• The best news, almost

    I made it through the red tape more quickly than I expected and have been cleared by my insurer for a CPAP machine. The supplier will even come to my house. This is welcome news.

    Here’s the bummer: the process took just long enough that I’m now up against a week’s vacation, and they probably can’t squeeze in delivery of the machine before I leave. I’m on the wait list just in case they get a cancellation. So, in all likelihood, I’ve got about 10 more days of sleep deprivation to endure, plus however much longer to adjust to the machine.

    Still, this is far ahead of the schedule I expected, and I should count my blessings that therapy even exists. Oh, how people must have suffered before there was one.

    This also means it won’t belong before I can bore you with actual data of apnea events per hour by day (the machines nowadays collect it and I’m pretty sure I can get it).

    Other updates:

    1. I tried extended release Ambien (6.5mg) two nights ago while traveling. Hotel sleep usually sucks, so I was hoping this would do the trick. I still woke to consciousness with many apnea events between 3AM and 6AM. WTF?!

    2. A reader who used to work for “a leading health insurance company” said he did an analysis of CPAP coverage policy about a decade ago. He concluded, at the time, that it would be cheaper not to require a sleep study (which are very expensive) and to let doctors prescribe CPAP machines, then evaluate the data over the next few months. This is plausible because many people get sleep studies and CPAP machines and then stop using them, effectively wasting a lot of expense.

    This study had no impact on coverage policy. Had it been in place, it’d have saved me about 10 weeks of delay.

    Assuming the analysis is correct, why would an insurer leave money on the table? Some possibilities, all pure speculation: (a) Maybe it would have devastated sleep study labs and maybe they had some clout because they’re needed for other diagnoses. (b) Maybe the savings would be small relative to the headache of changing the policy. It’s not the low lying fruit. (b) Maybe the evidence supporting this idea is thin (it seems like it would be) and insurers don’t want to risk encouraging even a low level of diagnostic errors.

    3. I started using the Provent therapy last night. Possibly coincidentally, I do not recall a single apnea event (I’m not claiming there weren’t any, just that I slept through them all). However, I wasn’t on a therapeutic level of Provent, just a training level. Even the training level creates some back pressure though, so maybe it can help a little (?). Confounding the results: (a) I was on Ambien, (b) I was extremely tired from my trip, having sleep poorly the night before (see #1), worked out for the first time in a month, given a talk, and met with tons of people at Ohio State University (tiring for an introvert).

    I’ve got three more training nights of Provent before I’m on the real deal. I’ll get a handful of nights of experience with that before I get a CPAP machine — good opportunity to gather info about whether Provent would be helpful for traveling.


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  • Why so public?

    In the last few days, three colleagues have admitted to me that they’ve been taking Ambien for years. One has sleep apnea, another suspects he might, and the third has convinced himself he does not. From the correspondence, I think my attention to the condition may persuade one or several of them to get testing/treatment. And that’s just three people I know of. There are probably others who will benefit from my posts about obstructive sleep apnea.

    That’s a significant impact from a few hours of my time — possibly a greater impact than thousands of hours I’ve spent on some research projects. It’s reason enough to put in the effort.

    But I’ve also benefited tremendously from writing publicly about my health conditions. (Sleep apnea is just the latest. I’ve written about my battle with insomnia and a heart thing too.) The feedback from patients and clinical experts is valuable and rapidly expands my understanding of the problem and treatments for it.

    Moreover, it’s cathartic. Encountering a new health problem that brings you into close and frequent contact with our unpleasant health system can be frightening and frustrating. Expressing that is helpful. Finding the humor in it is helpful. Writing is how I do that. This is where I write. You are whom I write to.

    Yesterday, a friend asked me if I am concerned about the risks of publicly disclosing my health conditions.

    I felt the answer almost before I could reply, “Hell no.” I am offended by the thought of self-censoring. Why would I do that?

    Well, maybe some future employer or insurer would deny me employment or coverage, rendering me jobless or uninsured, he suggested. Or maybe disclosure of taking a sleep aid could play some role in some legal proceeding I cannot anticipate, he speculated. These are extremely theoretical and low probability events, at least in my case (YMMV). I think my employment prospects are enhanced, not diminished by the kind of blogging I do, bringing evidence to issues in an accessible way. Writing about my conditions and my experiences with the health system as I address them is just a part of that. It’s personal — when so many of my posts are not — and, therefore, brand enhancing.

    I could, likewise, make arguments about why I’m not worried about underwriting. (It’s mostly gone now, but one might worry about its return. Still, I would never conceal my conditions anyway.) And, a legal situation that turns on my taking Ambien for a few nights here and there? I mean, really.

    But all of this argument would miss the main point. I am morally offended by the idea of self-censoring. I want to live in a world in which patents can share their stories, publicly, if they wish to. (Naturally, if one wants to keep things private, one should.) I think it’s healthy and normalizing. Nobody should feel they need to live in the shadows. Doing so feeds the erroneous notion that our experiences with poor health are ugly, shameful ones.

    Sometimes I know what the morally right thing to do is. It’s the thing that if I don’t do it, I could not live with myself. What I wrote to my friend is, I’d rather be dead than to feel I cannot speak my mind.

    * OK, in some cases we might be blamed, if we take reasonably preventable risks.


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  • Rule outs

    In the last two days I’ve received some interesting feedback from readers about obstructive sleep apnea that could be valuable to many, but isn’t clearly applicable in my case.

    1. One reader who was kind enough to speak with me by phone (video chat, even!) told me about a connection between being tongue tied as an infant (ankyloglossia) and developing OSA. More on this here, here, and here. I was not tongue tied as an infant, but I thought this information might be helpful for others.

    2. Another reader wrote that he had success treating OSA with the Buteyko method, which includes, among other things, training to help people who breathe through their mouths and/or sleep on their backs to stop doing so. Both of these will increase risk of OSA and snoring. I do neither.

    This doesn’t necessarily mean there’s no value in the other aspects of the Buteyko method for people like me. I certainly cannot know without having done it. A video on it I watched raised an interesting point. One contributing factor to airway collapse may be high velocity airflow during sleep. Bernoulli’s principle tells us that higher velocity means lower pressure. Keeping the pressure higher in the airway is exactly what CPAP machines do. But if the velocity of air during breathing could be decreased through practice, that may help. (It would seem to me that this may only be helpful for mild cases, if at all. The breath can only get so slow.)

    Clearly this would take considerable training — to change how one breathes during sleep, if it’s even possible. I gather that’s, in part, what the Buteyko method is about, but I have not examined it closely (there are lots of books and videos out there). Nevertheless, I could not help but think about slowing my breath as I fell asleep last night. I seriously doubt this had any impact on how I breathed during sleep, but it could not hurt any. At the very least, it’s relaxing. Coincidentally (?), I had the best night sleep in weeks, though not without apnea events, only a few of which woke me.

    Having said all this, it is important to emphasize that OSA can occur in people who don’t back sleep or mouth breathe. It can also occur in people who are not overweight. I do/am none of these, yet …

    More generally, OSA is not always due to things that are (potentially) modifiable with changes in habits, diet, and lifestyle. Sometimes (often? usually? almost always?) other interventions are necessary.


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  • Sleeping mouths and ears

    A reader said I was onto something yesterday when I reported I slept better with my tongue suctioned to the roof of my mouth. Apparently, this is one of many techniques and exercises that some practitioners recommend for obstructive sleep apnea.

    Holy crap! I just used engineering logic to cook up the approach in the middle of the night. I almost can’t believe I stumbled onto something that’s, well, a thing.

    Anyway, according to this general line of thinking, I’m told (no studies have I read), the totally wrong way to hold one’s mouth during sleep is slack-jawed and with the tongue resting on the bottom of the mouth. This is the way I have always slept!

    The right way, apparently, is to keep the jaw more tightly shut (but with teeth a little apart) and the tongue glued to the top of the mouth. Is this a general truth or does it just help some people and not others? I have no idea. Anyway, this is my new sleep mouth strategy.

    There’s a sleep ear strategy too. Sometimes it’s the sound of the apnea events that wakes me. When that’s the case, and it isn’t always, ear plugs can help. There are studies on this.

    Anyway, apart from nights I was on Ambien, last night’s sleep was the best in weeks, perhaps due to these two strategies. Lots of apnea events, of course, some of which woke me. But I was not conscious for any long stretches.

    Other updates:

    1. A reader shared this link, which has information about the risks of pharmacological sleep aids. The last page has a tapering schedule.

    2. The Calgary physician I’ve been corresponding with said getting through a sleep apnea diagnosis would take considerable time there too. But he suggested that once diagnosed, a patient would be on a CPAP machine more quickly than what I’m experiencing. Score one for Canada. (On the other hand, without the prolonged wait, would Canada produce a blog series like this?!?)


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  • Why does it take so long?

    Over the weekend, when I messaged Aaron about my obstructive sleep apnea (OSA) situation, his reply was, basically, “Why can’t they get you a CPAP machine right away?”

    Welcome to the U.S. health system. Here are the sources of delay, with time=0 the moment the doctor had a diagnosis and called me.

    • I was not available when the doctor called, though I would have picked up if the caller ID had indicated it was him. I called back within a day and got voice mail. I left a message. I never got a call back. (USA! USA! USA!) Meanwhile, I suspected I did not have OSA because (a) during my sleep study, nobody came in to fit me with a CPAP machine, as I was told would happen if they saw apnea events; (b) I assumed the doctor would express more urgency if I had that diagnosis. So, score this as a communication failure for which I am only partly responsible.
    • ~1 week later I remembered I hadn’t connected with the doctor and called back. This time I got him and my diagnosis. I can take some blame for this delay, but it was not without some justification (see above).
    • Knowing little more than what I could recall from the ICER report I was involved in, I told the doctor I was interested in an oral appliance. Once those words came out of my mouth, he decided not to put in a request for a CPAP machine. That made sense to me at the time, but now I think that was bad care. He trusted the patient too much. I’ve never had this diagnosis before! However, I also take some blame for my ignorance about CPAP and bias against it. A far better process would be an informed, shared decision-making one, perhaps starting with a referral to some instructional videos. I did all this work on my own this past weekend (as I’ve documented in prior “sleep apnea” posts), which reduced my fear of CPAP tremendously. Now I’m all for it.
    • This false assurance followed by self-education process cost me another week or so. But, the prescription for a CPAP is now in! I also have a dental appointment for an oral appliance (intake, not to actually make the thing). I can do both, at this stage, but will probably go with CPAP as my first treatment. If that fails me for some reason, I am that much further along in the oral appliance branch.
    • However, both branches (CPAP and getting the intake dental appointment) take about 4 weeks. The former is because of insurance delays. The latter because the dentist I want to see is busy. I’m sure I could find another dentist, but I don’t know how to judge them. Anyway, it doesn’t matter because I want to do CPAP first.
    • So, what is the insurance company doing for 4 weeks? Utilization management. It wants to make sure I have all the documentation to justify CPAP. This is somewhat reasonable. On one hand, nobody would get CPAP if they didn’t have some sleep problem, so wasteful utilization is somewhat bounded. On the other hand, we would not want docs just giving out prescriptions for the thing without being sure it was warranted, and the sleep problem wasn’t actually something else (like insomnia that can be cured very cheaply with CBT). CPAPs are not cheap!
    • Should this take 4 weeks? That’s a cost-benefit or marketing question. My insurer could certainly hire more claims processors. That’d boost admin costs, showing up in higher premiums. By the way, I’m being generous here, I was really told it could take 4-6 weeks, but could be faster. So, I figure 4 is about the average.

    So, there you have it. After an insurance-created, multi-month delay in getting my diagnosis, there’s about another ~1.5 months to treatment. And that’s just to start treatment. I expect an adjustment period. It won’t actually be working for me for several weeks after I start. So, let’s call it 2 months to treatment from diagnosis. I guess it could be worse. It sure as hell could be better, but that might cost us even more than we already pay.

    That’s a long time to have crappy sleep! Now you see why I’m working so hard at interim solutions. BITWMA!


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  • Breakthrough

    I’m an engineer at heart (and by formal training), so I know the credo:

    1. There’s only so long I’m going to let a problem bother me before I will try to fix it.
    2. When I set my mind to it, I will damn well fix it.
    3. An inelegant solution beats no solution. Let them laugh, you still solved the problem.

    My obstructive sleep apnea situation provides me with generous time in the wee hours for my engineering brain to tinker with ways to remain unconscious during apnea events. (The story of why a long-term treatment is taking so long is another blog post, but it’s the usual thing: our health system is not very good at some things, and delivering me a CPAP machine quickly is one of them.)

    My problem in sleeping through apnea events in the early AM is that I’m a very light sleeper then. Every. Single. One. Wakes. Me. Up. Consciously. I can count them. Yes, 9 per hour (as verified in the sleep lab) seems just about right. The first one comes just moments after I drift off. My sleep is way too light to get through it.

    But, I reasoned, if I could get through that first one, I’d be able to stay unconscious a lot longer, through many subsequent ones. How to do this?

    There are drugs (see my prior posts), but not ones I want to take every day. Last night I was Ambien free.

    Then there are an assortment of mechanical solutions, all of which are aimed at keeping the tongue out of the airway. I have so much time to experiment with these, including last night between 2:30-6AM.

    I tried biting my tongue to hold it outward. Yes, that’s dumb, but one gets desperate. It didn’t work. I unbite it as soon as I fall asleep. Plus it’s very drooly, which also wakes me.

    I tried sleeping on my stomach, to maximize the gravitational pull on my tongue mouth-outward. To my surprise, I can do this. It didn’t help. I drift off, staking a claim on sleep. Mean Mr. Apnea snatches it away.

    I tried thrusting out my lower jaw as is achieved by mandibular advancement devices. Nope. Can’t sustain it while entering sleep. Also drooly.

    I tried all manner of pillow architecture. Didn’t do a damn thing.

    After all this, at 4:30AM last night, I’m thinking, thinking, thinking. There has to be a way.

    Suction. I can create a partial vacuum in my mouth, easily. I bet you can too. In part it’s how you scratch your hard pallet with your tongue or click your tongue against it. Once initiated, the tongue can be pinned to the roof of the mouth, where the suction is not that hard to sustain for many minutes. All I had to do was keep the tongue suctioned up there long enough to get through the first apnea event and, voila, I entered sufficiently deep sleep that I was unconscious from 4:30-6AM, during which time, no doubt, I experienced about 15 more.

    Engineering wins.


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  • The Ambien trials, part 3 (and other updates)

    Intervention: 5mg of Ambien at 10PM, another 2.5mg at 2:30AM

    Result: Slept from 10:30PM-6AM (7.5 hours). I’d be lying if I said it was the best sleep. I can recall several wakings — more than the (old) normal. I’m definitely groggier than normal this morning too. Still got some Ambien in me from that early morning dose, small as it was.

    Conclusion: This version of Ambien is not the best for me. Either an extended release version, taken at bedtime, or a fast acting version, taken at 1-2AM or so, would be better, as has been suggested by several readers.

    Anyway, I’m going to wrap up these trials for a few days and go without Ambien. I’m very concerned about getting reliant on it. I definitely will want to use it during a few, upcoming trips. I’m sure I won’t have a CPAP machine (yet) for them. (Cue grumble about the stupidly slow health system, considering what we pay for it.)

    Other updates:

    1. Some reading, but by no means thorough, suggests to me that OSA can have some connection to inflammation and, by logical extension, perhaps tendinitis. The pathway would be that OSA causes stress hormone spikes. I guess it’s stressful to not breathe. Go figure. I have noticed for years that during times of stress, my arm and knee tendinitis is much harder to manage. (Sometimes this is how I know I am experiencing subconscious stress — before I recognize it consciously, I feel it physically.) I’ve been experiencing management challenges of both for a handful of months now. My suspicion is that this was an early warning sign of OSA. Had I only known! Hopefully, OSA treatment will also improve my tendinitis. I thought I had two problems when I may really only have one.

    2. A reader and CPAP user recommended this small CPAP machine for travel.

    3. Another reader, and physician, recommended these as an alternative to any of the devices I’ve discussed so far. Super simple, but expensive (and, frustratingly, disposable so the expense just lasts forever). Maybe a good travel alternative or an interim measure while waiting for a long term solution. I’ve ordered the starer kit and will report back.

    4. As a sleep aid, a reader recommended trazodone as an alternative to Ambien. I’ve heard this advice before.

    5. I saw the CPAP machine of yet another friend on this gathering I’m at. His was smaller and quieter than the first two I’d seen. And, by quieter, I mean effectively silent. I was impressed. This friend had also used, and liked, a dental appliance. It was years ago and he didn’t remember much about it. However, after some discussion we jointly concluded that it could not have been a mandibular advancement type.


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  • The Ambien trials, part 2 (and other updates)

    Taking the full, 10mg dose of Ambien “worked” better than the 5mg dose I tried two nights ago. I say “worked” in quotes because it’s confounded with lots of other things. For one, I was already more sleep deprived. For another, my anxiety is coming down somewhat about my diagnosis and what to do about it. That alone should help me sleep.

    So, the fact that I woke at around 4:45AM on 10mg instead of 2:15AM on 5mg may not have been caused by the dosage difference. Also, to be more precise, on 5mg, I slept from 9PM to 2:15AM (5.25 hours), with a few, trivial moments of sleep thereafter, which hardly count. On 10mg, I slept from 10:15PM to 4:45AM (6.5 hours), with a bunch of quite nice, multi-minute dosing until 6AM (so, let’s say I got more like 7.25 hours of sleep).

    But, still, what woke me both times, and interrupted my dosing thereafter, were apnea events. I’m sure of that now. This ain’t no insomnia of yesteryear.

    So, my fundamental question remains: As I wait for the gears of the health system to turn to deliver me a longer-term treatment, how can I best remain unconscious during/through those events? My trouble spot is typically 1-2AM onward.

    One physician recommended a dose of sublingual zolpidem (brand: Intermezzo), taken in the middle of the night. The purpose of this variant is that it is intended to treat difficulty returning to sleep from nighttime waking. I would like to try it, but my PCP hasn’t provided a prescription. The active ingredient is the same as Ambien, so I’m tempted to try a half dose of that tonight in the wee hours, maybe chewed up to speed its delivery. Crazy? (Anticipatory concern: If I end up using Ambien for a week or two, I wonder how to come off it. Taper? Or, should I not use it regularly over that span? Take a break every few nights?)

    Other updates:

    1. While dosing intermittently this morning, I messed around more with a pile of pillows to try to get the tongue gravity assist I wrote about yesterday. I don’t think it helped. Maybe the gravitational force one can get to act on the tongue while sleeping on one’s side — constrained by the limits of comfortable neck contortion — is simply not enough. I forgot to try some sort of stomach sleeping, but I’m pretty sure I won’t find that easy to pull off.

    2. I’m on a retreat with a bunch of buddies, three of whom have OSA. All use and like their CPAP machines. Two have given me demos of theirs. They are way quieter than I imagined. They’re also bigger than I had hoped, particularly with the humidifying attachment, which also acts as a noise dampener. (Cleverly, one fellow puts ice in his humidifying compartment in the summer.) We talked at length about all the wonderful and annoying things about the machines, masks, etc. (I’ll talk to the third friend today. He’s also used oral appliances.) One thing they suggested is that if I am going on a short trip and don’t want to be bothered bringing the machine, I could just not. My case is mild and I can get a passably decent night sleep with a dose of Ambien (or maybe even without it). Be flexible. It’s nice to have a support group.

    3. A TIE reader and sleep specialist physician in Calgary reached out to me. After some email, we spoke by phone for an hour yesterday, going over all my questions. This was AMAZING! I am incredibly grateful to him for the time. It’s exactly what I needed and was not getting from the US health system, within which I feel like I’m on a conveyor belt. No clinicians I’ve seen here want to talk about all the confusing issues I’m dealing with. This is all old and boring to them and I’m just one patient of dozens they have to cram into their busy days. It sucks. This kind Canadian offered to try to help me find someone locally who would give me the attention I want, if that’s possible here.

    He also sent me some reading:


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  • Readers’ feedback on obstructive sleep apnea

    I am grateful for the feedback I’ve already received about obstructive sleep apnea. (All prior posts on this topic are appropriately tagged.) Below are a few things I’ve heard and some additional, related information I dug up. I am going to presume anyone reading this will know what the acronyms and other jargon mean (if not, Google is your friend).

    Disclaimer: In no case should you assume my evidence review has been thorough. I’m still cutting my way through the thicket here. None of this is clinical advice. I have a PhD only, anyway (not that there’s anything wrong with that).

    1. CPAP > MAD. The most common feedback I received was to encourage me to go right to CPAP, skipping MADs. Some suggest this because the evidence shows that CPAP has better outcomes. This is true! See the ICER report and the AHRQ report that it updates.

    However, it’s not that MADs are ineffective. Here’s a recent review that has come out since either of these reports that makes that point. Here’s another one. Notice that MADs aren’t worse on all measures.

    An important consideration is that, as with any treatment, clinical effectiveness (as demonstrated in trials) isn’t the only variable. According to some studies, CPAP has lower adherence, which suggests there are things about it that some patients don’t like, relative to MADs. CPAP machines are also more difficult to travel with (particularly when backpacking or to locations without power). I am especially concerned about how either device will play with my fragile sleep profile (easily awakened by noise or discomfort). That could go either way. MADs are silent, but could be uncomfortable. CPAP machines make some noise (I need to hear some to appreciate how much) and also must impact comfort somewhat.

    But, MADs can break. I haven’t seen relative failure rates of them vs CPAPs, but I’m willing to believe MADs fail more often. Breakage of one is why one respondent switched to a CPAP machine, though he also said that what insurance would cover played a role in this decision too. It’s potentially meaningful that I’ve yet to hear from a single patient who prefers MADs. But, not everyone who responded has tried both. Some have. Some admitted they haven’t. I suspect CPAP is just more common, perhaps a consequence of coverage (?).

    Another critique of MADs is that they can cause jaw pain. True! But at least one study shows that doing jaw exercises can help with this. Clearly MADs are going to affect one’s bite and teeth more than CPAPs. On the other hand — and I’ve done zero work chasing this down — I have seen some anecdotes about CPAPs associated with ENT issues.

    Also, and again I have not chased this down, I saw something about the possibility of CPAPs potentially causing a progression from obstructive sleep apnea to central sleep apnea. I guess that might make sense if the brain starts to learn it doesn’t need to do any work in keeping the airway open, but this could also be internet BS (?).

    Given these other considerations, it might be reasonable to trade the lower effectiveness of a MAD for higher comfort or convenience if it provides those (for an individual patient). Ideally, a patient would try both. Over time, many do. And I may be one of them.

    2. Don’t use Ambien. One respondent said this was not an OSA solution. Clearly I know that. Its purpose, in my case, would be to address short-term, OSA-exacerbated insomnia issues until I get a longer-term (and proper!) OSA device. (If you’re just joining me, yes, I know all about CBT for insomnia.)

    One respondent said it or benzodiazepines were associated with future dementia. First of all, association studies — let’s be careful. Second of all, there are studies that say otherwise. Third of all, risk vs. benefit. Forth of all, short-term use. Enough about this.

    3. Sleep position matters. A friend made the point (implied it, but I still have enough wit to make the inference) that OSA is a mechanical issue and is addressed with mechanical solutions. This being a physical world, I am free to experiment with various mechanical solutions on my own, as I wait for the real deal.

    For obstructive sleep apnea, the issue is that the tongue is blocking the airway. In part that is (or could be?) because the airway has lost some muscle tone or resiliency of some sort (I’ve yet to internalize all the clinical jargon). But gravity also plays a role. For most sleep positions, and especially supine (on one’s back), the tongue is pulled down into the airway by gravity. Stupid gravity.

    I can still remember my physics well enough to reason that the effect of gravity on the tongue would be the opposite (away from the airway) in a prone (on the stomach) position. Maybe, maybe, it’s also possible to get this effect on one’s side (where is the fancy jargon for that?) — my preference — if one can get the mouth pointing somewhat downward.

    You can probably imagine how one might do this with the right pillow architecture and neck/head tilt. here’s the best picture that sort of illustrates it that I could find on the internet, if only she’d tilt her head a bit forward and/or rotate it a bit pillow-ward (see what I mean?):

    This idea led me down a rabbit hole searching for evidence of sleep position on apena events. There’s stuff out there, but it’s pretty much all about how supine sucks and prone rocks, relatively speaking. OK, but what about clever, mouth downward side sleeping?

    With a pile of pillows, I did a bit of experimenting with this early this morning (more to come) and it’s clear one can get some gravity going in the right direction. The process measure here is drool. If it’s coming out of your mouth, figure your tongue is subject to the same forces, provided physical laws are constant across space. I cannot yet conclude it helps any, but I was already pretty wake from hours of apnea events and lack of effectiveness of my small Ambien dose, etc.

    Naturally, one could just go full prone, but that’d take considerable adjustment for me. I searched for prone sleeping pillows. Not convinced I’ve found anything worth the money. I did find this, for side sleeping, but it’s hard to tell if it’s worth it.

    4. What about OTC MADs? One respondent pointed out they’re out there, which I knew. But which are worth trying (again, as an interim step before getting something better or a CPAP machine)? No idea and I couldn’t find any sound guidance on this point (feedback welcome).

    5. Nobody said this, but there are a lot of crappy studies out there about OSA and treatments. I can’t be bothered to find them now, but I chased down some work about how playing various wind/brass instruments might be associated with more/less OSA. I play trumpet, so this is relevant. I don’t think any of this stuff is conclusive and the studies are not very good.


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  • The Ambien trials, part 1

    What does one do with oneself between diagnosis of obstructive sleep apnea and treatment? My appointment with a dentist just to start the process of getting an oral appliance is one month away. That will be followed by an adjustment period of how long I don’t know. The oral appliance may fail and then I’d go to a CPAP machine. This could all take a while. I’m thinking it’ll be months until back to anything like normal.

    So, I have a lot of time to tinker with myself.

    My preference is to go unconscious for the duration, but I’d settle for 7-8 hours at night. What I mean by this is that though I can’t stop the apnea events without treatment, I might be able to keep them at a subconscious level, which is better than nothing. In fact, I suspect this is how I’ve been living for months, if not years. I very much doubt that my awareness of apnea events starting in December was the first time they occurred.

    Maintaining unconsciousness is hard for a recovering insomniac whose sleep is disrupted multiple times per hour. I can usually do it for the first 3-4 hours of the night. The trouble begins around 1-2AM and can last several hours. At worst, I’m up for the day. This is to be avoided!

    Small doses of Benadryl (Diphenhydramine*) can work for me, usually. I didn’t know I was treating OSA this way. I thought it was just dealing with occasional, short-term insomnia spikes. (PSA: Long-term, insomnia not associated with another problem, like OSA, is best treated with cognitive behavioral therapy.) By small doses I mean 1/4 of one pill (6.25mg). A full dose is two pills (50mg).

    I told my primary care doc this yesterday and she suggested I give Ambien (Zolpidem*) a try. So, now I’m tinkering with that. But, how to use it?

    My first trial was last night. Being risk averse, I tried a half a pill (5mg) at bedtime. That knocked me unconscious until 2:15AM. I suspect apnea events woke me, and they certainly kept me awake thereafter.

    So, the first trial failed. What’s next?

    My choices are (a) take the full, 10mg pill at bedtime or (b) take a half pill (5mg) when I wake around 1-2AM. The first of these would be the “normal” way to take the drug. It’s as directed. But would it sustain through my trouble spot?

    The second of these would seem to target my problem very precisely. I bet it would work in the sense of helping me sleep in the wee hours, but maybe I’d have trouble waking in the morning. That could be a risk worth taking, since I typically don’t have to get up at any particular hour.

    I have 9.5 more pills in the bottle, so I can try both of these, as well as a few other variations, if I think of any.

    * Approximately nobody knows these things by generic names, so I am not going to use them exclusively, if at all. Yeah, that’s giving in to the brand manufacturer. Sue me.



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