I found out this past week I’ve got sleep apnea. Apparently about 39 times an hour I stop breathing for at least 10 seconds, and wake up because of it, and don’t remember it.
But in between, I get 1.53846 minutes of extremely restful sleep.
The good news is that a very low pressure cpap completely prevents the apnea, so I’ve got to get one of those, and I’ll be fine.
I wouldn’t really have expected this, because far from sleeping too much (as apnea sufferers tend to), I tend towards insomnia. But the doctor said it can go either way, hypersomnia or insomnia.
I’ve heard some folks say treatment for apnea can make a big difference in your life. I don’t want to get my hopes up or anything, but that’d be neat.
The sleep study which discovered this was recommended by a trip to an ENT specialist, which was part of the ongoing attempt to discover why I’ve had a cough since about February.
It was kind of funny, I saw the notes that the sleep lab sent back. They said, apparently with a straight face, that it was vitally important that I lose massive amounts of weight, or no treatment would be effective — and just after that, that a very mild cpap treatment completely eliminated the problem. So maybe no treatment would be effective except the one they had tried that very night and confirmed was completely effective? I don’t know. Maybe that weight loss stuff was boilerplate.
Since I’m aware that significant weight loss virtually never lasts for more than 5 years, and usually more weight comes back after that than you lost in the first place, weight loss doesn’t seem like a useful long term solution to me. I mentioned this to the doc and he accepted that reasoning, then mentioned bariatric surgery, and since I’m not into Russian roulette, I said I wasn’t interested in that either. To the doctor’s credit, he accepted that as well and we went on with the cpap plan.
I mentioned that I was disappointed that I would have to use a cpap, and he smiled and offered me a tracheotomy as an alternative. I decided the cpap would be fine.
He did give me a good scare-the-patient story, about how he actually did have to schedule a tracheotomy for a patient with extremely severe apnea for whom the cpap wasn’t effective, and the guy died of sleep apnea in the two weeks before the surgery happened.
So I’m taking it seriously. Cpap it is. Bring it on!
> It was kind of funny, I saw the notes that the sleep lab sent back. They said, apparently with a straight face, that it was vitally important that I lose massive amounts of weight, or no treatment would be effective — and just after that, that a very mild cpap treatment completely eliminated the problem. So maybe no treatment would be effective except the one they had tried that very night and confirmed was completely effective? I don’t know. Maybe that weight loss stuff was boilerplate.
It seems contradictory, but I think they meant “The physical cause of the apnea will not go away unless you lose weight, but the CPAP will keep the physical cause from obstructing your airway.”
All I have to offer is anecdotal evidence, but here’s what I’ve got:
When I weighed 190-195 pounds, I didn’t snore ever. Then my enlistment ended, I lost the enforced exercise habit, and I started putting on weight.
When I got up to around 230, Alison started noticing, but only if I was asleep before she was. She also noted that I would stop breathing and gag/gasp momentarily until she could get me to roll off my back.
Over 250, and Al couldn’t sleep unless she had earplugs, and even then they didn’t work completely. Extra white noise, like a fan set on “high” mitigated some of it. She said that even if I slept on my side I’d periodically stop breathing.
I was at 265 when I got the CPAP. It eliminated all the snoring and apnea.
Then I started dropping weight thanks to a. some medications that affected my appetite for a while until they were adjusted, b. the benefits the medications were meant to provide anyhow, c. a fairly easy exercise regimen, d. stepping up my physical activity (biking anywhere I can & staying out of the car for any trip under two miles). I still use the CPAP, but when we travel or go camping I don’t always bring it along. Al’s noticed that I still snore, but it’s much more gentle, goes away if I get off my back, and the apnea part — where I stop breathing — isn’t as severe and is also correctable if she can get me to roll onto my side.
I share your sensitivity to the reflexive, dogmatic “lose weight” prescription, but I think it’s important to sort out ways a sleep apnea is a symptom of a physical condition. Everything I read suggests that, except in cases of deviated septums and deformities in the turbinates or adenoids, an excess of tissue in the soft palate is often to blame for the obstruction, and that doctors believe some of that is due to fat in the tissue around the palate. Since you can’t selectively “spot reduce” fat (short of cutting or sucking it out of a specific spot), the obvious solution to the physical obstruction that causes the apnea is to reduce how much fat you carry overall.
Personally, I plan to continue to lose weight by exercising and minding what I eat. Once I’ve lost a few more pounds I’ll probably try to get another sleep study done. I like my CPAP, to the extent I get much better rest from even just 5.5 hours of sleep than I used to with seven or eight, but I’d rather not have to have it at all: It was a pain to get the mask fitted correctly, it still gaps every now and then and shoots air into my eye in the middle of the night, it requires periodic cleaning, Ben sometimes gets into the bedroom and changes the humidifier settings on me and causes floodouts if I don’t notice, it gets singled out for attention in airports, and it’s torture to use during cold season unless I dry myself out with decongestants. Those are all tradeoffs worth making, because the association of sleep apnea with heart problems, hypertension and screwy sleep-dep-related body chemistry concerns me.
But I can remember a time when an unassisted five or six hours of sleep was perfectly adequate. If substantial weight loss maps to my sleep apnea being lessened or eliminated, I’ll take that as one more reason to keep up the exercise.
I’m ready to believe that if I were thinner I might not have sleep apnea, and that it has gotten worse as I got older and fatter….
But it’s a medical fact that substantial weight loss is virtually always impermanent. Even if I were able to lose large amounts of weight, the odds are only about 5% that I’d be able to keep it off for even five years. And if I didn’t, I’d likely end up heaver than I started. Changing food intake in a way which results in weight loss tends to cause weight gain in the long term. (And I don’t know if exercise alone would cause significant weight loss — and even if it did, will I be able to keep up a serious exercise regimen for the rest of my life?)
It just seems like poor long term planning to count on weight loss as a remedy. The odds are badly against it working for more than a few years, and if it did work for a few years, it’s likely to make the problem worse in the long term.
So I’m not so much skeptical of a correlation between weight and sleep apnea, as of there being much chance of doing anything permanent about it that way.
That said, when the ENT guy checked out the inside of my sinuses he saw some serious blockage just in my sinus anatomy, and it was that which inspired him to do the sleep study in the first place, not my weight or any symptoms of apnea… so there’s a pretty good chance I’d be hosed by my sinus anatomy even if I managed to become svelte as a kitten.
Ed,
I’ve got a couple of relatives that have really been helped by the cpap. Hope it works for you. One thing that they’ve mentioned is that you usually have to be free of all facial hair for the mask to really work.
Thanks, Jeff. I was kind of suspecting this might mess up my plans to emulate ZZ Topp. :)