Dr. Keith Roach

DEAR DR. ROACH: My friend uses an Inspire device for sleep apnea. It bothers him during the day when he feels it stimulating his tongue. Can you tell me about this? — R.S.
ANSWER: Obstructive sleep apnea is caused by the back of the tongue closing the airway when the muscles relax during sleep. (Snoring is caused the same way, and severe snoring is a red flag that OSA might exist.) Although OSA is common in people who are overweight, a person at any weight with a tight airway anatomy may develop sleep apnea.
The airway can stay closed, despite a person trying to breathe, until oxygen and carbon dioxide levels in the body become abnormal enough where the person wakes up for a few breaths. (I think of this as an alarm bell going off inside the head.) This may happen hundreds of times a night without the person being aware at all.
Sleepiness and lack of concentration during the day are common symptoms of untreated OSA. The primary treatment is continuous positive airway pressure — essentially a fan blowing air in during sleep via a mask, which keeps the airway from closing.
CPAP devices remain the first-line treatment for OSA. Although CPAP devices are effective for most people, quite a few can’t tolerate the mask or the pressure, so the Inspire device is an alternative. This device measures when inspiration begins through an electrical lead on the chest. It then stimulates a main nerve leading to the back of the tongue so that every time a person breathes, the muscle is stimulated to move the tongue out of the way and reopen the airway. The device has been proven to improve the severity of sleep apnea.
Serious adverse effects of this device were rare, but 40% of people, like your friend, had discomfort from stimulation; 21% developed tongue abrasions; and 10% had dry mouth. Other options include dental devices, ideally ones that are custom-fitted by a dentist with expertise in devices for sleep apnea.
DEAR DR. ROACH: I am seeing a lot of posts online and on social media advising against eating yogurt with raw fruit, but I can’t find research to back up this claim. Can you share your knowledge on this topic please? — T.G.
ANSWER: I have found two claims as to why this should not be done. The first is a claim that there is bacteria in the fruit that will grow in the yogurt. I do not think this is a major concern, since the bacteria around (cleaned) fresh fruit is generally nonpathogenic, meaning it won’t harm you.
The second claim is that acids found naturally in fruit (such as citric acid, which provides the tanginess found in many fruits) will break down proteins within the yogurt. While this is true, your stomach acid and digestive enzymes will do a much more thorough job of breaking down proteins, which is in fact necessary for you to absorb amino acids that are present in the protein.
From my perspective, there isn’t a reason not to add fresh fruit to yogurt, but you can add fruit to the yogurt just before serving if you are concerned.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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