Wednesday, July 27, 2016

Dealing with and Treating Sleep Apnea

ResMed CPAP Machine with full-face mask
More than a month ago I was diagnosed with moderate to severe sleep apnea. When it exactly started, I am not entirely sure, but I must have had this sleeping disorder for at least two years now.

At first, I noticed that I would often wake up the next day feeling not refreshed and tired throughout the day. After nights of stronger sleep deprivation, I would end up forgetting simple things; once I could not remember the PIN number of my credit card (good thing that I had enough cash on me that day to finalize the purchase).

What would happen to me was that I would occasionally stop breathing, which is the Greek meaning of apnea, with pnea standing for breath. This would result in strange suffocating dreams. I would see myself in tight places that I needed to crawl and climb through. This was basically my brain signalling me to wake up as it was not receiving sufficient oxygen.

In other cases, I would wake up coughing and even gasping for air. This would be sometimes so strong that I would have to get up and walk to an open window to let the fresh air calm me. I attributed this to asthma, as I often find myself slightly short of breath even during the day, although thank goodness I don’t have asthma attacks and, in my case, it is on the milder side and does not leave me out of breath.

But my wise wife had told me to get checked for sleep apnea. I discarded this – out of pride or foolishness, or both – until the month of June, where I had my worst sleeping episodes in my life. I would hardly get a wink, and if I did, I would wake up coughing. One night, I just could not get to sleep, no matter how hard I tried; all in all, I had perhaps one hour of sleep that night!

The next day was very difficult, not to say torture, but I am quite good at controlling my mood for the duration of my long workdays. However, I would get home, completely exhausted, and, at times, I felt even slightly depressed, which is generally quite an anomaly for me.

This continued for a while, with me forcing my way through days that should have been easy and enjoyable ... until one day I could not remember Tom Hanks! I could not remember the actor of Forrest Gump! I knew then that I had to go to our family doctor for a check-up.

As she heard about my symptoms and after asking me some more questions, she concluded that I had sleep apnea and sent me to a clinic for a sleeping test. The test was at-home with an oximeter attached to a finger to check the oxygen rate of my brain as well as another device on my chest to check my pulse and heartbeat, I suppose. It was a doubly uncomfortable night, but at least it took place in the comfort of the home instead of an overnight stay at the hospital.

The next day, I found out that I had had about 250+ episodes of apnea over that night, which broke down to slightly less than 30 an hour! This was definitely not good news, but it was at least something to work with.

The sleep specialist checked with me one by one all the symptoms of classic sleep apnea: Yes, my weight gain over the years did not help the issue, my BMI was too high, my neck circumference was not good either; I did snore; I had trouble breathing through my nose; I woke up to go to the bathroom more than a few times at night; I had night sweats and occasional migraines the next day; I felt like crap the next day.

Now before the diagnosis I had experimented with a new cervical pillow, breathing strips, a mouth guard, and they may have given me some slight relief, but nothing major nor of substance. So the chosen treatment, not cure, ended up the dreaded and feared CPAP therapy.

The CPAP machine, short for Continuous Positive Airway Pressure, is supposed to provide me with constant air pressure throughout the night. It detects episodes and provides the additional air to prevent them from becoming more serious.

The lack of oxygen, at some point in the quite dangerous territory of 70%, would cause damage not only to the brain but also to vital body organs and could lead to a number of ailments, including stroke, diabetes, and obesity. So in a way, it was a vicious cycle since part of my weight problems came from the disease itself, which ended up aggravating it!

As I cannot breathe through my nose, I was given a full-face mask. Now this looks worse than it is, but it is rather hard to get used to it. At first, the mask would feel too tight and not let me sleep. Then, once I somewhat got used to it, I had to worry about mask leaks. This means that the mask would not seal completely and air would escape making the treatment somewhat ineffective.

Then, after a while, I seemed to get the hang of it, but for some reason, my sleep specialist decided to increase the air pressure by 3 cmH2O. This was the worst part of the therapy as I would feel dizzy the next day, felt occasionally nauseous and slightly confused and would have headaches upon waking. I contacted him via email, but he did not respond until we met again on our then weekly appointments.

Now one thing needs to be mentioned here. You need a prescription to obtain a CPAP machine, and it is purportedly illegal to change the pressure settings. As I am wont to do, I asked for possible side effects, and my specialist told me that it would be bloating, sometimes rashes as well as mask discomfort. Nothing serious though.

I looked up information online and almost all of them claimed that it was safe. The creator of the machine supposedly had said that the only way it could cause serious harm was to hit somebody over the head with the machine itself. CPAP has been deemed the best therapy under current standards.

However, the fact that it had to be prescribed first and then supervised did ring an alarm bell with me, alongside the numbness in my fingers upon waking at night. I would not be able to feel my pinkies, in some cases half of my hand and that was a side effect I did not like and that worried me a little.

It seems that it was more tolerable after the air pressure was regulated and decreased. My numbness was partly due to the positioning at night (I am usually a stomach sleeper, but with the mask and the tube, that becomes impossible). Although I did respect the opinion of my specialist, the fact that he is young and that he is selling the equipment for profit made me suspicious of the whole thing. I had renamed it CRAP.

Yet, as they say, it takes time for one to adjust to this type of therapy. One really needs to be patient. After the specialist lowered the air pressure and found a suitable range (they have the ramp option, which increases air pressure slowly within certain given parameters), I ended up having a few relatively good nights of sleep. That means, for our intents of purposes here, I would sleep for the occasional three-hour block and briefly enter the deep sleep stage. That definitely made me feel better the next day.

I would still have the occasional dream of constricted space – for instance, last night I had a dream of two friends pulling my head underwater at an open-air swimming pool – but I would suddenly feel literally a fresh breath of air and would not awaken as a result.

I was given another test this time under the CPAP machine to check for any possible underlying issues, but the good news was that my oxygen levels were stable, and my incidents were low. On some nights I even reached the 0 threshold of incidents (my AHI was 0.0), which my sleep doctor had previously thought not to be really possible.

So there you have it! After some very difficult times and some additional difficult times to try to adjust to this machine, I have recently found better sleep! I am grateful for today’s technology and resources, and, in this particular case, there is an option (not app yet) to follow some general results of each night’s sleep. At ResMed, they even give you a (rather generous) user score to help you along and to keep you motivated.

I hope that my positive sleeping trend will continue, but in the meantime I know that I have to develop more healthy habits. Yet with better sleep, I should hopefully have a somewhat easier time shedding some extra weight without having to overly sacrifice good food or the occasional wine in the process.

Anyhow, I hope this is of help for some readers out there. Nowadays I feel stronger affinity for others who also suffer from sleep apnea and are undergoing CPAP therapy. I have been following the message boards for tips and advice and thought I would share some of it with you right here on my blog.

If you are suffering from it or know someone who is, please consider my sympathy and here's a cyber high-five. If you suspect that somebody has this condition, please encourage them to see a sleep clinic as it is essential to discard this uncomfortable and possibly fatal disease.

If you do not have any sleep issues and have read this post merely out of curiosity or because of the simple and wonderful habit of reading my blog ; ) I would like you to cherish the fact that you have good sleep as there are many in the world who do not or cannot sleep well at night, whether they are suffering from sleep apnea, insomnia or any other sleeping disorders out there. And most importantly, I would like to wish all of you sweet dreams!


Clarissa said...

Thanks for sharing your story! It will help many people. Apnea is a bad condition but you are showing persistence and courage in battling it. This is very inspiring.

Arash Farzaneh said...

Thank you for your support, Clarissa! It means a lot to me!

Cynthia Bowers said...

My husband suffers from sleep apnea as well, and it’s such a scary condition for both of us. He too had a very hard time sleeping, had awful dreams, and headaches. After finally getting used to the CPAP machine, he sleeps ten times better and I don't have to spend multiple nights on the couch to escape his insufferable snoring!

Swimming Pool said...

This board is very helpful. I was diagnosed with sleep apnea in November and I am still waiting for my CPAP machine. My insurance has denied it and I have appealed it. I am to the point of being somewhat scared with the following symptoms that I am having. I would be interested in knowing if anyone else has them. Everytime I wake up my whole body is numb, my mouth is so dry I I have no saliva in it. This makes me try to gasp for air. Another thing is my body sometimes gets so weak I feel like I can barely walk or even lift my arms up. Are these symptoms familiar? My oxygen level goes down to 70 and I also, get no REM sleep. I am bi-polar and thought my clinical depression was caused by that until I found out sleep apnea also causes it. My memory is so bad that I can't even finish a sentence without forgetting what I was saying and I have gained a tremendous amount of weight, which my DR. said could also be caused by sleep apnea. Will check back for any responses that may be helpful.

Arash Farzaneh said...

Hi Swimming Pool,

Sorry to hear about what you're going through and it's just not right that your insurance is not covering this! I was lucky on my part to have extended medical benefits that covered most of the costs as it is unfortunately very expensive.

But it is definitely worth the investment. I also had problems with memory due to the lack of quality sleep or rather sleep overall and as I mentioned in my post, I would forget simple and common names like Tom Hanks!

I have been using CPAP now for almost four years. Although the mask can still be inconvenient at times, I don't mind it as I get to sleep much better than before.

That being said, my sleep is far from perfect even with the machine and that is due to stress and anxiety. We must keep in mind that CPAP is a treatment and not a cure.

In fact, until somewhat recently, I would still wake up with a pounding heart and a dry mouth even with the machine. I personally think that anxiety is one of the culprits behind sleep apnea. As I am losing weight now and doing my best to deal with stress and anxiety, everything has gotten better. I am documenting my process and progress in a book, and the day when I am finally free of symptoms, I will publish it and share my knowledge with others.

In the meantime, I hope you feel better and are able to receive the treatment you need. I recommend a combination of psychoanalysis and CPAP with intermittent fasting, if you can. It has sure been working for me so far!

Again all the very best and thank you for sharing your experience here!

Arash Farzaneh said...

Glad to hear that, Cynthia! It does make a difference and although not comfortable, it's worth the good night's sleep it comes with, and yes, it takes away the snoring (but now my wife has picked up the snoring in our household ; ).