Why Are You Sleepy?

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Do you wake up feeling tired? Have a strong urge to sleep during the day? Become drowsy while driving? Fall asleep while watching TV or a movie? Snore? Does your snoring keep your partner awake? Do you suddenly wake up during the night gasping for air or with a dry mouth?

If you answer “yes” to any of these questions, you might have “obstructive sleep apnea” or OSA. This is a condition in which your airway becomes obstructed during sleep causing you to stop breathing normally. Because this happens while you sleep, you probably don’t know that you have OSA at all.

What Is Obstructive Sleep Apnea (OSA)?

OSA occurs when your muscles relax and allow the soft palate and tongue to close off your airway. This causes you to stop breathing several times during the night for up to 10 seconds or longer and produces a drop in the supply of oxygen to your brain. This cycle can be repeated 30 times or more each hour, all night. No wonder you wake up tired!

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OSA is serious and, if untreated, can lead to high blood pressure, diabetes, obesity, depression, lack of sexual desire, heart disease, heart attack, dementia, or even stroke. OSA deprivers you of deep, restorative sleep (commonly referred to as REM or “rapid eye movement” sleep) so necessary for good health.

Symptoms of OSA

Symptoms of OSA range from chronic fatigue or sleepiness during the day to snoring and consciously disrupted sleep at night. Common symptoms include

·      Feeling tired or exhausted upon awaking in the morning

·      Frequent drowsiness when engaged in normal activity during the day (driving while drowsy is a major cause of traffic accidents)

·      Depression or changes in mood during the day

·      Loud and frequent snoring that sometimes awakens your partner

·      Waking up while gasping for breath or choking

·      Dry mouth or morning headache

OSA is also associated with high blood pressure, lower sex drive, and weight gain.

Men suffer from OSA at 2 to 3 times the rate for women. Persons who are 30 or more pounds overweight or who have thick necks (17 inches or more in circumference) are susceptible to OSA because being overweight enlarges the soft tissue in the back of the throat.

OSA can afflict persons of any age, but it usually peaks between ages 40 and 60. Smokers experience sleep apnea at 3 times the rate for non-smokers.

A large majority of persons are unaware of having OSA and do not seek treatment for it. The cost to society of not treating OSA is significant since it results in traffic accidents, stroke, and heart attacks. That’s why truck drivers and others who need a commercial driver’s license are required to be screened and treated for OSA.

What Should You Do?

If you have trouble sleeping or have any of the above symptoms, you should be checked by your health care provider. At Kathy’s Urgent Care, we can help determine an appropriate course of action to cope with your individual situation.

Above all, do not self-medicate with alcohol or sleeping pills. Alcohol relaxes the muscles that control the soft tissue around your throat, making your problem worse. And most sleeping pills contain muscle relaxants that have the same effect. Using either will likely make your problem worse.

Depending on how severe your problem appears, we can recommend at-home testing kits or refer you to a sleep testing facility as needed. The home kits cost about $250, and some vendors accept insurance payment. Sleep testing facilities are more expensive and are usually covered, at least partially, by health insurance plans. Either route can give us the information needed to follow up.

While you might need assistive measures—CPAP or EPAP devices, dental appliances, etc.—quite often you can achieve good results simply by losing weight. Losing weight often controls snoring and can reduce or eliminate sleep apnea over time. Doing so, however, takes a while and can be difficult to achieve. We have learned that medically supervised weight control programs and changes in lifestyle are most effective in achieving permanent improvement. In most cases, surgery should be considered a last resort.

OSA can lead to very serious health issues and even cause death. Get checked by your health care provider and decide on a weight loss program or other measures to relieve your symptoms. Don’t put this off!

Remember that at Kathy’s Urgent Care, we can help with this and related health problems.

If you’ve had experience with OSA and various treatment options or if you have questions or opinions about OSA, please leave a comment below.

America’s Growing Waistline

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America’s collective waistline has been growing for several decades. And that’s causing problems for most of us in terms of poor health and the higher cost of coping with obesity-related diseases and conditions.

Recall the conversations from your latest high school or college reunion.

“Joe sure has put on weight since we played basketball together!”

“I wouldn’t have recognized Rebecca outside of this party. She was always so slender.”

Among our relatives, we nag one another and ourselves about how many pounds we’ve put on. And we moan about how hard it is to lose the weight, how much we need to get more exercise, and so on.

Was it always this way? Yes . . . and no.

How We Got Here

The early Greek physician, Galen (129-210 C.E.), tried to help his overweight patients by urging them to eat more slimming foods such as greens and garlic. He held that appetite was controlled by the liver and that a balance in “humours” needed to be restored.

During the Middle Ages and Renaissance, ballads, plays, and literary works often poked fun at those who were considered fat. But such concern with weight has had its ups and downs throughout history and in various cultures.

When food was scarce, consuming large quantities of food whenever possible led to the storing of body fat as a hedge against leaner days. People even regarded being overweight as a sign of prosperity when food was scarce for most of the population.

Of course, one could go too far in that direction and become guilty of gluttony—one of the seven deadly sins according to Christianity. And when food became more plentiful, gluttony was an obvious sign of selfishness. Being overweight carried a stigma of moral condemnation.

As food production became more reliable in Europe and North America in the 19th and 20th centuries, to a large extent because of mechanized farming, average intake of calories gradually increased for most people.

Historians have now determined that the Body Mass Index (BMI) for students at West Point during the 19th century averaged only 20.5. For persons born between World War I and World War II, however, a surge occurred that pushed the average BMI to about 22.4. BMI averages have ballooned in the decades since then, except for a minor dip in the trend during the Great Depression (another time of food scarcity).

Many factors have worked together to accelerate the trend toward our current situation where about 70% of Americans are considered clinically overweight or obese. In addition to more reliable availability of food, these factors include labor-saving devices and technology at work and in the home, a more sedentary lifestyle for millions, and a fast-food and processed food industry that has pumped unneeded sugar, carbohydrates, and saturated fats into the American diet at the expense of fresh fruits and vegetables.

Our Obesity Epidemic

Conduct an Internet search for “obesity” and you will find that we are now confronting an “obesity epidemic” (see the CDC video, The Obesity Epidemic).

This means that according to official public policy for government agencies and professional associations such as the AMA, obesity is considered a medical condition.

The CDC calculates overweight and obesity BMI levels according to the following criteria:

  • If your BMI is less than 18.5, it falls within the underweight range.
  • If your BMI is 18.5 to <25, it falls within the normal range.
  • If your BMI is 25.0 to <30, it falls within the overweight range.
  • If your BMI is 30.0 or higher, it falls within the obese range.

Being overweight or obese now has recognized consequences, a variety of causes, and methods of treatment. We will consider these topics in later posts, but for now we’ll briefly mention the general significance of this condition for our society.

In an important 2015 article, “How Obesity Became a Disease,” for The Atlantic, Harriet Brown reports that the AMA’s decision in 2013—to “recognize obesity as a disease state” that includes several characteristics requiring many different approaches to treatment—was not without controversy.

In fact, the AMA’s Committee on Science and Public Health advised against such a step. In their view, obesity does not resemble other diseases since it has no symptoms and is not always harmful (as in times of famine).

“[T]he committee worried that medicalizing obesity could potentially hurt patients, creating even more stigma around weight and pushing people into unnecessary—and ultimately useless—‘treatments.’”

By voice vote, the AMA membership decided otherwise. Such a decision promotes greater standardization in treatment options and more advanced research into how society can cope with the problems resulting from an overweight and obese population.

The situation is indeed dire. Overweight and obese persons are at much higher risk for cardiovascular disease, type 2 diabetes, sleep apnea and deprivation, and other health problems. Childhood obesity is also increasing and clearly contributes to higher rates of adult obesity.

While treatments also contribute to much higher expenditures for health care, many of the costs to society are indirect or hidden. Transporting overweight persons by car takes more gasoline, while buses and trains need to be refitted to accommodate heavier riders. Even loss of productivity at work represents a significant economic cost.

Higher medical and other costs explain why the increasing number of overweight and obese persons has become such an urgent public and health care issue. In future posts, we’ll address how health care professionals can help individuals and society to cope.

In the meantime, feel free to add your own comments and observations. To add or view comments, click on the title of this article above.

Coping with Your High-Deductible Health Plan

What Is a High-Deductible Health Plan (HDHP)?

Wonder why you’re paying more for a health insurance plan that doesn’t cover what it once did? Join the crowd! Health insurance has become more confusing and more expensive in recent years. Many of us, even if we still have a health plan through our employer, don’t understand what’s happened.

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The newest, disturbing trend is the rapid growth in high-deductible health plans (HDHPs) that charge high premiums for reduced coverage.

A high-deductible health plan includes any plan that requires out-of-pocket expenditure of $1,350 for an individual or $2,700 for a family per year before it pays for medical expenses. For many HDHPs, payment doesn’t kick in until much higher deductible amounts (say, $6,000 or more) have been met. Such very high deductibles mean that we’re essentially purchasing health insurance that covers catastrophic situations.

Still, we need to remember that even HDHPs can save money. That’s because they negotiate reduced rates for specific forms of treatment with health care providers.

For example, a provider might charge $500 for a certain procedure, but your insurance company has previously negotiated with the provider a price of $300 for that procedure, saving you $200 even though you’re still on the hook for $300 if your deductible amount is unmet. Without your insurance plan, you would have owed the provider $500 out-of-pocket.

Downsides with HDHPs

HDHPs caught on with insurance companies and employers as a way to reduce the cost of health care. They reasoned that if we were forced to pay more of our health care expenses out-of-pocket, we would think twice before running off to the doctor with a cold or a sore back. For more serious situations, we would have an incentive to shop around to find care for the lowest possible cost. Since fewer claims would result, insurers and employers could reduce premiums too.

Sounds rosy, doesn’t it? But since more employers offer only HDHPs and because many of us, even on the public health insurance exchanges, can afford only high-deductible plans, recent experience has exposed some flaws in the argument for HDHPs.

1.     Many people postpone or avoid altogether getting the health care that they need. A California woman with a $6,000 deductible plan chose not to have surgery to remove what her doctors thought was a benign polyp in her uterus. Months later, surgeons operated, discovered that the polyp was cancerous, and performed a hysterectomy. She continues to be monitored closely, although she appears to be cancer free. Such stories with worse outcomes are not uncommon.

2.     Comparative shopping for health care is very complicated. Health care providers often fail to reveal what care will cost their patients, and health insurers will not disclose their contracted rates with providers. Solid information about quality of care is also hard to obtain.

Suppose you shop around for prices on knee replacement surgery. You will find that prices vary widely, that details of procedures and equipment vary, and that providers often avoid justifying such differences. It’s worse than comparative shopping for a refrigerator or a car!

3.     The distinction between “in-network” and “out-of-network” is tricky. Insurance companies contract payment rates with a list of specific providers (= “in network”). Only charges from in-network providers count toward your deductible.

Charges from out-of-network providers can balloon to very high amounts. And providers can move from in-network to out-of-network without notifying you.

If you are treated by a hospital medical team, some team members might be in-network and others out-of-network. Finding out which doctors are in-network and making sure that only in-network doctors are treating you is nearly impossible. The final bill in such situations can be a nasty surprise!

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Suggestions for Coping

Consumer Reports offers some beginning tips.

Know your freebies. By federal law, health insurers must pay for many preventative procedures at no cost (neither co-pay nor co-insurance) to you. Check out the official list of free preventative services. The list includes annual physical exams and many other services and treatments.

Shop around for both price and quality. This will not be easy. You will need to contact your insurance company (online or by phone) to learn what services are covered and, as much as possible, at what cost in their network. Then you should contact individual providers (physicians, hospitals, medical centers, etc.) to learn as much as they will reveal about possible cost. Finally, check rating services or ask a trustworthy health professional about quality of care. Be persistent.

Talk with your doctor about what treatment or medication you need and how much it will cost. Bear in mind that many physicians do not have accurate or complete information about costs, especially when prices vary widely. And not all physicians are comfortable discussing such matters. But you might remind them that financial stress is also bad for your health.

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Try to schedule expensive treatment early in the year, before your deductible resets. Doing so can save you a lot of money.

Use non-taxed funds to pay for out-of-pocket medical expenses. See if your employer offers a Health Reimbursement Plan. Check into whether you qualify for a Health Savings Account, perhaps one that your employer supports.

Remember that only in-network charges count toward your deductible or overall cap amounts.

Other Useful Tips

A provider’s flat fee might be lower than a patient’s financial obligation would be if a claim were submitted to the insurer before the deductible amount has been met. Although health care providers are required to submit insurance claims for patients who have insurance, some patients withhold insurance information for routine, non-life-threatening situations for which they must pay out-of-pocket. This might save them money especially if they cannot use funds from a Health Savings Account or can’t afford to contribute to one. (If you have a chronic condition that is expensive to treat, this option might not be advisable.)

Ask your doctor about how you can save money on prescription medications. Sometimes a cheaper alternative medication or a generic form can be used. There might be trade-offs in effectiveness, however. So always ask for professional help in making such decisions. And never reduce dosage to save money without consulting your doctor.

When purchasing prescription medications, decide whether you should use your insurance. For occasional purchases, ask your pharmacist what the cash price would be. Often, it will be lower than what you would pay by using your insurance card, especially if your deductible is not yet met. This is because of the rate that the insurer has negotiated with the pharmacy. The pharmacist is not permitted to remind you or initiate discussion of the cash price with you, but the pharmacist is required by federal law to tell you what it is when you ask. Such purchases will not count toward your deductible.

Save on prescription medications also by using a discount card. Companies such as GoodRx offer deep discounts on prescription drugs. Prices can vary widely, though, by pharmacy. Drug manufacturers also offer discounts, typically for persons who meet certain financial qualifications.

Get medical attention when you need it. Sometimes, of course, a minor illness or injury will heal if given a little time. But you should not ignore symptoms that might indicate a serious condition. Doing so could result in a more severe situation that will cost you a lot more money and, possibly, your long-term health.

Coping with high-deductible health insurance plans for medical treatment and prescription medications is perplexing, difficult, and time-consuming. At Kathy’s Urgent Care, we try to be as transparent as possible about costs to help you manage your health care responsibly.

To add or view comments, click on the title of this article above.