What is Pickwickian Syndrome?

Charles Dickens is best known for his characters Tiny Tim, Ebenezer Scrooge, the Artful Dodger, Nicholas Nickleby and David Copperfield. But perhaps his most influential character was Joe the “fat boy” in Dickens’s first novel The Posthumous Papers of the Pickwick Club.

You say you’ve never heard of Joe or the novel? You’re not alone because it doesn’t get read every year at the holidays nor is it a regular part of school curriculum. However, the reason why Joe is an influential Dickens character is that the author’s description of his physical attributes prompted researchers to name a medical condition after him.

Take a Deep Breath

Dickens paints Joe the “fat boy” as a young man who is quite large and continually falls asleep regardless of where he is, what’s happening around him or even what he’s doing. It’s this combination of being severely overweight and having a propensity to doze off that led experts to identify the pickwickian syndrome, a variation of sleep apnea.

More commonly referred to today as obesity hypoventilation syndrome (OHS), the condition affects extremely obese individuals who exceed the medically recommended weight per height by 20 or more percent. Carrying that weight carries a lot of health complications, including heart disease, diabetes, and sleep apnea, which are interruptions in breathing while asleep. And when you do not sleep well night after night, the cumulative effects can further complicate your health.

OHS is more involved than just a few seconds of not breathing. Rather, one’s breathing becomes chronically compromised, with respiration falling below normal levels. In serious OHS cases, blood oxygen levels begin dropping and that can trigger the small vessels that feed oxygen into the lungs to constrict. This then increases pressure, which eventually can place stress on the heart.

Another consequence of chronically decreasing breathing ability is an gradual increase of carbon dioxide in the blood because your body is less capable of expelling it from the lungs efficiently.

CPAPOther OHS and sleep apnea side effects include:

• sleepwalking

• anxiety

• irritability

• lower sex drive

• memory loss

Feeling Better

Probably the most effective treatment for OHS is to lose weight so your body mass index (BMI) hits within the recommended ranges, and to manage that healthy weight for the long term. As the pounds drop off, your body should become more efficient at distributing oxygen and expelling carbon dioxide.

Or your physician may recommend you wear a continuous positive airway pressure (CPAP) device while you sleep. This machine uses forced air to keep your airways open and prevent breathing interruptions.

In extreme cases, surgery may be prescribed. Children diagnosed with pediatric obesity hypoventilation syndrome may undergo adenotonsillectomy to remove tonsils and adenoids. Adults may be advised to pursue bariatric surgery to aid the weight-loss process.

Professional Guidance

Dickens may have created Joe the “fat boy” as an unexpected farce to keep readers interested, but there’s nothing farcical about breathing disorders induced by obesity. If you have concerns regarding your health, always consult your physician.

What is a Home Sleep Study?

If a medical professional thinks you may be suffering from a sleep disorder such as sleep apnea then they will often suggest a sleep study to diagnose exactly what the problem is.  Sometimes this can be done in a sleep lab when a device called a polysomnograph (PSG) records information but it can also be done at home and this is what a home sleep study is.

Why stay at home?

There are some clear benefits as to why a home sleep study may be more beneficial and give better results than one in a lab.  First is the most obvious; people respond better in their own home and their own bed whereas when staying somewhere unfamiliar, this can alter sleep patterns and skew the test results.

Home sleep studies are also ideal for people who are house bound, elderly or have other chronic illnesses that mean they need the care of a family member or a nurse.  It is also ideal for people who work unusual shift patterns that means attending a sleep lab is difficult.

It also works out much cheaper to do the study at home without having any effect on the results of the test.

What happens in the study

The main areas that are studied are the oxygen saturation, heart rate, airflow and effort as well as snoring and sleeping positions.  The only things that are done extra in a lab is monitoring brain waves and leg movements.

Usually you can simply collect the device from a scheduled location rather than someone needing to visit the home and is a light and easy to carry device.  The common form of the device works by putting a belt around your midsection and attaching a clip on your finger.  An airflow sensor goes under your nose and you are ready to turn the machine on.

What kind of conditions are diagnosed?

Sleep apneaOne of the most common conditions that is diagnosed by this type of study is sleep apnea.  It is diagnosed across three levels of severity, which are

  • Mild – 5-14 episodes in an hour
  • Moderate – 15-30 episodes in an hour
  • Severe – more than 30 episodes in an hour

Sleep apnea is a disorder where patients have pauses in breathing or episodes of shallow or infrequent breathing.  Every time breathing pauses, this is called an apnea and can last anywhere from ten seconds to several minutes and can occur from five to 30 times an hour.  A shallow breathing event is called a hypopnea.

There are two main types of sleep apnea; central and obstructive, though people can have a combination of the two.  In CSA, breathing is interrupted due to a lack of respiratory effort while in OSA, this is because of a physical block to airflow despite respiratory effort and snoring is common in these cases.  It is thought that around 12 million Americans have OSA and there may be many more cases where people don’t realise they have the condition and it goes unreported.

What is Insomnia?

Insomnia is a sleep disorder that can affect people in one or both of two ways – either they have trouble falling asleep or staying asleep.  Either way it means they don’t get enough good quality sleep and don’t feel refreshed when they get up in the morning.


InsomniaInsomnia is generally said to be either acute or chronic, the first being a short-term condition while the second is an ongoing condition.  Acute insomnia can be caused by things such as stress, family or work pressure or a traumatic event.  It typically lasts from days to weeks.

Chronic insomnia lasts at least a month or longer.  Many times, it is a secondary condition, meaning it is a symptom or a side effect of something else.  Some medical conditions or medicines can cause insomnia.

When insomnia is the primary condition, it isn’t because of a medical problem but tends to be triggered by a life event.  This can be long-lasting stress or emotional issues though the complete causes are uncertain.


Insomnia causes daytime sleepiness as well as a lack of energy.  It can bring on feelings of anxiety and depression and make people irritable.  Focusing on tasks can become difficult and attention span, ability to learn things and to remember things can all be effected.  This means it can have a serious effect on work or school life.

Insomnia can also lead to other serious problems.  For example, the lack of concentration can effect ability to drive leading to an accident.  Or operating machinery when suffering from daytime sleepiness could lead to an injury.


The first step to treating insomnia is to identify the underlying cause of the problem if it is a secondary condition.  It may be something as simple as caffeine before bedtime causing you to be unable to fall asleep so by cutting out caffeine around three to four hours before bedtime, this can be alleviated.

Some of the main medication conditions that see insomnia as a secondary effect can include:

  • Conditions that cause chronic, ongoing pain including arthritis and headache problems
  • Respiratory conditions such as asthma
  • Overactive thyroid
  • Gastrointestinal disorders including heartburn
  • Stroke or heart failure
  • Menopause including hot flashes
  • Other sleep disorders including restless leg syndrome and sleep-related respiratory problems

Emotional disorders are another likely cause of insomnia with conditions such as depression, anxiety and PTSD being major issues.  Alzheimer’s and Parkinson’s disease have both been shown to have insomnia as a secondary condition.

Certain medicines have been shown to cause insomnia including asthma medicines such as theophylline and also cold and allergy medicines.  Beta-blockers cause insomnia also.


Doctors use a range of tools to diagnose insomnia and find any underlying causes.  The primary way they understand the condition is by asking about your sleep history.  This can include information about:

  • how often you have trouble sleeping
  • how long it takes to fall asleep or how often you wake during the night
  • whether you snore loudly or wake with feelings of gasping
  • how refreshed you feel when you wake
  • if you doze off during the day or have trouble doing tasks because you are not properly awake

Doctors will often ask you to keep a sleep diary for a week or two detailing when you go to sleep, naps taken and when you wake up.  If you think you have problems, it can be worth starting this immediately.


Obviously, treatment is wholly dependent on what type of insomnia you have and any underlying causes that are uncovered.  Treatment can be as simple as changes to lifestyle such as the caffeine tip mentioned earlier, changing sleep routines or the make-up of your bedroom.

Another method used is CNT – Cognitive-Behavioural Therapy.  This is designed to target thoughts and actions that disrupt sleep and alter them in a positive way.

Sometimes over the counter medicines can help the conditions and herbal remedies such as some teas can be beneficial.  As a last resort, doctors will sometimes prescribe medication for short or long-term use to get you sleeping once more.