Posts Tagged sleep apnea
I am curious about how other people think about this sort of stuff. Do you find it interesting? Boring? Of value? Problematic? Indication of societal decline and the end of days?
Sleep seems like a problematic area for most of the people I know. I wonder if this extends as far into the general population as I think it does. From all the articles and websites dedicated to the topic, you’d think so. But then, you rarely hear from people when they’re happy; you most often hear from them when they have a complaint (if nothing else, working in video gaming has taught me that).
At any rate, I’m curious to see how many people find tracking of value.
Because a picture is worth a thousand words, and, honestly, because I am feeling too tired to do much of a write up on anything today… The sleep graphs from last night, starting with the fitbit.
And now the Zeo:
It felt very weird. Not painful, but weird. The whole process took less than an hour.
The doctor’s assistant numbed the inside of my nose using lidocaine on a q-tip.
The doctor injected a local anesthetic twice on both sides. That’s when I started feeling light headed. It’s apparently very common for patients to faint at that point, since the injections are taking place in an area with a lot of nerves.
Dr. Robson Capasso (who introduces himself by his first name, which I like) tilted the chair back for me as soon as I said I was feeling light headed (which nicely prevented me from falling out of the chair, yay). He had a resident shadowing him, and so he was explaining as he did things (and you know how awesome I find that).
It’s called radiofrequency turbinate reduction. My boyfriend got it done, also, as part of his general sleep apnea surgery four or five years ago (his surgery worked; sadly, I am not a candidate for that same surgery since I do not have the same structural cause).
But back to the procedure itself. To quote obstructednose.com:
All of these methods aim to shrink the underlying turbinate by applying heat to the surface lining of the turbinate and creating a lesion. A probe is inserted into the turbinate tissue between one and six times, while the needle is heated and the underlying tissue is shrunk.
Zeo arrived today. I haven’t even opened it yet.
Wouldn’t that be nice?
In my obsessive googling of those terms, I came across an interesting article abstract.
It’s not conclusive, not by a long shot. And I wish I had access to the full article, but since I’m no longer university faculty, I no longer have access to those databases. I hear that I could just go to the Stanford Medical Library and plop myself down there to do research. Can’t take any materials, but could at least read them on site.
Wait a minute. Scratch that. Sono.org, you have come to my rescue! Voila.
It’s a small study. Only 26 completed it, and that’s hardly a sufficient sample size. Then again, with this sort of thing you’re already limited by access to patients with sleep apnea who are willing to try acupuncture and (likely) don’t have other medical issues going on to cloud results. Not a huge group. Of course, we also need studies like this to prove that it’s worth the investment to do larger studies.
Tried a different CPAP mask last night and, according to my fitbit, slept slightly better.
Still not great. I should be around 95% sleep efficiency, ideally. And I ought to have more full sleep cycles in there; most people need a full 90 minutes to have a complete sleep cycle. It looks like I had two blocks that were long enough. I really would like to have three full cycles a night.
I am tired.
Very, very tired.
This was last night. 18 times awakened. Bah. And this isn’t even bad in comparison to the last few weeks. For this same night, my CPAP tells me I was averaging 12 hypopneas an hour. This is not good. But it’s better than the 25 I got a few days ago, which, according to the fitbit, translated into 38 times awakened during that night:
Technically, no one else in my family has ever been diagnosed with Sleep Apnea, but I’m pretty sure I’m not the first to have it.
What I’m about to say will no doubt provoke my father into an argument (one we’ve had before). But.
In 1990, one of my uncles mysteriously died. He was 38, seemingly hale and healthy. No one, at the time, could figure out the cause. All we knew was that during his sleep, he cried out and accidentally struck his wife. By the time she was fully awake and realized something was wrong, it was too late. She called for help, but the ambulance arrived far too late to do anything. The only theory the coroner had was that it was some sort of heart failure.
Sixteen years later another uncle cried out in his sleep, waking his wife. Her cry for help reached their son, who performed CPR while she called for an ambulance. This time, the ambulance arrived in time. It was cardiac arrest, in an otherwise hale and healthy man.
In the hospital, right after the attack but never again repeatable, my uncle evinced a heart arrhythmia. A prolonged QT, somewhat rare and unusual in that it strikes only during sleep. Very simply, that means that his heart took too long between beats.
My father may be right, and Sleep Apnea may have nothing to do with it. But. Sleep Apnea is known to cause cardiac arrest. Sleep Apnea is even known to cause not just heart arrhythmias, but also a prolonged QT.
“After adjustment for age and body mass index, the odds ratios were diminished but still remained significant: Sleep clinic OSA patients had a 2.6-fold greater risk of long QT syndrome than controls, while OSA patients from the general population were at 2.3-fold increased risk.” – Jancin, Clinical Psychiatry News.
Then let us look at the other comorbid conditions:
Each condition listed on that graph has enough supporting evidence to be included in the general sleep literature (although “pacemaker” is really more a treatment than it is a condition). But that graph, while lovely and useful (snagged from ResMed) is not absolutely comprehensive. It can’t be, because 1) it only addresses men, and 2) there are new developments that haven’t yet been accepted into the cannon. We also have evidence of links to Ischemic Stroke, GERD, PCOS, and Metabolic Syndrome.
Let’s be clear here. Correlation does not necessitate causation. Just because two conditions often show up together does not mean that one causes the other. Many of those correlations are still under study, although some (like the one with PCOS) have enough substantiation to be widely accepted.
Then there are the other standard signs (not conclusive on their own, but alarming when taken in conjunction) like snoring, trouble sleeping, frequent wakings, and fatigue (though don’t ever tell a doctor you have fatigue, they seem to think that translates directly to “depression” or “hypochondria”). To my mind, the presence of any of those serious conditions is good enough reason for someone to get a sleep study. Combine them with each other or any of the other signs… yeah. Get thee to a sleep doc.
Back to my family. All on my mother’s side of the family we have: sudden death during sleep, cardiac arrest, heart arrhythmia (specifically prolonged QT), GERD, ischemic strokes, frequent wakings, trouble sleeping, snoring, fatigue, and –if we’re counting me– PCOS and… wait for it… wait for it… SLEEP APNEA.
Sounds like a party, no?
I may be emotional about this issue (all right, I’m definitely emotional about it). But that doesn’t change the fact that within that one branch of the family we have 10 of the conditions known to be linked to sleep apnea — in addition to Sleep Apnea itself. My mom alone has six of those conditions. Six.
There is no way I am the only one.
Edited to add: Oh, ya. And one of my maternal cousins has a Sleep Apnea diagnosis, too. There are at least two of us in my generation.
To use the fitbit for sleep tracking, you slip it into the wristband that comes with it. In this picture, which I snagged from the engadget review, you can see the band and the fitbit. Do not wear it this way. It may look pretty and snazzy like this, but the fitbit will slip right outta there. (Enough reviews complain about this problem that it’s worth noting). Do the smart thing, slip the fitbit all the way inside the band. You won’t be able to see it anymore, but it won’t slip out.
You wear the band on your non-dominant hand. I don’t know why they specify the non-dominant hand, but I’m willing to accept that there’s a reason for it.
When you’re ready to sleep, press down on the button for several seconds until the word Start pops up. Do the same thing in the morning until the word Stop pops up. If you forget, it’s okay. You can add in sleep times manually on the website, too.
So far as I’m concerned, the sleep tracking is the most useful function of the fitbit.
On its own, the fitbit cannot give you conclusive information about your sleep. It can’t tell you if you have DSPS, or Sleep Apnea, or Restless Leg Syndrome. But it can tell you if your sleep is disturbed, which could indicate any of those conditions. Or could indicate that your cat likes jumping on your stomach at 2 am with claws extended.
Each pink spike in the graph above indicates a time when I moved around while trying to sleep. It doesn’t necessarily mean that I fully woke up each time, just that my sleep was light enough, or disturbed enough, at that point that I moved. At a sleep lab they’d call that an arousal (which is nowhere near as fun as what I usually mean when I use that word). When you’re in a deeper sleep phase, you don’t move around much.
This particular graph is from last Wednesday and indicates a very good night for me. I had 17 brief arousals, and managed to get over eight hours of sleep. I also was asleep at a decent time, which is an issue for me (remember my prior post about charting sleep?).
And here’s a bad night.
You can see that I was a lot more restless that night (Sunday). I still woke up 17 times. But I stayed awake, or aroused, a lot longer. And as I said earlier, not aroused in the good way. I totalled six and half hours of sleep, although I was in bed for 13 hours. This is incredibly useful information; I wish to heck I’d had this info when I was a teenager getting nagged for sleeping in so late on weekends and being zoned out in morning classes (8am Italian was excruciating).
If I’d known how bad my sleep was, I might have been able to do something about it. Or my father (the pediatrician) might have.
You see, I have sleep apnea. Want to know what the difference between those two nights is? The good night, I used my CPAP. The bad night, because of congestion, I didn’t use my CPAP.
See what I mean about that sleep tracking being useful? On its own, the fitbit doesn’t tell me I have sleep apnea. But it does tell me when I’m having trouble sleeping. And these results are consistent enough for me to say that my CPAP definitely makes a difference.
Here you can see how much sleep I actually got this month. Not how much time I spent in bed trying to sleep, but how much sleep. This is a key distinction.
You can also see how frequently I wake up during the night. There’s a huge variation there. Some of that correlates with how long I spent in bed (if you’re only in bed for four hours, you’re going to wake up fewer times than you would in eight). But there are other potential factors as well.
This data can help me figure out if the nights I take a decongestant are, overall, better. Or worse. Or no different from other nights. Likewise with taking Ambien. Or with exercising before bed. Or having a glass of wine before bed. Or changing my diet. Or any other variable I care to examine.