Ask the Experts: Sleep Apnea; Barrett’s Esophagus; Inguinal Hernia Treatment
Q: I’m sure my wife has sleep apnea—she rouses several times during the night, making choking sounds, and often is tired during the day. She isn’t taking my concerns seriously, so how can I convince her to discuss her symptoms with her doctor?
A: You are correct that sleep apnea symptoms warrant a consultation with the doctor. The condition occurs when soft tissue at the back of the throat blocks the airway during sleep—the brief awakenings your wife seems to be experiencing are a sign she isn’t getting sufficient oxygen.
Getting treatment for her symptoms will make a big difference to your wife’s energy levels, as well as help her stay alert during the day. It should benefit her overall health, too, since sleep apnea is linked to high blood pressure, heart attack, stroke, diabetes, depression, and memory problems. A recent study (Journal of Clinical Sleep Medicine, Jan. 15) suggests that seniors whose sleep apnea goes untreated have more doctor’s appointments, emergency room visits, and hospital stays than seniors whose sleep apnea is treated. I hope this will convince your wife to seek medical advice. If she is diagnosed with sleep apnea, she may need to use a continuous positive airway pressure (CPAP) machine at night. These devices deliver a steady flow of air to the lungs via nasal cannula or a face mask. I use one myself, and it has made a world of difference to my sleep.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine
Q: My brother has been diagnosed with Barrett’s esophagus. Can you tell us more about this condition and how it is treated?
A: Barrett’s esophagus is a condition that can develop if the esophagus suffers long-term exposure to stomach acid—as such, it typically occurs in people with gastroesophageal reflux disease (GERD), in which stomach acid leaks up into the esophagus. The lining of the esophagus is different from the lining of the stomach, and there is a “border” separating the two types of tissue at the area where the organs meet. In Barrett’s esophagus, the cells that line the stomach grow above this border. Over time, these cells can become abnormal, and may turn cancerous. This is rare, but it means that people with Barrett’s esophagus must be closely monitored. If GERD is present, this also should be treated with antacids and lifestyle and dietary changes, such as quitting smoking, losing weight if necessary, avoiding dietary triggers (fatty foods, citrus, tomatoes, garlic, chocolate, peppermint, caffeinated and/or carbonated beverages, and alcohol), and not eating within two to three hours of bedtime.
If monitoring suggests that your brother’s condition is worsening, his doctor may recommend a biopsy to examine for abnormal cells. If these are found, they can be destroyed using a technique called ablation, in which the cells are heated or frozen.
Brijen J. Shah, MD
Gastroenterology
Q: My husband has developed an inguinal hernia. Can you tell us more about these hernias, and how they are treated?
A: An inguinal hernia occurs when body tissue (usually part of the intestine) bulges through a weak area in the abdominal muscles. Older people are at particular risk of this because the abdominal muscles tend to weaken with age.
An inguinal hernia can cause pain, and a sense of pressure in the groin. It also is possible for a complication called strangulated hernia to occur if the bulging tissue is trapped in the abdominal wall. This cuts off the blood supply to the trapped tissue and is a medical emergency. Signs include sudden, intense pain, nausea, vomiting, and fever—the hernia bulge also turns a reddish-purple color.
If your husband’s hernia is not causing problems, his doctor may recommend monitoring, but if it is painful or grows larger, surgical repair may be necessary to push the bulging tissue back into place and reinforce the weakened area with synthetic mesh. If surgery is not advisable for any reason, your husband may gain relief from wearing a truss, which is a supportive undergarment that holds the herniated tissue in place.
Celia M. Divino, MD
Surgery
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