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Author Topic: Asthma and Sleep Apnea  (Read 1133 times)
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kbiggs

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« on: Oct 15, 2017, 08:39AM »

I was recently diagnosed with both asthma and sleep apnea. Iíve had allergies since I was a kid, and Iíve used antihistamines and different nasal sprays for years. About 7-8 years ago, I started getting bronchitis and/or pneumonia during most winters. I was diagnosed with asthma until February of this year. Since then, itís been a question of management and adjusting to ďthe new normal.Ē 

With sleep apnea, Iíve snored for years, but a while ago I started getting morning headaches, sleepiness, lack of focus, etc., and my wife started wearing earplugs at night (big hint!). Did a home sleep study, and was given an APAP machine, a Philips Respironics. Iím on day 4, and Iím adjusting to the feeling of sleeping with a mask. (It reminds me of the face-hugger from the Alien movies... )

I hate to admit it, but it really has affected my playing. Iím finding it difficult to practice. Part of it is the energy needed to playóit can be exhausting to just practice for 1/2 an hour sometimes. Part of it is also time management. I work about 50 hours/week in a career that requires focus, attention, energy... hard to come by with two energy-sucking diseases... excuses, I know...

While I am complaining a little bit (maybe more than a little...), I would appreciate hearing from others out there who have one or both of these conditions. What have you done that has helped, and especially how have you managed with these diseases and kept playing?

Thanks.
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« Reply #1 on: Oct 15, 2017, 08:47AM »

I, too, have asthma, allergies, and i suspect some mild sleep apnea as well.  I don't have a lot of advice to offer; I'm interested in seeing what others say.  My asthma is more or less well-managed.  If I get enough physical activity (I have a desk job, so I sit a lot), drink enough water and keep an eye on my gluten intake, I can keep my allergy and asthma symptoms pretty well at bay.  My snoring has gotten worse over the last year, though and sometime I do wake up with a mild headache.

I'm hoping if I get some more exercise (like more than none) and try to keep my diet a little cleaner I can reverse some of the sleep issues.
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« Reply #2 on: Oct 15, 2017, 09:12AM »

I haven't had asthma since I was a kid.  But I was diagnosed with obstructive sleep apnea in 1990.  I've used a CPAP since then.  I think if I didn't start using the thing I wouldn't be talking to you now.  The sleep tech in my evaluation was a step away from waking me up because my blood oxygen was approaching 80%.

There are more different kinds of masks than you can imagine.  I tend to like the nasal pillow type of mask which just goes against your nose.  My wife, who also has sleep apnea, likes the full face kind, or the one that goes over your nose.  Comfort can also be affected by your choice of headgear.  I tend to like ones that are least obstructive.  Originally I had something that went over my whole head like a shower cap.  Ugh.  Now I have an Airfit P10 which has two straps.  Only downside is the straps tend to stretch and I have to replace them every few months.

It takes a while for the CPAP (or APAP in your case) to really "take hold" and make you feel better.  But it will happen.  Give it a little time.

Feel free to contact me directly by e-mail or PM if you have specific questions.

Btw, I have a Respironics as well.  In fact, this one is my third.  It has a "snitch chip" that monitors my sleep which my doctor reviews every year.  This one is an SD card.  My older one has a credit card sized monitor that you can't read (and my doc no longer has her reader).

I don't use the humidifier; found the extra moisture made me drip from the nose during the night.  Ugh!  Also, I have the polymer (looks like paper) filter and a foam filter.  The paper filter needs to be replaced monthly, and the foam filter goes in the wash about once a week.
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« Reply #3 on: Oct 15, 2017, 10:55AM »

I have been using a CPAP for almost 2 years now.  I started a topic about it here.  My first suggestion is to try 14 days of Prilosec to see if reducing stomach acidity helps - sometimes there's some acid reflux that makes sleep apnea worse. Prilosec is very inexpensive over the counter and the effect of the 14 day course lasts 3-4 months.

A good CPAP mask fit is essential.

Experiment with the pressure and humidity.

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« Reply #4 on: Oct 15, 2017, 05:38PM »

I have been using a CPAP for almost 2 years now.  I started a topic about it here. 

I read the thread you started. Iíll go re-read it.

A good CPAP mask fit is essential.

Yeah. I chose the ďnose maskĒ style. Itís already giving me pimples on the bridge of my nose. I may have to go the nasal pillow route. Early days yet.

Experiment with the pressure and humidity.

I think after the intial 30 days, my doctor might give me a little leeway to play around within a range of air pressure.

Currently no problems with heartburn or anything like that. Early days yet.

My lowest O2 sat was 82%, my average O2 was 92%, with an average of 59 events per hour. Oy. No wonder I felt terrible in the mornings.
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Kenneth Biggs
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« Reply #5 on: Oct 15, 2017, 06:20PM »

I played around with the pressure every night for at least a month, to narrow down the range that worked without pushing too much air into my stomach, which is the only real problem I've had.  Recently I reduced it more.  My apnea episodes stay right around 1 now.

I tried a nasal pillow and couldn't use it because air kept coming out of my mouth. Some might say I couldn't keep my mouth shut...
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« Reply #6 on: Oct 15, 2017, 08:18PM »

...

I tried a nasal pillow and couldn't use it because air kept coming out of my mouth. Some might say I couldn't keep my mouth shut...

I use a chin strap.  Actually, what I did was take one of my wife's "stretchy" hair bands and run it from under my chin to over my head.  While I have air leaking out the mouth, I'm still getting plenty of air in the lungs, so it's all OK.
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« Reply #7 on: Oct 16, 2017, 01:09AM »

I have mild asthma, which presents as a persistent cough.  It's a nuisance while playing.  I control it with a drug called benzonatate, and when it's really bad some codeine cough syrup.

Other people who play trombone seem to have more air available.  Since I don't play professionally, this isn't a huge problem - I just breathe more often, sometimes in places that doesn't serve the music well.

I also have obstructive sleep apnea, narcolepsy, and other undiagnosed/mysterious sleep conditions.  The net result is that my sleep is very inefficient, and I can sleep very long hours and never feel truly rested.  I tried an extended trial of a CPAP machine, and it did no good at all for me.

I was forced to quit working and go on disability about twelve years ago because I kept falling asleep at work. 

I don't think that I have anything particularly useful to tell you, except that over time I've learned to adjust to the situation and function in a limited way. Finding energy to practice is a problem. Some days I fight through it, some days I take a day off.  My goal is to practice an hour a day, but sometimes I only make 1/2 hour.  On days where I have a rehearsal, that is my practice. 

I've adjusted my goals as a trombonist to be to try to maintain my current playing level rather than work hard at getting better. 

The bottom line is that treating my issues medically has not been useful, so the only thing I can adjust is my attitude.  Wish I could offer a more magic answer...
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« Reply #8 on: Oct 16, 2017, 10:12AM »

I am a dentist and I treat sleep apnea.
There are different causes of sleep apnea.
There are variations in severity of sleep apnea.
There are different types of sleep apnea.
Every type of sleep apnea can be treated with a cpap because if forces air into your lungs even if you stop breathing.
Somne people have central apnea, where the brain just doesn't signal the body to breath. CPAP's are great for this.
The other types of sleep apnea are due to obstruction whether it's the nose, throat, trachea, obesity, etc.
The incidence of GERD in patients with sleep apnea is higher than in non sleep apnea patients. We don't know exactly why.
Other treatments for sleep apnea are oral appliances like the ZYPPAH and some other more elaborate appliances. Also the Medcline pillow can help (also helps with GERD).
I personally tried a CPAP and since I sleep on my side the mask would move when I moved, the seal would break and it sounded like a jet taking off in my face. Some masks also would pool water and I'd wake up feeling like I was drowning. But for many people the CPAP works great.
I use a Somnodent appliance for mild sleep apnea and a Medcline pillow for GERD.
Losing weight definitely helps but for some it's anatomic. I have a 15 y/o woman that has sleep apnea and is 5"5" and 105 lbs. So obesity is not the issue with her.
If you have sleep apnea or think you may get an exam.  It's easy. What ever you use, use it. Putting a strain on your heart may not manifest as an issue until your older and now you have CHF. Not good.
Feel free to ask any questions.
Dave

PS i
Asthma is beyond my field.  But since I too have asthma, I can sympathize. Having the humidity in the cpap was helpful. My upper airway felt less irritated. I don't think I would have tolerated the dry air.
Now I just have a humidifier and my Medcline pillow and my somnodent. So far so good.
« Last Edit: Oct 16, 2017, 03:25PM by ronkny » Logged

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« Reply #9 on: Nov 09, 2017, 11:08AM »

Update:

Itís been three weeks now. Thereís improvement in my sleep apnea overall, although my AHI still ranges from 4 to 8. My provider has already increased the baseline air pressure from 4 to 8. I still feel sleepy in the mornings and donít have as much energy throughout the day as Iíd like. No GERD, but Iím using a chin strap to avoid swallowing air. 

I have a new mask, an under-the-nose style similar to nasal pillows. Philips Respironics Dreamwear (Dreamware?). It has one opening instead of two nostril openings. No more pressure sores on the bridge of my nose, which is still healing.

I bought a Sani-Bot to clean my mask and hose. I canít compare it to other cleaning systems, but it seems to work well.
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Kenneth Biggs
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« Reply #10 on: Nov 09, 2017, 06:40PM »

I'm a retired respiratory therapist of 35 years...I started a sleep lab in the Pittsburgh area in the early 80's when the OSA diagnosis was in its infancy before the advent of CPAP masks...The only treatment back then was to get a tracheostomy, pretty radical and was only done on patients who had lethal arrhythmias during their apnea...To your issue kbiggs...I commend you for continuing the therapy, many people would have given up by now. Proper mask fit is imperative and usually poorly accomplished. You should not have pressure sores on any area of your nose with a proper fit. having said that many people continue to tighten the mask to avoid leaks... I used to tell my patients that the mask should fit your nose like a hat on your head, not too tight or loose, but comfortable. Any small leaks are compensated for with the machine, so long as they don't blow into your eyes, small leaks are fine...I'm glad to hear your pressure was increased from 4, while I have seen some therapeutic benefits at pressures that low, it is rare and pressures in the 7 to 15 range are more common...Keep working with your home care company until it is right, the long term effects of OSA are real and debilitating...When you get it right you shouldn't feel tired after a normal nights sleep.Your asthma is a separate issue. I'm big on my patients using a peak flow meter daily to monitor their airways. The peak flow will clue you into an approaching crisis long before you feel it... I strongly suggest you see a pulmonologist to treat your asthma. it's a serious chronic condition...
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« Reply #11 on: Nov 09, 2017, 11:00PM »

I'm sure everybody's different but I did a lot of experimenting with the pressure between 4 (which did nothing) and 16 (which was clearly too much), and settled on 11.5 which I used for about a year.  Recently I backed it down to something like 8 or 9 and I still get the same benefit.

If you know how to change the setting, I would try increasing by one or two each night to see when you sleep well.  You'll know if you go too far.  Then you can fine-tune it.
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« Reply #12 on: Nov 10, 2017, 08:18AM »

My machine is a Philips Respironics, an APAP (automatic positive airway pressure). It ďsensesĒ how much air pressure to exert. An internal modem allows the machine to talk to my provider (Kaiser), who monitor and adjust the range of air pressure from the office. In other words, I donít think I have access to adjusting the air pressure unless I hacked the machine, which would void the warranty. Iím sure that Kaiser would also have something to say about that.

Yes, I continue to use my peak flow meter. Other than the last 2-3 days due to a cold, Iíve noticed an overall improvement in my asthma symptoms, as well.

Odd, but my peak flows continue to be relatively high (a good thing, I know!) for my age, weight and height (54, 160#, 5í11Ē). I regularly blow between 600 to 650, even when I have a cold or when Iím suffering from allergies. Itís usually my symptoms that tell me more: cough, feelings of chest tightness, feeling mildly SOB. Iíve mentioned it to my doctor, and that Iím a bass trombonist, Iím used to moving large amounts of air very rapidly, etc. He didnít seem excited or curious about my symptoms, my readings, or that Iím a bass trombonist!
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« Reply #13 on: Nov 10, 2017, 11:10AM »

Without veering too far off course - I am a CPAP user for 13 years.  In the past year, the fatigue and focus issues that you mention started to creep back into my world.  Over the course of testing for upcoming gastric sleeve surgery I found that my blood sugar was elevated in the the diabetic category.  I immediately moved to manage this through a better diet that is protein centric and very low in carbs.  The quick muscle fatigue and other symptoms subsided very quickly along with about 35 of the quickest pounds I've ever lost.  Even though your body type doesn't suggest it, I would pull the thread to see if something else is at play.
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« Reply #14 on: Nov 10, 2017, 06:25PM »

Kb, if you continue to be symptomatic I would suspect some type of massive leak, either at the mask or from your mouth...You appear to be very knowledgeable on this diagnosis/therapy and I would urge you to continue to seek an effective treatment.  As a side note anecdotally I never felt the best therapeutic results were derived from any variation of nasal pillow...If my patients couldn't tolerate a nasal mask,(which was rare) I would try to steer them to a full face mask...

On your peak flow meter, you can have excellent peak flow numbers and still have some of the symptoms you described...The peak flow gives an indication of an airway obstruction either due to inflammation, spasms, mucus plugging or in sever cases airway collapse.

I'm not surprised that your doctor was indifferent to your bass trombone comments, but if you feel he isn't addressing your real symptoms, I'd change doctors, and again I would urge you to see a pulmonologist...Best of luck to you, have a chronic illness is challenging to deal with in the best of circumstances...       
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« Reply #15 on: Nov 10, 2017, 07:32PM »

CPAP changed my life for the better. I use it 100%, every night. I know it helped my playing.

Getting the mask to fit is a real art, keep experimenting. I find I have to give the "DreamWear" headgear a little tug at the points were the tubes go from horizontal to vertical, pulling down towards the neck.

Kaiser Permanente NorthWest (KPNW) HMO will let you exchange the mask for a different model for free for the first 30 days (nights:). You can get a new nosepiece (Nasal Cushion) every month, and new headgear every six months (I think). I find the nosepieces get soft after about a month or two. They may look fine, but start to leak. My first machine lasted 5 years.

KPNW also has a good  "change your doctor" policy. I find that many doctors are very good musicians. Our community band has 2 MDs, one Child Psychologist PhD, and we had a retired Medical Teaching Scientist PhD trombonist. Find a musician doctor at your clinic and ask for a "get acquainted" appointment.


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« Reply #16 on: Nov 11, 2017, 07:31AM »

Have been using a ResMed CPAP for five years.  Tried a nasal mask and chin strap for a few months, had to go to one that fit over my nose and mouth.  I still wasn't great so my doc started giving me testosterone as my blood levels were low.  Helped some.  My wife added Fenugreek, an herbal supplement supposed to boost the body's ability to make and use testosterone, to my daily vitamins. 

With all that, I still started nodding off on the freeway at 4 in the afternoon and had significant brain fog, so got a referral to a neurologist. He prescribed Modafilin, a stimulant, so I could function.  It worked, but I didn't feel right, wold rather fix the root cause than band-aid the symptoms with drugs.  Sleep study found the CPAP was working.  Stopped the testosterone, no change to the negative.  Read that sometimes Fenugreek if taken for a long period can cause the symptoms it is trying to help: fatigue, brain fog.  Stopped taking it, felt a whole lot better in a week.  Am off all meds, prescribed or herbal, except the CPAP.  Not feeling great, but the brain fog has lifted and I can function at work.

Lessons learned:  Keep plugging away.  A symptom can have multiple causes.  Do your own research, doctors don't know everything.  Find a doc interested in pinpointing the cause of your problems, not just treating the symptons.  Just because somethig is herbal and needs no prescription doesn't mean it is automatically good for you.     
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« Reply #17 on: Nov 11, 2017, 03:50PM »

I have been using a CPAP for almost 2 years now.  I started a topic about it here.  My first suggestion is to try 14 days of Prilosec to see if reducing stomach acidity helps - sometimes there's some acid reflux that makes sleep apnea worse. Prilosec is very inexpensive over the counter and the effect of the 14 day course lasts 3-4 months.

A good CPAP mask fit is essential.

Experiment with the pressure and humidity.

Thanks for that Doug. I have only recently come to the conclusion that stomach acidity was part of my Sleep Apnea problem and so, after seeing your post last week, I asked my doctor about Prilosec. He had to look it up because I think that is an American brand name. He said Sozol Pantoprazole (pantoprazole sodium sesquihydrate) was the same thing, and I tried it last night. Resulting, I believe, in the first good night's sleep I have had in a long time. Good! I will have to see if this continues because the Chemist thought that it might take a month for the tablets to work correctly.

On the subject of Sleep Apnea, I do not use a mask because a Specialist I saw said that my original sleep tests show that I do not snore when I lay on my side. I have now trained myself to do this. Also tests about 18 months back using the CPAP mask were inconclusive. Now that I have your stomach acidy solution, and combining this with sleeping on my side, I intend to do some more sleep tests. But this time using take-home equipment, rather than try and sleep in a strange bed and surroundings, which I believe was the factor producing unreliable results. Plus, the place where I had them (SNORE Australia) seem only to be interested in selling you a CPAP machine for the profit. >:( 
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« Reply #18 on: Nov 11, 2017, 04:02PM »

My wife had a hiatus hernia and also reflux.  We wound up raising the head of her bed with a couple of jack stands.  Worked for a while but she complained that she was constantly sliding down toward the foot of the bed.

Now she takes the Prilosec and doesn't need the bed raised.
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« Reply #19 on: Nov 11, 2017, 04:50PM »

Prilosec is the over-the-counter version of omeprazole.  It can work immediately but usually takes a few days for the full effect.  14 days of it will control acidity for about the next 3-4 months.  Unless you have a very serious problem that's all you need.

In a short search, pantoprazole sodium sesquihydrate appears to be similar but not necessarily the same.
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