Get Some Sleep: Tired, crabby, snoring? Might be apnea
January 18th, 2011
03:41 PM ET

Get Some Sleep: Tired, crabby, snoring? Might be apnea

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

If you’re not sleeping well, if your partner complains that you snore loudly or you’re finding yourself excessively tired and having trouble concentrating during the day, you may have sleep apnea. It’s a common disorder that should be diagnosed by a doctor.

The two most-often diagnosed types are obstructive sleep apnea and central sleep apnea. The bottom line for both is that your breathing is disrupted while you sleep, waking you up sometimes dozens of time during the night, depriving your brain of oxygen and often resulting in fatigue, difficulty focusing and even worse physical problems such as high blood pressure and heart disease.

If you have sleep apnea, chances are, you’ll be told you need to sleep with a continuous positive airway pressure machine, or CPAP.

Positive airway pressure is like blowing air into a balloon but in this case the balloon is the patient’s throat; when there is air in the balloon (the throat), then the sides of the balloon (the soft tissues in the throat) cannot collapse and the tissues in the throat are propped open. The forced air functions much as a stent would. It is not oxygen therapy, but oxygen can be added.

Sleep apnea is usually adequately treated with a CPAP even if oxygen levels were quite low. When oxygen is added, it is usually because patients have another lung or heart disorder that contributes to low oxygen at night. If patients have emphysema, congestive heart disease or neuromuscular disorders, they will need specialized PAP machines, and may need oxygen as well.

If you have obstructive sleep apnea, your upper airway collapses, either partially or completely, during sleep and the oxygen level of your blood is often low.  You'll also have frequent  very brief awakenings, called micro-arousals, that disturb the quality of sleep and stimulate the sympathetic nervous system (that is the adrenalin, fight or flight response). This puts stress on the heart. The most common symptoms are snoring and daytime sleepiness or fatigue.

Central sleep apnea occurs when the brain, that is the central nervous system, does not signal properly to the diaphragm,  the muscle that controls your breathing. The most common symptoms are frequent awakenings at night and daytime sleepiness or fatigue.

The CPAP is the gold standard therapy for both obstructive and central sleep apnea, although the devices used for CSA function a bit differently from the standard CPAP.

The CPAP gets a bad rap. True, few people say to themselves: “I think that I’d like to start sleeping with a hose strapped to my face.” Still, I and my thousands of patients who use CPAP are here to tell you that it is nothing short of a miracle for many people. In fact, the majority of my patients feel so much better that they wouldn’t give up their CPAP even if they found out that there are no long-term consequences to sleep apnea.

They use the CPAP because when they wake up in the morning, they feel “like Dorothy landing in OZ,” as one CPAP user told me. “My old life, before CPAP, was in black and white; now I live in Technicolor!”

Honestly, I couldn’t make up the things that people have said to me in their attempt to praise the CPAP and to describe how good they feel after starting this therapy. One patient likes to call CPAP his “happy pill.” Another woman told me that she felt “20 years younger” after one month using her CPAP. Today I saw a patient who said that it CPAP was “life changing.” The best to date is an older patient who said that putting on his CPAP mask at night gave him great comfort, “as though someone is cradling my face.” Seriously, could I make that up?

CPAP, for the uninitiated, involves wearing a mask that at the very least has some nasal prongs - yes, they go up your nose, and at the most has a mask covering most of your face. Many patients wear something in between,  a mask (I refer to it as the “Bozo the clown”) that covers only the nose. There are three basic styles: the nasal pillow mask, in which prongs fit in the nose (why we call them pillows is a mystery to me); the nasal mask, which covers only the nose; and the full face mask, which really means only that it covers the nose and mouth. Rare is the mask that actually covers the whole face. There are many manufacturers and a variety of styles.

There are also several major manufacturers of the CPAP machines themselves. I have worked with them all and they all usually have their pros and cons. It is important that the machine give what we call compliance data, that is, the sleep center should be able to download data that show how many nights patients use the machine, for how long, whether they are still having apneas, whether the mask is leaking a lot, etc. I have seen cheap machines on the internet that do not give such data and do not come with a heated humidifier.

All major insurance companies that I have encountered will cover the more sophisticated machines as well as the heated humidifier that fits onto it. In general, all the major brands of CPAP machines have become smaller and quieter in the past five years. Some machines are easier to use than others if people have arthritis in their hands or other disorders that affect their dexterity. Any mask can be used with any PAP machine.

Studies have shown that usage patterns are set early in the course of CPAP treatment. Patients need very close follow up in the first few weeks or months of treatment. That is why I handle all the CPAP machines and masks at my sleep center. I have a very hands-on approach to prescribing this treatment, and I am starting to see more and more sleep centers take this comprehensive approach to diagnosing and treating sleep apnea. For example, the mask is chosen based on patient comfort, but, at first, patients need the recommendations of knowledgeable sleep professionals. They need to have available to them many masks to try, and I mean take home and sleep with for a week or two. When patients find the right mask for their face and their sleeping positions, the battle to get accustomed to CPAP is usually won.

There are other alternative treatments for sleep apnea, and I will cover them in my next column, but none even comes close to CPAP in terms of effectiveness. If a person will wear the CPAP, then the effectiveness at eliminating apneas, maintaining good oxygen levels, and consolidating sleep approaches 100%. Importantly, there are few side effects, and none is serious. How often are doctors able to offer a treatment that works so well and has no risk of causing harm? No, you cannot suffocate if the electricity goes off because there are little exhalation port holes. And we cannot discount the added benefit of patients feeling that the treatment is helping them. While few people would say that they “love” their CPAP, some do, and the vast majority of my patients say that they love the way it makes them feel and for that they are grateful to the CPAP.

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Filed under: Sleep

soundoff (317 Responses)
  1. Howard Jones


    January 18, 2011 at 16:08 | Report abuse | Reply
    • Hijacked Healthcare

      I guess it is next to impossible to rely on news organizations to inform us about anything without having a motive.

      I have been around a long time and I have never seen such obvious advertising disguised as news than on CNN and other main organizations. They are all bought out and owned by drug companies and other organizations that have an agenda.

      Bring back unbiased news. Bring back truth. Stop selling us products. We are tired of it.

      January 19, 2011 at 14:37 | Report abuse |
    • Rebecca

      Would have been good to tell people about nose strips as a solution for some people with trouble with breathing through their nose / snoring. They're cheap and they gave me the same 'On top of the world' feeling after I started using them! Good quick diagnosis to see if that's actually the reason you're tired..

      January 25, 2011 at 13:18 | Report abuse |
  2. sounding

    Good article. Might want to cover more of the physical manifestations of sleep apnea. I have sleep apnea and used to have periods of sleep paralysis. When a normal person sleeps there body becomes paralyzed so that they won't thrash about and hurt themselves or the person they're sleeping with. I could be completely awake, sitting down, relaxed and not be able to move at all.

    Another example would be my sister who has the CPAP, but can't get used to wearing it. She slept on my living room floor one night. In the middle of the night I was awakened by the windows rattling. I went and saw what sleep apnea was doing to her. She was asleep and unaware of what her body was doing to her. Laying flat on the floor she wasn't breathing; her body would bend at the waist, lifting the torso off the floor, then her head would fall back letting the air rush into her nose and mouth (with a huge, loud snore), then her muscles would relax and her body would slam to the floor. Then this would repeat all night long. I know at some point the muscles will get too tired to lift her, and she will suffocate to death.

    I know that sleep apnea can affect your day-to-day life, easily forgetting simple things like dementia. Always so tired, some people even fall asleep at a moments notice like narcolepsy.

    You may not know if you have these symptoms, but listen to others. If you snore, get it checked out with a sleep expert.

    January 18, 2011 at 16:23 | Report abuse | Reply
    • RabiaDiluvio

      Your sister needs to give it a try and wear it for as long as she is comfortable every night until she gets used to it. The gradual approach. When she can start getting through the night without taking it off, she is through half the battle. I can't live without my BiPAP now, but for the first several weeks I was convinced it was a medieval torture device. Also, tell her that there are many different options for mask, etc.

      January 18, 2011 at 17:02 | Report abuse |
    • Mamudoon

      Sleep paralysis is about the most terrifying thing a person can experience, IMO. I've had it twice. The first time happened for about five seconds, but it was the scariest five seconds of my life. I woke up, couldn't move (or breathe), and tried to scream, but couldn't do that, either. It was absolutely terrifying.

      The second time happened a few days ago. It was weird – I didn't have that feeling of intense terror, but I was SO, SO, SO exhausted that I tried to move, but couldn't. But I could "feel" my body moving, and I could blink my eyes, and when I opened them, I saw that I didn't actually move. I wondered if my hand was rotting and wanted to look at it, but couldn't move it. How insane is that?! It lasted about 5-10 minutes, when I finally got enough strength to shake my head really hard, and I snapped out of it like someone flipped a switch in me. Functioned totally normally right away. I don't even know if that was actually sleep paralysis, but it seems to be the most likely explanation (for someone who doesn't to drugs, anyway, haha).

      I hope I don't have any more episodes of it. It's really scary, and I've been through a lot of scary stuff.

      January 19, 2011 at 04:13 | Report abuse |
    • sounding

      @Mamudoon – you've described a sleep paralysis episode pretty accurately, although I've never known them personally for such a brief period of time. My episodes, unassisted, last from 30 minutes to four hours. If my eyes are open at the beginning of the episode, then I can see, otherwise I can't open my eyes and I can only groan. If someone is around me during an episode and they understand what is happening, then if they massage my limbs, I can usually come out withing minutes. I am always aware of everything around me – some thought I was having a seizure (even a doctor), one person thought I was dead (couldn't find a pulse). It even happened in church once. Yes, it can be unnerving if you don't understand it. Now I just relax through it – enjoy the ride.

      January 19, 2011 at 08:57 | Report abuse |
    • Kiko

      Hello there, I found your blog via Google at the same time as looking for a rtlaeed topic, your website came up, it appears great. I’ve bookmarked it in my google bookmarks.My site is about .[]

      August 4, 2012 at 02:45 | Report abuse |
  3. Kenneth Clayton

    Yes, it is a good article. Obtructed air passage causes my sleep apnea. I've been using the CPAP machine for five years. Reecently took a short business trip, and left the machine at home. I did not believe my condition was so dependent on the CPAP machine. I thought I could get by without it.

    I was so wrong! I was tired, had difficulty thinking and feeling lousy. Lack of sleep adds stress to our lives, we age faster, and our quality of life is reduced. I think the condition adds wiegh to our bodies too. It is difficult to relate to others the indcredible difference a good night sleep can make. Now I am working to reduce my weight, and that will help me too.

    January 18, 2011 at 16:43 | Report abuse | Reply
  4. Bob

    Shut it Julia

    January 18, 2011 at 16:44 | Report abuse | Reply
    • chele

      Yeah, really! I'm with you there.

      January 18, 2011 at 17:49 | Report abuse |
  5. neuroperson

    As a sleep doctor, I'm astounded how misleading this is. Not everyone loves CPAP, actually most do not. Oral Appliance therapy is FDA approved for mild to moderate Sleep Apnea. Those with positional apnea on their backs only may respond to a simple positional pillow. And how about weight loss as a treatment and a cure for Sleep Apnea? This is a CPAP promo-piece, I would get a second opinoin from another sleep doc.

    January 18, 2011 at 16:44 | Report abuse | Reply
    • RabiaDiluvio

      I agree. In general there is a lot of misinformation and inadequate info given at treatment. Those that might benefit from CPAP are not always told about what to expect from a mask, the availability of BiPAP, the process of getting used to it (how to get used to it GRADUALLY without expecting miracles overnight), different machines and masks that are available, etc. They are great at promoting the devices, but not so great at supporting the patient/consumer.

      January 18, 2011 at 16:54 | Report abuse |
    • sounding

      Thank you. It's good to know there are other options out there. It would be good to read about these options and the pros/cons of them. There is a surgical option too, but I've only heard of limited success with it. Perhaps these will be discussed in future articles. At the same time, perhaps the author is only an authority on CPAP – wouldn't want them to write about something they are not an authority on. Perhaps you could co-author an article with her.

      January 18, 2011 at 16:59 | Report abuse |
    • Andy

      Glad you brought this up. I am unable to get comfotable with the CPAP regardless of how hard I tried normally preventing me from falling asleep (and if I did, I'd awaken with the mask on the floor beside the bed evidently removing it in my sleep, ergo no benefit). After 1 1/2 years of different masks, nose pillows, etc, I gave up. After a bit of thought, I decided to try a (positional) pillow to prevent me from sleeping on my back. Immediate results! CPAP is not for everyone.

      January 18, 2011 at 17:17 | Report abuse |
    • Linda

      It is very disturbing how many articles on CNN purport to beinformational but are promotional.

      January 18, 2011 at 17:19 | Report abuse |
    • Jim W

      Both my wife and I use CPAP machines. In my case it is both obstructional and central, during one night's test my O2 sat dropped to 58% for a short time. The general thought that "just lose weight" is wrong. When I was down to 7% body fat I had the same problem. Statements like those from neuroperson do little more than stigmatize the problem.

      January 18, 2011 at 17:43 | Report abuse |
    • Rediranch

      @sounding – I had surgery for my apnea, I was having 76 episodes an hour (stopped breathing). They removed my uvula, straightened my septum, and trimmed the turbinate tissue in my sinus cavity.

      I'm now down to 24 episodes. Not cured, but if i can maintain my weight I do ok.

      January 18, 2011 at 18:40 | Report abuse |
    • mimi506

      I agree, check other options these machines and getting the hoses and facial tubing replaced every 6 months can be quite expense even if you have insurance in which we do. My HUSBAND HATES THE CPAP machine it causes his chest to become tight as if he is having a heart attack or close to it. The CPAP has been in our household for over10 years, what a waste anything that makes you feel this awful is good for you????????

      January 18, 2011 at 20:37 | Report abuse |
    • steve

      CPAP was pure torture.

      January 18, 2011 at 23:43 | Report abuse |
    • Valeria

      So far I've only read your how to choose the best sleep apnea maihcnes and masks page and there are quite a few mistakes in it. And I don't mean grammar or spelling. I mean the information itself that is provided is mis-leadng or erroneous.I'm sure you MUST have meant nose mask when you used no mask but accept that we ALL make typos and spelling mistakes at times.

      August 4, 2012 at 01:11 | Report abuse |
    • SDR

      Weight loss won't cure sleep apnea unless the weight is in the area that is obstructed, i.e., the neck region (area). Have you seen how many thin people have apnea? I agree that weight loss would probably help but I highly doubt that weight loss is a cure. Just my opinion

      October 23, 2013 at 20:30 | Report abuse |
  6. Arturo

    I have sleep apnia... my 5 yr old son snores all knight n I'm worried he may have sleep apnia.. I'm going to take him to see the Dr. Now that I read this article.

    January 18, 2011 at 16:49 | Report abuse | Reply
  7. DJ

    I was diagnosed with Sleep Apnea about 4 years ago. I was falling asleep in meetings at work, and generally lethargic all the time. Through a sleep clinic, I found out I was waking up 50+ times per hour! I tried the CPAP for about an hour, and absolutely hated it. Did not like the feeling of something strapped to my head, and the thought of having to do it forever. I opted for the throat surgery (UPPP), and it worked wonderfully for me. I've slept well since the surgery, and am not tired during the day any longer.

    January 18, 2011 at 17:02 | Report abuse | Reply
    • Matt

      I have been using CPAP a few years now and I hate it as well. It constantly builds up moisture in the hose and/or nose pillows and tries to drown me in my sleep, however if I sleep without it, I feel like a zombie. YET, even with the machine, I'm still not 100% rested. After quitting smoking and dropping 20+lbs, I'm giving serious consideration to the surgery myself, although the ENT doctor I consulted with did his very best to try and scare me away from it, referring to it multiple times as "the most painful surgery you may ever have". How do you rate his description? Was it miserable and, if so, were the benefits worth it? My biggest concern is not the pain but the cost itself. Pain is temporary, debt collectors are forever 🙂

      January 18, 2011 at 18:03 | Report abuse |
    • Rediranch

      @Matt – I had the UPPP. It was very painful – but only for a few days. I was on some pretty strong pain meds (narcotics), and the worst pain was swallowing. I lost 20lbs while waiting to be able to eat again – gained most of it back.

      Yes, it was very painful – but I went from 76 episodes to 24. Unfortunately, 24 is still not low enough, so I'm looking to see if they will do more with my nose, and if that goes ok and they can't do more, I'll try CPAP again (hated it).

      January 18, 2011 at 18:45 | Report abuse |
    • DJ

      It was painful, but only for a few days. I really don't think it was much worse than having a bad sore throat. But there are some side effects to consider. The removal of the tissue in your throat changes the way you swallow food and drink. When you chew or drink now, the tissue in your throat holds the food stays in your mouth until you want to swallow. When some of that tissue is removed, you end up choking on your food because you swallow accidentally. You do relearn how to swallow normally, but it takes several weeks. The surgery is a great way to lose weight, because you can eat very little for about 2 weeks (I lost 15 lbs). Also, sleeping is difficult at first because you involuntarily swallow saliva in your sleep, which causes you to wake up choking. However, they do give you sleeping meds to help this (which I highly recommend taking). That problem only lasted a few days, fortunately. Make sure to have a good 5-7 days of recovery, meaning no work. You'll be exhausted from the surgery recovery, lack of food and sleep. Ok, that all sounds awful, but for me it was entirely worth it. I won't have to drag around a breathing machine for the rest of my life.

      January 18, 2011 at 19:40 | Report abuse |
  8. Dick Ruben

    Dr. Shives...With all due respect, I have tried many masks, all to no avail. While I will admit that I went into this with a negative attidude, I was told by my neurologist that my"problem" was extremely dangerous. Trust me when I tell you after being told this, I can honestly say without hesitation that I "hate" this CPAP. I'm 76 years old, I'm not physically well having forr example prostate cancer. I also suffer from a blood disorder called "Von Willebrands". While I can appreciate so many others that have spoken positively, I'm sure I'm not alone feeling as I do, I only wish things were different.

    January 18, 2011 at 17:24 | Report abuse | Reply
  9. Ken

    I got diagnosed with sleep apnea about five years ago. It took me most of the first year just to get thru one night. It is definitely the hardest thing I have ever done to live with this thing. However, after perserverance, I finally got to wearing it every night and this is my fourth year. The machine has done wonders for me. I feel like a new person. It is a shame that people cannot get the support they need for the first few months. Unfortunately, money rules. Even now it is still hard to wear the mask, but I know what will happen if I do not.

    January 18, 2011 at 17:29 | Report abuse | Reply
  10. Dustin White

    I also hat the UPPP surgery and my post op sleep study showed that my sleep apnea was 100 percent cured. Doesn't work for everybody but I am young and thin and extremely large tonsils were what was causing my sleep apnea. I will also say my sleep apnea was the most severe case my surgeon had ever seen. I went from waking up hundreds of tiems a night to not at all. Surgery wasn't near as bad as I heard it was going to be either.

    January 18, 2011 at 17:30 | Report abuse | Reply
  11. Boston

    I was diagnosed with a moderate level obstructive sleep apnea eight years ago (sleep disturbance index of 10). I was told that surgery might help, so I had a four-procedure operation with a painful recovery, but the surgery only reduced my sleep disturbance to 9. After another year of feeling like my throat was closing every time I tried to relax and go to sleep, I visited another ENT. After a thirty second look down my throat with a scope, he said, "I know what your problem is. You have Laryngopharyngeal Reflux (LPR), and the stomach acid has irritated your voicebox and caused it to swell. With a change in my diet and eating schedule, I am symptom-free. Only when I violate my rules about what, when, and how much I eat do I start to have symptoms again.

    Before you get outfitted for a CPAP machine, consider investigating WHY you may have apnea. I consider it a sin, almost malpractice, when a doctor gives a patient an apnea diagnosis, but doesn't bother to find out the cause. Do you want to address only the symptoms, and in an inconvenient way, or do you deserve to have the cause addressed? Of course the cause of your apnea may not be fixable, but in my case it was. I could have avoided the painful surgery, had my doctor bothered to think outside the little diagnosis box that so many doctors are trained to be stuck in.

    You may indeed need a CPAP machine, but you deserve to have a doctor will play detective first, and rule out underlying causes that can be fixed.

    January 18, 2011 at 17:32 | Report abuse | Reply
  12. Philip

    Millions of children wake up in the middle of the night because their stupid dad thinks it's thrifty to recycle clothes-dryer heat, venting it indoors. This one case involved an ignoramus who thought putting a nylon stocking over the end of the vent made it dust-free somehow. The build-up of minute dust particles hardly effects our old lungs, but gives young children fits. If you take them to the doctor, he won't ask about this before prescribing drugs for it. And even after the drug is pulled from shelves for 'finally being found unsafe', he won't even apologize. He'll just keep doing it.

    January 18, 2011 at 17:36 | Report abuse | Reply
    • Think

      Why would your doctor ever think to ask you, "By the way, do you vent your dryer into the house?" Come on, that is the parents' job, to stop and think, "Could there be something in the home environment causing my child to have these problems?"

      And if a drug is unsafe, how do the doctors know? They're trying to prescribe something to help you. Blame the drug companies for faulty studies. Don't blame your doctor, geez.

      January 19, 2011 at 10:42 | Report abuse |
  13. BF

    I was always told I didn't have sleep apnea because I am thin & don't snore. Yet after 8 hours of "sleep" I still feel exhausted & am constantly tired & never well rested. I finally saw a sleep specialist, had a sleep study done & was told I only had 2-3 instances of obstructive apea but had a hundred sudden arousals in a period of a few hours. He was unsure as to what was causing my problem. The doctor put on a sleep med, which messed me up so bad that I now have severe insomnia (which I never had before) & I CANNOT fall asleep without medication (a different sleep med). Since a sleep doctor & a sleep study have not helped & made my problems worse, I did my own research & I am now fairly certain I have UARS, upper airway resistance syndrome. I am going to meet with an ENT to discuss an oral appliance & am hoping this may help.

    January 18, 2011 at 17:36 | Report abuse | Reply
  14. chele

    And you're a beast.

    January 18, 2011 at 17:50 | Report abuse | Reply
  15. Scotty

    I've had obstructive sleep apnea for 18 years.

    Surgery – Don't ever do that. I suffered so bad you could not pay me enough money to do that again. Also, the tissue eventually grows back and you're back to square one.

    CPAP – I sleep with it every night and never skip a night. Slowly I adapted to the mask.Now, I put the mask on and I'm sleep in 5 minutes, usually less. Yes, every now and then I have an uncomfortable night. But that equates to 1-3 times out of 30 days. However, I'm rested when I wake up and no longer fall asleep at stop lights. Yes, I would stop my vehicle and fall dead asleep.

    Weight, I was 120 pounds when I started. Being fat was not the culprit. However, people that are overweight tend t ohave more problems with apnea.

    Keep this in mind. If you don't get it treated, you will cut your life almost in half. A guy with sleep apnea died during testing last year. He was young too (I believe 27). Heart could no longer withstand the rigors of struggling to breathe.

    Your call. Breathe right or possibly die tonight.


    January 18, 2011 at 17:51 | Report abuse | Reply
    • UNABLE to use CPAP

      First off, I am glad that you have found success Scotty but you are the EXCEPTION TO THE RULE. Less than 50% even tolerate the CPAP for a variety of reasons and do not even dare say the did not try. I live with someone who's life is a living nightmare because of this and he has done everything under the sun. Surgeries, multiple machines, 20 different masks, pillows, new beds, etc etc etc!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I am scared he will die soon and he is young. But there is nothing WORSE than blaming someone for it and assume that it is ALL IN THEIR HANDS! I literally want to smack someone when they say that. Do NOT assume the person is not trying. No one knows MORE THAN THEY DO how much suffering they are dealing with and how more than anything they want ot get better. This article is nothing more than an advertisement in disguise. I am sick of this bullcrap. Doctors need to stop pushing the CPAP and try sometthing else because MOST cannot even use it !

      January 19, 2011 at 14:31 | Report abuse |
    • sounding

      @UNABLE to use CPAP

      Getting used to any 'new' routine, especially something that makes you feel like Darth Vader, or increases a claustrophobic feeling, takes some 'serious' getting used to. IF CPAP is the right treatment, then it will take a great deal of support from family, friends, and the medical industry to help adapt and encourage treatment. Even then, some personalities (like my sister) will refuse, and we have to accept their decision (hate it, but it's their life).

      I disagree with your figure of 50%, but will accept it as an emotional response. There are a lot of options and finding the right doctor, neurologist, sleep clinic is only one of the first steps.

      January 19, 2011 at 17:01 | Report abuse |
  16. Andy

    I have worked 5 years doing sleep studies in a Sleep lab. Good article. There are other options but CPAP (or BiPAP) can almost always be adjusted to work. Skinny people can have OSA, often it is congenital, basically a narrow airway. UPPP works 50% of the time and is often not permanent, the tissues can grow back, and the surgery is very uncomfortable. We test a lot for UARS and it is treated with CPAP very effectively. Sleep paralysis is not a symptom of OSA. Mandibular advancement oral appliances work IF that is the problem, often it is not.

    January 18, 2011 at 18:05 | Report abuse | Reply
  17. Susan

    I know how dangerous sleep apnea can be. I awoke one morning with chest pains that wouldn't go away. I made it to the ER and ended up spending several days in the hospital undergoing tests to determine what was going on. I did not have heart damage or a heart attack, but what I did have was congestive heart failure. My left ventricle had double the pressure of normal. The reason was sleep apnea....fluid builds up in the heart because it isn't working properly due to lack of oxygen. Sleep apnea adversely affects the heart, the brain, and the lungs, as well as your sleep. My doctor told me that many people who die in their sleep actually die from sleep apnea....the heart just can't do its work and finally gives out. Believe me, having the chest pains and finding out I was having congestive heart failure was an excellent motivation to put my CPAP on and wear it every night, all night. Any discomfort it causes is nothing compared to the chest pains I suffered. SLEEP APNEA IS A VERY DANGEROUS PROBLEM!

    January 18, 2011 at 18:18 | Report abuse | Reply
  18. Jane Fort

    If you are traveling with a CPAP machines be aware that if you take them hand luggage (recommended, so they get to the destination in one piece) they have to be inspected by TSA. This only take a minute, but be prepared for people grumbling in the line behind you!

    January 18, 2011 at 18:25 | Report abuse | Reply
    • sounding

      Also, make sure you carry your doctor's prescription for the CPAP in the same case (very important); not everyone in TSA knows what a CPAP machine is and it's purpose. Yes! Always take your CPAP as carry-on luggage.

      I noticed recently that there are electrical outlets towards the base of some of the seats, so it may now be possible to sleep during the flight. Something that always scared me – that I would get too exhausted on a flight and might fall asleep. I actually did once and the guy next to me was very understanding and helped me through it.

      January 18, 2011 at 22:01 | Report abuse |
    • Soul Catcher

      I can see it now...

      TSA: What is this timer for and why does it connect to the internet, Mr. .... Honest Abdul?
      Honest Abdul: It is for my snoring I have obstructed breathing here is my doctor's note/ prescription.
      TSA: Well we'll have to verify the obstruction ... assume the position and open wide.
      Honest Abdul: Gack ... Gack ... oooooOOOO!
      TSA: Seems clear to me, bag him and tag him.

      February 9, 2011 at 13:00 | Report abuse |
    • RM

      Also for those that carry their CPAP or any other medical device with them as a carry-on, the TSA has ruled that the CPAP cannot be counted against your limit of two carry-on's. With the CPAP you can still have your carry-on and one personal item plus your CPAP.

      April 13, 2011 at 16:14 | Report abuse |
  19. Pat

    I had terrible Sleep Apnea, but I could not stand my CPAP machine. It felt like I was trapped in a wind tunnel. When I was on the internet I saw this company called 1-800-snoring, so I called. They sent me to a dentist in my area (YES DENTIST) that made me a custom oral applaince. I LOVE IT!! I sleep so much better, it is much easier to carry when I travel and no more wind tunnel feeling! It is worth a try for all of you who do not like your CPAP!

    January 18, 2011 at 18:27 | Report abuse | Reply
  20. U. R. Sosimple

    I've been wearing my nasal mask for 12 years now and I'd never give it up. When I had my sleep study (after being told that I stopped breathing for up to 30 seconds while 'sleeping') I experienced more than 300 micro-arousals in a 5-hour period. Now, I'm sound asleep in 5 minutes or less without fail. If you position the hose properly there is no condensation run-back. One thing I don't recall seeing in posts is above to thoroughly clean the mask daily, especially if using a heated humidifier. This is very important as it gets rid of bacteria that can breed in a warm, moist environment.

    January 18, 2011 at 18:34 | Report abuse | Reply
  21. JohnnyJett and the Dirty Socks

    I have had surgery to correct a deviated septum, soft pallet removed, tonsils removed and uvula. I still had snoring problems and wake up tierd and fatigued. I went to my doctor he suggested a new sleep study and a proceedure that removes a bump in my nasal passage (can be done in the office) as well as a spray they put on your throat to make it vibrate less, both are simple proceedures. I am trying everything including dropping 25 lbs so I don't have to use the cpap, but if that does not work I may have to conceed to an appliace or cpap

    January 18, 2011 at 18:45 | Report abuse | Reply
  22. Live Oak

    I was diagnosed with sleep apnea in my 40s. I have snored all my life and apparently have had sleep apnea since birth. When younger, I had to have a T & A as I only had a third of my throat available for breathing (they were huge). When I was tested, I was told I had a moderate level of apnea, and that it was actually worse when I was relaxed at home – I don't sleep well anyway for a few nights when in a new place, and that was affecting the results. My problems are that my cats play with the hose (no way to keep them out of the room), but more importantly, I have to use the full face mask. They also gave me a chin strap as I become an open-mouth breather while sleeping and the air does no good without a way to keep my mouth closed. When wearing the mask, I feel trapped like someone is holding my head down and I fight the machine. I also cannot tolerate the air being forced into my mouth. I cannot yawn and swallowing is difficult. I believe I would do better on the cannulars (nose prongs), but could not get the approval. The machine sits by my bed, not being used. It's been idle so long now, it needs to be rechecked, etc by a sleep center. Wish there was another way.

    January 18, 2011 at 22:57 | Report abuse | Reply
  23. George B from Ohio

    Wow ... all her patients with such profuse praise of their CPAPs ... I've been trying for more than a year to find a mask that will work, no matter how loose I adjust they tear up my face, or they are noisy, everyone I've ever talked too about this subject hated their CPAP and end up discontinuing. I'm going next month to get a dental appliance and give that a try. I'm not overweight so that may work for me. Sleep apnea is not something you want to ignore, I must admit it has helped some, but I also have been following the From Fatigued to Fantastic protocol, so not sure what is helping me the most.

    January 18, 2011 at 23:13 | Report abuse | Reply
  24. lovehurts

    i have this in a very bad way, i can't seem to sleep until 4 or 5am eastern time then i wake up around 11 am, i'm tired and my health h=gets worst

    January 19, 2011 at 01:25 | Report abuse | Reply
  25. Mamudoon

    My mother has sleep apnea, and her CPAP has changed her life. She's gone from being exhausted and totally miserable to being a happy, optimistic person. She said she wouldn't trade it for anything.

    Now, if they could just find a treatment for people like me who take a very long time to reach REM sleep (the reason I'm exhausted all the time, as confirmed by a sleep study).

    January 19, 2011 at 04:17 | Report abuse | Reply
  26. Sleep apnea Sufferer

    Sleep apnea has been around for a long time but recently has been linked to all kinds of health risks. I'm surprised that there aren't more resources out there for those who suffer fromsleep apnea.
    There is life after sleep apnea!

    January 19, 2011 at 06:55 | Report abuse | Reply
  27. Sam

    I love my CPAP. I only got tested to make my mother quit hounding me about it, after a teasing session from my husband on how bad I snored. I had been attributing my fatigue to having Rheumatoid Arthritis. I was a college student when I got it, and my professors never objected when I dozed off in class because of RA. When I got the CPAP, I was a whole new person. I hated it at first, and spent the first month ripping it off at night. Then one day I was so exhausted I managed to sleep through the night with it on. Then I realized as I woke up that I had no dry mouth, and was feeling amazingly rested. I've been fine with it ever since. My professors noticed it, and my grades shot up. My RA doesn't bother me nearly as bad, and I have less "bad joint days". I can't go without it now.

    January 19, 2011 at 08:31 | Report abuse | Reply
  28. Rebecca

    Good article, but excessive tiredness isn't always due to sleep apnea. I turned out to have narcolepsy, which is also diagnosed through a sleep study and multiple sleep latency test.

    January 19, 2011 at 08:58 | Report abuse | Reply
  29. sounding

    What I'd prefer over a CPAP machine would be one of those portable Hyperbarric Chambers. Everything I've researched on this would help most any ailment. It puts oxygen into a cellular level. Unfortunately, I don't have $10,000 to spend on it.

    January 19, 2011 at 09:21 | Report abuse | Reply
  30. Lisa Shives MD

    To Mike who left message on Facebook. We do pro bono sleep studies (that is for free or for a small charge) if someone has no insurance and/or no job. Call sleep centers in your area to see they offer something similar. Good luck!

    January 19, 2011 at 16:36 | Report abuse | Reply
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  33. practical

    Those of you who hate your CPAP: talk to your doctor. There are a lot of different options available, both in terms of masks and mask usage. I was having problems with my mask chafing the side of my nose when I first started the machine. Turns out that the nasal pillows were a little too big. There are different attachments that can make the mask more comfortable to wear, like cloth coverings for the rubber parts of the mask. If your machine has a ramp function (and it should), talk to your doctor about starting at a lower pressure.

    It is true that there a chance that CPAP does not work for you. However, CPAP (and other treatments) is more likely to work for you than oral surgery, which is not only extremely painful, but has a success rate of less than 30%.

    January 24, 2011 at 02:41 | Report abuse | Reply
  34. Sleepy


    I have used my CPAP for the past 14 years. My condition had become dangerous to me and my child as I was falling asleep behind the wheel. Since I have been having problems most of my life with "chronic fatigue syndrome -misdiagnosis," depression – misdiagnosed" when I finally was tested in a sleep study to be suffering from Sleep apnea, I can't say weight has a lot to do with my condition. I was told it seems this may have been the cause of my problems for most of my life. It took me about two weeks to get used to my mask, now I can't function not even one day without using my CPAP machine. I had to have my pressure adjusted only once over the past 14 years, but other than that I was told this would be something I had to use for the rest of my life.

    It's amazing how no one has mentioned the fact that you can die of cardiac arrest from severe sleep apnea, or how sleep deprivation can be a danger to your health and others. There is so much that can be misdiagnosed when all you need is a good nights rest.....CPAP has been my life saver.

    January 24, 2011 at 15:20 | Report abuse | Reply
    • Ed Gould

      I had a stroke about 11 years ago and shortly (3-4 months)afterwards I started with the sleep apnea. MY PCP doctor sent me to a day time sleep test (forgotten what the real name was) and of course I could not sleep. Between stroke issues and some work related issues I put that aside and decided to go on LTD and after that started I thought I would address the Sleeping issue. It took me 5 months just to get into see a neurologist and when I got in he heard my issues and ordered a night sleep test. When the results came in he said he could "cure" me with a CPAP machine. I though what the heck go for it. Well it did help but minimally. I wasn't getting the fall asleep issues 3-4 times a day I had them 2-3 instead. I got tired of waiting for 4-5 months to see the doctor and went to see another neurologist and he said lets have you take a sleep test. Sigh... I told him I already had one and got the CPAP machine so he looked at the results of the sleep test and asked me to hget up on the examining table and he put a toungue depresser in as well as shinning a light he said what may help is if you have the operation to widen my airways. So I said hmmm OK and went ahead and made an appointment to get that done. I was LTD so I could spend the hours waiting. I had the surgery and it was the most painful thing I have ever experianced. The pain killers they gave me barely made it possible to function. DO NOT EVER UNDERGO that operation unless its life/death, just take my word for it.
      AFter that had healed the sleep apnea continued. I kept looking for foctors that could at least come close to fixing my problem. I think over the next say 6 years I kept trying different doctors and going through sleep tests (I have lost count of the number). About 3 years ago I was reading a magazine article in my doctors office that listed the great doctors for different specialty's and I ran across the University of Iowa. I go out that way to visit a friend once a year so I figured why not combine the visit with a doctors visit. Of course the doctor wanted a sleep test, although this doctor got a little smart as when I told him of the CPAP machines I had tried he suggested I try a BIPAP.

      Believe it or not it actually helped for a little while anyway. Two years later the problem is back. I really needed this adressed so I started to look again as the drive to IOWA is a solid 5 hours. I cannot drive alone (stroke issues) so I had to beg friends to come along with me so they could take over driving if it was needed.U got tired of IOWA because the drive was difficult and getting to be expensive. My doctor suggested some one else and so I went to ssee him. New Hospital new doctor. The doctor saw me and of course ordered up a sleep test. The damn hospital put the sleep climnoc right next to the CTA EL so once an hour a train went past the window and I couldn't sleep. ANyway I went back and he said he wanted to increase the pressure on the BIPAP by 5 LBS (I think) it was high I remember that. I said "NO" everytime some doctor increase the pressure beyond X I have reall bad acid reflux (if you have ever had it it is bad) he threatened me that he would write a letter to the disability people and tell them I was refusing treatment and that they should stop paying me. I called his bluff and said go ahead try it. I walked out and never went back.
      Another friend suggested the MAYO clinic so I made sure my insurance covered it and made an appointment. I thought IOWA was bad but Minnasota is worse as far as distance that is. I asked my doctor to send the results of all the sleep tests up there and I got the paperwork from the U OF I to send it to the MAYO clinic. Well I got up there and the next day I went to see the Dr at Mayo clinic. I walked in and exchanged pleasantries with the doctor and went through the history. So he says finally he can't do anything for me as my doctor had sent only the last sleep test. I was livid I went home and sent a juicey email to my doctor complaining that I madt the trip for no reason as he didn't send all the results of the tests. He said he gave the job to his assitant with instruction and I guess he didn't check the assistant's work.
      So it was three days wasted and money for motel etc etc etc... just because the assistant didn't do the job. I was madder than H***. I got this story from the assistant there was a button on the screen that he didn't know about he had to click on to get all the results.

      My doctor (PCP) finally said he would try changing the pressure as he had a little experiance in the area. AFter he raised it above the threshold the acid reflux was back and really bad and i was losing sleep at night like you wouldn't believe. I finally heard about a place where you can have an in home sleep test. Let me warn everyone this is not a test you want to do at home. The application of pressure sensors is a real PITA and with my unit if some lead comes undone there is a flashing light and it will not wake you. There are a bunch of other issues as well. I had it over a weekend so I had three chances to get a decent test and none of the tests came out well.
      SIGN we are getting there...
      I found another sleep specialist and she seems pretty good. No real head way on the apnea as the headgear I have tried just doesn't work for me. I had another sleep test (of course) but it is too soon to see if she can fix it or not.

      There are a whole lot of items I did not talk about above mainly not to confuse the issue (and for brevity). Out of the clear blue about a year ago I started having issues with my water tank running out in the middle of the night. I fought the provider as they refused to help me out. I talked to the manufacture's rep (online) and he never heard of the issue. I finally got in the mail an side container that heated the water and it helped until that started to run out as well.

      So I am in the middle of an on going issue that everyone keeps fighting me on to resolve issues.

      ps: I have found out that between Neurologists and Cardiologist both seem to have "god" complexes.

      February 5, 2011 at 00:33 | Report abuse |
  35. jj

    I didn't realize I had a problem, but got fat, grumpy, unmotivated. I realized I wasn't dreaming – for a long time. I took the test, and had episodes every minute. (and from what I've read, it takes an hour or so to get to REM sleep. Wake up for a second, and the clock starts over).
    I assume most don't adapt well to the mask. I was lucky, and had no problem, tho I sometimes found it beside me. In my sleep, I unhooked the strap and removed it! I immediately felt better. I started sleeping better, and I felt compelled to walk every day. A mile the first... on the 5th, I was up to 5 miles – it felt great and I couldn't stop. Then I had to stop for a week, and I never felt that urge again. I haven't lost the weight of mood I had hoped, but I dream again!
    Aside from the weight, my big problem is my chin, which isn't hinged correctly (says my dentist). And I can feel the difference – if I put my chin on my chest, the air supply is cut off. If I thrust my chin fwd, so the front teeth are in the normal position, I can breathe fine. I hate the look of the mask, but I don't have to see it. I can't sleep without it! I left it at home on a trip to the mountains, and drove 90 minutes back home to retrieve it! I take it when I sleep on the boat.
    I do agree – doctors push these devices. It's how they make their money. I know I needed mine!
    And remember – medical equipment isn't included as carry on when you fly. They can't restrict it or charge extra for it.
    (and NEVER put medicine in baggage! They may lose it, or you may sit on the tarmac for the day)

    January 25, 2011 at 23:30 | Report abuse | Reply
  36. Jen

    I have CSA. Surgery is lovely is an option for those suffering from OSA only. My apnea occurs courtesy of a short circuit, not being obese (so this weight Im losing, 50 lbs down so far) is meaningless for my apnea. Anyone who tries to call folks with apnea "fat people who need to lose some weight" as some on here have so far are really clueless. I have used a CPAP for 5 years. It took me 4 months of hunting to find a mask that would work with my claustrophobia, mainly because I had to tell my initial DME to take a hike because they were not listening to me, and get on the internet and find some forums to talk to other CPAP users to ulitmately be able to find something that made the machine work with me and my sleeping patterns. Now, other than when I have a cold or the occassional bad night from a leak, it has made my ability to function during the daytime much better, I am less prone to getting sick, and generally just feel better. I sometimes think we are preconditioned by the naysayers out there to HATE our CPAPS. Luckily, both my brother and father also suffer from CSA and used CPAPs before me, with positive aspects and I wasnt subjected to the negativity.

    January 26, 2011 at 12:09 | Report abuse | Reply
  37. EN

    I'd like to hear about alternative/complimentary therapies for sleep apnea. Salt therapy, also known as halotherapy, can help those who suffer from a range of respiratory illnesses–sleep apnea included. It depends on the cause of the sleep apnea, but if your nasal cavity and sinuses are filled with mucus, the obstruction in your air flow may be the cause of your snoring and salt therapy/halotherapy may be an effective cure. For more on salt therapy, see http://www.respirasalt.com.

    January 27, 2011 at 16:45 | Report abuse | Reply
  38. robert

    I am schedueled for uppp surgery in ten days. I'm looking forward to the results it will offer as I was diagnosed with moderate apnea. I'm feeling a bit apprehensive about what the recovery may deliver. What specific pain medication will be prescribed? How long will I be allowed to use that medication? Will I have issues with nasal regurgitation? Will I be able to swallow food and liquid without choking? Will I experience a long term change in the sound of my voice? Has anyone reading this had the surgery....and if so might you address my concers regarding your personal experience? Perhaps the doctors monitoring this site may offer a response. Thanks

    February 8, 2011 at 15:36 | Report abuse | Reply
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    May 30, 2011 at 14:42 | Report abuse | Reply
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