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Re: Q A to Froggyanna: CPAP and sleep apnea?

Posted by froggyanna on June 3, 2003, at 14:19:30

In reply to Q A to Froggyanna: CPAP and sleep apnea?, posted by gouda on June 3, 2003, at 6:20:45

Hi gouda (do you come with crackers?) heh heh,

> First, I just wanted to say thanks for your lengthy post!
You're welcome! I just gotta get it outta my system. Get ready for an even LENGTHIER post!!

> Gave me lots of reassurance since I am also taking depression meds
> w/ Strattera and good laughs with the ripping nails (which I am
> doing as I take breaks writing this post).
Has anything helped you with that? I've done it for as far back as I can remember, and I have never found anything that would help me stop. Nails, skin, stray hairs, anything "protruding" gets an unreasonable amount of attention, and I go into paroxysms of desperate attempts to remove the offending "object." It's only just this past week that I came to the startling understanding that this could be related to my ADD, or perhaps even be OCD. I've always been embarrassed by it. I tend to be a perfectionist on top of the procrastination. In computer terms, that would mean having an outrageous urge to put every single pixel in line (which I have done quite a bit as a sometimes graphic designer). Of course, that's only when I'm not ripping at my fingernails! But it's funny.... you'd think I'd want to have perfect manicures every day, but no, I rip my fingers to shreds. It's got something to do with the feeling of it, and getting rid of those extra bits of skin, a release of tension, perhaps. Anyone else have any insight into this? Also, right now my knee is bouncing up and down like crazy, and I really wish this agitation would go away.

> Second, my question: I like how you ruled out sleep apnea ... which got me
> thinking about sleeping problems. But I am new to this ADD stuff, what advice
> do you have to give about getting testing done on sleep disorders?
> How do you snore exactly? Do all ADDers have sleep problems?
Hey, that's three questions. But OK. First, though, I "ruled out sleep apnea" as the cause of my ADD. Is that what you meant? Cuz I can't rule it out of my life! I've definitely got it!

I'm new to this ADD stuff, too. I haven't heard that all ADDers necessarily have sleep disorders. But my psychiatrist told me that many people in his practice who don't have SERIOUS APNEA have sometimes been able to rid themselves of ADD-like behavior through the reduction of snoring. Because even mild snoring means that you are not sleeping optimally. And if you are not sleeping optimally, then you are more prone to going through your days fuzzy, distracted, etc. So that's why he initially prescribed buspirone for me -- to see if it relieves my snoring/apnea and thus relieves my ADD-like behavior (assuming I DON'T have ADD). I was skeptical, though (but excited that it might be that simple!). Alas, it has not really done anything to stop my apnea, or even the snoring. So dang it, I must have ADD!

About six years ago, I was evaluated for surgery for apnea. I decided not to do it, because the success rate is not very good, and it's a truly gruesome proposition. We're talking about major trauma to the throat and soft palate, cutting away lots of tissue, "pulling" the tongue forward by cutting it and repositioning it to allow more room around the airway, and even breaking and repositioning the jaw. I talked to three people who had it done: an older fellow in his late 50s-early 60s, and two women in their 30s. Only the older man felt that it was worth the pain. His apnea was significantly reduced if not outright cured (I can't recall). The women found no relief at all and had very difficult recoveries. Yeesh. The surgeon took pictures of my airway with one of those little cameras on a wire (had to take it down the nose) and showed me right there as I was sitting that my airway is significantly narrower than normal. He showed me pictures of "normal." I could see that my poor little passageway was MUCH smaller than most people's. I'm just built that way. I asked him if this is from being overweight, and he said, "NO, this would be the case even if you were very thin." Lucky me.

And I WAS very thin as a 14-year-old summer camp student and the other girls in my tent threatened to throw me out of the tent at night or put rocks in my bed so I wouldn't lie on my back snoring. I already had social phobia to begin with, so this was quite traumatic. I don't recall how the problem was resolved. I think I've blocked it. Somehow, through my first marriage, it never was a problem to my ex-husband. Nor was it a problem to the various men that I dated after divorcing. But once when I was vacationing with my mother and two daughters, and my mother and I were sleeping in one of the beds together, we woke up the next morning and my mother said, "You made sounds that I've never even heard before!" She said at one point that she wanted to put my pillow over my head. Thanks, Mom.

Apnea is when your airway gets loose and closes completely down, which is why they call it Obstructive Sleep Apnea. And when that happens, your mind wakes up to deal with it. You choke, you gasp, the airway opens, and you go back to "sleep." You usually don't even know you're doing it. But your roommates do!!! And you never go down to the deep third and fourth levels of sleep because you're always waking up. Snoring is caused by the airway not completely closing -- all the soft tissue is loose and rattling around, but air still gets through. Apnea sounds like snoring until the obstruction happens -- then there's silence for about 10 seconds followed by a loud snort as your mind "fixes" the problem and the air rushes in.

To get a sleep study, you usually need to go to a dedicated clinic or hospital department. Most big cities have a "Sleep Disorders" clinic of some kind. Another doctor generally refers you but there's no reason you couldn't suggest it to your doctor first. It's an overnight stay and they really wire you up. They measure your breathing, your heart, your brainwaves, and your leg muscles. That's what I know about, at least -- there could be other things. Some people have Restless Legs Syndrome, where your limbs jerk around, so they want to include that in the picture. And they videotape the whole night in all your glory! Usually, if you've given them enough data to go on during the first half of the night, they wake you up and put you on a CPAP mask. Then they titrate the air pressure for the rest of the night to find just the right pressure that keeps your airway open without causing other kinds of discomfort.

> Third, another question: what is CPAP? I gather it is some kind
> of device you wear when you sleep?
Yep, the Continuous Positive Air Pressure machine, our friend Mr. CPAP. It's just a little portable "box" that blows air through a flexible tube. It is adjusted to your precise pressure. At the end of the tube is either a mask that fits over your entire nose or "nasal pillows" that get inserted into your nostrils. The mask has an elastic band that holds it in place, and the "pillows" are attached to headgear that fits around your entire head. They both have their advantages and disadvantages and everyone responds to them differently. They definitely take getting used to, which is why a lot of people are noncompliant and consider surgery. People keep trying to come up with variations on these two themes, to increase the comfort and the likelihood that more people will be compliant. I'm waiting for the device that hangs from the ceiling! (My fantasy.) The tube comes down at night with a remote button that you push, you place the mask or the pillows over your nose and somehow "lock" them in place, and the tube just follows your movements as you toss and turn in happy oblivion. You don't have the flexible tube hanging and dragging all over your pillow and behind your head, you don't have the sadistic-looking mask over your head, and at the touch of a button, the tube zips back up into the ceiling in the morning! Just like Star Trek! :-)

> Fourth, your new addition of Wellbutrin: my experience with Wellbutrin...
SOMEthing has definitely reduced my appetite, but I noticed that even with the buspirone and Straterra. I'm just glad that this is happening, because I have been binge eating for years on Prozac and Zoloft. I now need to lose about 150 pounds. As for staying calm and focused, what dose are you taking? I've just finished 5 days at 100mg 2x/day and tomorrow I start on 5 days at 150mg 2x/day. I will then go to 200mg 2x/day if I'm "not impressed," as the pdoc says. Did you gradually increase like this? I haven't had any of the "tingley" things you mention -- I hope I can avoid that by going slow. But I also haven't noticed any improvement yet in my agitation or the urge to rip flesh. I can't stop shaking my leg or picking. And did you say that "extreme calm" was one of your CONS? How so?

> Fifth, Strattera at night: ... I've been taking it 2-3 hours before
> my bedtime, and it's been great to help me "fall asleep"
Maybe I'll try that. Maybe I could take it with my second dose of Wellbutrin for the day. I like to make these things as easy to remember as possible! But it would be hard to do that if I were to get a normal 8-5 job -- the hours wouldn't work. Right now I'm still not sleeping regular hours. My go-to-bed and wake-up times are all over the map. I hope that these meds can help me to regulate that some.

> Sixth, Strattera and irritability: Same problem as you, if not worse.
Rats. OK, that's two of us then who are hoping that this will wear off. Anyone else got some encouraging reports? Did any of you have irritability initially but it eventually went away? ADDled minds want to know!! :-)

If you've bothered to read this far, thank you -- I appreciate the space to write like this. I don't mean to be a blowhard, but there is so much about all of this that is fascinating to me, and writing helps me to understand it better.





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