Sleep apnea

[Simaril]

I'm not a real pilot, though I play one on the internet....but I AM Board Certified in Sleep Disorders Medicine, and I'm medical director of our sleep laboratory. I've treated sleep disorders for about 15 years. So here's a viewpoint from the medical establishment side of things.


First, if it were me, I would want to be absolutely sure the diagnosis were right, and that means a sleep study. Home sleep studies are not reliable enough to be real substitutes, though they can be used to screen -- if they are completely negative, you're in the clear, but if they are positive then you have to get a monitored study to document severity and to get the right treatment level. Although modern CPAP/BiPAP is much less of a problem than it used to be, it still isnt something you want to do if you don't have to . Monitored treatment studies allow the technician to adjust the pressure real time, which is important because too much treatment pressure can be miserably uncomfortable, and too little will allow symptoms -- and damage -- to continue. Also, at our lab we have almost a dessert tray with different styles of masks. Some cover the nose, some the nose and mouth, and some just fit in the nostrils without covering anything. Here's a really popular one right now

If it were me, I would not trust the internet for diagnosing or treating a problem this serious. The home test with internet prescription is....unwise. The docs writing those scripts cannot have your best interest in mind, since there's no hint of individual attention and care.





Here are some quick screening questions:

1. Do you snore? Snoring is NEVER normal, since its the sound of air flowing through a tube that's too narrow. (Just like the rude sound you get when letting the air out a balloon's mouth.) People who snore also have higher blood pressures, and higher risk of heart attacks, than similar people who don't snore. This makes sense because the stress of working to breathe through a narrow passage gives you higher adrenaline levels all night long -- and those levels may persist through the daytime.

2. Do you feel rested after sleep?  Sleep that does not restore you normally is abnormal. Snorers who have nonrestorative sleep after getting enough time in bed are likely to have sleep apnea, or another kind of sleep disorder.

3. Do you have high blood pressure and a neck size larger than 45cm (about 17 inches)? People with high blood pressure and 45cm necks have a 90% chance of having sleep apnea, even before any other testing is done.


4. Have others heard you get quiet/stop breathing, or do you wake up gasping at times? Frequent awakenings without good reason can also be a sign of sleep apnea. I've often seen guys who thought their prostates were making them wake up and pee find out that treating the sleep apnea make the night time urination go away.

5. Are you tired when awake? If you had enough sleep, you should not feel tired, and you should not be drowsy when sitting still with nothing to do. If you struggle to stay awake, something is up.

[Simaril]

Originally posted by Vulcan
Hmm high blood pressure, weight gain, headaches. I snore a lot, and loudly

Is this the sort of thing one would get: http://www.sleeptech.co.nz/s8asc.pdf  ?

That model is a really good one, because its small and VERY quiet. (It uses a centrifugal system for the pump instead of a valve that opens and shuts as the pump runs.)

There are some machines that auto-sense the obstructions patients have, and adjust the pressure jsut enough to keep the space open. Some of these devices can even produce a "report" that looks just like a sleep study.

The problem with the home diagnostic machines, and the home self adjusting ones, is simple for us simulation pilots to understand: They rely on AI. Just like a human pilot is much smarter, more adaptable, and accurate than the AI from a boxed sim, the software in those machines is going to make mistakes when things aren't exactly the way the program wants them to be.

And mistakes on a sleep study can mean anything from getting an uncomfortably wrong pressure treatment, all the way to being diagnosed with sleep apnea when you don't really have it at all. Too high a pressure can actually make the number of apneas INCREASE instead of making them go away.

A good sleep study from an accredited sleep lab has multiple layers of quality assurance. For example, even though the technicians score the data first, I view every second of a sleep study I interpret -- its not enough to just view the computer printout. We have proficiency testing, comparison scoring between technicians, regular educational conferences, and comprehensive systems to make sure our patients are followed and supported every step of the way. When troubles come up , we work to get them solved so people can keep using the treatment that helps them.

So if it were me, I would want to plug in with  a good sleep specialist.

[lasersailor184]

Simiril, I hope you don't mind me asking a question...


All the time, it takes me 30-45 minutes to fall asleep.  Is this abnormal?  Or is it just my ADD riddled mind keeping me up?

[DiabloTX]

Unless it's something that is stress related or I've had too much coffee before bedtime, I think of dark grey battleships on dark blue waters silently cruising to some point unknown extremely relaxing and helps me fall asleep very quickly.  Also, for some reason the image of a 109G firing up and taxiing for take off helps me fall asleep as well.  And I don't even much care for 109's but it's the only plane that helps me fall asleep.

[Elfie]

1. Do you snore?

Eh....I snore so loud they can hear me in the living room.....with the bedroom door shut....

2. Do you feel rested after sleep?

I can't remember ever waking up and NOT feeling like I could sleep more.

4. Have others heard you get quiet/stop breathing,

My wife says I do sometimes....

If you had enough sleep, you should not feel tired, and you should not be drowsy when sitting still with nothing to do.

If I sit down to watch tv....I'm out cold in minutes

Mebbe I should have a sleep study done....

[FiLtH]

Great info Daddog!

     I hope I never get it because with my luck the hose would get wrapped around my neck and strangle me!

[Dago]

Originally posted by Simaril
That model is a really good one, because its small and VERY quiet. (It uses a centrifugal system for the pump instead of a valve that opens and shuts as the pump runs.)

T

I use a REMstar Plus C-Flex CPAP w/ Heated Humidifier, how does that one stack up?  Any suggestions for a small travel CPAP?

[Simaril]

Originally posted by lasersailor184
All the time, it takes me 30-45 minutes to fall asleep.  Is this abnormal?  Or is it just my ADD riddled mind keeping me up?

"Normal" time to fall asleep is 20 minutes or less.

We all have a biologic clock, which synchronizes itself by specific inputs. In order of importance, our brains set the "wake up" time by: Habit (getting up the same time every day); bright light (sunlight is about 20 times more intense than even bright indoor light); eating; and activity.

Some have strong clocks, and can sleep easily no matter what. Those who have less intense signals from their clocks may have trouble getting to sleep or staying asleep. If you're someone with a weaker clock, expect that you may have to coddle it if you want to have regular sleep patterns when you need them.

Rules for better sleep:

Get up at nearly the same time every day. That helps set your clock. Focus on the time you get up because you can force yourself to get out of bed, but you can't force yourself to fall asleep.Even if you just got to sleep an hour earlier, sleeping in may confuse the clock and make it harder to get to sleep other days. Be consistent!

Do not nap, especially when you're fighting insomnia. When you have trouble getting to sleep, remember that being tired is a GOOD thing, not something to get frustrated over. Frustration keeps you awake, because it causes adrenaline and other stress hormones to release -- not good when you're trying to get to sleep.

Do NOT lay in bed awake. Tossing and turning, or reading/TV, teach your body to be awake in bed -- and that's the habit we're trying to break Allow no more than 20 minutes to fall asleep. If you can't fall asleep in that time, get out of the bed and read (or do something boring -- NOT computer games!) until tired enough to try again. Being in bed "resting" also allows your brain to get "micro sleeps", short periods of 30 seconds to a few minutes that DO NOT rest you but DO get you just a little less tired -- so its even harder to get into good sleep. Get out of bed!

Use the bed for only 2 things, one of which is sleep. Don't do work, or watch TV, or whatever -- you want your body to think of "bed" and "sleep" as if they were one word, the same thing.

If you still have trouble breaking the habit of insomnia, you can try sleep restriction therapy. Pick your wake up time, and don't even try to go to bed until 5 hours before that. Follow all the rules above, even if it means you only get a couple hours' sleep that night. Get out of bed at the right time even id you just fell asleep. DO NOT NAP.

Because of the extra fatigue that program produces, most healthy people will find that they get to sleep and stay asleep well the next night, or the night after that at worst.

[Simaril]

Dago --

Thats a good machine too. The CFlex is a brand specific software tweak that allows the machine to slide the pressure around a little to maximize comfort. For some people its just nice, but for others its vital to make CPAP tolerable. If your body really likes or wants the CFlex, then you may have trouble with other brands.

Just like cars, there are a lot of brands, but they all do pretty much the same thing pretty much the same way. And just like cars, the manufacturers scramble to make something that differentiates them from their competition. I wouldn't tell someone to ditch something that's working for them unless there really was a problem they were running in to.


If you were looking for a small machine you cant get one much smaller than the S8 that was linked. Most insurance companies won't pay for a second machine, and these can be very expensive -- especially if purchased cash at a medical supply company. If you were looking to buy a travel machine with REAL money (instead of that funny stuff the insurance company spends for you), I'd look online for a source that seems reputable and has a history. Online prices look to be several hundred dollars less than what I see from home care companies. If you can use that info to squeeze a better price locally, that's great (but don't hold your breath).

[LePaul]

I had a Sleep Study done in mid April.  I got the results 3 weeks later.

My problems with fatigue have been on going for close to a year.  Id sleep 8-9 hours and feel dead tired waking up.  I blamed it on having allergy issues last summer...but come fall and winter, i was still feeling groggy all day.  Oddly enough, as the day went on, I felt better.  

I also had a lot of aches and pains which Id blamed on the statin/cholesterol lowering medicine Im on.  But I also had an old bed that was way overdue to be replaced.  Once I bought a new bed with a pillow top mattress, almost all the achey pain went away.  

So, part of the problem was a good bed.

The Sleep Study showed that it took me almost  2 hours to fall asleep.  I work up repeatedly.  I have a hard time staying asleep.  Thankfully, no sleep apnea and minimal snoring.  Their diagnosis was my going from 3rd shift to second shift hours broke my sleep cycle.  For the past few weeks, I've been doing the Sleep Hygeine thing.  Go to bed at a specific time everyday for 2 weeks.  I used Advil PM the first week and as the second week rolled along, I've used it less.  

Basically, I'm teaching my body to sleep again.

For the past three weeks, Ive only had one or two nights of insomnia.

The rut I was in for a long time was this:  bedtime at midnight (since I get home from work around 1030)...then Id wake up at 2am, 3am, 4am, etc etc.  With the Advil PM, I sleep thru the night.  And its not nearly as problematic as the prescription sleep meds.

Its amazing how something as simple as Sleep can be taken for granted!

[Simaril]

Originally posted by Dux
Is surgery any kind of option for this?

Lumping patients together, the overall success rate for surgery is 50% or less. For soem patients, whose throats collapse from the sides as well as front to back, the success rate is so bad that surgeons won't even touch them. Laser surgery is a bit less effective than the gold standard surgery, the UPPP (Uvulo-palato-pharyngoplasty). The nylon palate stiffener inserts (the "Pillar procedure") is much easier to get done, but is no more effective than standard surgery, and can only be used for the simplest patients. Since they're cherry picking the easy ones, that success rate isn't all that hot.

Of course, if you'r elucky enough to be one of the patients whose surgery works, the success rate is 100% -- for you. But even then its not a lifelong guarantee, since time or weight gain can make the problem come back again.

[Dago]

Originally posted by Simaril
Dago --

Thats a good machine too. The CFlex is a brand specific software tweak that allows the machine to slide the pressure around a little to maximize comfort. For some people its just nice, but for others its vital to make CPAP tolerable. If your body really likes or wants the CFlex, then you may have trouble with other brands.

Just like cars, there are a lot of brands, but they all do pretty much the same thing pretty much the same way. And just like cars, the manufacturers scramble to make something that differentiates them from their competition. I wouldn't tell someone to ditch something that's working for them unless there really was a problem they were running in to.


If you were looking for a small machine you cant get one much smaller than the S8 that was linked. Most insurance companies won't pay for a second machine, and these can be very expensive -- especially if purchased cash at a medical supply company. If you were looking to buy a travel machine with REAL money (instead of that funny stuff the insurance company spends for you), I'd look online for a source that seems reputable and has a history. Online prices look to be several hundred dollars less than what I see from home care companies. If you can use that info to squeeze a better price locally, that's great (but don't hold your breath).

I never use the C-flex, tried it at first, but the tech who set up the machine set the time frame too long, so I quickly learned to do without it.  No problems at all, never use Cflex now.

Will probably break down and buy my own travel CPAP, tired of dragging a large unit in it's own container.  Just wondered if you knew any better than the others.

Thanks for the answer.

[lasersailor184]

Originally posted by Simaril
"Normal" time to fall asleep is 20 minutes or less.

We all have a biologic clock, which synchronizes itself by specific inputs. In order of importance, our brains set the "wake up" time by: Habit (getting up the same time every day); bright light (sunlight is about 20 times more intense than even bright indoor light); eating; and activity.

Some have strong clocks, and can sleep easily no matter what. Those who have less intense signals from their clocks may have trouble getting to sleep or staying asleep. If you're someone with a weaker clock, expect that you may have to coddle it if you want to have regular sleep patterns when you need them.

Rules for better sleep:

Get up at nearly the same time every day. That helps set your clock. Focus on the time you get up because you can force yourself to get out of bed, but you can't force yourself to fall asleep.Even if you just got to sleep an hour earlier, sleeping in may confuse the clock and make it harder to get to sleep other days. Be consistent!

Do not nap, especially when you're fighting insomnia. When you have trouble getting to sleep, remember that being tired is a GOOD thing, not something to get frustrated over. Frustration keeps you awake, because it causes adrenaline and other stress hormones to release -- not good when you're trying to get to sleep.

Do NOT lay in bed awake. Tossing and turning, or reading/TV, teach your body to be awake in bed -- and that's the habit we're trying to break Allow no more than 20 minutes to fall asleep. If you can't fall asleep in that time, get out of the bed and read (or do something boring -- NOT computer games!) until tired enough to try again. Being in bed "resting" also allows your brain to get "micro sleeps", short periods of 30 seconds to a few minutes that DO NOT rest you but DO get you just a little less tired -- so its even harder to get into good sleep. Get out of bed!

Use the bed for only 2 things, one of which is sleep. Don't do work, or watch TV, or whatever -- you want your body to think of "bed" and "sleep" as if they were one word, the same thing.

If you still have trouble breaking the habit of insomnia, you can try sleep restriction therapy. Pick your wake up time, and don't even try to go to bed until 5 hours before that. Follow all the rules above, even if it means you only get a couple hours' sleep that night. Get out of bed at the right time even id you just fell asleep. DO NOT NAP.

Because of the extra fatigue that program produces, most healthy people will find that they get to sleep and stay asleep well the next night, or the night after that at worst.

Thanks!  I'll try it out.

[scottydawg]

Originally posted by Simaril
Use the bed for only 2 things, one of which is sleep.

Couldn't resist this one...

What's the OTHER thing?

[Shifty]

Originally posted by Simaril
I'm not a real pilot, though I play one on the internet....but I AM Board Certified in Sleep Disorders Medicine, and I'm medical director of our sleep laboratory. I've treated sleep disorders for about 15 years. So here's a viewpoint from the medical establishment side of things.


First, if it were me, I would want to be absolutely sure the diagnosis were right, and that means a sleep study. Home sleep studies are not reliable enough to be real substitutes, though they can be used to screen -- if they are completely negative, you're in the clear, but if they are positive then you have to get a monitored study to document severity and to get the right treatment level. Although modern CPAP/BiPAP is much less of a problem than it used to be, it still isnt something you want to do if you don't have to . Monitored treatment studies allow the technician to adjust the pressure real time, which is important because too much treatment pressure can be miserably uncomfortable, and too little will allow symptoms -- and damage -- to continue. Also, at our lab we have almost a dessert tray with different styles of masks. Some cover the nose, some the nose and mouth, and some just fit in the nostrils without covering anything. Here's a really popular one right now

If it were me, I would not trust the internet for diagnosing or treating a problem this serious. The home test with internet prescription is....unwise. The docs writing those scripts cannot have your best interest in mind, since there's no hint of individual attention and care.





Here are some quick screening questions:

1. Do you snore? Snoring is NEVER normal, since its the sound of air flowing through a tube that's too narrow. (Just like the rude sound you get when letting the air out a balloon's mouth.) People who snore also have higher blood pressures, and higher risk of heart attacks, than similar people who don't snore. This makes sense because the stress of working to breathe through a narrow passage gives you higher adrenaline levels all night long -- and those levels may persist through the daytime.

2. Do you feel rested after sleep?  Sleep that does not restore you normally is abnormal. Snorers who have nonrestorative sleep after getting enough time in bed are likely to have sleep apnea, or another kind of sleep disorder.

3. Do you have high blood pressure and a neck size larger than 45cm (about 17 inches)? People with high blood pressure and 45cm necks have a 90% chance of having sleep apnea, even before any other testing is done.


4. Have others heard you get quiet/stop breathing, or do you wake up gasping at times? Frequent awakenings without good reason can also be a sign of sleep apnea. I've often seen guys who thought their prostates were making them wake up and pee find out that treating the sleep apnea make the night time urination go away.

5. Are you tired when awake? If you had enough sleep, you should not feel tired, and you should not be drowsy when sitting still with nothing to do. If you struggle to stay awake, something is up.

I'm glad this thread started. I've been considering going to have the sleep test. My wife tells me I quit breathing often than gasp for breath. Guess I better make the appointment. I've even woken myself up gasping for breath.