DEAR DR. DONOHUE: Would you address central sleep apnea and the BiPAP machine? I saw a sleep specialist who told me I have central sleep apnea. My wife has sleep apnea too, and she uses a CPAP machine. The specialist told me I needed a BiPAP machine. It looks exactly like my wife’s. I don’t know what mine is supposed to do and how to tell if it is functioning correctly. – W.B.

Apnea is “no breath.” Sleep apnea is periods during sleep when a person’s breathing stops for 10 seconds or more. Eventually breathing starts again, but the continual repetitions of apnea fragment sleep and make people groggy the following day. They also aggravate many medical conditions, like heart failure and high blood pressure.

Sleep apnea comes in two varieties. The more common one is obstructive sleep apnea. Lax tissue and flabby muscles in the back of the throat obstruct the flow of air to the lungs. In this kind of apnea, snoring often builds to a deafening crescendo and suddenly ends with eerie silence, which is when the no-breathing episode kicks in.

With central sleep apnea, the problem lies in the brain’s sleep center, which fails to generate signals responsible for rhythmic breathing. People with this kind of apnea don’t usually snore. Often, central apnea is associated with heart failure or some neurological problem like a former stroke.

CPAP – continuous positive airway pressure – is a device with a mask that increases incoming air pressure so it can pass through the throat obstruction. It can also be used for central sleep apnea. The BiPAP machine operates on the same principle but has an additional feature. During expiration, it lowers air pressure so the person can breathe out more easily.

If you have an associated illness like heart failure, treatment of that improves central sleep apnea.

You’ll know if your machine is functioning properly. You won’t feel groggy during the day.

DEAR DR. DONOHUE: I’ve been diagnosed with rheumatoid arthritis. I have a friend who says she has rheumatoid arthritis and lupus. She tells me that she went to a doctor in Europe and was given a week-long series of injections that treated the immune system. The procedure cost $5,000. She tells me she is pain-free and has been so for 10 years. Why isn’t this treatment available in the United States? – C.F.

ANSWER: If I am not in error, the treatment is available here. I believe your friend is referring to what’s called biological medicines that are used for serious and unresponsive rheumatoid arthritis. Three biological drugs are given by injection, under the skin. They are Humira, Kineret and Enbrel. Remicade is another biological drug that’s given by intravenous injection. I’m certain your doctor knows about these medicines.

I have never seen a person with both rheumatoid arthritis and lupus. I suppose it could happen, but it must be quite unusual.

The booklet on arthritis describes osteoarthritis, rheumatoid arthritis and lupus. Readers can obtain a copy by writing: Dr. Donohue – No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: When we were young, my brother, sister and I ran everywhere barefoot. Money was short in those days (the late 1920s). It wasn’t unusual for one of us to step on something, usually a nail, and run home, crying for Grandma.

Grandma would wipe our foot with a kerosene rag and send us back out to play. Does kerosene prevent lockjaw? – J.F.

Not that I know of. You are the second person to tell me about the kerosene treatment. The other told me about a relative’s farm accident in which the person lost his leg. The stump was dressed with bandages soaked in kerosene. It worked. He didn’t get an infection. The thought of it gives me shudders. I don’t recommend anyone trying it. Tetanus – lockjaw – is best prevented through immunizations, which have to be repeated every 10 years throughout life.

DEAR DR. DONOHUE: I am a 17-year-old boy with a tongue ring. My family says that the dentist told them it would cause cancer. I have had the ring for two years. I am deeply concerned, if this is true. Please reply. – D.T.

D.T., don’t be offended by my interjection of a personal note here. For the life of me, I cannot understand why anyone would have the tongue pierced to insert a metallic ring. It’s weird to me.

I can’t find any evidence that tongue rings cause cancer. They can bring on infections. They often interfere with speaking. They can chip teeth, and they might alter taste.

Do you still want to keep that thing in your tongue?

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

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