Ohio, Other States Running Out Of Lethal Injection Drug

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The Texas death chamber in Huntsville, Texas, where death-row inmates receive a lethal injection.

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After Ohio death row inmate Harry Mitts, Jr. is executed on Wednesday, the state will have officially run out of pentobarbital — the lethal injection drug.

That's because the Danish pharmaceutical company Lundbeck LLC, which manufacturers the drug, has cut off its supply in deference to the European Union's opposition to capital punishment.

As NPR's Kathy Lohr reported in July, "Several states are dealing with a shortage of lethal injection drugs and have had problems getting enough to carry out executions."

Reuters says states such as Georgia, Texas and Ohio have had to alter the drugs used in executions:

"Before 2011, several states used the anesthetic sodium thiopental as part of their lethal injections. But Hospira Inc. halted production of the drug that year, forcing states to look elsewhere for drugs that could be used for lethal injections. Many turned to pentobarbital, which now also is in short supply.

Texas, which executes more people than any other state, said in August that its supply of pentobarbital also would expire at the end of September, allowing it to conduct only one more execution with the drug, on September 26."

The Ohio death row inmate Mitts — convicted of killing two men, including a police officer, two decades ago — will be the 26th person executed in the United States so far this year, according to Reuters.

Lose Weight Before Trying Other Sleep Apnea Treatments

CPAP masks have become much more comfortable than in years past, doctors say. But they're probably not the first thing to try for sleep apnea most of the time.

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So your snoring is driving your partner crazy. Does that mean you're destined for one of those awkward-looking sleep apnea masks?

Not so fast, doctors say. Many snorers don't have sleep apnea, which causes a person to frequently stop breathing for brief periods during sleep. It's a big cause of chronic sleepiness and has been linked to a variety of health problems. Sleep apnea can also make a sufferer miserable.

"Poor concentration, daytime sleepiness, high blood pressure, certainly overweight, people who are complaining about a lot of fatigue, all of those ought to make us wonder if a patient has sleep apnea," says Dr. Molly Cooke, president of the American College of Physicians, which issued new guidelines on treatment of sleep apnea on Monday. They were published online in Annals of Internal Medicine.

The big surprise here is that the doctors didn't find any evidence that sleep apnea boosts a person's risk of death. That's been commonly assumed to be true.

But the guideline committee didn't find any research that measured risk of death, heart disease or stroke in people with sleep apnea. "I had gotten it into my head that sleep apnea increased the risk of premature death," Cooke told Shots. "That turns out not to be true."

The reviewers also found out that surgery didn't help most people, even though it's been heavily promoted for sleep apnea.

"Surgery should be used as a third or fourth option if it's used at all," Cooke says. It can cause short-term problems like excessive bleeding, and long-term problems with swallowing. "It's not the get-it-over-with panacea that people sometimes think it is."

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For most people, the guidelines say, the first and best treatment is simple and obvious — lose weight. "Not everyone with sleep apnea is overweight, but most patients are," Cooke says. Losing weight gets rid of fat that blocks the windpipe. It would "not only fix your sleep trouble, it would help your cholesterol, it would help your knees, your clothes would fit better and you would be a happier person," she says.

Patients who still have symptoms at that point might need to go to a sleep clinic and do an overnight test for apnea.

For people who are diagnosed by a sleep clinic, the No. 2 treatment of choice is CPAP, or continuous positive airway pressure.

It involves an pump that delivers pressurized air to a patient's nose and keeps the airway open. But it requires wearing a tight-fitting face mask during sleep, which really bothers some people. The studies reviewed here show as many as one-third of people bail on CPAP.

Don't fear the CPAP mask, says Dr. Safwan Badr, a sleep physician and president of the American Academy of Sleep Medicine. "I can tell you that CPAP is a lot more comfortable than it was 10 or 15 years ago."

The machines are a lot quieter, Badr tells Shots, and no longer sound like there's a hurricane in the bedroom. But the biggest improvement is the addition of heated, moist air. Without it, the inside of the nose gets dried out, and generates secretions to compensate. "The whole airway becomes congested."

CPAP does have its challenges. "Try to sleep with your eyeglasses; it takes getting used to," Badr says. A doctor has to invest time in explaining why it's worth trying, he says, and then follow up and troubleshoot any problems.

For patients who just can't hack the mask, the guidelines suggest trying something called a mandibular advancement device that moves the lower jaw forward a bit, making more room in the back of the throat. It's a little like a bite guard. But CPAP should come first, Cooke says. "CPAP corrects more of the abnormalities that are seen in a sleep study."

Badr is also a big supporter of CPAP. "At the end of the day, what we're trying to do is pressurize that airway, one way or another, and keep it open," he says. That's the mainstay of treatment, and it will be."