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 Sleep Disorders: Sleep Apnea is the Monster Under Your Bed

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Herzl

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Age : 65
Location : Oklahoma
Registration date : 2009-05-17

PostSubject: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 4:54 pm

Billy Mayes died in his sleep. My neighbor who abused his dog died in his sleep. I didn't know Billy Mayes, other than I absolutely abhorred the sound of his voice, an immediate muting in order whenever one of his commercials came into my space. When I was a child, the man who cut my hair died, in his sleep. I intensely disliked him because he had a habit of squeezing my head while he was cutting my hair. He was the person all the parents took their kid to, to have their haircut. While I was 'tender-headed,' I was perfectly willing to keep still to avoid that squeezing, and he squeezed anyway. His daughter was a classmate. I felt sorry for her that he had died, but was relieved, as I am now, never to hear Billy Mayes voice again. For the posting police, I am writing here about a significant medical problem, and the healthcare system that interacts with it, and not about being relieved, or 'compassionate,' that somebody else died.

Sleep Apnea is a huge problem, the most common sleep disorder, and a significant cause of morbidity and mortality. I've had sleep apnea as long as I can remember. When I was a snoring child, I couldn't breathe through one side of my nose. In swimming, I had the problem that when they required that I switch sides of exhalation, I was in trouble. Later in life, I had a significant problem with unsatisfactory sleep. I was taking massive doses of decongestants trying to get a better nights sleep. I slept with a fire bell connected to my telephone, my answering service an alarm, so that I could hear it over the decibels of my snoring.

Eventually, I had surgery that had been discredited to the status of 'cashectomy,' to try to address my sleep apnea. The surgery was 'pre-approved,' but the insurance company refused to pay, after the fact. Had they indicated that the surgery was unapproved in advance, I may have avoided unnecessary pain and suffering for a procedure that didn't help me, and the effects of which I live with to this day.

There is a gaming of the system, on both sides, the doctor who has found an opportunity to make money off a trusting patient, and the insurance company that doesn't act as an advocate for good care, but as a troll to punish both the doctor and the patient by a denial after the fact, the very nerve of them to make a claim! Of course, the good doctor will deny that he knew the procedure was useless. The insurance company may say that they have no intent to interfere with the doctor-patient relationship, but are not required to pay for discredited procedures. Their guilt is in their practice of denial, after the fact. Denials have now become routine, even when the procedure is indicated and useful. From paying all claims, to not paying for bad care, they are now standing in just not paying. Forget regulation or ethics, their only ethos is profit. Stormtroopers doing what they are told, 'to take care of my family.'

In order to get a CPAP machine, the now available and only reputable treatment for sleep apnea, one must have a 'sleep study.' I wrote my first prescription for a CPAP machine for myself with a letter of medical necessity and cash on the barrelhead to the company that sold me the machine. Most people don't have that privilege. America is the only country in the world that restricts the sale of these machines. In most countries, it's like buying a glucometer, over the counter. The reason it is restricted this way in America is to ensure that the proper people get paid for the privilege of having one.

In a 'sleep study,' you are attached to a hundred uncomfortable electrodes with as many wires attached to your head and body, and spend a most unusual night in a room similar to a hotel room without King Size, being watched while you sleep. In cardiology, there is the 'Holter Monitor,' an EKG rhythm-monitoring recorder you take home with you for a day. Modern CPAP machines have that same capability. Once upon a time, to diagnose a cardiac rhythm disturbance, you spent the night in the Intensive[, then later times, Intermediate] Cardiac Unit, and the printout of the nurse-monitored rhythm strip was reviewed by the doctor, the nurse faithfully reporting any 'problems' during the night. To reduce costs, and found as effective and reliable, you now take that 'Holter Monitor' home and the cost of the study is a couple hundred instead of thousands.

The restriction of CPAP machines to going through a superfluous 'sleep study,' is illustrative of the massive inflation of health care costs in America. The good doctors, spreading their white coats to bar the door from the 'abuse' and 'misuse,' the unmonitored (read unpaid) use of such a machine that can have complications is just, well ... unthinkable. Better that the hundreds who die in their sleep every night be blessed with a 'tsk,' than, miss dollars. Or have a sinus infection or two go undiagnosed. Heavens forbid, even bronchitis is possible!

Not long ago, my Hypertension doctor wanted me to have a 'sleep study.' Of course, I offered to bring my current printouts from my CPAP machine. No, I needed a real 'sleep study,' and of course based on that study, I needed a new machine. I never saw or talked to the 'sleep doctor.' Its more than interesting that I couldn't get the prescription for the machine [without an uncomfortable confrontational hassle] to take to my previous machine supplier, for whom I had a multiple years relationship and had purchased two machines over time from directly, it had to be directly conveyed to their purveyor of choice. My recent sleep study, again 'pre-approved,' was denied after the fact. Same with the new and different machine. Now, I owe a bit over six thousand dollars. Fine. I want to live.

My neighbor who died was known to have a sleep disorder. Not thinking how wonderful it would be if he died, I tried to tell him that he should have a 'sleep study.' An arrogant minor opportunistic politician, he had insurance, and 'connections.' He couldn't listen. When I heard that he had died in his sleep, I thought, now that is a well-deserved death, and thankfully, a dog-abuser's dog has been saved. How wrong I was. While he abused the dog, at least he gave it attention. He seemed to love the dog in his way, to the extent he was capable. Some would say he was probably beaten as a child. I could care less. So was I, and abusing anything, and especially a helpless dog, is the last consideration in my mind. An abomination. Under the good widow's administration however, the dog then was not only abused, but unloved, still standing in the snow and mud with no place to lie down. Brilliant.

I won't miss Billy Mayes nauseating voice, but I won't say I'm glad he died, our relationship perfected with my ability to press my mute button. He certainly had the resources, as my neighbor, to have a sleep study if he wanted, and if his doctors had the intelligence to think of the possibility. It sounds as though Billy Mayes wasn't under any care, and if so not under any effective care. I have no doubt that he could get all the Oxycontin he might want. Dare I say that Michael Jackson's sleep disorder should have been professionally diagnosed, not with an unlearned observance by Bubbles or a nurse. Yes, even skinny vegetarians, particularly those with no nose to breath through, and even women have sleep disorders and sleep apnea.

My hope here is that you remember that oftentimes, people who die in their sleep, do so from sleep apnea. When you think of Billy Mayes, consider that you may need a 'sleep study.' And a real check-up, not that now prevalent listening through cloth.

The healthcare system is in serious need of reform. Profit as the only moral imperative is overwhelming our culture and society, on all sides. You must be your own advocate. Start by supporting healthcare reform. The status quo ante is killing people every day, and night.
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Centurian 803
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Age : 67
Location : Oak Ridge, TN
Registration date : 2008-09-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 6:40 pm

I've been on night shift and haven't been watching the news. Did the autopsies for Billy Mayes and Michael Jackson say they died from sleep apnea?
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N7COF

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Location : Steamboat Springs, CO.
Registration date : 2009-04-05

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 7:23 pm

I have severe mixed sleep apnea and have been on a BiPAP machine for 3.5 years set at 22/17 pressure.

Unlike Herzl I was lucky to have one of my doctors steer me clear of the surgeries since my main cause was neurological not obstructive pathway. Anyway I had other specialist still recommend some horrid operations & fired them all.

This is a underreported & also exploited condition by many in health care. It can effect not only your heart but other major organs and systems in your body.

Some mostly good info below.

From Merck online - http://www.merck.com/mmhe/sec04/ch057666/ch057666a.html

Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and temporarily decrease the amount of oxygen and increase the amount of carbon dioxide in the blood.

People with sleep apnea often are very sleepy during the day, snore loudly, and have episodes of gasping or choking, pauses in breathing, and sudden awakenings with a snort.
Although the diagnosis of sleep apnea can often be based on symptoms, doctors usually use polysomnography to confirm the diagnosis and determine the severity.
Continuous positive airway pressure, oral appliances fitted by dentists, and sometimes surgery are used to treat sleep apnea.
Sleep apnea occurs when breathing is interrupted during sleep for periods of more than 10 seconds. There are three types: obstructive sleep apnea, central sleep apnea, and a mixed type.

Obstructive sleep apnea, the most common type, is caused by repeated closure of the throat or upper airway during sleep. This type of apnea affects about 4 to 9% of middle-aged people in the United States. Obstructive sleep apnea is more common in obese people. Obesity, perhaps in combination with aging and other factors, leads to narrowing of the upper airway. Excessive use of alcohol worsens obstructive sleep apnea. Having a narrow throat, thick neck, and round head—features that tend to run in families—increases the risk of sleep apnea. Hypothyroidism or excessive and abnormal growth due to excessive production of growth hormone (acromegaly) can contribute to obstructive sleep apnea. In children, enlarged tonsils or adenoids, some dental conditions (such as a large overbite), and some birth defects (such as an abnormally small lower jaw) can cause obstructive sleep apnea.

Central sleep apnea, a much rarer type, is caused by a problem with the control of breathing in the brain (which is accomplished in the brain stem). Normally, the brain stem is very sensitive to changes in the blood level of carbon dioxide (a by-product of metabolism). When levels are high, the brain stem signals the respiratory muscles to breathe harder and faster to remove carbon dioxide through exhalation, and vice versa. In central sleep apnea, the brain stem is less sensitive to changes in the carbon dioxide level. Because the brain stem responds slowly to the buildup of carbon dioxide in the blood, the body's response is exaggerated, resulting in overventilation. Similarly, because the brain stem responds slowly to the removal of carbon dioxide from the blood, the body's response—a pause in breathing—is prolonged. People who have heart failure or severe brain disease, such as a stroke that affects the brain stem, may have central sleep apnea. In one form of central sleep apnea, called Ondine's curse, which usually occurs in newborns, people may breathe inadequately or not at all except when they are fully awake. Using an opioid, a strong prescription pain reliever, can cause central sleep apnea. Being at high altitude can also cause central sleep apnea. A brain tumor is very rare cause. Unlike obstructive sleep apnea, central sleep apnea is not associated with obesity.

Mixed sleep apnea, the third type, is a combination of central and obstructive factors occurring in the same episode of sleep apnea. Episodes of mixed sleep apnea are most often begin as obstructive apneas and are treated like obstructive apneas.

Rest of article - http://www.merck.com/mmhe/sec04/ch057666/ch057666a.html
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Hermit

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Age : 64
Location : Ascension Parish
Registration date : 2008-04-22

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 7:29 pm

Centurian 803 wrote:
I've been on night shift and haven't been watching the news. Did the autopsies for Billy Mayes and Michael Jackson say they died from sleep apnea?

Heart attack and drug overdose, respectively.
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LtMac

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Age : 56
Location : Jackson, Tennessee
Registration date : 2008-06-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 7:37 pm

I have sleep apnea, went through the required sleep study, and now sleep with a CPAP machine also. I sleep really well now. The only weird problem (if you want to call it a problem) I've had is in trying to replace my mask. I have the full mask that covers the nose and mouth. I went to the home health provider to get a new one and of course they had to contact my insurance company. The insurance company insisted that I get a new complete machine, even though my other machine was only two years old. Now I have two machines, with one put away as a back-up. I thought it was kind of unusual for an insurance company to insist on spending money. Smile

LtMac
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PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 8:25 pm

My barber was very nice; I was very sad when he died. I now cut my own hair.
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Herzl

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Age : 65
Location : Oklahoma
Registration date : 2009-05-17

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 8:39 pm

Part of the story here is that 47 million Americans have no health insurance whatsoever, and another twenty million plus are under-insured, 'coverage' useless if they get sick, or need any significant testing or treatment. The 67% of bankruptcies being a result of health care costs should be understood as working people who had jobs and income, and had the misfortune to become ill. The indigent do not declare bankruptcy. The 6% incidence of sleep apnea cited is only a tip of the iceberg. The uninsured and under-insured and those who don't want to go broke being diagnosed or treated who do have insurance, divided by the incidence of ignorance of the possibility among some significant percentage of the physician population, do not count.

As if an autopsy could diagnose sleep apnea. Please. The sleep disorder that Billy Mayes was determined to have was having died in his sleep. Death is a fairly serious complication of sleeping. The relation is purely speculative and opportunistically employed to make a point. I juxtapose the absolutely obnoxious voice, but acceptable personage of Billy Mayes to your compassion, to the massive entertainment accomplishments of a demon. Michael Jackson's pursuit of good sleep has been being discussed in the news as a possible relation of his having a (retarded) anesthesiologist traveling with him during a late 90's tour. The only time I have slept without my CPAP machine is during power outages without a generator. Each time, an adventure in whether I will wake up.

As or more important than the condition itself to this discussion about healthcare, is the web spun by money, the mix attempting to draw you to think about the greater issue of how our healthcare system in America finds itself to be the disgrace of the developed world. Full of whiz-bang technology and bereft of 'heart' as one dissatisfied patient expressed upon the denial of her claim for treatment that would have saved her life. We all share in this reality, as both cause and effect.
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Winslow

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Age : 71
Location : Midlothian,Va.
Registration date : 2008-04-11

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 10:02 pm

I use a CPAP machine for the last three years now,I still like to nap whenever
I feel like it.There is no more spontaneous sex during the night however,when
wearing that headgear I look reptillian. Mad

Winslow sunny
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Centurian 803
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Age : 67
Location : Oak Ridge, TN
Registration date : 2008-09-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 10:50 pm

Winslow wrote:
I use a CPAP machine for the last three years now,I still like to nap whenever
I feel like it.There is no more spontaneous sex during the night however,when
wearing that headgear I look reptillian. Mad

Winslow sunny

Same here. My former wife said I look like a space alien. alien
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puros_bran
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Location : Brandenburg, Ky
Registration date : 2007-12-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 11:38 pm

Uh is this a conversation about sleep apnea... billy n mikey... insurance...dogs... or sex with reptiles..

and you knuckleheads accuse me of not clearly talking about what I am talking about.... sheeeeeeeeesh!

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"Pacem en Puffing!"
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Hermit

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Age : 64
Location : Ascension Parish
Registration date : 2008-04-22

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Fri Jul 03, 2009 11:54 pm

puros_bran wrote:
Uh is this a conversation about sleep apnea... billy n mikey... insurance...dogs... or sex with reptiles..

and you knuckleheads accuse me of not clearly talking about what I am talking about.... sheeeeeeeeesh!

It's the sex with reptiles thing.
Pay attention or go back to sleep. Rolling Eyes
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puros_bran
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Registration date : 2007-12-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Sat Jul 04, 2009 12:12 am

After re-reading I'm quite sure it's a hair cut thread.... yes I get them too.

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PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Sat Jul 04, 2009 3:10 am

Wait,what about my barber? He was an honorable man.
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Vito

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Registration date : 2007-12-10

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Mon Jul 06, 2009 8:26 pm

I had severe obstructive sleep apnea that was diagnosed as "life-threatening". My sleep study showed that I stopped breathing for an average of 33 seconds out of every minute. I know what it's like to awaken after 6 hours of "sleep", head pounding from oxygen debt, feeling exhausted, and knowing that another one or two hours of the same kind of "sleep" won't help.

I had two corrective surgeries. The first one was skull base surgery that removed a benign tumor (2 cm. diameter x 7 cm. long) from below and behind my left eye. It was causing a noticeable asymmetry in the back of my throat. It showed up clearly on MRI imaging. (For you purists, I know it should correctly be called NMR, which it was, before the medicine men decided that it would be better not to have to explain that the "nuclear" in nuclear magnetic resonance had nothing to do with ionizing radiation.) In a certain sense, I suppose I was fortunate to have had such a clearly identifiable cause for the obstruction in my airway. The insurance companies approved the surgery as an acceptable elective procedure.

The only problem was that it didn't cure my sleep apnea. A follow-up sleep study showed that my apnea was somewhat diminished, but still moderate to severe. They prescribed a CPAP. It didn't work. More precisely, it DID work when I kept it on, but I couldn't keep it on. I kept ripping it off my face in my sleep. I was glad to be rid of the tumor, but I still had the sleep apnea problem. Then I talked to a doctor who said, "We can cure this."

Huh? Cure? I was not accustomed to doctors using the "c" word, but this guy was emphatic. "Really", he said, "the same surgeon who removed your tumor has developed some other methods that will restore your breathing during sleep to normal." Well, the surgeon really DID do a great job getting the tumor outa there, so I went for it.

They were right. The second surgery involved removed my tonsils, uvula, and some other tissue, straightened a deviated septum, and shaved some of the cartilage from the septum to open the airway behind the nostrils and reduce the pressure differential between outside and inside the nostrils. (Apparently a reduced airway in the nose pulls a partial vacuum at the nostrils, which tends to collapse the nostrils, further increasing the pressure differential.) For two weeks after the surgery, I had the sore throat from hell.

Anyhow, following the second surgery, I haven't had any sleep apnea. Of course, none of that would apply to those who have something other than obstructive apnea. I might also mention that it's important to keep one's weight down. Having to move a bunch of flab out of the way just to pull in enough air tends to encourage shallow breathing. It's important to get plenty of exercise, stay lean, and generally encourage good pulmonary function.

Going the surgical route came at a cost. I would advise against removal of the uvula. I have to be careful not to laugh when I eat or drink, or the stuff can go down the windpipe. That's a matter of training.

The removal of the tumor had some collateral damage. It was growing around a bundle of nerves, and even though it was microsurgically removed, there must have been some trauma to a couple of nerves. One of them was the motor control nerve for my left eyelid. It doesn't open fully, especially when I'm tired. It's not enough to impair my vision, but sometimes my left eye looks like I'm stoned.

Another effect of the tumorectomy was a decrease in high frequency response in my left ear. I can't hear much above ~7 kHz in that ear. But there was an unexpected plus that came out of it. For some reason I can "hear" harmonies much better than I ever could before the surgery. I mean, I can hear them in my head and follow them as their own melodies, as distinct from the melody itself. This is a great thing. My ability to compose music has skyrocketed since then.

Was it worth it? For me, the answer is yes. I don't think I'd have survived this long if I hadn't had the surgeries. I can't say whether anyone else would have similar results. In any case, I wish y'all the best in your quest to de-apneize your sleepage.

jocolor
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Hermit

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Age : 64
Location : Ascension Parish
Registration date : 2008-04-22

PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Tue Jul 07, 2009 12:59 am

I've had pretty good results from Breathe-Rite strips.
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Vito

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PostSubject: Re: Sleep Disorders: Sleep Apnea is the Monster Under Your Bed   Thu Jul 09, 2009 3:44 am

Hermit wrote:
I've had pretty good results from Breathe-Rite strips.
Hey...that's terrific, Hermit. Just one question, though—how do you get them to stick to the back of your throat?

jocolor
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