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No chronic medical condition is as common and commonly unrecognized at obstructive sleep apnea. Somewhere between 10 and 16 % of Americans over 40 stop moving air in and out of their lungs/experience low oxygen/secrete a surge of adrenalin/have sky high blood pressures/ rouse themselves from sleep anywhere from 4 to 60 or more times an hour. That is the physiologic equivalent of being in a combat zone in which mortars are fired from 4 to 60 times an hour every night. In the military, they call it PTSD. At home, they call it OSA.

Sadly, at least 80% of the people who have OSA do not know it. All would benefit from treatment, if they only knew they had the disease. And if they only had health insurance.

And that is the problem with OSA. Since it is commonly not diagnosed in the early stages, many people move on into the advanced stages in which they suffer from depression, chronic pain, uncontrolled high blood pressure, stroke, heart attack, poor concentration, poor memory, weight gain, accidents--all of which combines to make them unfit for work. And without a Job middled aged Americans are likely to be uninsured.  

OSA deniers will say "Lose weight! Exercise!" If they only knew. Recent studies have shown that sleep deprivation makes people hungrier and makes them crave high calorie, high fat, sugary foods--the body's way of compensating for poor energy. Sleep deprivation also raises the blood levels of inflammatory factors that make us hurt. And sleep deprivation lowers the effectiveness of pain medicine like codeine. So, telling someone with untreated severe OSA to cure himself by losing weight and exercising is sort of like telling a heart patient "Unclog those coronaries with a brisk aerobic exercise program." Might work if the heart could handle it.

I see a lot of people in my job as a family physician in a "free clinic" for the uninsured. Many of them are middle aged and have lost their jobs. Many of them know about their depression, their chronic back pain, their heart problems, their high blood pressure, the erectile dysfunction that is ruining their marriage. Most do not know about the sleep disorder that is making all of the above worse--and which lead to them being fired from their job for being 1) late 2) forgetful 3) crabby 4) too sick 5) having too many on the job accidents. Without insurance, they are in a Catch22---they can not get a sleep study to prove they have a sleep disorder so that they can get Medicare. Without Medicare, they can not afford effective OSA treatment. So, they are told "Lose weight!" by the health insurance deniers who seem to think that all chronic disease is caused by a moral flaw.

OSA is a hereditary illness. You do not have to be fat to have it--though OSA will make you gain weight. All you have to have is one parent with the disorder (part of the cause is abnormal nerve endings in the airway that do not sense airway closure), bad allergies, a receding chin, radiation therapy to your neck, pregnancy or some other condition that causes your stomach to swell, an orthopedic problem that requires you to sleep on your back, a hiatal hernia, big tonsils, a goiter, an Adams apple or some combination of the above to have OSA. The major symptoms---snoring so badly that you stop breathing--will only happen when you are asleep, so if someone else fails to mention it to you, you will have no idea that you are doing it. You will get sicker and sicker---and fatter and fatter---and poorer and poorer---and will wreck your car because you did not even know you were sleep deprived---and if you survive the car wreck you will have a stroke or heart attack in the middle of the night when you are not doing anything (except experiencing sky high blood pressure and dangerously low oxygen levels)--and eventually die. And they will say "You did it to yourself. You should have lost weight." When they should be saying "If only he had been diagnosed with OSA in time. If only he had health insurance so he could get treated."

So, get insured. Get your sleep disorder treated. I dream about the day when I will come home from the office without having to worry about the ten people I saw who have no hope at all of getting better, because they do not have the insurance to fix what is really wrong with them.

Originally posted to McCamy Taylor on Sat Sep 14, 2013 at 04:16 PM PDT.

Also republished by KosAbility and Daily Kos Weight Loss.

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Comment Preferences

  •  Tip Jar (143+ / 0-)
    Recommended by:
    viral, KrazyKitten, swampyankee, lunacat, JeffW, Carol in San Antonio, karmsy, Susan from 29, splashy, Radiowalla, LakeSuperior, churchylafemme, KateCrashes, barbwires, Boston to Salem, Wee Mama, MisterOpus1, bythesea, renbear, jeff in nyc, Chaddiwicker, Mortifyd, belinda ridgewood, lcrp, Got a Grip, postmodernista, Jim Riggs, Turn Left, mookins, mapamp, dmhlt 66, historys mysteries, SoCalSal, doingbusinessas, blue91, antirove, Lorikeet, SteelerGrrl, TrueBlueMajority, on the cusp, Keone Michaels, kcc, sfarkash, emeraldmaiden, JDWolverton, slowbutsure, chloris creator, CTLiberal, jan4insight, cardinal, monkeybrainpolitics, jaebone, envwq, bluesheep, Loonesta, oldpotsmuggler, Miss Jones, PinHole, GeorgeXVIII, fallina7, dejavu, Lily O Lady, SuWho, sngmama, 417els, dotsright, Cassandra Waites, ybruti, congenitalefty, greycat, basquebob, ER Doc, NYC Sophia, Spirit of Life, boophus, BlackSheep1, Leap Year, Lujane, Debs2, countwebb, m00finsan, denise b, theKgirls, bgblcklab1, Involuntary Exile, geebeebee, mettle fatigue, aitchdee, Chinton, Eileen B, tin woodswoman, Dianna, Creosote, here4tehbeer, Matt Z, Mokurai, Dood Abides, MartyM, worldlotus, Clues, riverlover, Euroliberal, kaliope, kkkkate, BocaBlue, Diana in NoVa, Wife of Bath, edie haskell, emmasnacker, TDP, Its any one guess, ScienceMom, sewaneepat, wasatch, figbash, mikidee, rubyclaire, gypsytoo, ladybug53, allergywoman, Blue Bell Bookworm, OIL GUY, tommyfocus2003, Gorette, Leslie in KY, CarolinW, Unknown Quantity, Nina Katarina, radarlady, BlueZone, Dave in AZ, TexDem, Empower Ink, kharma, BeninSC, Thunder, CharlesII, bleeding blue, Kasoru, BachFan, radical simplicity, Aaa T Tudeattack, BusyinCA

    "A dog starved at his master's gate/Predicts the ruin of the state" Blake

    by McCamy Taylor on Sat Sep 14, 2013 at 04:16:03 PM PDT

  •  The heartbreak of OSA is the profit margin on (62+ / 0-)

    the medical devices. It is beyond outrageous. To the point where the big mfgs refused to allow their prices to be listed on independent websites or sold at a discount to the uninsured.

    A doctor's Rx is required for a new mask. Think about it, the machine already requires a Rx, and you can't use the mask without the machine, so why should a new mask require a new Rx every 6 months?

    We need universal single payer healthcare because the lack of treatment for OSA is much more expensive than treatment. Even at the inflated prices.

  •  You may be interested in the notices/links (9+ / 0-)

    in this diary for Centers for Disease Control, HHS and the Food and Drug Administration:

    http://www.dailykos.com/...

  •  I was just talking to a patient about this (27+ / 0-)

    It is a vicious circle like you outlined. Unfortunately, for those who do have apnea and are being treated with the breathing apparatus, if they have to use the mask it can be just as equally difficult for them to sleep. Technology simply must come up with a better apparatus for those forced to use that cumbersome mask.

    Nice diary, though.  T and R'd.

    Lawrence, KS - From ashes to immortality

    by MisterOpus1 on Sat Sep 14, 2013 at 05:16:14 PM PDT

  •  Thanks for this! (16+ / 0-)

    Have you seen this recent "before and after" CPAP?

    Before and After using a CPAP machine

    My husband had sleep apnea prior to his kidney transplant, it was HORRIBLE. The peritoneal dialysis is what caused it. It's completely gone now that he's had a transplant.

    I don't know what we would have done without the machine.

    Lisa

    All Kossacks are my allies, but if you can't express your thoughts in a civil and kind manner, I won't be engaging in a conversation with you.

    by Boston to Salem on Sat Sep 14, 2013 at 05:17:49 PM PDT

  •  My husband hates his CPap machine. Finds it (9+ / 0-)

    uncomfortable and says he doesn't feel better after sleeping with it.

    Is there anything else he can use besides the CPap?

    Confession time: When I'm not ranting about politics, I write romance novels

    by teresahill on Sat Sep 14, 2013 at 05:19:01 PM PDT

    •  How long did he try? (6+ / 0-)

      As I said above it took my husband about two weeks to get used to it enough that he could fall and stay asleep. We both tried to be super patient about it. He was also prescribed a few doses of ativan for the first week which helped as well.

      Lisa

      All Kossacks are my allies, but if you can't express your thoughts in a civil and kind manner, I won't be engaging in a conversation with you.

      by Boston to Salem on Sat Sep 14, 2013 at 05:24:06 PM PDT

      [ Parent ]

    •  There is nothing that is really as effective for (13+ / 0-)

      run of the mill OSA. He should try different types of masks, the variety runs that gamut from simple nose canulas to full face masks that cover ear to ear and chin to forehead.

      There is also a forum, CPAPtalk.com that offers advice from other users that he may find helpful.

    •  Yes. I failed CPAP--slept worse with it than (13+ / 0-)

      without it. I had surgery on the soft palate to open my airway, I got a HEPA filter in my bedroom to control my allergies and I have an oral appliance made by my dentist that pulls my jaw forward to  use if I get a cold. I always side sleep and I take a decongestant and antihistamine before I go to sleep and avoid muscle relaxers and alcohol at bedtime.

      I could not use CPAP because I have a narrow airway so I have to have a full face mask, but I brux which causes the mask to shift up and down through the night AND I am allergic to the stuff masks are made from. Result was no deep stage sleep at all---awake to light sleep over and over through the night on CPAP. So, if you think CPAP isn't working, make them do another sleep study. Pulse oximetry will not tell if you are sleeping---just that you don't have low oxygen. I did not have low oxygen on CPAP--I simply never really slept.

      I find that about 30% of people can tolerate CPAP and get better. The people who can sleep through anything are more likely to tolerate CPAP. "Light" sleepers will probably have trouble with it. Men with beards and mustaches have problem with the mask not fitting. People with sensitive skin often have problems with the mask.

      Surgery can cure many people, an oral appliance is as effective as CPAP (and much cheaper) and a combo of things will work better than a single one.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sat Sep 14, 2013 at 07:35:28 PM PDT

      [ Parent ]

      •  As per my post below, I agree with you so much (4+ / 0-)
        Recommended by:
        Lujane, aitchdee, worldlotus, ladybug53

        I really believe the CPAP distribution system is the biggest scam out there.  Dental devices can work very well and are fundamentally much less expensive.  I too also have a HEPA filter in my room and take Generic Sudafed and Benadryl before I go to sleep.

      •  Been wanting him to try the dental thing. (6+ / 0-)

        Will definitely push for that and do the hepa filter and the antihistamine. Thanks.

        Confession time: When I'm not ranting about politics, I write romance novels

        by teresahill on Sat Sep 14, 2013 at 09:26:18 PM PDT

        [ Parent ]

        •  I am so glad to hear that (4+ / 0-)
          Recommended by:
          aitchdee, Matt Z, worldlotus, ladybug53

          Cost of Kirkland brand benadryl at Costco:  365 pills for $4

          Cost of Brand 12 hr Sudafed at Costco:  30 pills for $20

          Cost of a mouthpiece:  You can do a mail order one for $50 or get one through dentist covered by insurance:  Cost before insurance is $500 to $1,500.  The cost after insurance is dependent obviously on your plan.

      •  OSA treatments (0+ / 0-)

        Surgery May cure Some people if their apnea was on the mild side, but my experience has been that the usual surgery (UPP) doesn't reduce airway obstruction enough to achieve an acceptable Apnea Hypopnea Index in folks whose apnea was severe. The ONLY surgery that will cure all OSA is a tracheostomy, which is the recommended treatment for severe OSA in someone who can't tolerate CPAP.

        Oral appliances, usually mandibular repositioning devices, can also be effective for mild OSA. Chronic oral appliance use is now associated with a high rate of complication in the form of displaced,crowded or loose teeth.

        If a tolerable mask is found and the patient still can't tolerate the pressure there are several options. First should be ensuring proper humidity levels. Second many machines nowadays are equipped with an optional setting designed to make CPAP more comfortable: Expiratory Pressure Relief or CFLEX depending on the manufacturer. My opinion is that these should always be set for maximum relief on everyone, but especially so if their prescribed setting is above 8-10 cm H20. A third option is Bilevel PAP or BiPAP which gives a higher pressure on inhalation and a lower pressure on exhalation. BiPAP is especially useful for people with COPD who are notorious for not being able to tolerate standard CPAP. A fourth option would be AutoPAP, a mode that delivers higher pressure when needed as is usually the case during REM sleep or supine sleep, but then delivers a lower pressure when not needed, usually during side sleeping or non-REM sleep. This AutoPAP mode might be especially useful for those who find they pull their mask off during sleep without realizing it.

        For people who simply can't tolerate the mask itself even after trying multiple types of masks, there are also other options. There is a relatively new "mask" that is actually a mouthpiece that fits into the mouth kind of like a scuba device that may be more tolerable. Another option may be found at nomask.com ( I am not affiliated with this company  and can't personally vouch for the product, but it might be worth checking out.) Another relatively new option are the adhesive Pro-Vent nostril valves (again, not affiliated). They are disposible after each night's use, do not require any machine at all, are often well tolerated by folks who hate CPAP; however I don't believe they are yet covered by insurance so there would be the out of pocket cost to consider. For some people, depending on the results of the initial sleep study, positional treatment may be effective. In other words, sleeping only on one's side. There are belt-type devices designed for this purpose which have a hump across the back to prevent one from inadvertently rolling onto his or her back. I've even heard of folks who sew tennis balls onto the back of their pajama shirts for this same purpose. As already mentioned, cognitive therapy or mild anti-anxiety agents may be helpful.

        For those who are using CPAP but still don't feel more rested,
        there may be a number of reasons. Inadequate titration is probably the most likely- in other words the machine is not delivering enough pressure to maintain a patent/open airway. Significant mask leakage or mouth opening is another strong possibility and must be addressed if present. If present, Periodic Limb Movement of Sleep (sort of like restless leg syndrome) may also need to be treated to prevent frequent arousals and fractured sleep. It is very important for OSA patients to avoid alcohol and other sedating medications (ie Ambien, Trazadone, etc.) as much as possible since they increase the severity of airway obstruction thus worsening apnea and could render the prescribed CPAP pressure ineffective.

        Thorough patient education is imperative. Untreated OSA leads to a much increased risk of worsening hypertension, worsening blood sugar levels, transient ischemia attacks (mini strokes), cerebral vascular accidents (strokes), cardiac problems such as congestive heart failure and/or atrial fibrillation. Anyone who dismisses CPAP out of hand does so at serious risk of early death.

        •  Forgot to mention (0+ / 0-)

          a couple options which may be effective for OSA.

          Sclerotherapy is the injection of a drug into the tissues of the pharynx which cause scarring and tightening of the tissues leading to an increased diameter in the upper airway and thus reducing apnea.

          Ablation is kind of like using a laser to achieve the same goal as above.

          Neither of these are FDA approved for OSA, ,but studies are being conducted.

        •  I keep telling him that, and he's had the CPap (0+ / 0-)

          adjusted twice by going back to the sleep clinic and having them figure out the levels he needs.

          I think he has the scuba mouthpiece now, and he rolls over or just moves, and it slips off and doesn't seal properly. Or he gets really uncomfortable and takes it off half-way through the night.

          His has a water tank he fills every night, so I guess that addresses the humidity thing?

          I saw the nostril things when I went searching last night. May try those.

          Confession time: When I'm not ranting about politics, I write romance novels

          by teresahill on Sun Sep 15, 2013 at 10:58:15 AM PDT

          [ Parent ]

          •  Teresa (0+ / 0-)

            It's good that he's adding water, but that doesn't necessarily mean he's getting enough humidity. The humidifier should be heated. The heat may automatically come on or there may be a button that has to be pressed to turn the heat on. Then there  may be a humidity level setting that might run from 1 to 6 or something along those lines. I would set it halfway to start. If the room is cool or there is a fan blowing over the CPAP hose that can also prevent proper humidity because the air in the hose cools before it reaches the mask. Cooler air has less capacity to carry moisture.  In those cases there is frequently condensation in the hose eventually leading to water sloshing inside the hose and making it more difficult to breathe through.  The absolute best way of ensuring proper humidity is with a heated wire hose. It has a wire running the interior length of the hose. The wire is heated thus keeping the air warm as it traverses the length of the hose.  These are only made by one or two manufacturers as far as I know, and they are specific to their CPAP machines.

    •  Has he tried a dental device (6+ / 0-)

      I was diagnosed with Sleep Apnea, with the main symptom being that I was keeping my wife up at night.  I got a CPAP and couldn't live with it.  I switched to a dental device and it has been five years now and I haven't woken her up once.

      In Australia they sell these dental devices for $50.  In the US you are supposed to use a dentist, so they can run up to $1,000.  The sleep doctor I used to diagnose apnea seriously slammed the idea of using a dental device, but I got a second opinion from a respected ENT, who said for many cases of Sleep Apnea they can be pretty effective (particularly the milder cases).

      In most areas of medicine the recommended course is the approach that is the least expensive, least intrusive.  If that doesn't work then you go up the scale.  It is only in the Sleep Apnea world that they automatically send you to get a CPAP, the most expensive option that sticks you with a mask you have to sleep with tied to a machine.

      A simple dental appliance that is nothing more than a mouthguard could do the trick.

    •  Is he significantly overweight? (0+ / 0-)

      If so, you might consider weight loss surgery as an option.  Drastic yes, but it has a very high success rate at eliminating snoring and apnea.

  •  I have Apnea (18+ / 0-)

    Have used a CPAP machine since about 2000. The difference you feel when you first get treated is amazing. You don't even realize how tired you were all the time until you experience life after a good night's sleep.

    Progress 365 not just a slogan a goal - 300 progressive seats in the House and 65 progressive seats in the Senate.

    by jusjtim35 on Sat Sep 14, 2013 at 05:33:00 PM PDT

    •  i remember my sleep study with the mask (13+ / 0-)

      i felt like it was the first good night's sleep i ever had in my entire life.

      it was like being high.

      and I slept six whole hours in a row without waking up.

      nothing will ever be as wonderful as that first night with the mask on!

      Politics is like driving. To go backward put it in R. To go forward put it in D.
      Drop by The Grieving Room on Monday nights for support in dealing with grief.

      by TrueBlueMajority on Sat Sep 14, 2013 at 06:46:06 PM PDT

      [ Parent ]

      •  This!!! (1+ / 0-)
        Recommended by:
        TrueBlueMajority

        My OSA was so bad, I was falling asleep in the middle of phone conversations. And seeing as that I was working inbound customer care calls for a cell phone company...  ya it can get that bad.

        But the night of my sleep study. I wanted to punch out the nurse that woke me just for waking me up. I had never slept better than before.

    •  I have apnea and have used a bipap for years (2+ / 0-)
      Recommended by:
      aitchdee, ladybug53

      But my problem was not sleeping on my back and a soft palate. It is the vessels on the outside of my lungs having too high  pressure. Even though the pressure in my arms is low range. For the first time, since I was twelve and noticed it, I rarely get rapid heart beats ( I thought it was caused by worrying whether my stepfather was going to visit me in the night) ... Usually between 175 and 250 bpm. So I use the bipap religiously. I was the one who stopped the lung docs run to prove it was because I was a former smoker by keeping the O2 meter with a recorder overnight (borrowed from my O2 supplier) that showed my O2 sats dropped to 60% during sleep.  Immediate 2 sleeps tudies which it took me over a year to pay off my share.  [By the way when my sleep problems started I was 5'2" and weighed 82 lbs]... Yet my lung Dr said it was because I was overweight (by age 50) and slept on my back... Which is why he is my ex DOC.

      I have a lifetime of witnesses that I never sleep on my back (I flat can not , especially after I fell at 12 and was paralyzed for 3 days) and I was skinny as a reed most of my life until I started falling in my forties. That stopped too when I got put on O2 which I hate because I feel like I am leashed but I recognize that stroke was my destiny if I didn't use it. What finally got me help of any kind was a hematocrit of 61 which led to tens of thousands of dollars in copays and charge cards run to the max, only to have the Dr say it was because I was overweight.  Which most of the time, I had problems that the oxygen and bipap ended, I wasn't.

      Oh his evidence was that my lung functions improved by 1.5% when I lost 12lbs after getting the bipap. I was a lab tech and believe that 1.5% can be explained by a different machine, different operator or simply standard deviation. I worked with a ton of machines and fixed many of them myself. I know all about QC and have a degree in math.

      I rarely go to a doctor any more because the last one wanted to do heart surgery to burn off the extra node on my heart which he said caused the rapid heart beat. Well that saved me 8 grand and it doesn't happen so often any more with my O2 and bipap. I don't want to live at the cost of spending every cent on tests and treatments and ... I sure would like to find a Dr I could live with.

      Fear is the Mind Killer...

      by boophus on Sat Sep 14, 2013 at 10:04:15 PM PDT

      [ Parent ]

    •  I had a similar experience with reflux meds (0+ / 0-)

      I'd been accustomed to the constant pain and the lack of sleep for so long that I was overjoyed when the pain was gone for the first time, and I got the first full night's sleep in 25 years. I felt like doing the "Snoopy Dance" for days.

  •  I've been using a mask now for about (14+ / 0-)

    two weeks. It was frustrating the first few days as I had a terrible time falling asleep and would give up on the mask after a few hours. But I kept at it and I have been gradually getting used to it. I am now able to go a full night (6-7 hours of uninterrupted sleep) with the mask on. And my wife says I don't snore when I wear the mask.

    If you have been prescribed a CPAP machine and are having trouble sleeping with the mask, my suggestion is to see about getting a different mask. There are many styles, and some are less cumbersome to wear. (I'm using the face pillow type of mask - it only covers the nose.)

    But I agree with other commenters - medical science needs to come up with a better solution for OSA, if possible. The machine itself, while not as noisy as they used to be (or so I've been told), is a bit of a pain to have by your bed. It takes up a fair amount of space on a nightstand, needs regular cleaning, and if you travel you should take it with you - another pain, especially when flying.

  •  asdf (13+ / 0-)
    Recent studies have shown that sleep deprivation makes people hungrier and makes them crave high calorie, high fat, sugary foods--the body's way of compensating for poor energy.
    Do you have a link???  My sister-in-law may lose her job to EXACTLY THIS.  She is an incredibly overweight workaholic who can't sleep!  They all love her at work, but there have been too many times when her bosses boss has called her to wake her up.  

    Can you call yourself a real liberal if you aren't reading driftglass?

    by CJB on Sat Sep 14, 2013 at 06:16:39 PM PDT

  •  i love my machine and my mask (9+ / 0-)

    I've had it a few years now.  I know I sleep a lot better with it.

    It is a pain to travel with it.

    It means I can't have spur of the moment overnights.

    I used to snore loud enough to be heard in neighboring apartments.  Now I do not snore at all.

    I also use the mask that covers my nose.  I sleep on my side so that is not a problem.

    I have the machine itself on top of the headboard so I can move around and know the hose will follow my movements.

    But it is expensive.  It's like the masks have planned obsolescence--they break at exactly the same place.  And when that one little spot on the mask breaks, you can't just get a new mask, you have to get a new mask and headstraps and the whole contraption.

    and although I am "authorized" to receive new equipment every 90 days, insurance is not required to PAY for it every 90 days, so I don't get new filters and tubing etc as often as I should.  

    You can get away with cleaning it less often if you use distilled water in the water chamber.

    I can tell that when I am tired I crave high fat foods.  i can't figure out how to rearrange my life to get more sleep!

    Politics is like driving. To go backward put it in R. To go forward put it in D.
    Drop by The Grieving Room on Monday nights for support in dealing with grief.

    by TrueBlueMajority on Sat Sep 14, 2013 at 06:37:08 PM PDT

    •  I'd recommend always using (1+ / 0-)
      Recommended by:
      TrueBlueMajority

      distilled water-it makes the machine last much longer.  Plus who wants a bunch of chlorine by products up your nose?  With non-chlorinated water I would worry about brain eating amoebas or something.

      Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

      by barbwires on Mon Sep 16, 2013 at 05:57:56 PM PDT

      [ Parent ]

  •  Making the diagnosis (11+ / 0-)

    is problematic in itself. My long-suffering spouse of 15 years can attest to my disordered sleep breathing. I've had three sleep studies, all of which were nondiagnostic because I'm a terrible sleeper if I'm not in my own bed with spouse, cat, iPod, and routine meds, none of which were allowed.

    There are home studies available now, but insurance requires verification from a lab study, and I'm back to square one. I'm also not overweight, so I don't "look" like an OSA patient. Very frustrating.

     I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

    by SteelerGrrl on Sat Sep 14, 2013 at 06:40:27 PM PDT

  •  I have OSA (9+ / 0-)

    diagnosed 2 months ago. Got a CPAP machine, my energy levels are MASSIVELY boosted. I used to be falling asleep at my desk every day at 2PM, no more.

    "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

    by nosleep4u on Sat Sep 14, 2013 at 06:46:17 PM PDT

  •  Insurance doesn't always help. (6+ / 0-)

    My understanding from a coworker is that Coventry (in Georgia) won't cover sleep studies.  Because they suck.

    •  There are home sleep studies now. (3+ / 0-)
      Recommended by:
      Lujane, worldlotus, ladybug53

      I think they're fairly recent - just a started couple years ago.

      They're a lot cheaper. You take the device home, sleep with it taped you your forehead for one night, and send it in.

      "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

      by nosleep4u on Sat Sep 14, 2013 at 06:59:43 PM PDT

      [ Parent ]

    •  Coventry sucks in (1+ / 0-)
      Recommended by:
      ladybug53

      Kentucky Medicaid Managed care too.  They took all my speech-language therapy clients and cut their therapy in half from twice a week to once a week and I had to do major battle to get each case reversed.  Including going to the State Auditor, Attorney General, Medicaid Managed Care Oversight office etc.

  •  Sometimes losing weight does work though .... (8+ / 0-)

    I am a 71 year old and more than 5 years ago I lost weight about 60 lbs over three years and my apnea is gone now for at least 3 years as is my high bp.  

    My physician at the time was insistent that losing weight "might not" work especially as it related to bp treatment.  He wanted me to take drugs which I resisted after trying Beta Blockers and other BP meds.

    It did work tho.  Losing weight improved my health immeasurably.  It was hard but not impossible.  

    Good diary as I too believe insurance is the key to better treatment.

  •  Pediatric OSA: Tonsils! (11+ / 0-)

    I almost forgot. 50% of children with migraine headaches have OSA. Number one cause of OSA in kids who are not morbidly obese is big tonsils =small airway.

    I suspect that the huge number of 40-50 year olds I am seeing now with OSA is in part due to the fact that about 30 years ago they stopped taking out ANY tonsils. I sometimes see adults with OSA and huge tonsils that get better once those tonsils come out.  

    When I was 7, in second grade I was a mediocre student. I snored, I had apnea. I had big tonsils. They did not know what OSA was in the 1960s, but they knew my tonsils were always infected, so they took them out. When I went back to school after getting them out, it was as if a light was switched on. Suddenly,  I could pay attention in class. I remembered things. I started making straight 100s. My headaches went away. I had perfect behavior.  The OSA did not come back till I neared age 40 when the airway starts getting "floppier" (the way skin gets looser as we age).

    "A dog starved at his master's gate/Predicts the ruin of the state" Blake

    by McCamy Taylor on Sat Sep 14, 2013 at 07:49:04 PM PDT

    •  I'm a school speech therapist (5+ / 0-)

      and I've worked with kids like this. They get referred to me for speech problems, and I've started to notice a pattern of mouth-breathing, hyponasal speech, the tongue being carried in a forward position in the mouth, sometimes drooling or poor saliva control, and specific speech articulation errors. And they appear tired all the time and have trouble concentrating at school. I ask their parents to have them seen by an ENT, and lo and behold, they have huge tonsils and/or adenoids that are obstructing their breathing. I live in a very high pollen-allergy area and it seems pretty common here. Most of these kids improve vastly after surgery, and don't even need long-term speech therapy.

    •  another speech-language therapist here (1+ / 0-)
      Recommended by:
      ladybug53

      I have read that many cases of sleep apnea are misdiagnosed as ADHD in children.  Makes sense.  

  •  Strictly Speaking, Isn't OSA a Syndrome (3+ / 0-)
    Recommended by:
    churchylafemme, Lujane, worldlotus

    or even a disorder but not a disease?

    My understanding is that diseases usually have a single identifiable cause and a set of pretty specific symptoms, and some are communicable, infectious, or arise spontaneously from genetic or outside agents.  

    Could you clarify further?  Thanks.

    Readers & Book Lovers Pull up a chair! You're never too old to be a Meta Groupie

    by Limelite on Sat Sep 14, 2013 at 08:18:42 PM PDT

  •  How about "TRY to lose weight". (0+ / 0-)

    And really, really try, because without losing the weight you can/will die.

    It's a sad reality of life.  Some must cut calories to the bone before losing weight, but they will lose weight.  Everyone will lose weight by cutting calories to some point.  Everyone.  

    Being hungry sucks, it's painful, it makes you grouchy, gives you headaches, etc, but if you're facing a death sentence then why wouldn't you do it?  Buy a weight scale and take your consumption deathly serious.

    "So what if a guy threw a shoe at me!"

    by FoodChillinMFr on Sat Sep 14, 2013 at 10:24:22 PM PDT

  •  Hmm. (5+ / 0-)
    In the military, they call it PTSD. At home, they call it OSA.
    I so want to be supportive here...but OSA is not equivalent to PTSD. I have PTSD. I know the difference.

    One condition isn't better than the other, but they are really not the same. Given you're a doctor, McCamy Taylor, I'm sure you know this already. So, why say they're the same?

    I'm tired of people misusing psychological terms just to make a point that resonates. My trauma and recovery isn't just an adjective. Publicly watering down/confusing the definition of a diagnosis helps nobody.

    Check out my progressive tshirts & gear: DemSwag.com or my hand-drawn reproduction of Rachel's Excelsior Poster from Friends available on cards, stickers, curtains etc.

    by Eileen B on Sat Sep 14, 2013 at 10:43:00 PM PDT

  •  I have obstructive sleep apnea (3+ / 0-)
    Recommended by:
    Dianna, Diana in NoVa, ladybug53

    And have done well with a CPAP machine, but still have it enough so that I do feel tired and worn out a lot.

    I recently started a course of Modafinil (I use the generic Modalert 200mg), used to treat people with sleep apnea and narcolepsy, and it has made an amazing diifference.  I have long term anxiety and depression issues, and as soon as I began to take this, I haven't felt the gnawing deep chasm of depression I had been feeling earlier.  I don't want to pin it all on one drug, and have been taking it for about a week and a half, so I am wary of the placebo effect, but it's been miraculous thus far.

    Because it helps your brain to feel more awake and alert, my craving for sugary or high caloric food has gone away completely.  It's like someone has turned off a switch in my brain, and the desire is no longer there.  Beforehand it used to be ever present, and lead to a lot of bad food choices.  Now I am able to enjoy healthier food for the nutrition it gives me, as well as taste, and not feel like I need to have a big meal of carbs or sugar in order to stay alert and awake.

    It does mean that you aren't as tired later at night, but due to it's properties you'll be awake and alert again as soon as you wake up and take it.

    The best thing about it is that this not only gives me a new window of opportunity to help me get my life back in check, but it also lets me show all the people who have ever said I need to lose weight that my weight gain was not due to a lack of willpower.  The fact that I have all the willpower I need right now due to one pill pretty much puts that to rest.

    There is one downside though.  I am 38 yrs old now, and I feel that I have lost a lot of time in my life due to my weight and feeling sleep deprived.  Because I was less awake I was less active, meaning I gained weight, leading to me being more self conscious and ashamed of how I looked, and thus I didn't socialise as much as I would have liked, asked people out as much as I would have liked, or been loved like I have wanted to be loved.  Looking back at how much time I have lost does make me mad, mad at people for being so quick to judge, for the bullying and teasing, mad at myself for having this, and mad that the years I should have been going out and having fun and relationships in my youth are lost.  But on the other hand I am so glad that I now have this experience, that I can tell others about it, and that I can actively make decisions now to change my life for the future.

    I had to order mine in from India, because the pills are not on a Pharmaceutical Benefits Scheme here in Australia, so would normally be $782 for three months.  I got 144 for $187AUD off the web.  I don't want to get people to risk it if they aren't comfortable, but this is what I chose to do.  I had to take a risk because life wasn't getting much better for me.  Glad I have this option now, and glad of the change it has given me.

    I'd cry, cry for the future, but I wouldn't get anything done - 'When the River Runs Dry' - Hunters and Collectors

    by TDP on Sat Sep 14, 2013 at 11:48:00 PM PDT

  •  I can't use the mask (1+ / 0-)
    Recommended by:
    worldlotus

    I'm REALLY overweight but every time I tried to use the mask it turns out I took it off in my sleep. I'd keep it on if I could but it was off when I woke up every single time. I don't even remember doing it. It was just automatic. This was about ten years ago and I haven't tried again.

    "Luckily" I'm disabled so I can sleep on my own schedule. It helps when I get ten hours of sleep per night and can take a nap during the day if I need it. Still, I probably weight over 400 pounds. Even if I'm not as tired as a could be I'm still worried about dying young because of the weight.

    Why do I have the feeling George W. Bush joined the Stonecutters, ate a mess of ribs, and used the Constitution as a napkin?

    by Matt Z on Sun Sep 15, 2013 at 12:22:34 AM PDT

  •  I got my sleep study and CPAP when I had (4+ / 0-)

    Kaiser from my wife's job and I was a contractor. While I rarely heard myself snore, I was reportedly amazing.

    We need to hear what will happen with sleep studies and OSA treatments under Obamacare. Clearly, not having OSA excluded as a pre-existing condition is vital. But then what?

    Now I am working on losing weight. I have lost 45 pounds in the last year and a half, which is about half way to where I should be. I am currently losing further weight a bit faster on a very specific diet that I need to Diary. My working title is The Low-Carb Vegetarian. I also use The Hacker's Diet Online Web site to monitor my weight and everything I eat, and view my progress with graphs and statistical measures.

    Ceterem censeo, gerrymandra delenda est

    by Mokurai on Sun Sep 15, 2013 at 12:50:50 AM PDT

  •  This was both fascinating and heartbreaking (1+ / 0-)
    Recommended by:
    ladybug53

    I wish we had single-payer insurance for all, like civilized countries.  It's tragic that people suffer from these conditions when they would be so treatable with medical care.

    Long ago I realized that when I was sleep-deprived after working lots of overtime (not my idea, I might add, it was required), I would crave food, most of it sugary, like M&Ms, while I sat in front of the computer. It was years before I found out that sleep deprivation will do that to a person.

    Thanks for the diary. The solution shouldn't be political, but it is.  We have to elect responsible people who will ensure that everyone has affordable health care. Right now we don't have that situation.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sun Sep 15, 2013 at 03:44:49 AM PDT

    •  I have one leased out on the public insurance plan (1+ / 0-)
      Recommended by:
      ladybug53

      in Germany.all I need to do its call the company that leases it and ask for new filters, masks or hoses and they get delivered the next day.I have to document how many hours I use it twice a year, which isn't too difficult. it's probably saved my life and improved it in the meantime. My wife sleeps with me now that I don't shake the walls.

  •  Must Be Really Scary (1+ / 0-)
    Recommended by:
    ladybug53

    A couple of times a year, I have the experience of stopping breathing in my sleep. After a thirty seconds or so of not breathing, my body will send an adrenlin shot through my system that literally causes me to leap out of bed and run from the room. It's really scary for about a minute or so and then I'm fine.

    I can't imagine this happening several times a night.

    "I'll believe that corporations are people when I see Rick Perry execute one."

    by bink on Sun Sep 15, 2013 at 05:14:28 AM PDT

  •  I have OSA and was told by my doctor that losing (3+ / 0-)
    Recommended by:
    tommyfocus2003, rubyclaire, ladybug53

    even 10 pounds would make a difference....when I finally succeeded in losing 40 pounds, she then said it makes no difference....  I have used a CPAP for over 14 years and have had a terrible time with the masks due to wrong sizing....5 years for the doctor and supply company to figure out...losing weight, and a small face which makes fitting difficult.  I FINALLY got fitted properly this summer and what a difference.  Of course at that point my machine died and it has taken 2 months for my doctor's office to request a new one....and the company supplying it can't get it to me for 2 weeks.  When I go back in November I am going to request a different provider.  I feel 100% better on the CPAP, no morning headache, no need to sleep for 3 hours every afternoon.  I also have "borderline narcolepsy" and fibromyalgia so I also take Provigil...or the generic equivalent now which really helps and I have even been able to lower the dose of that.  With all the technology at our fingertips, you would think that something as important as sleep would get more study.....

  •  Republished to Daily Kos Weight Loss. (1+ / 0-)
    Recommended by:
    ladybug53

    Because it doesn't work for overweight people, either, and points out that judging others for their weight is simplistic and dumb.

    Thank you for sharing this with us.

  •  So many veterans have Sleep Apnea issues (1+ / 0-)
    Recommended by:
    ladybug53

    those with PTSD - and other medical conditions.  The VA eventually will address the issue if a veteran is persistent and advocates for himself.  I have been in PTSD/MST groups where several group members used the CPAP.  Many had some terrible adjustment problems with it, however.

  •  My husband has it and I have problems (2+ / 0-)
    Recommended by:
    ladybug53, Throw The Bums Out

    if I try to sleep on my back. I have a lot of background congestion (probably low-grade allergies) and a narrow airway, and then I am a large and very curvy woman. Too much poundage on my chest to sleep on my back.

    My solution to this is to bun my hair at night and put it on the middle back of my head. Fine if I am on either side, not if I am on my back. Natural nudge.

    My husband had a sleep study done and had real trouble falling asleep (not his own house, not his own bed, etc) and while we have a machine and masks that someone donated, he won't use it. (sigh) But I have it in case he changes his mind.

    My boyfriend also has it, and is hoping that if he loses enough weight he will be able to stop with it, as the need for it developed with the weight gain.

    When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

    by Alexandra Lynch on Sun Sep 15, 2013 at 07:52:49 AM PDT

    •  Donated CPAP machine? (0+ / 0-)

      Alexandra, just wanted to ask if the donated machine was reset according to your husband's prescription or is he trying to use it as it was set for the previous user?
      Also, if you didn't already you might find my comment above interesting:"OSA treatments".

  •  Also, losing weight isn't a simple equation (1+ / 0-)
    Recommended by:
    ladybug53

    People process food differently. The organisms in our body which help process food are probably more to blame than our eating habits.

    -You want to change the system, run for office.

    by Deep Texan on Sun Sep 15, 2013 at 07:56:40 AM PDT

  •  What about the didgeridoo? (1+ / 0-)
    Recommended by:
    rubyclaire

    I tried CPAP hated it - couldn't sleep - so, uh, how is that helpful?!  Although I have not yet tried it myself I have read about this as an effective treatment and that was actually confirmed to me by a researcher at the sleep center I went to.  I was being fitted for my mask and asked the tech if he had heard about it he said no but the researcher was passing by and she said yes - she had been involved in a study of didgeridoo for sleep apnea.  And she said it is indeed effective.  It involves learning the circular breathing technique used to play the didgeridoo (a real didgeridoo is not required, plastic piping will do) and practicing about 20 minutes a day.  The researcher said the problem was follow through - it works but only if you do it (obviously) and she said many of the people in the study just did not follow through. But this is certainly cheaper and less annoying than the CPAP which, like me, a lot of people give up on. Sorry if someone else posted a comment on this.

    Here is one of many links I found on this

    http://sleepapneadidgeridoo.com

    •  This is interesting. (0+ / 0-)

      I've never heard of this before. Basically this seems to be using a technique that is called Positive Expiratory Pressure or PEP therapy which is useful for people with COPD.  
      I'll have to do some research on this. I am more than a little skeptical that this is effective for sleep apnea, but could be convinced if there are reputable studies showing efficacy.

      •  I found this (0+ / 0-)

        http://www.bmj.com/...

        it is a report on a study conducted by a Swiss team

        •  Very interesting. Thanks for posting the link. (0+ / 0-)

          These results need to be replicated by other studies with larger sample sizes. If that happens then it appears that this instrument might be a good adjunct therapy to use in combination with CPAP or surgical intervention or whatever, but probably not as the sole treatment.  My question would be whether or not playing saxophone, tuba, french horn, clarinet, etc would accomplish the same outcome.

          •  My son plays (0+ / 0-)

            Euphonium and Trombone and they do use a similar technique, in fact, a few years back his teacher suggested he get a didgeridoo. Don't know about the other instruments, might be just a low brass thing.

          •  Any instrument that uses circular breathing (0+ / 0-)

            techniques will help.  Meaning anything that plugs up one's mouth so there is back pressure.  And you have to learn the circular breathing technique.

            Unfortunately for me, flute doesn't help.

            Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

            by barbwires on Mon Sep 16, 2013 at 06:05:06 PM PDT

            [ Parent ]

  •  Regarding masks (0+ / 0-)

    I would never get a mask. But I do love the nasal pillows- like the Swift pieces. I have an old swift 2 that I keep as a spare and use a newer Swift FX I believe.  Very streamlined and minimal bulk.

    Downsides- For the first 2 months I had to wrap an ACE bandage around my head to train my mouth to stay shut during the night. And colds/allergies its hard as the temptation to use nasal sprays to clear the nose is great. But the nose gets addicted to the spray and then needs it to work as normal. So.. clogged nose = a few shitty nights.

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