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CPAP is not the solution

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PioneeringTanPorpoise7797 +0 points · 22 days ago

Back in the seventies while finishing a routine annual physical with the campus physician I mentioned that was I tired all the time, from morning to evening, and couldn’t figure out what the problem was. The doctor appeared offended by the question, and said dismissively, “Well, maybe you’re depressed.”

That ended the conversation. I had to admit, I was depressed and tired, but was the weariness because of the depression, or was I depressed because I was tired? College had been a struggle. Staying alert, much less awake, in class while taking notes was all but impossible, and studying in the evenings became more unendurable with each passing year.

Over time, I had deployed a broad spectrum of solutions to combat the weariness including caffeine, sugar, naps, exercise and benzedrine, eventually settled on an hour of so of daily vigorous exercise and marijuana to get through the day. Endorphins from running and cannabinoids lifted my generally depressed mood. It helped, but it wasn’t enough; the fogginess, sense of being overwhelmed, irritability and depression remained. My human relationships were invariably rocky, and my grades were lackluster.

After college, my performance at work was tepid, and the daily weariness didn’t go away. I coped by getting through the day as best I could on caffeine and frequent walks around the office, then crashing on the couch immediately upon returning home. In my late 30’s, my blood pressure became high enough to warrant prescription drugs, despite relentless daily exercise. Thus began about twenty years of an annual increase in the strength and diversity of my blood pressure prescriptions. At the time, I was about 15 pounds overweight, otherwise in generally good shape, and was capable of running 10K’s and half marathons.

My diet seemed reasonable. I was aspiring to vegetarianism with varying degrees of commitment, but had an attachment to dairy products. At the onset of the blood pressure problem I considered whether salt consumption may be the problem, but since I never added salt to meals it didn’t seem a probable cause. The doctors suggested the high blood pressure was probably genetic.

At an annual checkup in the late eighties, talking with the doctor as usual about my blood pressure, I repeated the question, “Why do I always feel so tired?” This time, the doctor prescribed a sleep study. I was quickly diagnosed with sleep apnea and prescribed a CPAP machine. I used the CPAP for about twelve to fourteen years and it helped, but a stubborn blockage persisted in my sinuses, restricting the flow from the mask. I felt a bit more alert during the day, but my blood pressure remained high, and the weariness remained. By around 2010, I weighed about 192 lbs with a BMI of 28.2. By this time, I was taking about six blood pressure pills a day, including a potassium supplement. I was unemployed and building a house and my diet often featured pre-made convenience meals. At times I was only able to “sleep” lying in a recliner with a CPAP.

One afternoon while wiring the house, I caught the tail end of a story of a salt study in Finland on the CBC program “As It Happens”. The bottom line of the story was that after achieving a 30% reduction in dietary salt intake, the number of strokes in the study province dropped 90%, which of course made the study newsworthy.

That evening, I looked more carefully at the labels on the food packaging, and realized the quantity of sodium listed was just for a serving, but servings are often tiny. I still had no idea what normal was, or how to cope with the daunting and exhausting tedium of sitting down with a calculator to figure out how much salt I was eating before every meal.

Instead, I made a dinner from scratch using only foods I knew didn’t contain salt. Eliminating salt from food happily leaves only healthy options generally consisting of fruits, vegetables, pasta, oatmeal, and unprocessed meat and fish. The next morning after my first salt free meal, my blood pressure had dropped significantly, so the experiment continued.

Within a few days, my blood pressure had dropped dramatically, to the point it was difficult to get moving during the day. After a phone consultation, my doctor said it would be okay to start reducing my medication, as long as I was very, very careful and kept monitoring my blood pressure. About two weeks into my new diet, and a few miles into a bike ride my nose unexpectedly started to run, something that virtually never happened. I stopped and cleared my sinuses, and was amazed at how open my nose felt; I was breathing unimpeded through both nostrils. That night the CPAP was intolerable because so much air was forced into my lungs. I turned it off and haven’t used it since.

At the end of the month, I visited the doctor again. With no drugs my blood pressure was 130/90. Except for the fact that I am now old, the past eight years have been remarkable. For the first time I can remember, I wake up easily and have no desire to return to bed, though it’s not unusual to take a nap if the feeling comes. The foggy “bugged” feelings, irritability and moodiness have waned over the years, but the habits acquired over decades to compensate for weariness die hard. Only recently have I started waking up and not automatically rolling over for “ten more minutes”.

I still take two blood pressure pills a day (lisinopril and chlorthalidone) along with a potassium supplement, but my pressure is easily managed as long as I stay away from salt. I still eat salt in the form of occasional restaurant meals, a bit of cheese and french bread, but all in moderation and I try to keep my daily exposure under about two grams. The only practical way to achieve this is buy cooking at home. A recent study (https://medicalxpress.com/) said Americans consume about 9.6 grams of salt a day. It seems that as long as the base load doesn’t build up, things are better, but no salt is always better than a lot.

I often wonder how many others out there have the same problem. My past is littered with dropped balls, failures, and at best mediocre performance in life’s activities. I remember tantrums and arguments I caused simply because of my exhaustion. I am sensitive to salt, but I’m sure that not everyone with sleep apnea has the same problem. Nonetheless, the cost to our society by ignoring this problem becomes more and more apparent with each passing day. Investigations into two train wrecks in the past few years found that both engineers suffered from sleep apnea.(https://www.cnn.com/) At least in the case of salt, the solution appears very straightforward, and will no doubt be opposed by the “food” industry. At some point, society will have determine if the economic benefits are not outweighed by the chaos it causes.

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Biguglygremlin +0 points · 17 days ago Original Poster Sleep Commentator

Brilliantly written PioneeringTanPorpoise7795 and quite inspiring.

It certainly provides food for thought or at least thoughts about food. :)

It seems to me that we are very complicated and frail organisms trying to survive in chaos.

There are patterns in the chaos but are they real of just coincidence.

It seems to depend on predictability for any real confirmation.

I wonder how many others have similar experiences.

I'm certainly a prime candidate for the salt issue because I switched from tea and coffee to diluted cup a soup.

We all react to stress and distress differently but it almost always impacts badly on our eating habits.

What do you think was the link between blood pressure and apnea in your case?

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Sierra +0 points · 17 days ago Sleep Innovater

Yes, it is easy to get too much salt. I never add salt to my food, but as you mention others like manufacturers of prepared food love to add it. It is a cheap flavour enhancer. The lisinopril is a pretty common blood pressure ACEi drug that works by relaxing the blood vessels and hopefully over the longer term reduces the hardening of the arteries as often happens with age. I have taken ramipril for 20 years and more recently the newer perindopril. The chlorthalidone is a water pill and will reduce sodium. They are generally pretty save but you should get periodic checks of your sodium and potasium levels to be sure they are within range. My mother takes a similar drug and ended up in the hospital emergency with low sodium. She was avoiding all salt while taking a diuretic type drug. I took a diuretic for a while too, indapamide, which worked well for me, but I am no longer on it. There is actually one newer drug brand named Coversyl Plus which is a combination of an ace inhibitor and diuretic, in this case perindopril and indapamide. It was developed in Australia, and the combination is claimed to have additional benefits, especially for diabetics. If you are paying for your drugs, it is cheaper to buy the two drugs independently as generics though.

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Ruby +0 points · 17 days ago Sleep Commentator

A great post! There are so many simple things that can affect our moods and health in general. My blood pressure is quite good but there is no doubt that I should cut down on my salt intake anyway. It seems that moderation is the key in so much that we do, eat and drink. I love wine but can no longer drink even a glass without it causing my Restless Leg Syndrome to get worse. I will never be a vegetarian or vegan but need to eat more fruit and veggies and less meat and carbs. CPAP can help with sleep apnea but so can certain lifestyle changes (maybe not as much as CPAP). We should be better at taking care of ourselves but it is hard when the things that can hurt us are often so pleasurable. I'm talking food here, okay? It's been cloudy and rainy here for so long and it seems to truly affect a lot of people, including me. Not much I can do about the weather as I don't know any sunny dances but I think we do need to be aware of the things that affect us either good or bad.

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