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Page 14 THE MALDEN ADVOCATE–Friday, July 16, 2021 a vyvavvyvavy eniioorenior avvy Senior a vy nniorniiori by Jim Miller The Hidden Dangers of Sleep Apnea Dear Savvy Senior, How can you know when someone has sleep apnea? My husband has become such a terrible snorer that he wakes himself up at night, and he keeps me up too. Tired Teri Dear Teri, If your husband is a loud snorer who wakes himself up during sleep, he probably needs to be tested for sleep apnea, a dangerous disorder that affects more than 22 million Americans, but often goes undiagnosed. Sleep apnea is a disorder that causes a person to stop breathing during sleep, hundreds of times during the night, for 10 seconds or more at a time. Left untreated, it can cause extreme daytime sleepiness, as well as a host of serious health conditions like high blood pressure, heart attack, stroke, diabetes and dementia. In fact, it’s estimated that every year, around 38,000 Americans die in their sleep from a heart attack or stroke because of sleep apnea. But the good news is that sleep apnea is very treatable and most insurance companies, including Medicare, cover it. Who Has It? There are three types of sleep apnea: obstructive, central and mixed. Of the three, obstructive sleep apnea (or OSA) is by far the most common and occurs when the throat muscles relax during sleep, blocking the airway. While anyone can have it, sleep apnea is most common in people who are overweight, male, middle-aged and older. For women, the risk increases after menopause. The symptoms include loud snoring (however not everyone who snores has apnea), long pauses of breathing, gasping or choking during sleep and daytime drowsiness. But because most of these symptoms happen during sleep, most people don’t recognize them. It’s usually the person they’re sleeping with who notices it. Diagnosing Sleep Apnea To help you get a handle on your husband’s problem, the American Sleep Apnea Association has several diagnostic tests he can take at SleepApnea.org/treat – click on “Test Yourself.” If the screening indicates that he may have sleep apnea, make an appointment with his doctor or a sleep specialist who will probably recommend an overnight diagnostic sleep test called polysomnography, which can take place at a sleep center lab (see SleepEducation.com), or at home using a portable device. Treatment Options Your husband is at greater risk for sleep apnea if he’s overweight, smokes, and/or consumes excessive amounts of alcohol. Excess weight, especially around the neck, puts pressure on the airway, which can cause it to collapse. Smoking can increase the amount of inflammation and fluid retention in the upper airway. And alcohol and sleeping pills can relax the muscles in the back of his throat, interfering with breathing. Addressing these issues, if necessary, is usually the first line of treatment. If that doesn’t do the trick, mild cases of sleep apnea may respond to oral devices that fit into the mouth like a removable mouth guard or retainer. These devices work by positioning the lower jaw slightly forward to keep the airway open during sleep. Another noninvasive treatment option to consider is the new FDA approved eXciteOSA device (eXciteOSA.com). This treats sleep apnea and snoring by improving tongue muscle function by delivering electrical stimulation to the tongue through a mouthpiece that’s worn for just 20 minutes during the day. If none of these options work, the most effective and commonly prescribed treatment for OBA is a continuous positive airway pressure (CPAP) device. This involves sleeping with a snorkel-like mask that’s hooked up to a machine that gently blows air up the nose to keep the passages open. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. A recent Massachusetts Superior Court Judge held against MassHealth with respect to the countability of assets housed in an irrevocable Trust. It is well settled law that for purposes of determining eligibility for MassHealth benefits, countable assets include any portion of the Trust principal that could under any circumstances be paid to or for the benefit of the applicant. Such circumstances need not have occurred, or even be imminent, in order for the principal to be treated as countable assets; it is enough that the amount could be made available to the applicant under any circumstances. This was set forth in the Heyn case, a Massachusetts Appeals Court case decided in 2016. In this Superior Court case, the applicant had retained a limited or special power of appointment in the Trust that she created that she could have exercised during her lifetime “to appoint the remaining principal and any undistributed income of the Trust among the members of the class consisting of her issue of all generations or charitable organizations other than governmental entities, but no such power or payment shall be used to discharge a legal obligation of the applicant”. In a simple sense, appoint is another word for distribute and an example of issue would be children or grandchildren. MassHealth argued that if the applicant appointed Trust principal to family members, those family members could then in turn return the Trust principal to the applicant to be used for her benefit. The Superior Court once again cited the Heyn case which stated that “Medicaid does not consider assets held by other family members who might, by reason of love but without legal obligation, voluntarily contribute monies toward the grantor’s support”. The grantor of the Trust is also referred to as the Settlor or Donor, and in this case, was the applicant for MassHealth benefits as well. The court also stated that “the limited power of appointment is exercisable only in favor of permissible appointees, and any attempt to exercise a limited power of appointment in favor of an impermissible appointee (i.e. to use principal for the personal benefit of the grantor), is therefore invalid. An appointment to a permissible appointee is ineffective to the extent that it was: 1. Conditioned on the appointee conferring a benefit on the impermissible appointee 2. Subject to a charge in favor of an impermissible appointee 3. Upon a trust for the benefit of an impermissible appointee 4. In consideration of a benefit conferred upon or promised to an impermissible appointee 5. Primarily for the benefit of the appointee’s creditor, if that creditor is an impermissible appointee, or 6. Motivated in any other way to be for the benefit of an impermissible appointee. The above six items are set forth in the Restatement (Third) of Property and the Superior Court judge held that MassHealth cannot argue that Trust principal could ever be distributed to a permissible appointee in order to benefit the applicant and held that none of the Trust principal was countable. The applicant then qualified for MassHealth benefits. In the case at hand, no principal could under any circumstances be appointed to the applicant. The applicant clearly was not a permissible appointee. If she was, her retained right would have been deemed a general power of appointment thereby providing her a right to receive Trust principal. Joseph D. 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