrictive procedures limit the amount of food a person can consume. Mal-absorptive procedures limit the amount of calories you absorb and mixed procedures are a combination of both. All of the procedures restrict or limit food you consume and/or absorb and therefor restrict or limit the amount of micronutrients you consume and/or absorb. Patients who do not take their bariatric specific vitamins as prescribed will develop vitamin/mineral deficiencies. These deficiencies can lead to, but are not limited to, fatigue, weakness, headache, calf and leg pain, loss of night vision, dry skin and nails, seizures, cardiac arrhythmias, poor immune function, osteoporosis, neurological damage, neuropathy and even death (1).
In conclusion, patients who have bariatric surgery must take bariatric specific vitamins as prescribed before surgery and for the rest of their lives after surgery to promote health, healing, weight loss and weight maintenance and to prevent vitamin and/or mineral deficiencies.
Jennifer Jarrett Clark MS, RD, LDN
Registered Dietitian
Sources:
1. Source: Aills et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surgery for the Obesity and Related Diseases 8 (2008)
2. Source: Jacques, Jacqueline. Micronutrition for the Weight Loss Surgery Patient. Matrix Medical Communities :Edgmont, PA;1996
Posted on November 15, 2011 at 12:25 PM in Weight Loss Surgery
Georgia Eliminating Weight Loss Surgery Coverage for State Employees
A recent story from CNN has raised the eyebrows of the team here at New Life Center for Bariatric Surgery. There are currently six states that do not provide coverage for weight loss surgery for state employees. Georgia is about to become the seventh. The CNN story on Georgia’s decision to end a benefit to state employees that helps pay for bariatric surgery procedures discusses the possible ramifications of such a decision.
The story introduces us to Alice, a retired public school educator insured through the state of Georgia who weighs 305 pounds and suffers from a variety of comorbidities (obesity-related health conditions), including high blood pressure, arthritis, acid reflux, and sleep apnea. She has tried 10 to 12 different weight loss programs, and decided that weight loss surgery may be her best option. However, as the CNN story reports, high costs are causing changes in state medical coverage in Georgia, and starting in January, the state won’t pay for weight loss surgery – leaving Alice not enough time to complete pre-surgery requirements.
The story goes on to report the fact that Georgia has paid about 30 million dollars for an estimated 1600 people to get weight loss surgery over the last 2 ½ years. A CNN legal contributor, who has had weight loss surgery, says it would be more expensive for the state not to cover the surgery because of the costs of treating patients who develop obesity-related conditions such as diabetes, sleep apnea, acid reflux, and other life-threatening afflictions.
Six other states don’t fund weight loss surgery for state employees. Reporter Elizabeth Cohen says Missouri did fund the procedures, then stopped funding, then restored the benefit because they say they realized they were saving money in the long-term from reducing the threats that co-morbidities can cause.
The American Society for Metabolic and Bariatric Surgery (ASMBS) has activated a Rapid Response Team, along with the Obesity Action Coalition, to talk with Georgia state representatives and work to reverse the action.
If you would like more information on the health benefits of weight loss surgery, please contact Dr. Stephen G. Boyce.
Posted on at 12:01 AM in Bariatric Surgery, Dr. Boyce In The Media
Knoxville Bariatric Surgeon Now Performing Laparoscopic Greater Curve Plication Weight Loss Procedure
Knoxville bariatric surgeon Dr. Stephen Boyce is now performing laparoscopic greater curvature plication (LGCP) at his practice. He says the new procedure is designed to help patients lose significant amounts of excess body weight without removing stomach tissue or introducing foreign body implants. He also says he is excited about the procedure’s potential for patients to lose more than 50% of their excess body weight and improve their daily life through a healthier body.
At the New Life Center for Bariatric Surgery in Knoxville, Dr. Stephen Boyce is offering laparoscopic greater curvature plication (LGCP), a procedure approved for patients with a body mass index of 30 or greater. Performed without the introduction of foreign body implants or stomach tissue removal, Dr. Boyce says the LGCP technique reduces stomach capacity from an average of 32 ounces of liquid to 4 ounces, causing patients to feel full earlier during meals. Although the LGCP procedure is still in clinical trial, Dr. Boyce says, compared with other weight loss surgery procedures, gastric plication in Knoxville has proven to eliminate many of the risks associated with procedures that involve removing parts of the stomach or imposing foreign implants such as with the LAP-BAND® System.
LGCP is performed by dissecting one side of the stomach, allowing access to both the front and back surfaces, and then folding in the rounded part of the stomach and sewing it together. The result is a narrowed stomach diameter, allowing patients to experience fullness after eating less amounts of food. Because LGCP does not involve removal or rearrangement of the stomach or bowel, Dr. Boyce says the surgery is less risky than other traditional methods of weight loss procedures. “Early studies indicate that the LGCP is a safe, effective and less expensive weight loss surgical option for patients with a BMI between 30-50.”
Dr. Boyce says he hopes the new gastric plication technique will allow him to offer his patients in East Tennessee more options for weight loss procedures. He also adds that LGCP can provide patients with an innovative and advanced way to lose weight and gain confidence on the journey towards healthier living. Dr. Boyce says he looks forward to the what the future of bariatric surgery will bring and how procedures like LGCP can pave the way for more developments in weight loss. “I am most excited that new bariatric procedures like the LGCP will make bariatric surgery more accessible to patients who need help.”
About Stephen G. Boyce, MD
Dr. Stephen Boyce received his undergraduate degree from Texas A&M University and his medical degree from the University of Texas Southwestern Medical School. He completed his surgical residency at Parkland Memorial Hospital and went on to receive special training in advanced laparoscopic surgery and a Masters Certification in Bariatric Surgery. Dr. Boyce developed the New Life Center for Bariatric Surgery in 2002, becoming one of the nation’s first Centers of Excellence in 2005. His practice is also the only Center of Excellence in East Tennessee to offer all approved Bariatric operations.
New Life Center for Bariatric Surgery is located at 200 Ft. Sanders West Blvd MOB 1, Suite 200 in Knoxville, TN and can be contacted at (865) 694-9676. It also can be reached at parkwestcwlc.com or facebook.com/newlifecenterbariatricsurgery.
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Posted on November 11, 2011 at 2:21 PM in Weight Loss Surgery
RPM For Truckers, a website designed as a database of job opportunities for truck drivers, posted an article, called “Driving to My New Life”, about weight loss that touches on how bariatric surgical options may be necessary for people with morbid obesity to reduce health risks and slim down their physique. The article discusses how weight loss surgery can offer significant health benefits to the vast numbers of truck drivers suffering from obesity.
The article mentions these statistics according to the American Dietary Association: in 2007, 86% of professional drivers were overweight and 66% of these drivers were considered obese. Morbid obesity is defined as having a body mass index (BMI) greater than 35. Life expectancy can be decreased by 10 years for those with a BMI of over 40, and decreased 2-4 years for those whose BMI is between 30 and 35. The article discusses how weight loss surgery, also known as bariatric surgery, can help the growing number of severely obese Americans begin a new life through support, determination, and the right tools.
But how do you take action to control your weight loss and sustain it? As the article suggests, for starters, it’s important to consult with the right specialist, a bariatric surgeon, in order to find the surgical option that’s best for your goals. The American Society of Metabolic and Bariatric Surgery maintains a list of bariatric surgery programs designated as Centers of Excellence® based on the quality of care they provide, the quality of their results, their level of experience, and the safety of their programs. The New Life Center for Bariatric Surgery is proudly on that list. By doing your research and finding a qualified bariatric surgeon, you can increase your chances that the advice and care you receive is professional, ethical, experienced, and unbiased.
The article goes on to talk about how many patients have the fear that weight loss surgery won’t work for them because they’ve tried and relapsed time and time again. However, experience has shown that surgery options such as the LAP-BAND® System have incredibly high success rates in improving or completely resolving diabetes, high blood pressure, and elevated lipids.
Don’t let fear hold you back from taking the right steps towards a losing weight and gaining your life back.
Contact your family physician, or an experienced bariatric surgeon here at the New Life Center, to lift the burden of obesity from your life. RPM For Truckers suggests New Life Center for Bariatric Surgery in Knoxville, TN.
Posted on October 19, 2011 at 4:46 PM in Bariatric Surgery, Exercise, Uncategorized, Weight Loss Surgery
Physical Activity/Exercise Guidelines
The American College of Sports Medicine (ACSM), the American Heart Association (AHA), and the US Department of Health and Human services released guidelines for physical activity/exercise in 2008. Before the guidelines are discussed the difference between physical activity and exercise must be clearly defined.
• Physical activity: any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal (rest) level. This includes personal grooming/hygiene, feeding oneself, standing, walking from parking lot to entrance of building, family care, household chores, occupational requirements, gardening, and so on.
• Exercise: is structured physical activity specifically designed to improve one’s cardiovascular fitness, muscular strength/endurance, flexibility, and body composition (lean mass/fat mass).
• All exercise is physical activity but not all physical activity is exercise.
Cardiovascular Recommendations:
Most if not all days of the week (3-5 days/week) for at least thirty minutes per day. Moderate intensity level: Working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation (talk test).
METs: A metabolic equivalent or MET is a unit useful for describing the energy expenditure for a specific activity. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. Example: 1 MET is the rate of energy expenditure at rest, expressed as 3.5 ml/kg/min or 1 kcal/kg/h or 4.184 kj/kg/h. A 4 MET activity expends four times the energy used by the body at rest.
Two methods of assessing aerobic intensity:
1. Absolute Intensity (Overall guide)
Light: are defined as 1.1 to 2.9 METS
Moderate: are defined as 3.0 to 5.9 METS. Walking at 3.0 mph requires 3.3 METS of energy expenditure
Vigorous: are defined as > 6.0 METS. Running at 10 minute/mile pace is a 10 MET activity
2. Relative Intensity (Specific to individual): Intensity expressed in terms of percent of maximal heart rate, heart rate reserve or aerobic capacity reserve.
Moderate: 40-59% of aerobic capacity reserve (0% resting and 100% maximal) or a 5-6 on a scale of 0-10 (0=sitting, 10=maximal effort)
Vigorous: 60-84 % of aerobic reserve capacity or a 7-8 on a scale of 0-10
Four classifications of cardiovascular exercise:
Inactive: no activity beyond baseline activities of daily living.
Low Activity: <150 minutes (2.5 hours) of moderate intensity exercise or 75 minutes (1.25 hours) of vigorous intensity exercise per week.
Medium Activity: 150-300 minutes (2.5-5 hours) of moderate intensity activity or 75-150 minutes (1.25-2.5 hours) of vigorous intensity exercise per week.
High Activity: > 300 minutes (> 5 hours/week) of moderate intensity exercise.
A good rule of thumb is that vigorous intensity exercise requires only 50% of the weekly duration (time) of moderate intensity exercise to obtain the same health benefits.
The greater the amount of regular exercise (moderate or vigorous) performed on a weekly basis the greater the health benefits. Examples below:
Lower risk for premature death (17-28 years)
Lower risk for coronary heart disease (CHD)
Lower risk of stroke
Lower risk for hypertension (High blood pressure)
Lower risk for dyslipidemia (High cholesterol)
Lower risk for Type 2 diabetes mellitus
Reduced depression
Improvement in cognitive function
Reduction in the number of falls
Cardiovascular Activity
Any activity where the body’s large muscles move in a rhythmic manner for a sustained period of time (i.e. brisk walking, running, cycling, jumping rope, swimming, and hiking).
Three components to consider when selecting an activity (FIT Principle):
Frequency: how often on a weekly basis is the exercise performed.
Intensity: how hard to work during the activity. Moderate = brisk walking, vigorous = jogging/running.
Time: how long (duration) each session should last (i.e. 10-60 minutes).
Greg Stanley, MS, CSCS, HFS
Exercise Physiologist
Posted on September 14, 2011 at 11:35 AM in Bariatric Surgery, Weight Loss Surgery
Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Several types of sleep apnea exist, but the most common type is obstructive sleep apnea, which occurs when your throat muscles intermittently relax and block your airway during sleep. The most noticeable sign of obstructive sleep apnea is snoring, although not everyone who has obstructive sleep apnea snores. Signs and symptoms of obstructive sleep apnea include:
• Excessive daytime sleepiness (hypersomnia)
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache
• Frequent urination at night
• Difficulty staying asleep (insomnia)
Many people don’t think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. When the muscles in your throat relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this sequence is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night. Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk:
• Excess weight
• Neck circumference. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women
• High blood pressure (hypertension)
• A narrowed airway
• Chronic nasal congestion
• Diabetes
• Being male. In general, men are twice as likely to have sleep apnea
• Being black, Hispanic or a Pacific Islander
• Being older than 65
• Menopause
• A family history of sleep apnea
• Use of alcohol, sedatives or tranquilizers
• Smoking. Smokers are nearly three times more likely to have obstructive sleep apnea
Sleep apnea is considered a serious medical condition. Complications may include:
• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If there’s underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.
• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. Treatment of sleep apnea can improve these symptoms, restoring alertness and improving quality of life.
• Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.
• Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships.
• People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).
If you suspect that you have obstructive sleep apnea, you’ll likely first see your primary care doctor. Your doctor may refer you to an ear, nose and throat doctor to rule out any anatomic blockage in your nose or throat. However, in some cases, you may be referred immediately to a sleep specialist. The evaluation may involve overnight monitoring of your breathing and other body functions during sleep. Tests to detect sleep apnea include:
• Nocturnal polysomnography. During this test, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. This can help your doctor rule out other conditions — such as periodic limb movements or narcolepsy — that can also cause excessive daytime sleepiness, but require different treatment.
• Oximetry. This screening method involves using a small machine that monitors and records your blood oxygen level while you’re asleep. A simple sleeve fits painlessly over one of your fingers to collect the information overnight at home. If you have sleep apnea, the results of this test will often show drops in your blood oxygen level during apneas and subsequent rises with awakenings. If the results are abnormal, your doctor may have you undergo polysomnography to confirm the diagnosis. Oximetry doesn’t detect all cases of sleep apnea, so your doctor may still recommend a polysomnogram even if the oximetry results are normal.
• Portable cardiorespiratory testing. Under certain circumstances, your doctor may provide you with at-home tests to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.
• To eliminate snoring and prevent sleep apnea, the sleep specialist may recommend a device called a nasal continuous positive airway pressure (CPAP) machine. With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents apnea and snoring. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask.
Don’t stop using the CPAP machine if you experience problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings but it is important to continue using your appliance until further testing indicates otherwise.
For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don’t improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Try these tips:
• Lose weight. Even a slight loss in excess weight may help relieve constriction of your airway.
• Avoid alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
• Sleep on your side or abdomen rather than on your back. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
• Keep your nasal passages open at night. If you have congestion, use a saline nasal spray to help keep your nasal passages open.
Also of interest, there is a direct correlation between untreated sleep apnea and weight gain. Interrupted sleep cycles can affect hormone production in the body resulting in a metabolic disorder that causes weight gain. A follow up sleep study isn’t always necessary, especially if your machine is equipped with a memory card that records your oxygen needs at night. This chip can be brought to the sleep center and adjustments can be made from that information without the need for a full follow up sleep study. The Parkwest sleep center also has home monitoring options available for people who cannot come to the sleep center. If you have been requested to follow through with a sleep study, I hope this information details the importance of scheduling that appointment.
Robin H. Saunders, RN, BSN
