DEAR DR. DONOHUE: My son has sleep apnea. What causes it? He is 43. I don’t want him to die in his sleep. What can be done about this? — C.D.

ANSWER: Sleep apnea consists of periods during which the sleeper takes no breaths. The condition has this story line with few variations: The patient usually is an overweight male who’s a loud snorer. His snoring builds to a deafening crescendo, and then there’s an eerie silence. The silence comes about because the snorer has stopped breathing — apnea. The period of no breathing lasts from 10 to 30 seconds and is broken by the snorer grunting with an inhaled breath. Snoring and breathing then resume. These spells recur many times throughout the night.

Loose, flabby tissue in the throat completely collapses and blocks the passage of air to the lungs — the apnea phase. The snoring phase comes about from the vibration of those tissues as air passes by them.

Sleep apnea has many complications. Sudden death during sleep is not one of them. But it can lead to a rise in blood pressure. It invites heart attacks and strokes. Daytime grogginess is all but universal. A drop in the snorer’s blood oxygen level is the reason why bad things happen.

If your son is overweight, weight loss might be the thing that cures him. A mouth guard that pulls the chin slightly forward keeps throat tissues from collapsing. The family doctor or dentist can direct him to a place that sells these devices. The dentist might be able to fashion one specially for him. CPAP — continuous positive airway pressure — is a device that delivers pressurized air to the patient through a face mask. The pressure keeps the throat opened at all times. In severe cases, surgical or laser removal of the redundant tissue permanently opens the air passageway.

Sleep apnea is best diagnosed in sleep labs, where a multitude of body processes are measured during sleep. If you have never heard of such places, they’re everywhere. I’m sure there’s one near you.

DEAR DR. DONOHUE: I have had type 2 diabetes for 10 years. I am still confused when the ingredient label on an item lists sugar alcohol. How does this affect blood sugar? How do I count it for my carbohydrate intake? — C.L.

ANSWER: Sugar alcohols are neither sugars nor alcohol. Whoever named them did us a disservice.

They’re sugar substitutes and have names like sorbitol, xylitol, mannitol, maltitol, erythritol and isomalt. Manufacturers of candy, gum, baked goods, soft drinks and other foods are allowed to label their products as being “sugar free” if the sweetener used is a sugar alcohol. They don’t raise blood sugar as much as other carbohydrates do, including sugar.

A sugar alcohol has two calories per gram. Ordinary sugar and other carbohydrates have four calories per gram. Multiplying the sugar alcohol’s weight in grams by two yields the number of carbohydrate calories in the product.

Have you your own blood sugar meter? You can tell how much your blood sugar rises from a serving of a food with sugar alcohol in it by measuring your blood sugar before you eat it and again about an hour or two after eating it. You won’t see much of a rise, if any.

DEAR DR. DONOHUE: I have heart disease and have been to several cardiologists. Two years ago, my primary care doctor had my blood tested for homocysteine. It was at high normal. He put me on folic acid. None of the cardiologists ever mentioned homocysteine to me. What does this mean? — H.W.

ANSWER: An above-normal homocysteine level could be a sign of heart disease, artery hardening and a tendency to form clots.

However, lowering homocysteine with folic acid (a B vitamin), vitamin B-12 or vitamin B-6, either alone or in combination, doesn’t lessen the risk of heart disease, artery hardening or stroke. High homocysteine is not as important a risk as high blood pressure, diabetes, smoking or high cholesterol. Most doctors don’t check for it.

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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