ASK DR ZOE
My snoring is so bad it shakes the house – my wife sleeps downstairs and I can’t take much more!
Here’s a selection of what readers have asked this week…
IF you’re over 40, have diabetes, drink or smoke, you should think about your cholesterol levels – though anyone, regardless of these factors, can have levels above what is healthy.
And after the Christmas period, your level could spike up to 15 per cent, studies say, due to increased consumption of unhealthy food, more alcohol and less exercise.
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The slowing down of these habits in January does appear to lower cholesterol again. You can get a free NHS health check if you’re over 40, but if you think you may be at risk, or have a family history of high cholesterol or heart issues, consider one sooner.
You can buy cholesterol tests online or in pharmacies too, but the finger-prick tests have less accuracy. High levels do not cause symptoms, but can increase the risk of some life-threatening conditions.
A healthy lifestyle can improve it – including eating more fruit and vegetables, exercising and giving up smoking.
Here’s a selection of what readers have asked this week…
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Sleepless nights over axed snore op
Q: I SUFFER from sleep apnoea and have a CPAP machine, which I hate, for this. I’m a 60-year-old man and, if I’m lucky, I get four hours of sleep a night.
I lost weight as requested by the doctors, and my sleep apnoea has got a lot better.
I really don’t need the machine, but my snoring shakes the house. My autistic daughter wears ear defenders to bed and my wife has to sleep downstairs.
I was under a specialist, who mentioned having an operation to remove some of my tonsils to clear my airways.
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We discussed the side effects and agreed to have it done. But then he told me he was leaving and that I would have to see another specialist, who was adamant the operation would not help me and does not work. I was so upset. I can’t take much more.
A: Well done on the weight loss, it sounds as though it has made a big difference to your health. I see that the problem is now the snoring and how it affects your family.
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Have you been reassessed for sleep apnoea and advised that the CPAP machine is no longer required?
If this is the case, then it sounds as though you may benefit from a third opinion on the surgery.
NICE guidance states that tonsil removal surgery may occasionally be considered as a treatment for obstructive sleep apnoea if there is evidence the tonsils are causing an obstruction.
So it really does depend on your individual case and the opinion of an ENT surgeon would be valuable. They often work as part of the sleep clinic team.
Has anyone spoken to you about mandibular advancement devices?
They are another potential solution for some people with mild sleep apnoea or who snore.
These are worn at night and consist of plates that fit the upper and lower teeth to move the lower jaw and tongue to a more forward position during sleep.
They’re not the answer for everyone, but are worth exploring if you haven’t already.
VOICE LOST TO REFLUX?
Q: I AM in my early 70s and suffer from acid reflux that occasionally causes choking fits in the night.
My employment requires me to make regular speeches and, in May, I was halfway through one when it seemed like someone had pressed the mute button and I struggled to finish. This happened the next day and has persisted since.
It did cause me some panic as it happened in a very public setting.
Daily conversations seem unaffected. A chest X-ray came back clear and prescribed steroids have not helped.
My GP practice nurse is firmly of the opinion that my acid reflux is the culprit in injuring my vocal cords.
I can’t afford to wait a year for an NHS appointment. Should I seek private healthcare?
A: Acid reflux – the backflow of acid from the stomach – can cause damage to the oesophagus and/or voicebox.
This can lead to several symptoms, including heartburn, a persistent cough, the sensation of a lump in the throat, a sore throat, dry mouth or excessive throat clearing due to increased mucus.
If the vocal cords get damaged or scarred, it can affect the voice, too.
Most typically, hoarseness or other changes to voice quality occur, or the cords get fatigued, which may cause a gradual reduced ability to project and enunciate while giving a speech.
What you are describing sounds more like a “voice break”, as you describe a total lack of vocal ability and the issue comes on suddenly.
This can sometimes be caused by a neurological condition called spasmodic dysphonia. This condition causes the muscles of the voicebox to spasm involuntarily.
In addition to voice breaks, it can cause a shaky voice or fluctuating voice quality.
Any form of psychological stress can be a factor in triggering it, or making it worse, so again this does fit with public speaking, which most of us find a little anxiety-provoking, even if we’re confident and used to it.
It’s not curable, but in most cases can be treated either with speech therapy or Botox injections.
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If you have the means to see an ENT doctor privately, it would be worth considering, in my opinion, especially as it’s affecting your confidence at work.
Alternatively, you could start by having a session with a speech and language therapist to see what they advise.
Could I have lupus?
Q: FOR a few years, I have been waking in the morning to find my body aches as if I’ve been scrunched up in a ball all night.
I also have really painful joints – shoulders, elbows and wrists. My symptoms started about four years ago and I also struggle with fatigue.
I thought a holiday in the sun would help, but I actually felt worse and was subsequently diagnosed with rosacea.
I have had blood tests and nothing showed up for arthritis or my thyroid. I was wondering if it could be lupus?
I don’t want to keep pestering my doctor. I am 53, female and otherwise healthy.
A: Lupus would certainly be one of the things I would want to check for, alongside some other autoimmune conditions.
I’m interested to know more about the rosacea diagnosis – I assume you developed some form of red flushing or rash?
Did this come on when you were on your sunny holiday, and which areas of the face did it affect? I ask this because there is a distinctive facial rash that can be caused by lupus.
Your GP may be able to do an ANA test to see if lupus is a more likely diagnosis.
The next step would be a referral to a rheumatologist, who will use specific criteria, along with other tests, to either diagnose or rule out a diagnosis of lupus.
It tends to be shaped a bit like a butterfly, spanning the cheeks and bridge of the nose, and sun exposure can trigger it.
This type of lupus rash is often mistaken for rosacea due to its similarities.
In fact, lupus itself is often misdiagnosed because it can mimic other conditions and symptoms vary from person to person.
Having said that, the most common are joint pain, fatigue and a facial rash, all of which you have.
If you haven’t been tested specifically for this, please return to your doctor and share what you’ve been thinking.
See the NHS webpage on lupus to read up on it, and maybe even print it to take with you. Or copy the link to share in an e-consult.
This just highlights how important it is to always let the doctor, nurse or other healthcare professional know if you have any ideas or inklings about what might be going on.
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