Dear Dr Rosenberg,

My doctor placed me on a medication called Provigil for sleepiness. I have Sleep Apnea and wear my mask every night; despite that I am still sleepy. Shouldn’t the CPAP take of my sleepiness?

Unfortunately, not everyone who is placed on CPAP is cured of sleepiness. For as many as 15% of patients, the sleepiness remains a problem. In fact, one of the FDA approved indications for the stimulant medication Provigil is for people such as you. So you are not alone. However, you should stick with the CPAP for its positive cardiovascular and metabolic effects.

Dear Dr Rosenberg,

My husband has a problem with his feet. They hurt him so badly, that at night he can’t stand to have anything touching them. He sleeps with the covers off. His feet even go numb once in awhile. He has been checked for diabetes, but that was negative. Can you think of a reason his feet would hurt like this?

The question is; do your husband’s feet hurt at night only and when immobile. If so, and the pain is relieved by movement; that might be Restless Leg Syndrome. On the other hand, if this is an ongoing problem regardless of the time of day and is not relieved by moving the legs, this may well be a Neuropathy. Although Diabetes is a common cause of Neuropathy, there are numerous other causes. If this continues you might want to have your husband evaluated by a Neurologist. There are many tests such nerve conduction studies which can determine the cause.

Dear Dr Rosenberg,

My grand daughter is three years old. She stays with us one weekend a month. This allows my daughter and her husband some much needed rest. My grand daughter goes to sleep fine, but then every few hours she cries and we have to go into her room and pick her up. Sometimes we bring her back to our bed. This is what my daughter and son in law go through every night. How should we deal with a poor sleeper like this?

It sounds like your grand daughter has developed a classical form of childhood Insomnia called Sleep Onset Association Disorder. Some children can not soothe themselves back to sleep. They begin to associate falling back to sleep with some soothing activity on the part of the parent or caregiver. This usually spirals and get worse. One of the more useful behavioral techniques is called Graduated Extinction. This involves ignoring requests for a specified period of time; at which time a brief soothing intervention is performed. The time period is progressively lengthened over a series of nights until the caregiver no longer responds. Babies must be at least nine month old and 12 pounds to initiate this technique.

Dear Dr Rosenberg,

I snore loudly and my wife told our family doctor that I stop breathing. Our doctor told me I probably had Sleep Apnea and he sent me for a sleep study. When the study was over they told me I had something called Complex Sleep Apnea. They treated me with a machine called an Adaptive Servo Ventilator. It is small and looks just like my friend’s CPAP machine, but apparently it is different. What is the difference between what I have, this Complex Sleep Apnea and Sleep Apnea? I am overwhelmed with all this new information and frankly don’t understand it.

Complex Sleep Apnea is a recently described form of Sleep Apnea. It is a diagnosis made while CPAP is being applied. We find that about 15% of patients will stop making any effort to breathe for 10 seconds or greater when placed on CPAP. In fact, once the obstructive events are eliminated; these events will become the predominant form of abnormality. When restudied up to one year later, over half still had these abnormal breath holding events we refer to as Central Apneas.  Most importantly, it was found that their sleep was no better than it had been before. That is why Medicare and most insurers have approved this form of pressure delivery provided by the Adaptive Servo Ventilator. I am frequently asked why some people develop this in response to positive airway pressure. The honest answer is that as of right now we really do not know the cause.

Dr. Robert Rosenberg, Board Certified Sleep Medicine Specialist, will answer readers’ questions by incorporating them in furture columns.  Contact him at  askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Sedona, 210 S. Sunset drive, suite A-1, sedona, AZ 86336.