DEAR DR. DONOHUE: I am 64 and run two to three miles every other day. I also work out on the days that I don’t run. I am in good condition.

Unfortunately, I have a hole in my heart, sleep apnea, chronic obstructive pulmonary disease and an enlarged prostate gland. I’ve tried using CPAP for sleep apnea, but it doesn’t work for me. I had surgery to remove tissue from my soft palate and throat, but it didn’t help my sleep apnea.

Is it possible that the hole in my heart is causing the sleep apnea? I would have surgery to close it if I knew it would help. – J.W.

ANSWER:
Neither the hole in your heart nor COPD (chronic obstructive pulmonary disease) nor the enlarged prostate gland causes sleep apnea. The more common kind of sleep apnea is the obstructive variety. Redundant tissue in the throat and the back of the mouth so narrows the air passageway to the lungs that it obstructs airflow. During the night, those tissues sag even more, and people with the condition stop breathing in episodes lasting from 10 seconds to as long as a few minutes. Then the body rouses itself, the person partially wakens with a grunt and airflow resumes. Snoring is often a sign of sleep apnea. The snoring becomes increasingly loud, and then, at the onset of apnea (no breathing), it suddenly stops. Not all snorers have sleep apnea, but most sleep apnea patients snore.

This disorder has many complications. One is daytime sleepiness due to the many interruptions in sleep. It’s also a strain on the heart. It can increase blood pressure both in the lungs and in the body.

Don’t drink any alcohol or take any sedatives in the evening. They increase the laxity of throat tissues. If you are overweight, you must lose some pounds for the same reason.

CPAP, continuous positive airway pressure, is a mask attached to a machine that increases air pressure so that it can get past the obstructions in the mouth and throat. It usually works. Is it the mask that makes it impossible for you to use? If so, there are many models, and another might suit you better.

Paring away redundant throat tissues also works for many. Too bad it didn’t for you. Another try at CPAP is worth the effort.

DEAR DR. DONOHUE: I have diabetes, kidney failure and heart failure. I have chosen not to take dialysis, as my doctor says I’ll live only 2½ to 3 years. If I don’t take the treatment, how long a life will I have, and what will I go through? – J.S.

ANSWER:
How long you’ll live without dialysis is a question no one can answer. It depends on how bad your kidneys and your heart are. Without treatment, the body cannot rid itself of the waste products it produces. That, in turn, slows the production of red blood cells, and anemia results. Loss of appetite is universal without kidney function. Some people bleed from the digestive tract. All organs are affected. Most people die of heart failure and high blood pressure.

Why not get a second opinion? If, after a second consultation, you are firm in your decision not to pursue dialysis, then all should respect your wishes and your doctors should keep you comfortable and free of pain.

DEAR DR. DONOHUE: My identical twin died at age 17 of Bright’s disease.

I happen to be reading a book about the poet Emily Dickinson, and it was mentioned that she had Bright’s disease too. I have tried to get information on it without any success. Can you tell me about it? – M.A.

ANSWER:
Richard Bright was an English physician who lived in the 19th century. He was the first to describe swelling and urine protein as important signs of kidney failure. From that time on, many kidney diseases, including those causing kidney failure, were called Bright’s disease.

Now, with the help of kidney biopsies and sophisticated blood tests, it’s possible to distinguish the many different illnesses that lead to kidney failure and the signs that Bright described. The term “Bright’s disease” is obsolete these days.

DEAR DR. DONOHUE: I would love you to address the problem of night sweats. I live in a climate that is cool at night all year round, but I drench my nightgown and bedclothes every night. What’s causing this? – A.K.

ANSWER:
Body temperature has a normal daily variation. In the early-morning hours – around 3 a.m. – body temperature is at its lowest. That’s normal. For the body to achieve that lower temperature, it produces more sweat that evaporates for cooling. Some people have an exaggeration of this process and pour out sweat that soaks them and the bed.

Furthermore, at night, urine production slows. The body still wants to get rid of fluid, and it does so by increasing its sweat output.

Both of these are normal phenomena.

Check your room’s humidity. It might be too high for the sweat to dry. A dehumidifier could be the answer.

Alcohol and nicotine promote sweating. Don’t drink any alcohol after 5 p.m., and if you smoke, stop.

I must include the list of illnesses that can be linked to night sweats. Lymph-node cancer, including Hodgkin’s disease, is one. Diabetics tend to sweat more at night. An overactive adrenal gland or an overactive thyroid gland promotes night sweats. Hidden infections are another possible cause. TB is also cited as producing night sweats, but in truth it rarely does so. Other infections can. Although these illnesses are not usually found to be responsible for night sweats, you should mention this to your doctor so he or she can consider them.

If you take your temperature when you wake up sweating and find that it is normal, that’s a piece of evidence that speaks in favor of the innocence of your night sweats.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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