Update On Sleep Apnea

It’s about 3 months since I was diagnosed with severe obstructive sleep apnea, after spending a sleepless night in hospital wired up to a monitoring machine doing a sleep study. Since that time I’ve been trialing a Continuous Positive Air Pressure Machine, which is the front-line treatment for sleep apnea.

I found using the CPAP Machine challenging. The first problem was falling asleep with the mask on. I tried four different masks:

1. The full-face mask was hardest to fall asleep with, because it’s like sleeping with that creature from Alien on my face.
2. The nasal mask was also quite intrusive, with the additional drawback that my mouth would fall open during sleep resulting in air blowing out my mouth instead of into my airways.
3. The nasal pillow was the least intrusive, but the force required to hold it in place all night hurt my nose and became so painful that I couldn’t sleep with it. It also suffered from the problem of my mouth falling open, which I solved with a chin strap.
4. A nasal mask made by Fisher & Paykel ended up being the least intrusive, so I went with that.

The other problem was that as the CPAP machine ramped up the pressure to eliminate my hypopneas, I would wake up. After consultation with the sleep specialist, we set the machine to cap the pressure at 11cm H₂O. It’s better to get an imperfect sleep than an interrupted one. This meant that I no longer woke up due to the high pressure, but also limited the machine’s ability to further treat my condition.

Basically, CPAP is a pain in the ass. Check out this horrific image from Mandibular Advancement Device manufacturer SomnoMed’s website. I’m sure it’s designed to scare you off CPAP so you’ll use their oral appliance instead:

This horrific image should scare you off CPAP therapy

CPAP therapy also tends to induce central apneas. The results from my trial showed that I was experiencing central apneas and using the machine would be a trade-off between eliminating obstructive hypopneas and inducing central apneas. I’m a little concerned about the long term impact of that.

During the trial I also took a community college course where I learned to play the didgeridoo, which was shown by a Swiss study to improve sleep apnea. The circular breathing required exercises the ortholaryngeal muscles that collapse during sleep blocking the airway. I played didge for about 20 or 30 minutes a day. It’s difficult to give an exact measure because I found it too tiring to do in one sitting, so I spread it out over the day. I also did half an hour of vocal training each day, again hoping to tone my oropharyngeal muscles.

When I started using the CPAP machine, my Apnea/Hypopnea Index (AHI) immediately fell from 51 during the sleep study to 17 using the machine. After three months of playing didgeridoo, it had fallen to 11 while using the machine. That’s still a fair way off the normal level of under 5 unassisted, but at least it’s progress.

When I first mentioned the didgeridoo study to my sleep specialist, I didn’t think he was going to take me seriously. Sleep apnea is a serious condition and I don’t like not being taken seriously. However, he knew about the study and sounded fairly positive although the group size was small and no other researchers have replicated it. Given that I’m studying music and want to get a decent nights sleep, I was very enthusiastic about the idea of learning to play the didgeridoo. I was curious why he hadn’t mentioned it given that a study has shown it is effective, but he said:

“I’ve just never had a patient who was willing to give it a go”

He was happy for it to be part of my treatment plan.

When I asked what he attributed the improvement in my AHI scores over the course of the 3 month trial to, the sleep specialist gave a detailed technical answer based on the change in the CPAP machine settings. He didn’t consider the didgeridoo and vocal training but I’m going to continue them every day to see if I can improve my AHI even further.

I still wake up feeling pretty tired and have a mild headache all the time, but I haven’t found myself wanting to fall asleep on the train on the way to college in the mornings. I really don’t like the idea of using a CPAP machine for the rest of my life since it’s just plain hard to sleep with. I doubt the didge and vocal training will be sufficient to cure me given that my sleep apnea is/was severe, so I’ve decided to get a mandibular advancement device which is the other conventional treatment for sleep apnea. I’m hoping that the improved sleep it gives me allows my body to recover finally from the flu-like CFS symptoms. I often wonder whether my post nasal drip, sore throat and nasal congestion are in turn worsening the sleep apnea in a vicious cycle.

Meanwhile, I’m continuing a routine of daily meditation inspired by the ANS Rewire program which I’ve been on for about 5 months now. The symptom chart in the monthly progress spreadsheet continues to show a gradual improvement, even if some days I’m too pissed off to want to acknowledge it.

ANS Rewire is all about getting your nervous system to switch back from sympathetic fight-or-flight mode to parasympathetic rest-and-digest mode. Interestingly, I just read this in the chapter on sleep apnea in the book Sleep Soundly Every Night, Feel Fantastic Every Day by sleep disorder specialist Robert S. Rosenberg:

The autonomic nervous system consists of the “fight or flight” sympathetic nervous system and the parasympathetic nervous system. Normally, when we go to sleep, the calming parasympathetic nervous system predominates and our blood pressure drops an average of 10 points. However, in people with sleep apnoea, there is the stimulation of the sympathetic nervous system during sleep. This is in response to the low oxygen levels that accompany the respiratory events in conjunction with the stress response brought on by the effort to breathe against the closed airway. This results in surges of the blood pressure as high as 240 mmHG at the termination of each of these events. Therefore, people with sleep apnoea lose the normal drop in blood pressure with sleep. In fact, their blood pressure may skyrocket. Eventually, this nocturnal elevation spills over into the daytime and results in persistent hypertension.

That could explain why I feel tense and anxious all the time. The other advantage of getting the sleep apnea treated is that I expect to be able to exercise again, and in turn exercise is another factor that improves sleep apnea.