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DEAR DR. ROSENBERG: We have been living at the elevation of 7,500 feet for several years. Soon, we are moving to the beach in California. I am on CPAP and wondering if I will require a new sleep study, because of the lower altitude.

A: No, not really. First of all, most new machines have an altitude adjustment capability. Secondly, a recent study in the Journal of Sleep Medicine showed little if any change was needed in most patients with a change in altitude.

DEAR DR. ROSENBERG: I have atrial fibrillation and have been shocked twice to get me back to normal rhythm. However, in each case, I went back into atrial fibrillation within a few weeks. I do snore and my doctor recommends a sleep test. He says if I have sleep apnea, that could be why I go back into the abnormal rhythm. I am a retired engineer and want to understand the mechanics of what is going on.

A: Your doctor is probably correct. The incidence of recurrent atrial fibrillation in untreated sleep apnea is probably four to five times normal. There are several reasons. First, during the apnea the heart and especially the atria are stretched like a rubber band. Oxygen levels drop and pressure in the arteries leading out of the heart increases severely. This combination of factors leads to electrical instability and can results in atrial fibrillation. Therefore, it is very important that you get tested for aleep apnea. If you do indeed have sleep apnea, with treatment you might be able to stay out of atrial fibrillation.

DEAR DR. ROSENBERG: My 4-year-old daughter wets her bed at least once a week. Someone mentioned to me this is considered a sleep disorder. Should I be concerned?

A: No, actually that is considered normal for her age. The diagnosis of enuresis (bedwetting) does not begin until the age of 5. Even then, 15 to 25 percent of all children wet their beds. So, I would not be concerned at this point.

DEAR DR. ROSENBERG: My 9-year-old has Down Syndrome. She snores and is doing poorly in school. In fact, over the last two years, she seems to be doing much worse. Her teacher is concerned and told me sleep apnea is common in people with Down Syndrome. Is this true and why?

A: Yes, the teacher is correct; there is a very high prevalence of sleep apnea with Down Syndrome. The causes are multiple including muscular weakness, jaw position, enlarged tongues and enlargement of the tonsils and adenoids. Bottom line is, sleep apnea may be present in 40 to 50 percent of people with Down Syndrome. Untreated sleep apnea may further impair your daughter's mental function. I would discuss this with your health care professional.

DEAR DR. ROSENBERG: I have had trouble sleeping for more than 10 years. I estimate, that I average no more than five hours of sleep per night. I am irritable and have trouble getting through my day at work. However, I am not sleepy. In fact, if I try to nap I cannot. Does this make sense? You'd think with my lack of sleep, I'd be able to nap.

A: Yes, it makes sense. Many people who suffer from chronic insomnia have elevated metabolic rates. We find that in many people, this may be cause of the insomnia. It is referred to as a state of hyperarousal. Studies show that many of these people have a higher body temperature, faster heart rates, increased glucose utilization in the brain and higher levels of cortisol in their blood stream. This is one of the reasons many with insomnia require medications for sleep.

Dr. Robert Rosenberg, Board Certified Sleep Medicine Specialist, will answer readers' questions by incorporating them into future columns. Contact him at askthesleepdoc@yahoo.com or via mail at the Sleep Disorders Center of Prescott Valley, (newly Accredited by the American Academy of Sleep Medicine), 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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