PutSleepApneatoBed

CBT won’t do a thing for insomnia if the cause, as in my case, was the inability to maintain REM sleep due to an AHI of 83 during REM. Neither, of course, will sleeping pills.

In fact, when sleep docs were asked about sleeping pills at a national sleep meeting, the advice was that no one with an unknown sleep status should ever take sleeping pills. Why? Because, in people with sleep apnea, the only thing that keeps them alive is that they DO wake up to breathe. There are reasons why the death rate in people on sleeping pills is 5X normal.

Shaji- There can be a relationship between Sleep Apnea and GERD. When an apnea occurs, your throat muscles lockdown and inspiratory efforts create a vacuum that can suction stomach acids up into the throat. As you might guess, that can be very irritating, hence the choking or coughing.

Have you been diagnosed with Acid Reflux/GERD? That choking event sounds as though it could be a symptom…

There are problems in the Sleep Medicine Field wrt to Diagnostic Standards and Treatment Criteria.
Simply put, AHI is a crude and inaccurate a measurement tool. Plus, patients can have a deceptively low overall AHI and yet still have a very high AHI during REM sleep, even to the point of being unable to sustain REM sleep, which can have devastating cognitive impact over the long term.

Even the criteria for determining the number of apneas is problematic. Most insurers require that an apnea last 10 seconds or more, but that standard was developed in men. Women and children will often have shorter duration apneas, and hence their apneas may be undercounted.

Similarly, some insurers/labs require a 4% O2 desaturation rate, while others will accept 3%. Many fewer people will be determined to be positive for Sleep Apnea at the 4% desaturation requirement, notwithstanding that they are still having many respiratory arousals. And again, women and children may be under-diagnosed because they tend to desaturate less.

These are important policy issues because they determine whether insurance will pay for testing an treatment and financial considerations can often be a major hurdle to achieving treatment.

Better, clinically outcome oriented criteria, are urgently needed. Accordingly, there are studies underway to measure the cardiac impact of apneas and determine whether better diagnostic and treatment criteria can be developed based on those measurements.

Have you run into problems related to diagnostic criteria or standards in being diagnosed or treated? If so, were you able to work around it and achieve successful treatment?

Morning headaches can be the aftermath of low O2 episodes during the night (caused by, e.g., still having lengthy apneas or sleeping at high altitude without added O2.) Another possibility is headgear pressure points which can be remedied by adjusting your current headgear or switching out your headgear for a different type.

Impressive, Sierra! Is your day job as an engineer, physicist or science teacher?

Dear BUG:

I don’t think it was a placebo effect, but rather what, for lack of a better term, I’ll call the law of diminishing returns. it’s analogous to the answer I gave above to cpapuserbuttired re his PAP treatment.

When your testosterone level was so extraordinarily low, the impact of elevating it from, say, 2 to 10 points would almost inevitably be more dramatic than the effect you would feel subjectively in increasing from 10 to 20. The very first few points of increase were remedying a dramatic deficiency. You would expect dramatic results—-not so the subsequent increases.

Dear BigUglyGremlin (or may I call you BUG? 😉)

I have, thankfully, no personal experience with RBD, (although my poor Dad had such a bad case that he and Mom had to purchase a California King and Mom had to sleep facing away from him to avoid getting slugged inadvertently.)

However, there is someone on our Board at the Alliance of Sleep Apnea Partners (ASAP) who does. This gentleman has a rather dramatic history with RBD and was recently telling me about the medications he takes for his RBD which he feels are really helping him. I will ask him to post here and tell you about his experiences…Also, he has been participating in a lot of clinical research studies on the subject…

Sometimes, the relief during initial treatment from burden of life long exhaustion can be pretty dramatic. Mine was. But then, after a while, the slope of improvement tapers off. You may not be back were you were, but you may also no longer be feeling the major difference from your pre- treatment life. So, your sense of backsliding may be subjective. Another possibility: you may be experiencing mouth leaks or other leaks automatically raising the pressure on your APAP. That happened to me and I felt as though I was trying to exhale against a hurricane, and that in and of itself, was awakening me. A chin strap solved the problem, until I could learn to keep my mouth shut, which other patients assured me I would eventually be able to do. (They were right.)

Cpapuserbuttired: Are you having trouble exhaling against the higher pressure level? R U using Exhalation assist? Also, if the exhalation pressure is a problem, a BiPAP might help...for a lot of people however, exhalation assist helps.

One other thing: I’ve found that some formulations/strengths of melatonin leave me feeling VERY hung over and “drugged” in the AM. And I have avoided Valerian because it is not necessarily good for the liver, OSA and DM2 are already hard on the liver….