S.R is a 69-year old man who presents to the clinic because his “wife complains that his snoring is difficult to live with.”
1. As the clinic nurse, what routine information would you want to obtain from S.R.? * How long has this issue been occurring? * Do you take any medications? * How do you sleep at night? * Describe your normal daily routine and sleeping routine? (Time you go to sleep; how long you sleep average every night) * What is your diet consisting of? * Do you have any breathing difficulty throughout the daytime?

CASE STUDY PROGRESS
After interviewing S.R., you note the following: S.R. is under considerable stress. He owns his own business. The stress of overseeing his employees, meeting deadlines, and carrying out negotiations has led to poor sleep habits. He sleeps 3 to 4 hours per night. He keeps himself going by drinking 2 quarts of coffee and smoking three to four packs of cigarettes per day. He has gained 50 lbs. over the past year, leading to a current weight of 280lbs. He complains of difficulty staying awake, wakes up with irritable most of the time and reports difficulty concentrating and learning new things. He has been involved in three auto accidents in the past year. S.R.’s vital signs are BP of 164/90, pulse of 92 beats/min, 18 breaths/min with SaO2 90% on room air. His examination is normal, except for multiple bruises over the right ribcage. You inquire about the bruises, and S.R. reports that his wife jabs him with her elbow several times every night. In her own defense, the wife states, “Well, he stops breathing and I get worried, so I jab him to make him start breathing again. If I don’t jab him, I find myself listening for his next breath and I can’t go to sleep.” You suspect sleep apnea.
2. Identify two of the main types of apnea, and explain the pathology of each. * There are two main types of