Downstate Medical Center
Wired, masked and ready.
Posted on 08/05/2004 9:24:40 PM PDT by neverdem
CASES
The first thing I did after spending 23 hours in a sleep laboratory was to head for a Starbucks and have a mocha-plus-extra-shot.
It was truly heady - I hadn't felt so alert in years. But over the next couple of weeks, I became obsessed with my lack of sleep. I thought I could hear myself snore, and I would lie awake at 5 a.m., wondering what had woken me up.
The lab, at Downstate Medical Center in Brooklyn, had diagnosed mild obstructive sleep apnea, a condition that blocks breathing and suppresses oxygen levels. In my case, the problem was probably caused by a narrow airway, an oversized uvula, "high normal" weight and drinking alcohol before bed. As a result, I suffered from chronic sleep deprivation leading to daytime grogginess.
Dr. Chun Bai, the director of the sleep laboratory, had advised me to practice "better sleep hygiene." I should drink less wine with dinner, he said, go to bed earlier, use two pillows and sleep on my side. He also told me not to gain weight and to watch out when I drove at night.
I tried all of the above. They helped, but they were no miracle cure.
"Try to get more sleep," Dr. Bai had suggested. Easy for you to say, I thought.
Sleeping pills, Dr. Bai explained, would not be useful. The hormone melatonin, a popular sleep remedy, knocks one out quickly but can fragment later sleep. My problem is waking up too early. Ambien, a drug belonging to the class that doctors call sedative/hypnotics, works better and causes little memory loss, Dr. Bai said. But he doesn't like anyone to use pills for more than a month.
Before the 1980's, the only treatment for severe apnea - used only in the most severe cases - was a tracheostomy, a hole in the throat, plugged in the daytime to allow speech and unplugged at night to allow breathing. Some tradeoff.
But people like me, who have mild cases of apnea, now have choices, Dr. Bai said. There are dental appliances that pull out receding jaws. But I have a prominent jaw and already wear a plate to stop my nocturnal tooth-grinding. There is Vivactil, an antidepressant with a mysterious side effect: It stiffens the pharynx muscle that snoring sets abuzz. But I don't want to spend my life on an antidepressant, and its other possible side effects include nightmares, heart palpitations and black tongue.
There is also surgery, by scalpel or laser, to shave down the uvula and pharynx. But it is very painful, often doesn't work, produces unpredictable scarring and may force patients to learn new ways to pronounce words or even to swallow.
By far the most popular treatment is a continuous positive airway pressure, or CPAP machine. The machines cost from $700 to $2,000, but insurance usually pays for them because that's cheap compared with an apneic stroke.
My first night in the sleep lab, I met two patients devoted to the machine. Fernando Lopez said his had given him a "whole new world."
At 250 pounds, up from the 118 he weighed as a teenager, he said, he thrashed all night, snored like a bear and dozed so much at work that his supervisor told him off. On the machine, though, he woke up refreshed with the coverlet unmussed, he said.
Deborah Wood said she had spent her lab night lying awake in terror. Because the doctors needed data to readjust the machine she had used for five years, she tried to sleep without it. But ever since a friend died of apnea, she said, she was "very paranoid about sleep if I don't have my CPAP."
Intrigued, I returned to the lab for a second night. My scalp, cheeks, chin, chest and legs were again wired with electrodes that sent my brain waves, heart rhythm, eye movements, breathing and snores into a computer across the hall. Then the mask was added.
I hoped I would look kind of cool, like Tom Cruise in the cockpit in "Top Gun." Instead, with the mini-vacuum hose hanging off my schnoz and its brace on my forehead, I looked like the bounty hunter Harrison Ford shoots sub rosa in the "Star Wars" juke joint. Very sexy.
The mask, of meltingly soft plastic, formed a tight seal over my nose. Breathing was like scuba diving, but with an aqualung that wanted to supercharge me. If I opened my mouth, cold air burbled out.
Once again, I had no trouble falling asleep. The machine was no noisier than a computer. I've heard louder purring from cats. I remember the night as fitful; I woke up at least three times to check my watch, and I was half-awake and drowsy when I was rousted at 6 a.m.
Nonetheless, Dr. Bai, reading the computer later, said my first date with the machine had gone very well. Many people sleep only three or four hours the first night. And claustrophobics, describing a sense of being in a cave or buried chest deep in sand, often give up completely.
The mask definitely disturbed my sleep, he said. I woke up eight times, sometimes for 20 seconds. And I hardly fell into deep sleep at all. Only 6 percent of my night, according to my electroencephalogram, was in slow-wave sleep, while 20 percent was normal.
I would be tired that day, Dr. Bai said, and he was right. But I had still slept, albeit lightly, for 91 percent of my allotted seven hours, which is high "sleep efficiency." I didn't jerk or kick at all. And, most important, only two brief arousals were due to sleep apnea. The last time at the lab, I'd had 57.
Once the machine's pressure setting had been raised to 5, from the minimum 4, out of a possible 20, my snoring had disappeared and my blood-oxygen saturation rose to 94 percent, just a shade under what it is when I'm awake.
"If we ordered a machine for you, I'd set it at 6," Dr. Bai said. "After a week, you'd get used to the mask. You'd be sleeping like normal. And 94 percent oxygen - you'd feel the difference. Your brain and body will rest better."
I'm not ready for the machine yet. Even the most appealing sales brochures make it look like someone in bed with you would awaken to a vision of Jacques Cousteau's death mask. What I should do is to redecorate my bedroom to resemble a sleep lab; I got two extra hours there each time, maybe because of the blackout curtains. And just in case my sleep hygiene breaks down, it's comforting to know that CPAP is still out there, a sort of teddy bear for sonorous old gits.
Downstate Medical Center
Wired, masked and ready.
ping
So that's what I look like when I go to bed at night -- only thinner eyebrows and more hair.
I love my CPAP. Just started using it a few months ago. Wonderful.
LOL
The technology keeps getting better. The new machine I have is much smaller and quieter than the one I first got six years ago. The mask is lighter, fits better, and is less bothersome.
I have mild-moderate (not severe) sleep apnea. My hunch is that the condition is much more common than just those who have been diagnosed for it. It is especially common among middle-aged men who are even a little bit over their ideal weight. (I had it even when I was in my 30s and in real good shape.)
If you or your wife think you might have sleep apnea--you snore a lot and loud, you stop breathing periodically and then resume with a "snort," you feel tired and nod off during the day--I recommend that you get thyself to a sleep clinic and get tested.
I'm on night two of a home CPAP test ordered after my night in the lab last week. I woke more tired than I had hoped, but I did seem to have a bit more energy today. I am still witholding judgement.
It should be noted that *severe* sleep apnea can be *fatal*. I'm serious. Lots of men who die in their sleep have had a heart attack or stopped breathing because of sleep apnea.
Also, if you find your throat and sinuses are dry in the morning, make sure you get a humidification chamber for the air to pass through. That can really help.
I have been using a CPAP machine for 3 years now. Was always tired but now I get up with more energy than I have for years.
I had a hard time adjusting to the mask at first. For me the key was to use cool humidification. I was used to sleeping on my back too and that had to change, but it was worth it. The morning after my first good night using the mask I felt so incredibly awake. I litteraly didn't know what I was missing out on before
There are other options to the mask now, like this new item:
from http://nomask.com/
or
from http://www.cpapman.com/
Apnea can cause a lot of medical problems. Weight gain, heart failure and more. Several kids diagnosed as ADD actually have apnea or other sleep disorders. Don't ignore it.
I always wished someone made a Darth Vader styled mask. :)
I brought them along for the next post-op and Dr. Riley examined them, then recommended they have sleep studies too. Those showed upper airway resistance syndrome. They were twelve years old. I had brought along a book of the family history, with photos up to 120 years old. The sleep specialist looked at those, asked about my father's relatives and heard of their heroic snoring patterns, etc., then said that my father's line had a hereditary narrow jaw shape (obviously true from the album), and said my sons would develop disabling sleep apnea before they were 30.
That caught my attention big-time.
So I spent the next six years preparing for a death match with my HMO. I'm an attorney of the type known as "litigator" and knew just what sort of medical record to build for the surgery they would need when they reached adult height and their jaws were no longer malleable.
Then my surgeon's new partner called and said there was a new, less gruesome and arduous surgery to cure sleep apnea - one developed from children's orthodontia. Instead of lengthening the lower jaw (almost an inch in my case), it just widens it at the back. The orthodontia concept was to make space for teeth when a child's jaw is too small for all his/her adult teeth. That works just fine too for obstructive sleep apnea victims when the problem is that the rear jaw is so narrow the tongue tends to slop back into the airpath during sleep when muscle tension relaxes.
So I had it out with my HMO when my sons were seniors in high school, and won because their house doctor told them they were nuts based on the medical record I had developed over the years. Among other things I had paid for CPAPs and sleep studies for both of them from my own pocket, then fought through their administrative process to win reimbursement for that $8,000. They knew I'd do it again for $20,000+ of surgery, and that ERISA wouldn't protect them from a damages claim as I'm a government employee.
My sons had the surgery to protect them from full-bore sleep apnea, which seems to have entirely cured all sleep disorders, the summer between high school and college.
I thought there already was a machine for sleep-it was called a John Kerry speech.
At what point do they say that you actually have Sleep Apnea? I had a sleep test done and was told I quit breathing 6 times while sleeping for almost a minute each but I didn't have sleep apnea... anybody know?
"Sleep Apnea - cessation of breathing for 10 or more seconds during sleep"
Looks like you have it.
.."At what point do they say that you actually have Sleep Apnea? I had a sleep test done and was told I quit breathing 6 times while sleeping for almost a minute each but I didn't have sleep apnea... anybody know?"....
My husband was recently diagnosed with severe sleep apnea and he quit breathing 404 times during a 6-hour "sleep" period.
He usually wakes up in the morning and goes straight to the recliner to take a nap.
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