A Health Care issue?

I need lots of sleep. If I don't get 9hr/day I start getting cranky. So I've been cranky for at least 9yrs (Raising Kids).

I snore (supposedly). And apparently with those irritating gaps in breathing (not for 30sec, but for a "pause").

I've tried those nose-strips, but it doesn't seem to make a difference (at least with the snoring - I haven't been consistent enough to be able to monitor perceived sleep-quality).

Other technologies to consider

• the couch!

• Weight can be an issue. Gotta work on that Physical Fitness.

• my doctor (a man!) recommended sewing a tennis ball into the back of a TShirt to wear to sleep, so I'd be forced to only sleep on my side. I don't think that would be an improvement on the sleep quality side...

• [Snore Ender]? http://snoreender.com - equivalent to that tennis ball

• there are pillows that try to make sleeping on your side more comfortable.

• [CPAP] no I don't feel like doing a [Darth Vader] impression for the rest of my life

  • Les Orchard says the machine is actually not very irritating, for him or bed-partner. But recommends newer masks that vent air up, not straight out.

Might I have [Sleep Apnea]?

• http://en.wikipedia.org/wiki/Sleep_apnea

• I took an overnight test a few years back (2002?), they said no

  • jeez it was freezing in there, I should have complained. Maybe I need to freeze down our apartment? Is [Room Temperature] a factor in sleep quality? Our apartment is always in the mid/upper 70s, which is rather warm. This page says that 60-65 is preferable. Jeez, that's really cold. This says 60deg. This says 65deg for babies! The [National Sleep Foundation] is fuzzier: In most cases, temperatures above 75 degrees Fahrenheit and below 54 degrees will disrupt sleep, but even sleep researchers fail to agree on the ideal temperature for sleep. The point at which sleep is interrupted due to temperature or climate conditions varies from person to person and can be affected by bed clothes and bedding materials selected by the sleeper. In general, most sleep scientists believe that a slightly cool room contributes to good sleep. That's because it mimics what occurs inside the body when the body's internal temperature drops during the night to its lowest level.

  • in the follow-up the doctor told me about various ways of eliminating snoring, which all involved turning your soft palate into hard scarred tissue via electric shock, surgery etc. Yikes!

• took test Jan'2008

  • finally had follow-up May05:

    • during [REM] my [RDI] was 65+! Going back tonight for overnight calibration of [CPAP] machine, then have one delivered for me to test for 4-6wks, see if that helps with tiredness.

      • I'm a wee bit skeptical, it smells like the definition of sleep disorder is changing over time to include more people.

      • I had just a couple apnea events in the night, I believe

      • I had more Hypopnea but I don't have the numbers.

      • that [RDI] includes not just apnea and hypopnea, but also other events that "disrupt sleep".

    • ugh what a horribly uncomfortable night. Not being able to open your mouth the whole night is really weird. I woke up a bunch of times, really uncomfortable. But the tech said I had fewer "events".

• May12-13: [Home Care] company delivered [CPAP] (Respironics [RemStar] M-Series with [CFlex]) to my home

  • definitely a bit better than the experience in the lab

  • but still woke up a bunch of times

  • and some of those times had that same "going to burst" feeling. You open your mouth, and a burst of air comes out. You close it, and your cheeks puff out. Now what? So far it seems like the right solution is to tighten your cheeks back in, and just try to breathe normally through your nose, and things will get a little bit better. Part of what makes this machine better is that it ramps up the pressure over the 1st half hour; it also seems like the pressure varies during the night, or maybe depending on your behavior. I'll need to experiment a bit more, and actually read the instructions.

  • and must have had mask (the [Fisher And Paykel] [Flexi Fit] 407on too tight, because have ridge of redness on bridge of nose.

• May 13-14: night2

  • pressure seemed less distrurbing, but that could be because it was drowned out by soreness of nose where mask hits. Tried moving it a little, didn't help. Loosened the straps, that sometimes led to leakage which was just another distrurbance. This morning my nose looks much worse.

  • have to decide whether to put a band-aid on my nose, take break from machine for a couple days to let nose heal, or what

• May15-21

  • I call [Home Care] folks, they suggest "tissue" between mask and skin. Try it, no improvement.

  • I try to schedule visit to try another mask, have to wait until May21

  • I stop wearing for a week because of shifting beds around, letting kids sleep with us, etc.

• May21: I try on another mask at clinic (just touches under nose, fitting each individual nostril) (the [ResMed] Swift), they call it in.

  • then [Home Care] company calls, says insurance won't cover another mask until months have gone by, this would cost me $180. Woman says to try cosmetic sponge.

• May23-27

  • I try a cosmetic sponge. It's a wedge, so I have to try and cut it down to a thin strip. But it's still clunky enough to create annoying air gaps

  • then I try a cosmetic pad, thinner more cottony materials. Not bad. But something is still irritating that I end up taking off the mask by 2am each night.

  • summary of progress to date: I don't feel any more alert, am not drinking any less coffee. But JiHi still says I have less bags/rings around my eyes on the days I've used the machine.

• May27-29: baby sick, I'm sleeping on floor of other room, not bothering with machine

• May29-30: used machine for until 3am when got kicked out of bed by sick baby

• May30-Jun01: used machine a couple full nights. Bridge of nose turning to raw meat again. Have to give up and pay for new mask.

• talk to doctor he writes letter to try and get coverage

• Jun17: HMO and [Home Care] companies know nothing about letter. [Home Care] company will mail me new mask and try to get coverage. Have tried old mask a couple nights at a time, then taking break again.

• Fri Jun20: new mask arrives. Start using, initially only a few hours per night, because I keep getting kicked out of bed by sick kid in middle of night.

  • initially find lots of resistance to breathing out, which is very irritating. Bump up the [C Flex Comfort] setting, and that helps a lot. (Have always been a fan of the Ramp feature, too.)

• Tue Jun24: was getting really frustrated, having a hard time breathing out, even during the initial-ramp period. Then realized the problem was that I was congested, having a bit of difficulty breathing out through my nose even without the mask. The combo was a no-deal. So put the mask aside.

• Wed Jul02: started using mask again.

• Aug20: have used mask on-and-off

  • sometimes get kicked out of bed by non-sleeping baby, or by guests, etc.: not moving machine around

  • vacation

  • cold/allergy periods where breathing out is too annoying

  • not finding any difference between days-with-machine and days-without-machine

  • I think it's time to pull the plug on this experiment. Yep returned it.

Sept'2008: follow-up to [Sleep Clinic] doctor, he says go talk to [ENT] about implants and alternatives.

Oct'2008: went to [ENT] to discuss options

• (Wow, I just got my HMO statement, he tried to bill: $300 for the consultation; $400 for sticking the video-tube through my sinuses, and $150 for scraping some wax out of 1 ear. Retail Health Care pricing is just insane.)

• apnea causes

  • anatomy

    • my uvula is normal

    • my tonsils are small/atrophied: good

    • my soft palette is very long (can't see uvula easily)

    • my tongue is somewhat thick/meaty

  • loss of muscle tone while sleeping

    • age

    • obesity

      • 10 lbs might help but not likely

    • being male

    • alcohol, other depressants

• my apnea is considered mild

  • 14 [AHI] (5-20 is mild)

    • that's when oxygen level drop, so medical implications

  • another 13.8 [RERA]

    • sleep quality, but no oxygen effect

• [CPAP] is 100% effective

  • unless pressure was set too low

    • but they set that during the test

    • and my setting was normal, so not very suspicious

    • and [CPAP] stopped the snoring

  • if I got no energy benefit, then cause is probably something other than apnea

    • medical consult

    • psych consult: anxiety, etc.

• symptoms to treat

  • energy

    • Pro Vigil/Moda Finil

  • breathing quality

    • try Flonase for a month

  • snoring

    • [CPAP]

    • implants

      • i'm good candidate in terms of apnea numbers and anatomy

        • 70% likely succcess

      • but my Gag Reflex might make it impossible

      • $2k no insurance coverage

    • dental appliance

      • success rates all over the place

        • no way to predict, just have to spend the money and try

      • $2k no insurance coverage

      • a few people have to stop using: jaw joint or tooth pain

    • laser surgery

      • given my Gag Reflex definitely not good candidate

    • [UPPP] surgery

      • major surgery

      • covered by insurance

      • my anatomy isn't bad enough to be likely to benefit

    • sleep on side

      • [Tennis Ball], special pillow, etc.

Dec'2008 update

• bought a [Pure Sleep] mouthpiece

• my Gag Reflex was so bad I couldn't even keep it long enough to fit it.

Jan'2009: have been taking [FloNase] semi-regularly. JiHi says my snoring has actually gotten better. Could be a coincidence.

Feb'2009: when I get a cold, my snoring is still horrible.

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