Sunday, July 26, 2015

Why you should take your sleep apnea diagnosis seriously

I (somewhat erratically) maintain this blog to talk about topics that people don't seem to think about.  Usually I do it from a business perspective, but now I want to talk to all of you who (like me) have a diagnosis of sleep apnea.

First of all, who are you?  You are not necessarily middle-aged, male, and have a waist size of 38" or more, though those are 3 of the most common things.  If you feel tired often, but have figured it's because you're getting a little older, you probably should go get checked.  I am male and don't have either of the other two risk factors, but I have sleep apnea.  I was tired a lot, but I figured it was because of my lifestyle -- staying up late with the kids, and then leaving very early for a long commute to the office.

The doctors say I have a large tongue but a small lower jaw, and that's what is causing my sleep apnea -- losing weight won't really help me, it's the way God designed me.

The "gold standard" treatment for sleep apnea is the CPAP machine.  You have to wear something on your face to give you air when your body can't breathe in.  This treatment has a near-100%* success rate, but no one wants to wear a mask on their face -- besides unattractive look of it, it's uncomfortable, it's a hassle to keep clean, and finding the mask that fits properly can take over a year (remembering why you took off that mask can be more difficult than remembering your dream last night!).  ...and it can have an impact on the family too -- my full face mask startled my young children until I told them the doctors said I have to wear an "elephant nose" at night, and it though my wife is understanding, it has affected life activities in the bedroom too.

What are the alternatives?  Well yes, there are some, and they have varying degrees of effectiveness, but none of them are as effective as the CPAP machine.

  1. CPAP -- included for completeness, already discussed above, effective for 90%* of sleep apnea patients
  2. Lose weight.  This is probably the most effective alternative "cure" but you have to keep it up, and requires you have significant weight to lose - effective for 40%* of sleep apnea patients
  3. Dental device -- if, like me, you have a smaller lower jaw, sometimes this is effective.  Wasn't for me, though, and your jaw will be sore every morning for the first few weeks.  Effective for 25%* of sleep apnea patients
  4. Surgery -- if you've already had your tonsils removed, this probably won't do anything for you, but there are more things they can do than just remove the tonsils.  Varies based on the type of surgery, 15-35%* of sleep apea patients benefit.
  5. Pacemaker -- there is a "pacemaker for the tongue" to keep it out of your airways, but it's a very new treatment.  You have to maintain the device just like a pacemaker (batteries, etc.), and I have no idea what the side-effects are (does it impact your ability to talk?  no idea) -- insufficient data.
  6. "I'll just sleep on my side." -- usually not effective, but I'll give it a generous 5%* estimate
Is it really that big of a deal?

Yes.  It is.  Your heart can do its job to wake up the body enough for you to catch your breath a few times a night, that's no problem.  Sleep apnea patients wake up 25-50 times a night, but usually don't remember it.  That's a lot of wear and tear on your heart.

Also, general fatigue can lead to:
  • Car accidents
  • Poor attention span
  • Poor posture, and therefore back and other health problems
  • Poor judgement at work
  • Emotional health problems (which impact relationships at home and at work)

But I've lived like this for years!

This is the often overlooked piece of the puzzle.  According to a presentation I saw at Stanford's Sleep Clinic, you can live up to about 10 years like this before you start having noticeable health problems.  

You can also drive over 100 miles with a screw in your tire* without air leaking out, but chances are you would rather change the tire as soon as you notice it, because you don't want the risk of a blowout on the freeway.  So why would you take that risk with your body?

Ok, I've tried it, I don't like it.  I give up.

You owe it to your family, friends, and coworkers to keep trying.  Every night you don't, you shorten your life a bit.  

My story...

Three years after my diagnosis I'm still trying with my Variable BiPAP machine (similar to CPAP) -- the masks I've tried don't fit quite right for me.  The other options have already been ruled out for me (except the pacemaker option... not much is known about that one as of mid-2015).  However even though I'm not entirely successful, I've noticed a huge difference in my energy level, and my general health once I got above 4 hours of use per night.  ...and as I continue to get better at it, my energy level and health has continued to improve.

It's been worth the effort, and I wish I could just take a pill for it every day, but CPAP is the best solution for now.  My efforts paid off, yours will too.

Factors to play with

If you're having trouble and think you've tried it all, here are some factors to consider:

  • Type of mask
  • Tightness of straps
  • Is the mask seal clean?
  • Do you wash your face before you go to sleep?
  • Temperature of the humidifier
  • Your pillow (does it bump the mask off at night)?
  • Ramp-up settings of the breathing machine
  • Your doctor's settings on the machine
  • The air filter on the machine
  • Do you change your mask seal at least monthly, as designed?
  • Your mattress!  (if you've been tossing and turning thinking it was your breathing machine, but it was really your mattress, changing your mattress can help a lot! -- the Personal Comfort Bed is a great alternative to the Sleep Number Bed -- tell them referred you for $50 off)
...and if you're looking for tips, the CPAP Forum is a great place to get advice from breathing machine users who are just like you, but may have more experience.

* - this "research" should be treated as "what your friend thinks he remembers reading somewhere" at best, and if you want to know the truth, go research it yourself.  I am not a doctor, nor am writing this as a formal research paper.  I don't have sources, nor do I plan to add any.