For at least 7 years my family had complained about my snoring. I tried the nasal strips, nose drops, raising my head while sleeping, losing weight, all of the popular ideas, but nothing helped. Apnea never crossed my mind until I found out my mother, who has always been thin, was diagnosed with the condition. Unfortunately she would never do anything about it and eventually died from fibrosis of the lungs, probably as a result of the untreated apnea (recent studies have shown a correlation).
In addition to my snoring I noticed that my HDL levels were well below normal. Even when I was exercising 40 minutes a day, in great shape, and eating right, the snoring continued and the HDL levels never rose. I would fall asleep at my desk at work, had headaches when I got up in the morning, and fell asleep watching TV in the evening. How or why I went to the doctor to see about a sleep test, I can't even remember but the test came back with a diagnosis of severe obstructive sleep apnea. After a second test I was prescribed a continuous flow CPAP machine.
The good news was that within a year my HDL levels rose to "normal". I had not changed my diet or exercise routine (was retired by then) so the only variable was the CPAP machine. The bad news was that from the first night I suffered from painful gas. It took over a year of research and working with my HMO to discover that because of my hiatal hernia (another study has shown that over half of apnea patients also have gastric problems) the continuous pressure CPAP just pumped me full of air every night. When I was finally able to get a auto titrating CPAP the gas problems stopped.
What I had was NOT aerophagia, which is a term ascribed to the condition by many doctors, but gastric insufflation, which can be very dangerous. The other, more insidious result of the bloating is that many straight CPAP users simply stop using their machines because they don't realize they can get relief from an auto machine.
Apnea is a killer. Google the internet and you will see that diabetes, stroke, heart problems, lung diseases, and hardening of the arteries are just some of the nasty things that can occur if apnea is not treated. The good thing is that if apnea is caught in time many of the problems can be headed off. In my case I hope that I found out soon enough to prevent the problems experienced by my mother, grandmother, and great aunt due to hardened arteries (as indicated by low HDL levels).
For many obese people, whose apnea is the result of their obesity, a "cure" is as simple as losing weight. Of course, if these folks also have the inherited factors (as I did) that lead to OSA (obstructive sleep anpea), losing weight may lessen the problem but will not cure it.
If you are always tired, have headaches in the morning, and snore (all people with apnea snore but not all people who snore have apnea), you may have apnea. Only a sleep test can confirm the diagnosis. The CPAP is not the only treatment but is 100% effective.
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The genetic link is definitely there, particularly for those who are not overweight or obese. My mother passed away as a result of fibroid disease in her lungs. She would not treat her apnea and suffered unecessarily as a result. Untreated apnea can result in hardening of the arteries which can cause the type of lung problems she had as well as her macular degeneration. Her mother also died of hardening of the arteries to the brain and an aunt died of related heart problems. Low HDL levels, which are now being seen as associated with apnea can result in hardened arteries. My HDL levels were low until I started treating my apnea with the CPAP. Since my apnea is rated as "severe" the options of surgery and dental devices currently may not provide the relief I would need. As long as the auto-PAP machine I am using treats my apnea I will continue to use it. I do hope that some of the new treatments being studied (electric stimulation of the throat muscles, for one) will provide the answer in the future for those of us with severe OSA. The Europeans seem to be way ahead of Americans in testing new ideas. It's time for us to play catch-up.
October 22, 2009 - 8:38amThis Comment
Aren't those WOW moments amazing? I've had plenty of those as well. I can totally see how TMJ could be connected with nerves in your neck. My girlfriend was seeing a specialist here in the Phoenix area who is a dentist by education, but now he works in this area of facial pain, TMJ, etc. She had started out with her own dentist and was referred to the specialist. I think you are also correct about the TMJ including ringing in the ears sometimes.
My girlfriend also contends that there is a strong genetic link in apnea. She said her own experiences with it inspired her Dad to go into a sleep lab as he was having excessive sleepiness during the day. He was also diagnosed with it and is doing well with his CPAP machine. But they don't seem to be for everyone. Are you planning on looking into the TMJ aspect a bit more, even though your case, if you have one, may be mild? Thank you again for your very insightful posts! Big hugs, Michelle
October 21, 2009 - 11:03pmThis Comment
This is one of those WOW moments, Michelle. When I was diagnosed with apnea I also noticed I would wake with numbness in my thumb, pointer and middle fingers. It would go away when I moved my neck or rubbed the nerve on the back of my neck. The doctor said it was a pinched nerve. But it doesn't stop there. There seems to be a connection between the nerves in the neck and TMJ....and somehow apnea fits into this, too. It's all a gray area. Unfortunately the dental community doesn't talk to the medical community about the connection between TMJ and apnea. Dentists swear by their appliances for treating the problem and doctors think that surgery or CPAP therapy is the answer. Why can't we get them to talk to each other???? I don't have TMJ - or at least not a bad case of it but do have ringing in my ears and I have heard that is part of TMJ.
When HMOs start understanding that dentistry is an important part of overall health perhaps they will also pay for the dental appliances that seeem to work for some patients suffering apnea.
October 21, 2009 - 8:33amThis Comment
Hello fritzgla,
I wanted to thank you for posting such fantastic information about sleep apnea. Your article was really well-written and very informative. I can't tell you how many people I know, both men and women, with this problem. And those are the ones who know it! I wonder how many millions of people have it and yet either have no clue or else they just don't want to go in and get tested.
A good girlfriend of mine has it and she also had issues with TMJ. The specialist she saw said there is often a connection between the two, at least that he sees. He told her it's not one of those conditions that does not typically make the list of apnea-related issues but he sees it all of the time. He said clenching your jaw can help open an airway, or at least that's what some patients try in their sleep. For my friend he wanted to test her again for apnea to see what her current results were and then in his office he recommends an oral appliance to treat it. Are you familiar with that? It is supposed to be easier to use and less intrusive than the CPAP.
Thank you again for this great information! I think you have helped a lot of people with your post. Best in health, Michelle
October 20, 2009 - 11:54pmThis Comment
Hi fritzgla -
October 20, 2009 - 5:14pmCongrats again! It can be easy to give in to those who handle our standing up for our health by trying to ignore us or viewing us as complaining. It's funny, isn't it, how those who aren't living with what we're living with think they can impose determinations based on their view of the world. I'm so glad to hear that the HMO is now taking the information you bring to them seriously and has expanded the sleep lab. There's no doubt in my mind that you've helped others by speaking up and standing firm. Hope you have some really sweet dreams now that you're sleeping well, you definitely deserve them!
Take good care,
Pat
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Thanks, Pat, and good luck to Diane and her husband. Apnea is just beginning to be taken seriously by many of the doctors who previously considered it just a "sleep disorder". My HMO went from nearly total apathy - just slap a CPAP on her and she'll be "cured" - to finally listening to my complaints and suggestions. They have expanded their Sleep Lab staff and hold classes at the lab rather than at the DME provider. This is one of those cases that proves that patients must take their own initiative if they feel they are not getting the health care they need. I filed a grievance (as was told to do if I wasn't happy with the situation) and finally won. It took perseverance but now I am sleeping well and my apnea is in check, without the nasty side effects of gas.
October 20, 2009 - 3:12pmThis Comment
Hi fritzgla - Thanks again for contributing your knowledge to help others. Great information! Take good care, Pat
October 19, 2009 - 5:13pmThis Comment
The site below has a "self-evaluation" that can be used as the first step toward diagnosis. The test results can be printed out and taken to the doctor. The fourth question may be the most important one. An apnea sufferer will have periods of snoring, then stop breathing and suddenly gasp or snort. Have you observed this with your husband? This is an apnea and should be reported to the doctor. As I said in my post, while not all snorers have apnea, all those with apnea snore.
You asked about the "first line of testing" - that is generally an interview to assess whether a sleep test is warranted. The doctor should ask many of the same questions (and probably more) shown in the "self-test". If a sleep test is warranted, it can often be done at home. The patient has a cannula (to determine the breathing pattern), sensors to monitor the heart, and a fingertip oxygen sensor. The results are examined to see if apnea is present with a AHI (apnea-hypopnea index) rating. If the results indicate a CPAP is required a second test will determine the settings.
The self-exam is found at http://www.sleepapneainfo.com/sleep-apnea_l2.php?id=91
October 19, 2009 - 9:14amNote that similar tests can also be found at other Internet sites. Hope this answers some of your questions.
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Fritzgla,
Thank you SO very much, Yes, he does have the snoring/silence/sudden snort type behavior you mention, though not all the time. Now that we have moved and settled in, I'll get him online to take this test and get him to see his doctor. I also didn't know a person could do the sleep test at home. That is awesome (I had pictured the difficulty of getting him to a sleep lab, etc). Thank you SO much for sharing about this topic.
October 20, 2009 - 9:49amThis Comment
My husband snores, and at times I suspect sleep apnea. If he goes to his doctor, will the first line of testing be the sleep test? Is it pretty common for doctors to prescribe such a thing when someone's partner (me!!!) tells them that they snore too loudly and unevenly?
I would love it if someone who's had a sleep test would write about it in detail. Fritzgla, might you?
October 19, 2009 - 8:57amThis Comment