The Search for Cures

SLEEP APNEA (SLEEP APNOEA)

What is it?

Sleep apnea is a debilitating condition that affects an estimated 10% of the population.

What occurs is that the airway of the sleeper collapse, usually when the soft tissue in the rear of the throat collapses and closes during sleep, blocking off oxygen. Once the brain registers that the body's oxygen level has fallen, it wakes the sleeper up to a level where they start breathing again. This can happen consistently (as much as every minute) and when the sleeper awakens, they will feel as tired as when they first went to sleep. The long range effects of this can be quite devastating on the person's life, ranging from loss of productivity, falling asleep unexpectedly, stroke, clinical depression.

Is there a cure?

Though there is treatment, I've found no cures, hints of cures or even mentions of it in any kind of alternative treatments. I find this curious within itself and wonder if it's a recent condition, or if it simply was never recognized before. As I have this condition myself, this one is of particular interest to me.

Recently, having joined a gym, the owner mentioned that working out helps apnea sufferers. I'll be testing this out. :-)

SYMPTOMS:

Loud or heavy snoring:

This is a major warning sign. The louder the snore, the more likely the snorer has apnea. Snoring has generally been made light of, and pretty well trivialized by such things as sitcoms, etc. Snoring can also be loud enough to wake up the sleeper, and just as bad, wake up their partner, too.

Tiredness or sluggishness during the day:

If, after a good night's sleep, you still feel tired and have trouble going, it might indicate interrupted sleep due to apnea.

Person is able to fall asleep at anytime:

If you can nod off, no matter what time it is, and still feel tired after a nap, it might indicate apnea.

Waking up choking:

If you ever wake up without being able to take a breath, it can be traumatic, not to mention a it being a symptom of apnea.

Poor memory and lack of concentration:

Not only due to lack of sleep, but also can be due to lack of oxygen while you are sleeping

Frequent trips to the bathroom at night:

This might not be due to a weak bladder. It can also be a symptom of apnea.

Depression:

Clinical depression can be a symptom of sleep apnea. Lack of sleep can really throw your emotions into flux.

If you are suffering from clinical depression, I have found the Bach Flower Remedy, Star of Bethlehem to be of invaluable assistance.

I might have Sleep Apnea! What do I do now?

Sleep apnea is very difficult to diagnose yourself, and is typically done by a partner. I, myself, suffered from it for most of my life, and certainly increasingly badly for thirteen years. (circa 1987) I didn't realize just how serious it was. My wife noted that I stopped breathing from time to time, but I only thought it was once in a while. It wasn't until I woke up choking that I decided it was time to visit a doctor. I was referred to a specialist, who booked me in for a sleep study. I was diagnosed as having moderate to severe apnea. I stopped breathing 14 times an hour and woke up 30 times an hour on average.

If you suspect you have apnea, the first thing to do is go to your doctor and tell him your symptoms. He should refer you to having a sleep study done. This is normally done overnight in a hospital. About a dozen or so wires are attached to you to monitor such things as sleep patterns, oxygen levels, movement, etc. The results should indicate how well or badly you sleep.

If you go the doctor, and he doesn't want to refer you, then you should insist or go to another until you find one who will. Knowledge on sleep apnea is still relatively new, and not all doctors are educated about it.

In Australia, I went through the public hospital system. A process which was extremely slow. My initial appointment took 2 months. The sleep study then was booked for in another 9 months. I was lucky that there was a cancellation and I got in within 2 months instead. My next appointment was in another 2 months, making it almost 6 months since I began. And this was the hospital with shortest waiting list! I don't know what it's like in other countries, but if you can afford to go private, it's worth doing. Especially if you are chronically sleep deprived.

Known treatments:

CPAP /nCPAP (nasal Continuous Positive Air Pressure)

This is a mask that fits over your nose and is connected via a tube to what essential is an air compressor. The correct air pressure will act as an air splint and keep the air passageway open during sleep. It's not as if, though, the air is rushing in continuously. When you breath out, you breath out normally. It's just like breathing normally, except there's a little more pressure there. CPAP takes a bit of getting used to, but if you can learn to tolerate it, it can give you a new lease on life. The way I got used to it was a little at a time. My doctor considered my apnea serious enough to advise me to go right out and get a machine instead of waiting for the next sleep stud, which was 5 months away. (Apparently they get you in quicker the second time.). The first night was rather difficult as my mouth kept on falling open and the air tended to rush out my mouth rather than down my throat. I countered this with a chin strap, which effectively kept my mouth closed. Initially, I was only able to use it for two to four hours a night. It took around 3 weeks for me to get used to it, but once I did, it became almost second nature to wear the mask. There is the psychological impact of the mask, too. Many are said to have trouble adjusting to wearing it. I got past this by looking at the mask as something that would give me a superior's night sleep as compared to the average person. (Whether this was true or not wasn't relevant. The important thing is that it helped. I do note, though, I now need less sleep than my wife!)

Nasal Pillows

These are the alternative to the mask. They are nose plugs which deliver the air right into your nose.

Mouth Splints:

This is an alternative to those who find the CPAP too intrusive or unbearable. This is like a mouth guard that helps bring the chin forwards and opens up the airways. It is fitted by a dentist and cost can vary from AUD300.00 upwards depending on how much adjusting is needed. I spoke to someone who had it done, and though it helped, he said he chewed through the device in four months. Something to consider when looking at this option.

Surgery

Said to be very painful and only moderately successful, and only for a limited time.

Chin straps:

They are made of cloth and made to fit your chin. They are held in place by a Velcro strap.

Though they can be useful for keeping your mouth closed, they can also have the opposite effect of forcing your mouth open with the pressure.

I've stopped using mine for that reason. I find if I can make my lips tacky, they tend to stick together during the night and so I don't have as much leakage.

Sealing the mouth:

Chin straps are inherently flawed as they can also push your mouth apart while you sleep.

The other problem is that pushing up on your chin will not seal the lips. I've always felt that the key to mouth leakage was to use some kind of gummy sealant that would be easy to remove at a moment's notice, but seal the lips effectively while you sleep.

Fortunately, Listerine came up with an answer, though the intended use was for fresh breath!

I've found that you can effectively seal your lips together with 'FreshBurst® Listerine Pocketpaks oral care strips'

I tear them in half and put a piece each side of my lips. I moisten them and this provides a great seal that normally lasts the night.

There can be a intense sensation of heat to start off with, but this disappears after a few minutes and after a few nights, you don't feel it any more.

What to watch out for.

Emotions

Coming out of being sleep deprived can cause severe emotional strain on your feelings. If you were clinically depressed, that is, not feeling much of any emotion any more, you might well pass through a period of highs, lows and depression. In my experience, this is something the specialists don't warn you about, but probably should. This flux is said to last up to three months and is normal and a sign that you are getting proper sleep. It can be very difficult period, not to mention frustrating.

Health

You may also find you're suddenly getting sicker than normal as your body starts to adjust to proper sleep, oxygen and rest. I found that I caught colds, had high blood pressure, even my liver seemed to have problems. But they did settle down after a few weeks.

Different Models of CPAP

There are plenty of different models on the market. Some have more features than others, but basically they perform the same function; to blow air through your nose. Cost: : I've found that in this country (Australia) the cost can vary from $1000.00 to $2500.00. It seems to be a general policy that the company will rent you the CPAP for two months. If you decide to buy it, they will deduct any rent and deposits from the cost. You are also up for the cost of the connecting hoses, head straps and the plastic nose mold. They are hideously expensive and non refundable. Mine cost around AUD160.00 Do not assume that all machines cost the same or that the more expensive ones will have better features.

I made that mistake initially when I first got mine. Because I was so exhausted, I went to the closest place without doing any checking. I was able to rent a machine on the spot for the cost of $30.00 a month for two months. When I asked about the price, I got a vague figure of AUD1200.00. They mentioned it could be paid in monthly installments over a year. Two months later, I found that CPAP had changed my life around and I rang to find out what was involved in purchasing that model. I found the cost was AUD1590.00, which was going to hurt. When I asked about the payment plan, they said that it had been recently abolished by new owners and it was now cash up front. I found it amazing that a company could resort to such extortion. For many apnea sufferers, CPAP is as necessary for their health and quality of life as insulin is to a diabetes sufferer. The ethics of such a company leave me speechless. However, for me, it worked out in my favour. No longer sleep deprived, I was able to make several phone calls and discovered that not only had I picked the worst company, but I had also picked the most expensive one, too! I ended up going the same day to a local Chemist, Pymans Pharmacy, who happened to have a Fisher and Paykel model with a built in humidifier on special for AUD795.00. It was also much quieter than the other model CPAP I previously had. Also, the service, care and flexibility was in complete contrast to the other place. So, before you buy, shop around.

There are so many different models with different features and noise levels that it's worth trying one or two to see how you adapt to them. Correct pressure: Normally you need to go in for a sleep study so they can set the exact pressure for you. That's not always practical due to cost, waiting lists or the fact you're just renting a CPAP to see how you react to it. The pressure is provided by the specialist and is preset by the vendor. I was lucky with my first machine as the pressure seemed to be almost right, and I got some decent nights sleep. The second machine, though supposedly set to the same pressure of eight, was set a lot lower.

Symptoms of incorrect pressure

Despite the fact that this one was quieter and has a built in heated humidifier, I was experiencing a different quality of sleep. I would wake up constantly with a dry throat, I had the constant need to go to the bathroom. I also had restless sleep. Even though I seemed to getting some decent sleep, I found that gradually I was becoming more sluggish and my emotions started to decline once more. A sleep study will set it correctly for you. It's important to mention this, though, because if I had had the second machine first, I would have been deceived into thinking that CPAP wasn't making a difference.

If you are trying out CPAP, and you find that it's not working for you, make sure that the pressure is correct before you give up.

Autopaps:

One way of getting the correct pressure is by using an Autopap. There are several models on the market and are incredibly expensive. Not all will work for everyone. As always, try before you buy.

I use an Autopap-T. It cost me AUD2500 and thanks to a promotion at the time, it came with the latest ultra mirage mask. This machine adjusts its pressure on a 'breathe by breathe' basis. When it detects snoring or an oncoming apnea event, it will increase the pressure until breathing is normal once more. After twenty minutes, it will gradually decrease the pressure. This ensures that you will get the best pressure during the entire night.

There is also software available which will show a basic summary of data on your pressure, hours slept, apnea events, etc. Very useful information if you like to monitor your progress.

Update: There are now many more models on the market which are not only cheaper but are compact and lightweight. Things are finally starting to become more competitve.

When autopaps go wrong..:

ResMed are the makers of the Autoset-T, and claim that their machine is designed to last for years with a minimum of service. When it starts up, it does a self diagnostic test to see that it's working right.

However, I found that mine failed after nine months. One night I went to sleep, and noticed that it wouldn't start up automatically, and when I got it going, it would die on breathing out and pick up on breathing in. I returned it to the store I bought it from, and they replaced it with a temporary one while they sent my one off to be examined.

The worrying thing was that the self test program showed everything was working fine, but the pressure was showing as 7 when it was actually 4.

I wasn't very impressed, though, with the attitude of the person who I dealt. She went as far to say that I had probably caused the problem by using the software on my P.C. As a person who has been in the computer field since 1982, I know enough to know that there was nothing in the software that should have damaged the hardware, and if the software did damage it, then every doctor that ever uses it will run the risk of destroying this machine. It is my suspicion that my machine had been failing for a long time. My software showed constant apnea events and I had been once again getting the symptoms of apnea.

Also when I first got it, I found there was a whirling sound when it was starting up. Something the replacement machine doesn't have. I am still waiting for the machine to be returned and despite the attitude, am grateful that they have supplied me with a replacement.

Two months later, I finally got my own machine back. With it came a vague report of it being upgraded to new software. It seemed to be working alright, however, it was making a whirling noise. This got worse over time, bad enough so that it would be penetrating enough to wake me up. Then one night I heard a rattling noise, and so I returned the CPAP for repairs once more.

Nearly three months later, I got it back. This time they had replaced the motor, and kept the other one for investigation. The difference was immediately apparent. This motor is so quiet that you don't even know if it's on. If there's any noise coming from your autopap, have it investigated. It's not meant to make any noises. It's worked fine ever since.

The Mirage Ultra CPAP mask:

CPAP masks are not the most comfortable things to sleep with, and though you do get used to them, they are also somewhat restrictive. The mirage ultra is an enormous step forwards for comfort. The connecting hose swivels in two different directions, making it less intrusive and more flexible. The air flow from the mask is now directed to the connecting tube, so you rarely feel the rush of cold air on yourself or a partner. The mask itself is secured by a plastic clip and rarely comes off accidentally. The design it more friendly to fitting your face and the top support is easily adjustable and puts less pressure on the eyes. If you can afford it, I'd recommend it.

Update: 12th October 2005

I've just purchased the Mirage ACTiva ™ Nasal Mask. At a cost of AUD276.00, you'd expect this one to be very high quality, and so it is. I believe that CPAP masks and machines are outrageously priced, however, if you are going to pay for them, then it's worth getting the best you can get. While I was more than happy with the Ultra, it does have a lot of moving and breakable parts and can be a frustration when leaks occur, or you're trying to clean or put it together.

This mask has less breakable parts and comes apart and snaps together without any real problems. The biggest advantage, though, with this model is that due to a ballooning action of the nasal part of the mask, it takes very little to seal in the air and thus prevent leaking. This means you can make the straps much looser and also prevent that annoying redness that will show up on the bridge of your nose.

You can find more of ResMed's products at www.resmed.com

A cure for apnea?

It is claimed that a gastric bypass will cure sleep apnea in overweight patients.

I've not had an opportunity to test this, but I've been told that a product called 'Niteworks' cures apnea.

Personal observations.

I've noted the follow things since getting a CPAP.

• If the pressure isn't close to right, you never quite regain your alertness. The sleep specialist said this happened with some people, but they didn't know why. I would suggest it's due to incorrect pressure settings. My sleep specialist admitted that even with the sleep study, the correct pressure was still mostly guess work.
• 
  The liver seems to play up more when you get your proper oxygen while sleeping. Don't ask me if this is due to proper sleep, but both times I got the pressure correct, I suffered from jaundice. Tests had shown I had a fatty liver, and I suspect that proper sleep affected it in some odd way.

• It can take weeks to make up your sleep deficit. Sadly, this doesn't happen overnight. Seems that short burst of sleep can often be more effective than long periods of sleep.

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