1. Her sleep study
The sleep study was limited somewhat by a reduced total sleep time seen and of note there was no supine sleep sampled. In the non-supine sleep seen, there was a moderate degree of obstructive sleep apnoea with an AHI of 16 events/hr which has significantly worse in REM sleep.
Moving forward with this, we did discuss a trial of CPAP therapy, but she is reluctant to trial this at present. She would not be suitable for a mandibular advancement splint due to her dentures, top and bottom, which she has had since the age of 21 and I think surgical success rates given her anatomy would be very low. As such, she is going to manage things expectantly with a focus on weight-loss and I have discussed that she will need to lose about 15kg to make any difference with her sleep apnoea. She is quite motivated to do this.
2. Shortness of breath on exertion
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She is seeing Leighton to follow-up on a possible cardiac causes for this, but given these are unlikely and also the fact that the CT scan and lung function tests did not give us an obvious cause, the remaining possibilities are either asthma or vocal cord dysfunction. We did discuss exploring the option of asthma further with a bronchoprovocation challenge test or an empiric trial of treatment. She has elected for an empiric trial of treatment and as such, I will start her on Breo Ellipta 200/25 one puff daily for the next three to four weeks and then reassess her symptoms and perform lung function tests at that stage. If there is no response, we will discuss involving an ENT surgeon for investigation of a possible upper airway cause for her shortness of breath on
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Each year at least 40 million Americans suffer from long term, persistent sleep disorders, and an additional 20 million experience occasional sleeping problems. About 60 million Americans a year have insomnia and it tends to increase with age and affects about 40 percent of women and 30 percent of men. It is estimated that 18 million Americas are suffering from sleep apnea, 12 million have RLS, and 250,000 are affected by narcolepsy. Adults typically need between 6 and 10 hours of sleep per 24 hour period, and most people need approximately 8 hours of sleep per day. Infants generally need about 16 hours per day; whereas, teenagers require 9 hours on average. In the first 3 months of...
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Chronic sleep loss is becoming more common in modern culture and less restricted to sleep-deprived diseases such as insomnia. Suggested to be the result of a number car, industrial, medical, and other occupational accidents, sleep deprivation is beginning to be recognized as a public concern. As a result, the Centers for Disease Control
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Sleeping disorders are a very common thing that people face every day. A sleeping disorder is when a person is unable to sleep or unable to stay asleep when they have the chance to do so. There are many things that impact a person through out the day, causing sleeping disorders but the two most common are stress and medical problems. Stress is so common in adults and college students preventing them from being able to fall asleep and getting the right amount of sleep they need each night. Medical problems such as sleep apnea and night terrors also do the same thing and are not curable. This is not good because many people cannot perform a normal day without the right amount of sleep the night before.
Unpleasant breathlessness that comes on suddenly or without expectation can be due to a serious underlying medical condition. Pneumonia can impact the very young and very old, asthma tends to affect young children, smokers are at greater risk of lung and heart disease and the elderly may develop heart failure. However, medical attention always needed by all these conditions as it can affect any age group and severe breathlessnes. There are short and long term causes of dyspnea. Sudden and unexpected breathlessness is most likely tend to be caused by one of the following health conditions. There is accumulating evidence that in many patients, dyspnea is multifactorial in causes, and that in most patients, there is no single, all-encompassing explanation for dyspnea.
Sleep is one of our basic needs to survive and to function in day to day operations, but not everyone needs the same amount of sleep. Some people can survive on very little sleep, i.e. five hours a night, and some people need a lot of sleep, to the extend that they are sleeping up to 10 to sometimes 15 hours a night (Nature, 2005). According to Wilson (2005) the general rule states that most people need from seven to eight hours of sleep. The deprivation of sleep in our society in continually increasing with the demands in society increasing work loads, the myth that a few hours of sleep is only necessary to function properly and that sleep is sometimes considered as killing time (Nature, 2005). Sometimes sleep deprivation is also caused by other situations like sleep disorders, i.e. sleep apnea, chronic insomnia or medical conditions such as stress (Wilson, 2005).
Sleepiness, whether due to sleep apnea, heavy snoring, idiopathic hypersomnolence, narcolepsy or insomnia from any number of sleep-related disorders, threatens millions of Americans' health and economic security (1). Perhaps somewhat most concerning of these disorders are those that allow sleep without having any control over when it happens-idiopathic hypersomnolence and narcolepsy. The two are closely related in that both cause individuals to fall asleep without such control, yet narcolepsy occurs without any dreaming during naps (2). For years, narcoleptic people have been falling asleep in corners, concerned, as they have given numerous attempts to try to stay focused and awake. But besides the excessive fatigue that people experience, there surely must be more that can be associated with causing such sleepiness among people at an uncontrolled level. There might especially not be a reason involving the I-function of the brain, as people are not aware of when necessarily they will fall into their deep sleep.
-Shortness of breath=described as tightness of the chest. Some people have trouble breathing during exercise, others experience it after inhaling smoke, while others need to ingest a particular food-regardless of the circumstance, all people with asthma have trouble breathing.
Sleeping is something that is an essential part of human nature and is a must in order for one to be a functional human being. Sleep is an idea that is accompanied by many wives’ tales, including the idea that one needs seven to eight hours of sleep each night and alcohol helps one fall asleep and sleep more soundly. One myth about sleep is that during sleep, one is in a state of nothingness. In truth, however, it has been discovered that during sleep the brain is active, variations in heartbeat and breathing occur, and the eyes and ears are active throughout the time of sleep. These activities during a person’s sleep are important because they help that person be more aware, awake, and alert during sleep.
Kales, A. (1972). The evaluation and treatment of sleep disorders : Pharmacological and psychological studies. In M. Chase (ed.)The Sleeping Brain. Los Angeles : Brain Information Service.
Sleep disorders are an underestimated public health concern considering that fifty to seventy million Americans are affected. Technological advances in the field of sleep have facilitated various theories to explain the need for and the purpose of sleep. Scientist have uncovered many types of sleep disorders such as insomnia, sleep apnea, and narcolepsy. Sleep disorders affect men ,women, children, the elderly, and the obese in different ways. Factors such as the number of children and the effects of menopause have been studied to determine their effects on sleep. Various treatments have been utilized ranging from non-pharmacologic to pharmacologic methods. Scientist have pinpointed areas of the brain that are involved in sleep deprivation and hormones that ultimately affect sleep.
Sleep and Sleep Disorders. Centers for Disease Control and Prevention, 1 July 2013. Web. 7 May 2014. .