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Dr Paulose

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Anesthesia, Art Forms of Kerala, Charity, Coblator Surgery, CPAP, Ear, ENT For Pediatric (Children), General, Health Tourism, Laser Treatment, Microdebrider Surgery, Nose, Rhinoplasty, Sinusitis, Sleep, Sleep Apnoea, Snoring, Surgery, Throat, Tips, Treatment, Yoga · October 21, 2016

ENT SURGERY SCHOOL BY DR PAULOSE

ENT SURGERY SCHOOL

Those who are interested in learning ENT, Laser, Plastic Surgery, Anesthesia Procedures, Please enroll and visit the link below-

ent surgery school

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http://entsurgeryschool.com/

https://www.facebook.com/entsurgeryschool/

Anesthesia, Coblator Surgery, CPAP, General, Health Tourism, Laser Treatment, Microdebrider Surgery, Nose, Others, Sinusitis, Sleep, Sleep Apnoea, Snoring, Surgery, Throat, Tips, Treatment · August 13, 2016

Does Woman Snore?

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Does Woman Snore?

Many women do snore. It’s not your fault if you do. Snoring may be the subject of many jokes, but it definitely isn’t funny.

Its disturbing and not sexy at all, especially when you’re trying to sleep next to them. Yes  snoring is a problem for women too.

The biggest difference is that more women are too embarrassed to talk about it or get help.

By the time men and women are almost to senior citizen status the rate of snoring for both is about the same. During the younger years the ratio of men to women that snore is closer to 4 to 1.

There are many factors contributing snoring in younger women, obesity, thyroid issues, low Vit D, lack of exercise, and hormonal changes. The estrogens seems to protect the airway from collapsing, any change I the hormone profile can contribute the airway collapse. One can  see more post menopausal women snoring.

If you are a snoring girl, don’t be embarrassed about it, get help, before it destroy your sex life marriage and more important your health.

Please find out more in the video clip-

Sleep, Snoring, Tips, Treatment · April 9, 2014

Weight Gain or Weight Loss in CPAP Users?

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I have been treating snoring and sleep apnea patients for more than three decades. As a surgeon I try to do operate on these patients, but those who are unable to undergo surgery or unwilling for surgery I prescribe CPAP machine (Continuous Positive Airway Pressure).I must say CPAP is a wonderful machine having its advantages and disadvantages.

If you think that starting CPAP for obstructive sleep apnea would help you to lose weight, then read the recent study published in the Journal of Clinical Sleep Medicine find that this is not the case. In fact, using CPAP is found to cause statistically significant mild weight gain compared to sham CPAP users in this prospective randomized study.

After treating OSA patients over these years by CPAP therapy, I have heard many patients complaining of gaining weight and some say losing weight. Initially I thought patient who gets good sleep should lose weight and poor sleep should promote weight gain.

I read conflicting results on CPAP use and weight status. There are a number of possible reasons why this can happen, but no one is absolutely sure. Of course, I’ve also had many patients who did lose significant weight after CPAP, which only adds to my confusion.

So I thought write this article based on my experience, but I stress that more studies need to be done in this subject. Physicians should stress an active weight loss plan and not assume CPAP alone will lead to weight loss. A larger, prospective study may help clarify these findings.

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Obesity and Sleep Apnea

Obesity is causally linked to OSA. Why weight change after treatment with CPAP is not yet clear. Although hormonal changes would predict weight gain or loss, decreasing energy expenditure by reducing work of breathing would predict weight gain.

Metabolic Response in OSA

Sleep Apnea and Insulin Resistance

Obstructive sleep apnea (OSA) is characterized by sleep-related airway obstructions that produce apnea. These events provoke arousals and cause oxygen desaturations and heightened sympathetic activity during sleep and waking hours that may play a role in the development of insulin resistance. Obesity is a strong risk factor for OSA and both obesity and OSA are associated with increased insulin resistance and diabetes.

Obstructive sleep apnea (OSA) is associated with obesity, insulin resistance (IR) and diabetes. Continuous positive airway pressure (CPAP) rapidly mitigates OSA in obese subjects but its metabolic effects are not well recognized.

CPAP effectively improved hypoxia. However, subjects had increased insulin and IR. Fasting ghrelin decreased significantly while leptin, adiponectin and resistin remained unchanged. Changes in body weight directly correlated with changes in insulin and IR. Ghrelin changes inversely correlated with changes in IR but did not change as a function of weight.

Hormonal Changes

Hormones involved in the regulation of body weight and glucose metabolism include ghrelin, leptin, adiponectin and resistin. Ghrelin is an orexigenic hormone and it has been proposed as a cause of increased appetite and obesity .

Ghrelin is an appetite-increasing hormone postulated as a contributor to OSA-associated obesity as ghrelin levels were elevated .Leptin is secreted by adipocytes in proportion to body fat, being elevated in obese individuals and decreasing with weight loss. Adiponectin is decreased in obese individuals and in those with type 2 diabetes. It is thought to play a role in many of the metabolic complications suffered by these patients including metabolic syndrome and cardiovascular disease. However, its role in patients with OSA remains controversial.

CPAP treatment induced a decrease in fasting ghrelin levels, although body weight increased in most subjects. Adipokines such as leptin, adiponectin and resistin also appear to be influenced much more by adiposity rather than hypoxia. The fact that these adipokines remain unchanged after 6 months of CPAP treatment suggests that they are unlikely to play an important role in the development of the metabolic complications seen in the setting of OSA.

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CPAP and Body Weight

CPAP alone may not reduce body weight and that in the face of weight gain CPAP treatment may not reduce insulin resistance and leptin or increase adiponectin in obese subjects. It is possible that CPAP use has only a transient effect on insulin sensitivity and that changes in body weight are a much more important factor in the long-term regulation of insulin sensitivity.

Hypothyroidism and Sleep Apnea

Hypothyroidism is a condition where the body produces insufficient amounts of thyroid hormones, the most important of which is Thyroxine. Hypothyroidism produces many complications in the body including fatigue, loss of muscle tone, weight gain and sleep apnea, among others. It is thought that the symptoms of Hypothyroidism (swollen tongue and soft tissue in the mouth and throat) are responsible for the Sleep Apnea. As stated earlier, another frequent symptom of hypothyroidism is obesity, which can also cause sleep apnea.

This similarity in presenting symptoms raises a question on how patients with suspected OSA should be evaluated.

 Fluid retention may lead to pulmonary edema and cardiac failure

Complications of sleep apnea may lead to cardiac failure in some patients. Patients with hypertension are already at risk of developing cardiac failure and it is thought sleep apnea may increase the likelihood of this occurring. This in turn may result in gain in weight in some CPAP users.

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Conclusion

It’s all may be confusing to patients. I would recommend CPAP users must monitor their weight regularly and if there is substantial gain, then they should consult the physician. They also should start workout programmes to burn excess calories they saved overnight by decreased energy expenditure during work of breathing which is taken over by CPAP machine.

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