home
RSS
Get Some Sleep: Tired, crabby, snoring? Might be apnea
January 18th, 2011
03:41 PM ET

Get Some Sleep: Tired, crabby, snoring? Might be apnea

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

If you’re not sleeping well, if your partner complains that you snore loudly or you’re finding yourself excessively tired and having trouble concentrating during the day, you may have sleep apnea. It’s a common disorder that should be diagnosed by a doctor.

The two most-often diagnosed types are obstructive sleep apnea and central sleep apnea. The bottom line for both is that your breathing is disrupted while you sleep, waking you up sometimes dozens of time during the night, depriving your brain of oxygen and often resulting in fatigue, difficulty focusing and even worse physical problems such as high blood pressure and heart disease.

If you have sleep apnea, chances are, you’ll be told you need to sleep with a continuous positive airway pressure machine, or CPAP.

Positive airway pressure is like blowing air into a balloon but in this case the balloon is the patient’s throat; when there is air in the balloon (the throat), then the sides of the balloon (the soft tissues in the throat) cannot collapse and the tissues in the throat are propped open. The forced air functions much as a stent would. It is not oxygen therapy, but oxygen can be added.

Sleep apnea is usually adequately treated with a CPAP even if oxygen levels were quite low. When oxygen is added, it is usually because patients have another lung or heart disorder that contributes to low oxygen at night. If patients have emphysema, congestive heart disease or neuromuscular disorders, they will need specialized PAP machines, and may need oxygen as well.

If you have obstructive sleep apnea, your upper airway collapses, either partially or completely, during sleep and the oxygen level of your blood is often low.  You'll also have frequent  very brief awakenings, called micro-arousals, that disturb the quality of sleep and stimulate the sympathetic nervous system (that is the adrenalin, fight or flight response). This puts stress on the heart. The most common symptoms are snoring and daytime sleepiness or fatigue.

Central sleep apnea occurs when the brain, that is the central nervous system, does not signal properly to the diaphragm,  the muscle that controls your breathing. The most common symptoms are frequent awakenings at night and daytime sleepiness or fatigue.

The CPAP is the gold standard therapy for both obstructive and central sleep apnea, although the devices used for CSA function a bit differently from the standard CPAP.

The CPAP gets a bad rap. True, few people say to themselves: “I think that I’d like to start sleeping with a hose strapped to my face.” Still, I and my thousands of patients who use CPAP are here to tell you that it is nothing short of a miracle for many people. In fact, the majority of my patients feel so much better that they wouldn’t give up their CPAP even if they found out that there are no long-term consequences to sleep apnea.

They use the CPAP because when they wake up in the morning, they feel “like Dorothy landing in OZ,” as one CPAP user told me. “My old life, before CPAP, was in black and white; now I live in Technicolor!”

Honestly, I couldn’t make up the things that people have said to me in their attempt to praise the CPAP and to describe how good they feel after starting this therapy. One patient likes to call CPAP his “happy pill.” Another woman told me that she felt “20 years younger” after one month using her CPAP. Today I saw a patient who said that it CPAP was “life changing.” The best to date is an older patient who said that putting on his CPAP mask at night gave him great comfort, “as though someone is cradling my face.” Seriously, could I make that up?

CPAP, for the uninitiated, involves wearing a mask that at the very least has some nasal prongs - yes, they go up your nose, and at the most has a mask covering most of your face. Many patients wear something in between,  a mask (I refer to it as the “Bozo the clown”) that covers only the nose. There are three basic styles: the nasal pillow mask, in which prongs fit in the nose (why we call them pillows is a mystery to me); the nasal mask, which covers only the nose; and the full face mask, which really means only that it covers the nose and mouth. Rare is the mask that actually covers the whole face. There are many manufacturers and a variety of styles.

There are also several major manufacturers of the CPAP machines themselves. I have worked with them all and they all usually have their pros and cons. It is important that the machine give what we call compliance data, that is, the sleep center should be able to download data that show how many nights patients use the machine, for how long, whether they are still having apneas, whether the mask is leaking a lot, etc. I have seen cheap machines on the internet that do not give such data and do not come with a heated humidifier.

All major insurance companies that I have encountered will cover the more sophisticated machines as well as the heated humidifier that fits onto it. In general, all the major brands of CPAP machines have become smaller and quieter in the past five years. Some machines are easier to use than others if people have arthritis in their hands or other disorders that affect their dexterity. Any mask can be used with any PAP machine.

Studies have shown that usage patterns are set early in the course of CPAP treatment. Patients need very close follow up in the first few weeks or months of treatment. That is why I handle all the CPAP machines and masks at my sleep center. I have a very hands-on approach to prescribing this treatment, and I am starting to see more and more sleep centers take this comprehensive approach to diagnosing and treating sleep apnea. For example, the mask is chosen based on patient comfort, but, at first, patients need the recommendations of knowledgeable sleep professionals. They need to have available to them many masks to try, and I mean take home and sleep with for a week or two. When patients find the right mask for their face and their sleeping positions, the battle to get accustomed to CPAP is usually won.

There are other alternative treatments for sleep apnea, and I will cover them in my next column, but none even comes close to CPAP in terms of effectiveness. If a person will wear the CPAP, then the effectiveness at eliminating apneas, maintaining good oxygen levels, and consolidating sleep approaches 100%. Importantly, there are few side effects, and none is serious. How often are doctors able to offer a treatment that works so well and has no risk of causing harm? No, you cannot suffocate if the electricity goes off because there are little exhalation port holes. And we cannot discount the added benefit of patients feeling that the treatment is helping them. While few people would say that they “love” their CPAP, some do, and the vast majority of my patients say that they love the way it makes them feel and for that they are grateful to the CPAP.

Post by:
Filed under: Sleep

soundoff (124 Responses)
  1. FtghEncox

    affordable dissertation research paper medical college essay book

    November 29, 2020 at 09:41 | Report abuse | Reply
  2. FgsZisse

    animal rights essay i need a research paper thesis services

    November 30, 2020 at 15:09 | Report abuse | Reply
  3. FnsbEncox

    method of writing an essay george orwell essay on writing college essay organization

    November 30, 2020 at 15:30 | Report abuse | Reply
  4. KwgdMile

    assignment helper online do my paper college essay for sale

    December 1, 2020 at 01:59 | Report abuse | Reply
  5. DvscZisse

    type writer paper research paper assistance case study write up

    December 1, 2020 at 07:06 | Report abuse | Reply
  6. FsfEncox

    english thesis proposal pay for essay cheap mathematics research proposal

    December 2, 2020 at 07:31 | Report abuse | Reply
  7. JgscCrulk

    writing argumentative essay argumentative essay on homework essay help 50 first dates

    December 2, 2020 at 21:52 | Report abuse | Reply
  8. FqfEncox

    corporate finance homework help write my research paper for me complete research paper

    December 3, 2020 at 02:17 | Report abuse | Reply
  9. Mickellinw

    Free online dating helpful hints

    chew the fat and online dating service personals helpful advice: realization nonverbal communication.

    interaction is not based totally just however verbal password. a wide selection of comprehending is very much brought up that by gestures, pitch and by un verbal landline calls. without having having observing the public, It will be really easy to not understand or to give an incorrect meaning to words and phrases most typically associated with phrases. This are frequently the case while having e-mail addresses as folk aren't able to often look at the joy for your strengthen and appear a voice message as being alot much more serious than it is.

    being furthermore applying pleasant mannerisms is likely to make the distinction between a long lasting partnership international dating an blunder. It's important and vital therefore,, any time starting uniform dating or maybe a online chitchat,uncover this concept and so that it will specific loan providers chew the fat is minimal hearted and humor filled enough and when you are ready. knowing the function in the game mannerisms is cast as on a phone call and also talk is essential when we join your entire family at last. when you trust personal, his common to pay not as in order to the chats people take heed, however with young contacts we appraise this person to a steeper depth. make certain that the necessary messages time certain and you can't can't attract

    getting body gesture and chatis almost certainly characterized to be made into groups of explanations postures and. it can also be easier to discover the gesture linked persons if you take targeted types different specializing in sufferer signs.

    as soon as personal is heedful together with seemingly contemplating what will be said it is flattering allows you to that individual like are generally speaking with. the art of making your body exhibit that you have been hearing is not so difficult to learn. the reply is to disregard distractions, names and other people's support while keeping system primarily yet still. proceed or other people aren't forward to point to the person that you would like what it is said or offering developing to obtain better as a way to hear one. marginally lean your head about folks, check out person while they are chatting as well have shown your personal hobby courtesy of relatively furrowing forehead. their essential to stay specific when the other person is without a doubt conversing, pause relatively an individual react as you happen to be reading and absorbing everything they own shown.

    open minded mannerisms are available for those conversations confidently bringing about a association. create nonverbal communication translates to your favorite legs and arms aren't entered, wide biceps revealing too little concealment, total fixing their gaze and a grin shows you must be create and warming to the thought of your companionship.

    halt nodding on top of that concern sound will tell you the particular set urge your partner which keeps conversing. if you think about the other those people strategies they are happy that you're certain and have the identical beliefs to their personal.

    all in all advice could help other individuals to be aware of and asiame.com reviews like your story that will event your trusty arrive broad open and authentic. by way of our other gestures reports to discover more regarding far subliminal indicates you may use attract to their fantastic boyfriend or girlfriend.

    December 8, 2020 at 15:05 | Report abuse | Reply
  10. FbsbEncox

    generic cialis uk buy cialis online cheap cialis online generic

    December 10, 2020 at 10:07 | Report abuse | Reply
  11. FgnsZisse

    cialis male enhancement black cialis sale cialis switzerland

    December 10, 2020 at 11:39 | Report abuse | Reply
  12. detectives privados alcalá de guadeira

    detectives privados fuengirola

    https://www.argadetectives.com/detectives-dos-hermanas-sevilla.html

    December 10, 2020 at 13:16 | Report abuse | Reply
  13. FgrsEncox

    viagraonlineaustralia viagra viagra 100mg pills

    December 10, 2020 at 16:49 | Report abuse | Reply
  14. DvncZisse

    cialis from bc, no prescription buy cialis through pay pal generic medications cialis

    December 11, 2020 at 01:42 | Report abuse | Reply
  15. Wangpbf

    horrific sentence structure on the Tumblr

    Wouldn it be possible awesome if definitely pouring say for example a lot and rayla trying to leave the rain other than callum is derived over and use the side mean and set the mans not receivings over rayla whet more. Rayla stop and see the actions stoping some of the dust after striking the lady but also encounters callum wings beyond person in charge. this teeth and callum smile back and in addition they both assist to the site a tree and be seated together with each other, Callum continues to be useful weather off from rayla3 uncertainties: is there a reason charmingdate individuals who hates Aang let themselves through airbending associated with quarrels include things like more than just standing in front of the challenge moreover departing? 2. Zutarians cares much regarding Katara truly feel, only vessel the lady equipped with Zuko, including clear away Katara becoming worrior girlfriend, disregarding your lover just a household way of young woman which company never wanted those conflicts. Aang is order of a light-weight in her troublesome time. 3. is there all use concerning arguments since a lot of people on each side remain shut oriented? need to have to all players you have to be leaved

    One doesn must remain a fan of A find out your concepts behind airbending; locate several

    a singleirbender of the :TLA arena in addition a doesn hang on to individual legal rights in order to

    Airbending as a perception. (however, I wear do not like A in the face of galore anon

    states the they're healthy.)

    for the most part Zutara shippers basically lovers Katara by using Zuko correct after canon is passed, outcome

    creating Katara to process your woman's understandings a good in a way that the event

    as well unlikely made way for. moreover, on the grounds that Katara is a toddler your sweetheart to merely one area of character. some of us cure Katara staying a

    soldier lover and a mother as a result of which is what on earth sheIf and also no point in reasoning and arguing with that, you should why are you reasoning of it

    using my own blogging site? appears, the two of us think we have something in order to really bring about by way of

    telling you our favorite viewpoints. nearly all encouraged shippers on your either side am going to

    never be asked, but also there are a whole bunch of A:TLA readers which will wear correct

    you ultimately choose, or maybe what center analyzed the issue all that much, and i also met up with people with settled derived from one of cheesy to additional. further asks where refuse anyone with finish their separate essay sentences may possibly be individual

    so that you deletion.

    The beginning which i came to the realization that there seems to be a problem is at 8th mark. I before now suspected i had developed tourettes. My nanny been with them as probably did dad. this method wasn a growing trend in my life. I didn often remember the this dysfunction. our own first day's eighth mark formula consultant, one of the most severe i ever had, asked working on the entire classroom

    lots of people are practicing that many? was indeed having a debate about me, obsessively nodding the travel. this is this particular new one has really read. my spouse and i couldn often tell your sweetheart's why choose for the hold ddn. keep in mind this by no means struck me that i had to clarify ourselves to individuals. this excellent stage is one that I will keep in mind.

    i'm nonetheless a youngster, simply a kid. i still secure regular people wanting information about me whatever getting nicely ranting at. the thing that is uncomfortable a good number of is what individuals say. i am inclined to see a good deal of headcannons or defective policies and people decide they could be extremely laid back. the fact that absorbs. when someone absorbs that all customers know within this thing is that often much more bane and this uncontrollably fantastic it.

    Also almost all people put on know that I and several other medication is habitually in sorrow merely because of tourettes. I sit the actual night attempting sleep and i also bawl the big eyes available because it does any damage too much. rather to individuals who put on find tourettes information technology doesn't come across doing this. that bull crap to your potential customers. a limited amount of handheld my and i should have take note of his or her sugary thought in my personal heck.

    o. k Angel. you need to get it all out. merely crisis me and glide all of killer for.

    small, however,just yet an adult, toddler mention as to toxin which had been the one and only the infant powerfully inserted during my womb.

    I cried out and just as before making an attempt don't injury your ex the people that had me. A relaxing vocals came from my continue to as a doctor Loki experienced retained in my stead talked.

    December 11, 2020 at 17:07 | Report abuse | Reply
  16. KhedMile

    viagra in qatar buy viagra onlinne buy viagra from germany

    December 12, 2020 at 17:21 | Report abuse | Reply
  17. FsfgEncox

    where to buy viagra on line buy viagra no prescription by cipro oder viagra

    December 13, 2020 at 06:10 | Report abuse | Reply
  18. FqbfEncox

    5mg cialis generic cialis cialis generic reviews

    December 13, 2020 at 08:57 | Report abuse | Reply
  19. JgsvCrulk

    wildviagra viagra sources viagra forum

    December 14, 2020 at 09:23 | Report abuse | Reply
  20. FhsnZisse

    buy viagra with overnight shipping buy viagra australia cheaper viagra pills

    December 15, 2020 at 09:13 | Report abuse | Reply
  21. DvnjZisse

    buy generic viagra reviews viagra paypal australia where to buy viagra in sydney

    December 16, 2020 at 00:03 | Report abuse | Reply
  22. Boscoxzt

    going out with web business

    as request. you ought to enjoy relationship on a telephone, it's vital to stream a matchmaking instance. but, desire to make social actually quite a simple to attain a job, you would like to become a member of a .

    Read the whole ArticleThings women have to Stop enabling restrict Their sexual intimacy going out people

    libido content pieces may possibly 5, 2012

    personal seeing each other, new internet dating, personal , Hookup, hang out, Hookup while having teenagers, Hookup now with everybody, love adult dating sites, intercourse online dating, sexual intercourse , new sexual category, adult movie the night online store

    Read everyone in your ArticleSex How To get the finest Out Of It

    getting to know assistance superbly written articles April 11, 2012

    achieving possibly you can absent from an adultsex datingwebsite is designed to experience you individuals engaging pays. visualize one self registering on a adult sexual intercourse here immediately after which it communicating with man or woman and saying yes that two should really fit today to acheive put down then get extraordinary as a group!

    alan Lim

    Free carrying out absorbing

    going on a date wisdom blogposts november 15, 2009

    Free has taken a brand-new to value. Now you don't need to look somewhat or maybe a dream of acquire creases think about another person for being attracted to from a date.

    Read your complete ArticleFinding the perfect time with abdominal muscles internet dating article blog site

    seeing help and advice research April 30, 2010

    tips to find realistic seeing each other internet appraisals would be a rather long a time challenge, yet not if you know you have to look for. made by selecting the best paid dating sites read web portal, it to make the actual idea of what seeing web site to choose.

    mike Lim

    rrssues most typically associated with an international dating web business

    personals professional help well written articles september 4, 2007

    Using an dating foreign girls domain is the best meet new friends and also to juice up you're social life. from where more can latamdate scam you find a wide choice of days than on an online dating site web website.

    December 19, 2020 at 19:29 | Report abuse | Reply
  23. Garland Obryan

    Hi there I am so grateful I found your web site, I really found you by accident, while I was looking on Bing for something else, Anyhow I am here now and would just like to say cheers for a marvelous post and a all round exciting blog (I also love the theme/design), I don’t have time to look over it all at the minute but I have saved it and also added in your RSS feeds, so when I have time I will be back to read a lot more, Please do keep up the fantastic work.

    https://extraproxies.com/

    December 19, 2020 at 19:48 | Report abuse | Reply
  24. Tancth

    Russia stretches detention of ex

    Marine accused of drunkenly assaulting Russian police officers six months ago last summer must remain in custody.

    Trevor Reed, 28, From florida, Was detained in Moscow in August.

    The court confirmed Reed's detention on its website on wednesday, Saying his case would next be heard in court on March 11.

    Reed's lawyer and family could not rather quickly be reached for comment. The charge against him displays penalty of up to 10 years in jail.

    Reed is accused of attacking law enforcement in a car after they detained him at an address where he was inebriated, TASS cited case information as saying. He denied the allegations during a preliminary investigating procedure, It cited.

    Reed's father told the New York Times that he and the defence believed the allegations to be false. Government to go into the case. Embassy in Moscow did not in the moment comment, But said it had passed on a request comment to Washington. Marine had visited Moscow in May to learn Russian and see his Russian girlfriend, Whom he had met in Greece.

    It said police ended up being summoned after a party on Aug. 15 where Reed had drunk vodka and grown upset. Reed's girlfriend and others had called the police to halt him getting hurt, It wanted to say. excellent. Marine accused of espionage who has been held in custody since his arrest in december 2018.

    Both deny sexual crimes against them. (many other reporting by Gabrielle Ttrault Farber, Editing by Andrew Osborn and Timothy history)

    Trump threatens to crack down on social media after Twitter posts a fact check of his tweets on voting by mailPresident Trump threatened to impose federal legal guidelines on or even shut down social media platforms after Twitter added a fact checking reply to his tweets about mail in voting. The threat came obtainable two tweets. /react articles >Democratic presidential candidate Joe Biden released a video message on thursday marking the grim milestone of 100,000 america lives lost to the coronavirus pandemic, Telling the surviving: "the state grieves with you, Biden spoke after diverse tallies of COVID 19 deaths, Including Charmdate one compiled by, established that the novel coronavirus has killed over 100,000 people in the nation, Even as the slowdown in deaths invited businesses to reopen and Americans to emerge from more than two months of lockdowns. Biden, discussing from his home in Delaware, Drew on his own family loss when creating his remarks.

    NBC development

    Senate Democrats take on GOP court packing in blistering new reportSenate Democrats on Wednesday unveiled a new report on Republican efforts to pack the courts with conservative leaning judges and the outsized influence of one subdued activist. Gretchen Whitmer, A Democrat who has defended her tough be home more policies against armed protestors and attacks from President Donald Trump, Announced last week the lifting of some prohibitions ahead of the long Memorial Day weekend. The five men and one woman are named in a confidential report by the united nations panel of experts on Libya into a botched mission that ended with the mercenaries making a remarkable sea borne escape after falling out with their hosts. "transmitting is slowing down, the treating COVID 19 patients in intensive care is decreasing significantly, And the rising death toll curve has been flattened, Swedish forex Minister Ann Linde said at a press briefing. But the wider picture of the country coronavirus response is a bit more complex.

    December 24, 2020 at 11:01 | Report abuse | Reply
  25. Rocky Magnotti

    Hello there! I know this is kinda off topic but I'd figured I'd ask. Would you be interested in exchanging links or maybe guest writing a blog article or vice-versa? My website goes over a lot of the same topics as yours and I believe we could greatly benefit from each other. If you might be interested feel free to send me an e-mail. I look forward to hearing from you! Superb blog by the way!

    https://extraproxies.com/tag/multiprocessing/

    December 27, 2020 at 02:56 | Report abuse | Reply
  26. zortilo nrel

    I view something genuinely special in this web site.

    http://www.zortilonrel.com/

    January 3, 2021 at 17:18 | Report abuse | Reply
  27. AqwsEncox

    canadian pharmacies pharmacy canada pharmacy online

    January 9, 2021 at 09:10 | Report abuse | Reply
  28. NllpZisse

    canadian pharmacy reviews http://pharmacy-onlineasxs.com/ best erectile dysfunction pills

    January 9, 2021 at 12:50 | Report abuse | Reply
  29. LokuEncox

    ed online pharmacy reviews п»їviagra online canadian pharmacy

    January 10, 2021 at 13:21 | Report abuse | Reply
  30. JtmfEncox

    drugs from canada med rx pharmacy ed pills online

    January 10, 2021 at 17:04 | Report abuse | Reply
  31. FwsxEncox

    24 hour pharmacy near me canada drug pharmacy medical pharmacy

    January 10, 2021 at 18:31 | Report abuse | Reply
  32. FgvdZisse

    canadian pharmacy viagra online pharmacies ed treatment

    January 10, 2021 at 22:38 | Report abuse | Reply
  33. JlloCrulk

    online pharmacy reviews dysfunction pharmacy

    January 11, 2021 at 11:14 | Report abuse | Reply
  34. Noelia Wagenaar

    CPAP machines aren’t available through large retailers. But you may be able to buy batteries and accessories from some online sellers, such as Amazon. Check your product instructions for additional details.

    https://bestproductlab.com/tag/cpap-machine/

    January 12, 2021 at 09:22 | Report abuse | Reply
  35. NlbxZisse

    viagra wiki viagra for sale us real viagra online buy viagra without prescription sample viagra package buy viagra usa online india generic viagra how much does viagra cost with health insurance viagra in los angeles no prescription viagra urgent delivery of viagra viagra professional or viagra super active what is better buying viagra without a perscription viagra cheap master card order viagra online australia

    January 13, 2021 at 17:10 | Report abuse | Reply
  36. FgnhZisse

    austalia online viagra viagra toronto generisches viagra paypal viagra no pascription buy generic viagra through pay pal discussion on viagra reliable pharmacy online for viagra can i get walk in and buy viagra at wal mart today generic viagra uk next day delivery viagra brand viagra in india for men viagra in melbourne buying viagra with next day shipping how can i get free viagra buyng viagra in sydney

    January 15, 2021 at 02:19 | Report abuse | Reply
  37. JvcxCrulk

    buy genaric viagra generic viagra pill cialis viagra sales generic viagra with next day delivery viagra without a prescription johnson pharmacy generic viagra online canadian pharmacy xanax with viagra pfizer viagra viagra india website inurl:forum celiac. viagra can you get viagra without prescription viagra for every day use best viagra alternative viagra gel karmagara australia viagra on line

    January 15, 2021 at 10:25 | Report abuse | Reply
  38. frolep rotrem

    I do not even know how I ended up here, but I thought this post was great. I do not know who you are but certainly you are going to a famous blogger if you are not already 😉 Cheers!

    http://www.froleprotrem.com/

    January 15, 2021 at 12:17 | Report abuse | Reply
  39. maltepe escort,maltepe eskort, eskort maltepe,ucuz maltepe

    thnak baby admin

    http://www.teksert.com/

    January 16, 2021 at 17:10 | Report abuse | Reply
  40. NlbxZisse

    cialis canada paypal cialis 20mg no prescription buy brand cialis online usa http://cialijomen.com/ – cialis windsor canada pharmacy ’

    January 18, 2021 at 17:50 | Report abuse | Reply
  41. AqbvEncox

    generic viagra (sildenafil citrate) discover card and viagra viagra canada http://acialaarx.com/ – i do like to buy viagra from usa ’

    January 19, 2021 at 04:08 | Report abuse | Reply
  42. FbdhZisse

    cialis nz online differences between viagra levitra and cialis cialis for sale online http://21cialismen.com/ – overnight pharmacy 4 u cialis ’

    January 20, 2021 at 02:47 | Report abuse | Reply
  43. LcxEncox

    buy viagra in canadГЎ viagra for sale in sa viagra sydney genuine http://genqpviag.com/ – generic viagra forum ’

    January 20, 2021 at 07:48 | Report abuse | Reply
  44. JvcbxCrulk

    does cialis work cialis walmart cheap cialis with dapoxetine http://phrcialiled.com/ – where to buy cialis online ’

    January 20, 2021 at 10:09 | Report abuse | Reply
  45. JbdcEncox

    brand viagra canadian pharmacies young people viagra cheap viagra http://llviabest.com/ – precription strength viagra ’

    January 20, 2021 at 11:43 | Report abuse | Reply
  46. KbctMile

    buycialisonline cialis and high blood pressure mail order cialis http://mycialedst.com/ – buy cialis in canada ’

    January 23, 2021 at 04:12 | Report abuse | Reply
  47. NmilZisse

    online viagra on sale edmonton generic viagra blogs viagra buy usa address overnight delivery http://xz-pharmacyonline.com/en/career-opportunities.html – viagra alternatives in india ’

    January 23, 2021 at 13:43 | Report abuse | Reply
1 2

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.