Sleep Apnea: Diagnosed, But Not Cured
Back in December I made a crack about my undiagnosed sleep apnea.
It has been diagnosed. But the cure isn’t working too well so far.
“You surprised me,” the lady said. She said I had a severe case — one that she would have expected from a heavier person. She said it wasn’t weight that was causing the airway in the back of my throat to close off. More than likely, it’s the shape of my face. Jaw surgery might end up being helpful.
My “score” turned out to be 47 — meaning that over the course of six hours, I stopped breathing (for 10 seconds or more) an average of 47 times per hour. Some hours this happened more than 70 times.
The scariest part is that I stopped breathing for long periods of time during the night — 20 seconds, 30 seconds, 40 seconds . . . or more. There was one time I stopped breathing for 51 seconds.
Go get a stop watch. Take a deep breath, hold your nose, and close your mouth. Remain this way for 51 seconds.
I bet there are few of you who can do that. And if you do — you’ll feel the incredible strain it causes.
Now you’re starting to see why this is a problem.
Obstructive sleep apnea is caused by a closing of the airway at the back of your throat when you lie down and your muscles relax. On Thursday, I was lent a diagnostic CPAP machine for the weekend. You put a mask over your face — in my case merely over my nose. A CPAP forces air into the mask, and thus into my nose, for the purpose of keeping that airway open. If the mask is only over the nose, all breathing must be done through the nose, or it doesn’t work properly. The diagnostic machine is designed to determine how much air pressure is necessary to accomplish that and prevent me from having an episode of not breathing.
Unfortunately, the machine is a mess. The flow of air into the mask means that you are exhaling into the flow — rather like blowing into a high wind. As the pressure increases, it makes exhaling difficult — sometimes so difficult that I felt I wasn’t getting a full exhalation. Thursday night, I lay down with it at 10:30 p.m., and finally took it off in disgust at 1 a.m. Every time I would start to drift off to sleep, the machine would increase the pressure — which it was supposed to do, because it was sensing a non-breathing event coming on. As the pressure increased (as I fell asleep) it would get to the point where I felt I wasn’t fully exhaling. Take a deep breath in through your nose. Now exhale — but only halfway. Repeat several times. This is what it felt like.
Friday night I was much more tired, so I was able to fall asleep with the machine on more easily, and I kept it on all night.
But I woke up with a headache yesterday morning.
I didn’t even try it last night, and won’t tonight. The mask had fit so badly that I had a red and painful area on the bridge of my nose. It’s still there, 24 hours later — even though I didn’t wear it last night. They need only one period of 4 hours of continuous usage to do the diagnostic test, and they’ve got it.
It’s nice to know that the problem has been diagnosed. But the cure really sucks, and isn’t working too well so far.
Something you have in common with Andrew Sullivan. I’d have the surgery rather than keep that up. Seriously, changing sleeping position and avoiding alcohol are both helpful. I snore terribly if I’ve been drinking even a moderate amount. I also think this is the latest medical fad.
Mike K (86bddb) — 4/15/2007 @ 8:37 amYou need to get a different mask. I have a CPAP, and it’s made a tremendous difference. It’s the “nose-only” type, and it works quite well. If you have sleep apnea, I’d investigate a different mask before I’d go for surgery.
You might need to get the flow adjusted down a bit.
steve miller (b356eb) — 4/15/2007 @ 8:55 amI’ve been using a CPAP for over a decade now and it works really well for me. The big trick is to get the mask adjusted correctly. Yours clearly isn’t if you’ve got it on so tight that you’ve got a big sore spot on the bridge of your nose.
First, you need to make sure that your headgear is large enough. I have a big head and none of the “softcaps” was big enough to work for me — they caused my jaw to dislocate producing TMJ-like symptoms. I finally got them to give me a larger harness that my wife refers to as my “disco bondage headgear”, because it’s a bunch of stretchy straps that fit around the back of my head and neck.
Second, you need to adjust the mask so that it’s as loose as you can get it without leaking air. To do this, you put the mask on loosely. It will leak air around one edge. Slightly tighten that strap. A bit later, it will leak somewhere else. Repeat the procedure until the mask no longer leaks.
My mask also has what they call a “comfort flap”. This is a piece of very thin plastic that fits over the silicone mask and which produces a better seal with less pressure. It helps a lot.
And I hope that some of this info is of use. If you want to chat about it in more detail, feel free to drop me an e-mail!
I’ll just note that when I first got my CPAP at home, I had been so sleep-deprived for so long that I would stare at problems that I knew I should be able to solve, but which I couldn’t figure out for the life of me. The first morning that I woke up after having used the CPAP, I immediately thought “I don’t feel stupid!”
And that’s a really good feeling.
Bill Roper (f93cf2) — 4/15/2007 @ 8:57 amAs a long-term user of a CPAP (since 1990), let me say that sleep apnea is definately not a fad. Given any other choice I would not have it.
Symptoms are not necessarily obvious. The only indication I had was that my wife complained about my snoring and I was continually sleepy, to the point of falling asleep during ordinary conversations with family and friends.
I don’t think there is such a thing as a comfortable face mask. You’ll get used to it. I used to throw mine across the room (then retrieve it.) Pressure can be reduced, possibly to a more comfortable level.
After using mine for a year or so, I found it to be very disturbing to go without it, waking every 10 minutes or so. I bought a 12 volt power cord for my travel trailer.
Dryness of the mouth is another problem. I have a humidifier, but it seems of limited value.
At the time I was diagnosed, surgery did not seem to be a good option. Perhaps surgical procedures have improved since then.
Good luck.
brian (9506c5) — 4/15/2007 @ 9:05 amThere is another machine for serious sleep apnea that you may want to look into. It is called a
Bi-Pap machine. Instead of just blowing a steady stream of air into your face, it builds pressure till you inhale then backs off so you can exhale.
I’ve used on for years and can’t sleep with out it now. Machines and masks come in a large variety built by several manufacturers. Do some research before you decide to give up on your machine. Sleep apnea sounds benign but it is far from it.
Alilshy (3f8daa) — 4/15/2007 @ 9:16 amNot sure how much alcohol has to do with it — I often snore and I don’t drink at all.
Kevin Murphy (0b2493) — 4/15/2007 @ 9:28 amI too have been using a bi-pap machine for over 5 years now and can not sleep without it! I too had the “nose only” mask the first year or so. It gave my sinuses holy hell!! They stayed infected for months until I got a full face mask (one that covers both the mouth and nose) along with a humidifier. It works great! I think you need to have your pressures lowered at the least, or better yet, have your doc prescribe you a bi-pap.
lennie (1a2971) — 4/15/2007 @ 9:29 amI was diagnosed with SA in 2002. My GP immediately ordered up a CPAP, which I immediately canceled, and sought out an ENT specialist. The first sleep study I did, in the hospital, was one of the most horrible experiences ever, and it certainly wasn’t representative of a normal night’s sleep for me.
Long story short, I saw a good ENT who realized that my weight wasn’t an issue, and sent me home with a SNAP test which showed that my snoring (and ultimately the main airway obstruction) came from the soft palete. Shortly thereafter, she did a UPPP (which is now an outpatient laser procedure).
It works for me, and I would be terribly unlikely to stay compliant with CPAP, especially having to travel with it.
Pablo (08e1e8) — 4/15/2007 @ 9:44 amWomen get really turned on when they’re in bed with a man wearing a sleep apnea mask.
Jake Gittes (e6cddd) — 4/15/2007 @ 10:14 amI read, I believe in Men’s Health, that simply buying a special pillow can help. I suspect that I have sleep apnea too.
Psyberian (de47c4) — 4/15/2007 @ 10:22 amMy father uses a CPAP machine. It took him time to get used to it and to fine tune its settings. He uses it effortlessly every night now – no problems at all.
Note that there are different types of masks – ones that cover the nose and mouth, nose only, different shapes, straps, etc. Keep trying different ones until you find the one that works the best for you. Don’t forget how much money your insurance company is ponying up for this machine for you! Settle for only the best/most comfortable.
Based on my father’s experience, you’ll feel SO MUCH BETTER once you start sleeping properly!
The Liberal Avenger (b8c7e2) — 4/15/2007 @ 10:27 amI found the Men’s Health article. Using the “FDA-approved pillow” ($70) “led to a 60% drop in the number of times the participants stopped breathing.” See sonapillow.com.
Psyberian (de47c4) — 4/15/2007 @ 10:39 amI’m glad you were diagnosed. I hope everything works out well.
DRJ (50237c) — 4/15/2007 @ 10:41 amI was finally diagnosed last July. Fatigue, depression, irrational bouts of anger, and ready to go back to bed minutes after getting up – for years – all gone after not quite a year on the CPAP.
My pressure was prescribed at 11 but I after analyzing the results I had to go to an auto-set and my pressure was getting up to 19-20 at times. It is now a consistent 10-11 and has been for at least 6 months.
Wear that mask every night wherever you go. Consistently. I guarantee in no less than 6 weeks or so you will start feeling like a new man.
Robert (4138eb) — 4/15/2007 @ 11:28 amMy SA was pretty horrible when I was younger. I would wake up gasping for air 4-5 times a night often. After they did my sleep study they decided to hack off my tonsils, my ENT said they were the largest non-infected tonsils he’d ever seen. Since then it’s been a rare occurence for me to stop breathing completely.
Taltos (c99804) — 4/15/2007 @ 12:00 pmMy commiserations. No personal experience with sleep apnea but caregiver experience with congestive heart failure and emphysema so I concur with the commenters who say a properly fitted and regulated mask is critical.
nk (a3cd81) — 4/15/2007 @ 12:55 pmThe pillow only works to the extent that you are snoring and having your airway close due to sleeping on your back. The pillow helps you sleep on your side, that’s all. If you have SA even when on your side, the pillow won’t help much.
And I can’t sleep with a CPAP either. The feeling of suffocation is too much for me.
Jinnmabe (aad7f1) — 4/15/2007 @ 1:42 pmPatterico,
Obviuously you are loved, even by those who can’t remember ever agreeing with you on anything.
From a physician’s perspective and a user of CPAP I’ll add minimal to the wonderful advice you’ve already received.
1. I had a very difficult time at first, experiencing exactly what you describe. I thought of it as “breathing uphill”. After several days of “practice breathing”, focused consciously on breathing before I went to bed, I became more or less used to it without any changes. But it sounds like your mask doesn’t fit or is not adjusted correctly.
2. With a nose-only mask that fit, I still would get nasal congestion. I use Afrin nasal spray (generic, actually) every night before bed. (Using it once a day only you should not get problems from the Afrin).
3. People who deal with sleep apnea include ENT, Pulmonary, Neurology, and Psychiatry. Of the last 3 they usually refer to themselves as “Sleep Specialists”, having a particular interest and training in the area than maybe others in their field.
ALSO, the respiratory therapist from the home health company may be very good and can make suggestions- depends on the company and therapist.
4. I would not be quick to assume a complete correlation between 1 night of CPAP and a headache next morning. need to troubleshoot this a bit.
5. It is important. Not only will you function better using it, but people with excessive sleepiness may drive as “well” as someone intoxicated. Also, from my reading between the lines, I think Reggie White (the Hall of Fame Defensive lineman) probaly died from complications of untreated sleep apnea.
Yes, it is important.
email me also if I can be of further help.
MD in Philly (3d3f72) — 4/15/2007 @ 2:00 pmSA can be VERY serious. The husband of a coworker of my wife suffered a heart attack due to it.
Getting used to the mask sucks on toast, took me several months and there are still nights when I just rip it off and say the hell with it.
But life isn’t Burger King, we don’t get it our way.
Good luck.
Subvet (8e8e7b) — 4/15/2007 @ 5:02 pmWhen I mentioned that I was getting a CPAP machine, I was told that others with sleep apnea would come out of the woodwork to share their own experiences, as has happened here. My doctor noted that the alternatives to CPAP, surgery and a special mouth brace, only work for about half the people.
I did notice that the CPAP machine I was eventually given was quite different from the diagnostic one I first tried. Mine actually seems to back off the pressure when I exhale, and my mask fits quite well. The only real problems I have are that my moustache disrupts the seal slightly and that I cannot use it at all when I am congested.
russ (0aa093) — 4/15/2007 @ 6:05 pmI too have sleep apnea and was fitted for a CPAP machine. The first month I went to work with sores on my nose — until I started putting a band aid on that spot each night as a protective pad. Now sleep is long and wonderful, and my nose looks normal. Stick with it — when I was fitted in the hospital I hated it, but now am not comfortable trying to sleep without it. And having a full night of sleep is well worth adjusting.
Best wishes,
Robert (8c7279) — 4/15/2007 @ 7:04 pmRobert
Try a full-face mask. When the air pressure to my nose and mouth are the same, I don’t notice it at all, and can breathe normally. But with high pressure air coming in through the nose, and normal pressure air to the mouth, the differential is huge.
Xrlq (816a33) — 4/15/2007 @ 7:15 pmHere’s another option you may wish to consider.
Xrlq (816a33) — 4/15/2007 @ 7:22 pmI have sleep apnea. The first year on the C-PAP was hell. I wasn’t getting any positive results and it was uncomfortable.
I finally realized after much research on the Internet that I needed an auto-set machine. I bought one myself. Medicare or most insurance will not pay for it. They cost about $700 from CPAP-Pro.net (1-888-356-5221) I wear a nose mask and chin strap to keep my mouth closed. (I’m a mouth breather.) I also use salt water to wash out my sinuses before bed every night. Helps me breathe through my nose and keep my mouth shut. After getting the auto-set I finally started to see positive results. Mask adjustment is very important. If it’s too tight it causes severe discomfort. Too loose and it leaks. It takes some experience and willingness to experiment to get it right.
I’ve never had a problem with dryness. I tried a humidifier and it seemed to make my post nasal drip much worse. So I ditched it.
I polled seven people who had the surgery and only one of them felt it was a major success. The rest felt it was no help to a major mistake.
I’ve been using my autos-set for four years now and am well satisfied.
I do manage to use my sinus wash and Breath Right strips when I travel, rather than haul my machine around. I’m never gone more than 14 days and don’t suffer. However, I do find getting back to the machine is like coming home to comfort.
Good luck and don’t give up on the C-PAP, there are many options and new things coming out all the time.
Jimmy J. (773108) — 4/15/2007 @ 8:22 pmI hope you’re better soon!
I do wonder if the SoCal aridity makes it worse–I always have a humidifier going at night and sleep better.
Patricia (824fa1) — 4/15/2007 @ 8:34 pmMy sympathies, Patterico.
Here’s a story I wrote about sleep apnea last year.
Bradley J. Fikes (1c6fc4) — 4/15/2007 @ 9:03 pmBeen on “the cure” for about 4 years, myself. Have to sign on to the general comment that mask-fit is critical — as well as mask-type. During my sleep study, I hissed like a teakettle with a nose-only mask…which didn’t make the insurance carrier too happy. Fortunately, all the docs were very supportive of going the full-face mask route. I’ve done 3 versions since, and only the latest one has been worth as much as 2/3 of a bucket of warm p***. It’s a ResMed Ultra Mirage Full Face, by the way.
So, on to specifics. For the first month, I woke up clearer in my head but feeling like I had been kicked in the chest by a mule (I run a fairly high pressure). Anticipate a period of adaptation, and keep with it — your muscles may strengthen and cause all sorts of annoying things to fade with time.
Get used to the odd — After going on BiPAP, I slept through the night….unlike my prior experience, where I got up to use the restroom 2-3 times per night. I spent quite a while wondering what the connection could be between a face mask and a bladder or “kidney troubles”? [It makes more sense to ask how long you’d “hold it” if someone were strangling you for half a minute at a time during random parts of the night, but I thought of this long after I’d noted the phenomenon.]
Look after your filters religiously, and go heavy on the humidifier. I’m subject to allergies, and if your sleeping pressurized, then you’re getting twice the amount of air going through you as you would normally….with twice the number of allergens. Now, I actually look forward to strapping on the machine on days when I’ve had a lot of allergy grief. After about a half hour, the warm, moist, clean air starts opening things up — if I didn’t need it to sleep, I’d want one just for that. By the way, if you have a wild desire for self-aromatherapy, remember that this’ll be force-implanted into your system for hours while you’re not monitoring it, and err to the side of subtlety.
Arrange your lifestyle so that there’s a going-to-sleep ritual. Trying to read in bed, fall asleep with the TV, or whatever, will become incredibly complicated and painful.
For me, the masks die in two ways — first, the straps, made generally of neoprene, stretch with time. So If you get the fit exactly right tonight, that’s great — it’ll be useless by Thursday [Percentage-wise, the greatest amount of stretching occurs in the early going, but they continue to stretch forever]. Second, the silicone seal around the face loses its efficiency, becoming both stiffer and less “sticky”.
These two problems have three places where they cause concern: Going in, maintenance, and insurance. Going in, it is important to find a mask that is very easy to adjust, and yet also hold its adjustment from one wearing to the next. That way, you can start with the good fit you had the night before and merely shorten to compensate for stretch. For maintenance, especially for the seal, it is vital to clean it regularly and not expose it to heat or light to stiffen it prematurely. Finally, it should be noted that insurance carriers and suppliers can be totally schizophrenic about these items — I’ve been told, for instance, that a full-face mask was an option for which I would have to personally pay extra; and that the replacement period for a seal was different for the remainder of the mask, but that they could only be ordered as a set. Further, expect peculiarities as to “renting” vs. “buying” machines — my current insurance insists on maintaining the machine as a rental, which coincidentally ensures that my deductible out-of-pocket “copay” is extracted in the first two months of *every* year.
Finally, a couple of notes of caution….I’ve snored since I was a kid, and there are a variety of family stories (like sleeping through the ’71 quake even though my bed was moved 8″ away from the wall…). It didn’t keep me from graduating college and having a career….then, all of a sudden, when I was in my late 30’s, it got worse. I started conking out in meetings; abruptly realizing that I was at the office or at home without any recollection of getting there; thinking that I’d done everything right but ending up mysteriously behind schedule, and feeling like I was sleepwalking through my days, dragging from place to place. It was a horrible, weird, frightening, out-of-control feeling — if I could have thought of any specific misbehaviors I might have checked myself into rehab.
Just to run that through again: I had ample evidence of undiagnosed problems from age 9 to 38, and it was no big deal, but the sleep apnea changed — and moved seriously towards taking my life out of control — for almost two years until I got it diagnosed (after changing doctors).
As if that weren’t frightening enough, I got a reminder about a year ago. My pressure setting is fairly high — right at the top edge of the pressures available for my old system. Switching between breathing in and breathing out at such pressures put a huge strain on the machine, and it finally started to give out.
This is a subtle thing — it still whirred at night, and you could still get a breeze out the mask vents. It started where you couldn’t feel the “kick” after you exhale when it starts trying to help you inhale…and you start waking up with headaches, feeling a bit goofy. I figured out the problem fairly quickly, and managed to jump through the necessary bureaucratic hoops to get a new machine on order, only to need to wait for some weeks for everything to work out.
When I was young, I read “Flowers for Algernon” [“Charly”]. I watched the scene in 2001 where HAL is disassembled: “I’m afraid. I’m afraid, Dave. Dave, my mind is going. I can feel it. I can feel it. My mind is going. There is no question about it. I can feel it. I can feel it. I can feel it. I’m a…fraid. Good afternoon, gentlemen. I am a HAL 9000 computer.” — I never thought I’d live them.
During the time between making arrangements and sleeping a couple of nights after receiving the replacement unit, I slowly revisited many of the same symptoms that led me to seek help in the first place, but with enough awareness to see the difference from one day to the next. In case anyone is wondering, this is not recommended.
Anyway, congratulations on the diagnosis — it all gets easier once you know what is going on. Here’s wishing you luck to go through the treatment options and fighting with the insurance. I’m hoping that you’ll soon be one of us who can strongly recommend the treatment.
cthulhu (326ae3) — 4/15/2007 @ 10:11 pmgood luck with this. i hear there’s also a surgical option which can frequently be performed on an outpatient basis.
assistant devil's advocate (d77ebe) — 4/15/2007 @ 11:59 pmMy sleep apnea is rather mild, but I snore so loudly that it disrupts sleep for people in the next room. I wake every day with a dry mouth/throat, tired. I get up 4 or 5 times a night.
I did the sleep study as well. I’m not skinny, by any means (6’/235lbs) and I know I could stand to lose about 20 pounds, but I’m not overly fat either. I was by far the thinnest guy in the sleep clinic both trips. The sleep study was horrible. Wired 12 ways and the second session with the CPAP machine- it all sucked. My ‘magical sleep apnea number’ the number of ‘sleep-disrupting incidents per hour’ was 60- which is on the very low end of people who seek diagnnosis and treament, the sleep clinic told me.
I knew before I went that this is a soft palate problem. I can feel the loose skin just flapping back there, and it doesn’t matter whether I sleep on my back or side. Hell, I even snore sleeping on my stomache. But I have had zero success in convincing any of my doctors. They insisted on the CPAP machine, saying insurance would not even look at paying for surgery until I had tried it. I’ve had the machine for several months, and even consistently tried to use it every night for several weeks. I would make it partway through the night and rip it off halfway through- Though it improved the sleep I did get, and apparently kept me from snoring, I just couldn’t ever get used to the constraint on my breath and head movements.
The CPAP machine is not a solution. I know several people personally who have gotten used to it, but it’s primitve quackery- there’s got to be a better solution.
In the last few months, my condition has even gotten worse to where I feel constriction on my airway while awake. My soft palate just hangs down. The constriction on my airway feels much like when you have a runny nose where mucus leaves a trail down the back of your throat/right where your nasal passages start- you want to ‘snort’ it out of the way. In my case, I have that reflex all day long.
Unfortunately, there’s not much I can do about it while I’m here in Iraq, and when I get home my insurance will lapse, possibly or even probably before I can switch it up with new employment. So even if I can convince a doctor, and an insurance company that I need surgery, it’s probably going to be quite some time before it happens, and that’s only if I can overcome the medical establishment’s foot dragging and reluctance.
Thebastidge (5109f0) — 4/16/2007 @ 12:30 amMy ENT went to bat for me with the insurance company on that, using the results of the SNAP test. Well, that and the fact that I’m 5’11 and 185. She talked them into paying for the surgery.
Do the COBRA payments, and get it done ASAP! And find an ENT to evaluate you. If the situation is as you describe it, then the UPPP surgery wouldn’t be just for sleep apnea.
Pablo (08e1e8) — 4/16/2007 @ 2:30 amIn the link given above on SNAP:
“Conclusion: Although there may be some night-to-night variability in polysomnography testing, these results suggest that SNAP studies do not appear to accurately assess the severity of OSA” (emphasis added).
I’ve already been evaluated by an ENT. I went to the ENT clinic for referral to a sleep study clinic. I’ve done the process. I will be going back to follow up on the CPAP machine not working for me, but I expect it to still be a serious struggle to get any kind of surgery done- they strenuously resist it, from everything I’ve seen and heard. They can make you rent a CPAP machine for a few hundred dollars, or perform $10,000+ surgery- which do you think the insurance company will insist on?
The “sleep apnea” is not really the problem. Interruption in my breathing is a very minor side issue- I’m struggling for 10-50 seconds to breath through a closed airway because I can’t breathe through my nose at all when I’m asleep with the soft palate obstructing my airway. So I breathe through my mouth wide open and snore- worse than most people can imagine because the same looseness in the palate also seems to act like some kind of sounding board. I mean, it’s LOUD. Like if you were deliberately faking a snoring sound as loud as you can- it’s that loud.
I should’ve mentioned before- since my sleep apnea is on the low end of the scale, it makes it even harder to justify surgery, because sleep apnea is considered a dangerous chronic medical condition but snoring is considered cosmetic.
Thebastidge (5109f0) — 4/16/2007 @ 5:07 amLike I said- I could lose a little weight, but I’m not hugely fat either.
Thebastidge (5109f0) — 4/16/2007 @ 5:11 amSorry- to view the pic you have to be logged into myspace- should’ve realized.
Thebastidge (5109f0) — 4/16/2007 @ 5:14 amThe SNAP may not speak well to severity, but it apparently does a fine job of determining the source of the obstruction via analyzing the sound of the snoring, which I don’t believe is a component of the traditional sleep study. (I may be mistaken, but I don’t remember a microphone in the array of annoying cables) In my case, it was all soft palete/uvula, and the SNAP results were ammunition enough to get the Ins Co to pony up. In other words, this:
…is exactly right. I also had that snore that sounds like an amplified train wreck. Now I’m told that it’s at worst, cute. The ENT did mention that the fact that my weight is not an issue was an important factor in her argument.
If the problem has you unable to breathe properly while AWAKE, fixing it shouldn’t be cosmetic, and you can’t spend 24/7 on a CPAP. Also, I don’t believe it was $10K for the surgery. I seem to recall paying something like $1200 on an 80/20 copay. If I had it to do all over again, and I couldn’t get it covered, I’d pay for it out of pocket before spending the next 40 or so years on CPAP. If you find yourself in Southern New England when you get back from the sandbox, I’d be happy to turn you on to my ENT. Of course, every case is unique, so your mileage may vary.
Pablo (08e1e8) — 4/16/2007 @ 5:42 amWell, the information is definitely appreciated. I will look into that when I get home (July/August time frame).
FYI: The sleep study included video and audio in my case, but of the room in general- not specifically on my body. It’s part of what they used to correlate ‘sleep-disturbing events’ with the info they gathered from wiring me up like a science experiment. The mic and low-light camera were mounted on the wall across the tiny motel-like room. Uncomfortable realization when you wake up with your hand on your junk from scratching in your sleep- that who knows how many techs and medical personnel will review that.
Thebastidge (5109f0) — 4/16/2007 @ 5:59 amThey try to scare you with the idea that the surgery could profoundly affect your speaking voice as well.
Thebastidge (5109f0) — 4/16/2007 @ 6:01 amThe only issue I’ve had is that it’s easier for fluids to “go down the wrong pipe”, and that seems to be lessening over time. It just took a bit of getting used to things being reconfigured. My voice, speaking and singing, was not affected by the surgery. Half a million Marlboros, on the other hand….
Pablo (08e1e8) — 4/16/2007 @ 6:31 amActually, in post#31 above, I meant to say:
“Interruption in my breathing is a very minor side issue- I’m *NOT* struggling for 10-50 seconds to breath through a closed airway because I can’t breathe through my nose at all when I’m asleep with the soft palate obstructing my airway.
Thebastidge (5109f0) — 4/16/2007 @ 6:42 amPatrick,
corwin (dfaf29) — 4/16/2007 @ 6:46 amSorry to read about your apnea,and a few thoughts about help.First,I haven’t read your chart and the proverbial grain of salt is always present.
Sleep apnea can be central(nervouus system) preeipheral ar mixed.I think it’s safe to say yours isn’t central or mixed.Usually apnea is a function of a relaxation of mouth ,neck muscles whe3n you hit rem sleep.Most expert5s-and I’m not one-think it’s the genioglossus that’s causal.
Now,thoughts on thereapy.I’ve done a fair number of the UPP-where you shave the exces off the palate.It’s a quick,simple andpainless-for the surggeon proceedure.I don’t find it works well.It may be my lack of skills,but it’s thge simplest mechanical proceedure I know,so it’s doubtfull.What can you do that actually helps.
First,get a quick allergy test. I recommend a “Multi test”;it costs about $100 and is very quick.If your nasal passages are swollen shut,opening them gives an avenue for air.Secondly,see if a simple Nasal Cannula oxygen does a resonable job of lifting your ox. sat’n.I’ve been surprised how well it benefits my patients.I start them at 1-1 1/2 liters flow.Finally,some of the old tricyclics reduce rem sleep and therefore airway collapse.A good primer on this stuff is from neurology for the non neurologist.If you’d like,I’ll loan you the book.With the usual belief that loaned books aren’t returned.
Best wishes,
Corwin
I was diagnosed with sleep apnea last year. I hated the mask the first few weeks, but gradually got used to it.
Actually, it was worse than hating. During the evaluation in the sleep lab I woke up suffocating. As happened with you, the pressure got too high and I couldn’t exhale against it. It took me a bit to get over that anxiety.
There’s also a couple of tricks. If I climb into bed and I’m breathing hard the mask doesn’t provide enough air (because it’s starting low and building up airflow). At first I just breathed for a minute before putting on the mask. Now I’ve learned how to breath through my mouth with the mask on until I catch my breath.
Someone on my blog recommended the ResMed Ultra Mirage II mask, and that’s what I got. Overall it’s pretty comfy and easy to adjust.
Les Jones (514bb2) — 4/16/2007 @ 6:50 amOh, and I don’t think sleep apnea is a fad. Before treatment I would wake up feeling more tired than when I went to bed. After my shower I’d have to lie down to regain my strength. That doesn’t happen anymore.
Les Jones (514bb2) — 4/16/2007 @ 6:52 amI have sleep apnea as well. You have probably learned by now that there are three kinds of machines: CPAP, C-Flex, and BiPAP. I have the middle one. It is made by ResMed and is small enough to carry with you when you travel. It dramatically lowers the pressure when you exhale. I started with a Res-Med full face mask, but have switched to a Fisher-Paykell full face mask. Insurance carriers will typically pay for a replacement mask either quarterly or semi-annually. If you need to tighten the straps excessively, you definitely have the wrong mask. I have been to a sleep lab twice and am going again in a few weeks. The doc is using a few meds to open my airways better and wants me to use a nose mask as he believes it will fit better and allow higher pressures. I am getting oxygen at 1 liter/min from a concentrator, but the doc wants to eliminate that if he can. In addition, he wants to try a bi-pap machine instead of the C-Flex. I have a lot of experience with this if you want to share info.
Larry Rappaport (531f14) — 4/16/2007 @ 7:03 amAnd to note further – I have a RedMed CPAP and the nose-only solution. I was so tired that I had absolutely no difficulty adjusting – I thought I’d have trouble with the pressure, but I fell asleep within a few minutes the very first night. Now I can’t sleep well without it – when we lose power, I wake up almost immediately.
I used to wake up every morning with a headache and was groggy all day long, and like someone else commented, I’d find myself in a meeting or at home & not remembering how I’d gotten there. That’s gone.
Get the humidifying version of a CPAP – since I’ve gotten it, I _never_ wake up with a stuffy nose, and even though I’ve had a few colds, an Afrin (or Nasoflex) deals with it.
steve miller (0fb51f) — 4/16/2007 @ 7:34 amI had exactly the same problem. I already have chronic sleep issues and even with Ambien and Lunesta my mind was unable to calm down enough with that thing strapped to my face to even think about sleep. Two sleepless nights and it went under the bed. The CPAP made me feel like I was suffocating.
Mitch (353f8d) — 4/16/2007 @ 7:43 amMore comments for Patterico’s Symposium on Sleep Apnea:
1. I have great confidence in the medical information obtained through Mayo Clinic’s website (both for laypeople and medical types). If you look here: *and put sleep apnea in the search spot at top right you will find many articles, including an overview less than 1 year old.
* or is it http://www.mayoclinic.com/
2. The common factor in obstructive sleep apnea is the inability for free passage of air to and from the lungs while asleep. There may be different specific factors of anatomy and other coexistent conditions that cause this to be. Hence, short of a CPAP for both mouth and nose probably no one treatment or operation will treat all (losing weight will not help sleep apnea caused by hypertrophied tonsils, for example).
3. Some factors may be episodic- such as swollen nasal passages from allergies, inflammed epiglottis from acid refulx, or obstruction from your cat deciding to crawl on your face instead of your chest in the middle of the night. (“Just Kidding” on the last one.)
Hence, if someone can’t breath because of allergies, treat the allergies in some fashion first.
4. Other factors may be “permanent” but less complicated to treat- like that deviated nasal septum from that rock. you were hit with when 5 that you don’t remember, or the broken nose in the last physical confrontation. Fixing a deviated septum is easier than a major reconstruction of the pharynx. (H/T to corwin for being straightforward with us).
5. Insurance companies… now you’re making my blood pressure go up. Sometimes “they” will not listen to you unless you have someone stating they are certified sleep specialists telling them what you need (they may or may not tell you this is an issue up front). Different doctors have differing amounts of credentials, desire, opportunity, and resources to fight these battles on behalf of patients. It’s called “the hassle factor method of rationing, I mean “controlling costs”. They may not need a “Sleep specialist”, but need a handwritten letter or signature by a doc giving specific reasons why the high school grad reading the request should allow the doctor to do what they want. Maybe saying if the Ins company still gives grief they will pay attention when you tell them you will ahve your colleague in corporate liability and litigation know about the problem…
(Unfortunately, I have spent more time with the insurance company that with the patient to deal with a matter, and I don’t get to charge the insurance company for wasting my time).
6. “The CPAP machine is not a solution. … it’s primitve quackery- there’s got to be a better solution.
MD in Philly (3d3f72) — 4/16/2007 @ 9:23 amIn the last few months, my condition has even gotten worse to where I feel constriction on my airway while awake. My soft palate just hangs down. The constriction on my airway feels much like when you have a runny nose where mucus leaves a trail down the back of your throat/right where your nasal passages start- you want to ’snort’ it out of the way. In my case, I have that reflex all day long.
Unfortunately, there’s not much I can do about it while I’m here in Iraq,
Comment by Thebastidge — 4/16/2007 @ 12:30 am”
Well, I understand your frustration, but much we do in medicine is NOT “a solution”. We don’t “solve” high blood pressure usually, but hopefully we “manage it” well enough that the person does not suffer from complications of the illness. Managing sleep apnea with a machine is better than an operation that doesn’t work or suffering pulmonary hypertension and dying an early death. That said, surgical cures probably are more reliable now than 10 years ago if done by experienced folk.
Not reading your chart or looking up your nose, even if it is your soft palate causing problems, are there allergies or other factors causing inflammation and swelling that increase the problem. I remember once seeing a patient whose complaint was “sometning is in the back of my throat that makes me want to cough or gag all of the time”. The uvula was inflammed and swollen to the point that it was literally dragging on the back of the tongue. Some combination of treatment for allergies/postnasal drip and acid reflux gave marked relief within a few days.
You could note how much trouble you have sleeping and how distracting it is while awake. Just as a distracted and tired driver has about as much risk at having a car accident as someone legally intoxicated, you could ask your buddies and CO if they like the idea of facing the enemy with an inebriated soldier at their side!!! Hopefully that might get some attention and help for you.
I forgot to add for mitch. While Ambien and Lunesta (especially) are relatively mild, it is generally frowned upon to use any sleep promoting medications for someone who has sleep apnea. Not absolutely contraindicated, especially with milder things at lower doses. But if daytime somnolence and nighttime restless sleep are the issues, often attempts may be made to increase alertness/activity during the day, hoping that improved sleep at night will naturally result.
MD in Philly (3d3f72) — 4/16/2007 @ 9:27 amHave you guys heard about Virginia Tech yet?
Leviticus (35fbde) — 4/16/2007 @ 11:12 amNever mind.
Leviticus (35fbde) — 4/16/2007 @ 11:22 amI hope your treatment goes well, Patterico (and the others with this problem.)
htom (412a17) — 4/16/2007 @ 11:33 amMD in Philly,
Thanks for the info. I have been through the entire gamut of allergen testing. I came up severely allergic to bee stings suddenly a couple-four years ago. Preparatory to seeking desensitzation treatments, I was poked and scratched with every known allergen. Prior to the venom testing stage, I had no appreciable reaction to anything but the strongest dosage, and that was arguably just a reaction of the prick of the needle itself. (Sadly, I had no reaction to any of the commercial venoms available either, so I’m still guessing and a taking my chances whenever bees or scorpions are around.)
I have noticed a very minor change in my breathing after drinking beer, so maybe a minor allergy to brewer’s yeast as I’ve read that many people have, but the difference is negligable.
I did note the lack of solid sleep being more than a cosmetic problem with my ENT doc when I first sought treatment- indeed it was the primary reason for seeking a diagnosis.
At the time, the ENT doc did mention that I have a larger than average uvula and mentioned that reshaping it and possibly removing my tonsils might have some effect and that I ‘seemed to be a better candidate for surgery than most’ but that for what were essentially political reasons behind getting insurance to pay for it, that I would need the sleep study and to use the CPAP for a while.
BTW- I’m not a soldier, just a civilian contractor.
Thebastidge (5109f0) — 4/17/2007 @ 6:36 amTo “Thebastidge”,
Hmmmm,
As I am for exercising all options that I can think of that are “relatively easy”, let me add a few thoughts:
1. If your allergy testing was done in the states and your condition is worse since you’ve been in Iraq, I wouldn’t rule out allergies still, as I imagine there are things in Iraq to be allergic to that weren’t tested in the states (camel hair, for instance!?!?).
2. There is a condition called “vasomotor rhinitis” which has symptoms similar to allergy, but the cause is not allergy.
3. The enlarged uvula makes me keep gastroesophageal reflux on my list of possibilities. Frequent heartburn or chronic cough would be consistent with that. (A chronic cough is usually cause by post-nasal drip, subclinical asthma, or gastroesophagel reflux with night time aspiration.
Things to try
a. an old medication bought without prescription is cromolyn sodium, common brand name in US is “NasalCrom”. It is wonderful stuff, works for me when other things won’t. Whatever side effects it may have I’ve never known anyone to have them. It may not work “immediately”, as it prevents allergic reactions rather than stops them, so it may take a few days before you see the full effect (but I usually do ghet results first day).
b. you could always try Afrin (or generic equivalent), but using twice a day for more than 3 days may get “rebound” worsening (nose gets “addicted” to it). If used only at night can use long term safely.
A medication by prescription in US is “Astelin” for vasomotor or allergic symptoms, can use long term multiple times a day safely. I don’t know if it is available in Iraq. (As you probably know, many meds we need a Rx for in US are OTC elsewhere).
c. For reflux- things like Prilosec OTC and Pepcid-
“H-2 blockers” like Pepcid (famotidine) best taken before bed. Just like OTC ibuprofen, the Rx dose of Pepcid is 4x the OTC, and Rx Prilosec is 2-4x the OTC.
“I’m not a soldier, just a civilian contractor.” Maybe so, and thanks for the clarification, but I’m sure you are doing something important.
MD in Philly (3d3f72) — 4/17/2007 @ 6:31 pmWell, it’s possible that there is something worse in the air here- it IS a filthy place, and the most enlightened form of trash disposal is burning- when anyone can be bothered to dispose of trash.
And I have had a bit of chronic cough- between air quality and a couple pretty severe colds floating around the office, some international travel etc. And even a bit of acid reflux. I rarely get serious heartburn or upset stomache, but sometimes a bit of acid feeling low in my throat.
Thebastidge (5109f0) — 4/17/2007 @ 8:52 pmThebastidge,
I have a friend who served in Desert Storm that now has chronic respiratory problems from contaminants in the Kuwaiti air. In part, this was certainly caused by the burning oil wells but it also resulted from inhaling residue from burning trash, exposure to gases, and other contaminants that you may be exposed to as well.
DRJ (50237c) — 4/17/2007 @ 9:17 pmI’ll “try to be brief” (Ha, Ha.)
To clarify re allergies, the air in Iraq may not be “worse” than in the US, but there are different plants, animals, etc. one could be allergic to, which would not be tested for in the US (not too many camels in the typical US neighborhood).
I would try what I suggested above, including for reflux. The fact that you experience some acid low in your throat is important. (The symptoms not being severe is not as important). In addition to the meds, don’t eat/drink before bed, and raise the head of your bed by 6 inches by putting bricks/books under the legs of the bed. (DON’T use many pillows under your head or put something under the head of the mattress only). If it works let your ENT know for the next patient.
Fight a medical problem like a war, or street fight. Go full press until problem resolves or you are convinced treatment has been long enough and intense enough that continued trying will not be of more help. (No half-hearted attempts for 5-6 days and conclude “it doesn’t work”.)
MD in Philly (3d3f72) — 4/18/2007 @ 4:33 pmTry milk thistle. It helps your liver, one of the body’s main filters, and thus helps alleviate allergies and the bile taste that can be related to reflux.
DRJ (50237c) — 4/18/2007 @ 5:21 pmNot recommended for CPAPs: allowing your two year old to drop soft candy down the hose. It makes the air smell interesting, but you end up getting less of it to breathe.
Xrlq (538859) — 4/18/2007 @ 6:34 pmThebastidge, this might be of interest to you. http://www.gulfwarvets.com/du.htm
blubonnet (8d9f79) — 4/18/2007 @ 7:05 pmBlubonnet-
Depleted Uranium is just that- depleted. The problem with DU is heavy metal toxicity, like lead poisoning, but less likely because DU is very hard- doesn’t get ground up like soft lead does.
DU is less radioactive than background radiation. Don’t buy into DU scares. It’s like rifles with black composite stocks and pistol grips. The word ‘uranium’ is scary, so they hype it as the blackest of all evils.
I do appreciate the advice from everyone tho. I will try the advice on acid reflux.
Thebastidge (5109f0) — 4/19/2007 @ 3:37 amI’d heard that there was a good deal of government cover-up. Or should I say a bad deal of government cover-up. I hope that you are not one to have to endure such horrors. I have read a few articles recently that tell of the great percentage of new cancer rates-tumors and such, and a substantial rise in birth defects among Iraqis and soldiers family new births.
blubonnet (8d9f79) — 4/19/2007 @ 9:06 amThe greatest danger/health hazard from rounds made of DU is getting shot by one. Barring that, there’s really no big issue…
Scott Jacobs (feb2f7) — 4/19/2007 @ 9:38 amRight, like that lead poisoning thebastidge was talking about.
Ooooh! Then it must be EVIL! That bastard Karl Rove was behind it, wasn’t he?
Got links? Were they written by insane people or are they the result of competent research?
Pablo (08e1e8) — 4/19/2007 @ 11:09 amPablo, the above link from my post #57, offers more links, within it. All you have to do is google up depleted uranium, and there is plenty more information. There’s government provided “info” and other info, that says the government is covering up. There’s some pretty grim pictures too in that above link. You decide what is legitimate or not.
blubonnet (8d9f79) — 4/19/2007 @ 7:56 pmI just got one; I was excited about getting this. When I got it, I assembled the device, boiled the mouth piece, and tried it out. At first I thought I was doing something wrong, wasn’t sure I had a good seal. I pushed it up against my face as close as possible and I could still here what sounded like what my facial mask when there was not a good seal. I messed with it for a while and figured out that it was the rebreather holes on the nose puffs. They were almost whistling. If I put my fingers over the holes it seems to work fine. I tried to use it for a couple days but it was just too much to stand. I have not even mentioned the fact that the mouth piece was cutting in to my upper lip. So I call them and they say there is nothing they can do and that not all people will experience the same thing. They said there is nothing they can do and there are no returns or refunds. The phone support guy said that I should get ear plugs… Can you believe that…? They were telling me that it is working properly and I should get ear plugs.
CPAP PRO SUCKS! AVOID AT ALL COSTS! (7f3c5b) — 4/23/2007 @ 6:33 pmI just changed (a week ago)to a C-Flex from a CPAP I couldn’t use because of not being able to fully exhale. It is far superior, but I AM STILL SO TIRED after arising that I am back in bed within an hour. I am still exhausted (and dizzy) all day long. Will I ever feel awake again???
Evelyn (dc5051) — 4/28/2007 @ 9:36 pmWhile this won’t cure apnea, I have found that these easy to do things have helped the air flow.
1) apple cider mixed with water before i go to sleep
2) using a netti pot to clear out sinus passages
sinus problems in atlanta (4f4383) — 9/16/2007 @ 2:27 pmHave had sleep apnea for 20 years and have tried everything. Last year I was diagonised with RLS. I take Requip for that which has been calibrated to be successful at 2 milligrams. My problem is I wake up constantly at night. I use a responics comfort nasal mask. I’ve tried a variety of chinstraps but my mouth keeps popping open. I’m headed back to a full face mask to see if that helps. Sleep problems are like chinese water torture as you know. Every night is a new chapter. Any suggestions would be appreciated. Thanks.
John Pikor (757eff) — 1/22/2008 @ 4:35 amJohn, have you tried a little self hypnosis to program yourself to keep your mouth shut? It doesn’t always work, but it helps when you don’t use a chin strap.
PCD (f14ddd) — 1/22/2008 @ 5:14 amHas anyone had a allergic reaction to a resmed masks such as anger, violent behavior, inability to stay calm? I didn’t have this problem until two nights of using the cpap machine. When I put the mask on I have visual disturbances like flickering lights with my eyes closed. The air helping me breath feels good but I fear I might be allergic to the plastic attachments or face masks. Anyone else or hear of this?
chrisa (7e58fc) — 9/21/2008 @ 10:06 pm