Protect Your Health through Better Sleep — and Save Too! The Sleep Disorder Alliance is a group of independent companies that work with you and your insurance company to get the supplies you need at little or no cost.

http://nyshopexchange.dealshop.us/

I have been using the Respironics Full Face Quattro Mask since I started CPAP. I believe I made a good choice for a fist mask thanks to the help of the sleep lab letting me try on many masks during my study. This mask has not been perfect, but many of the lessons I learned can apply to all masks and all types. These are the tips that helped me with 90% of my mask troubles. If you are struggling try these some of these simple fixes that could make things better.

1.) How clean is your mask? Do you clean it every day? Mine gets slippery and won’t even hold even my wimpy 9cm of pressure if it isn’t 100% free of facial oils. Also even if you mask is 100% clean, wash your face before you go to bed. This helped me with my seal, but I have heard some others claiming that using a moisturizing cream helped them. I think these people have abnormally dry skin, so try at each end of the spectrum. I know my Father-In-Law swears by using Bart’s Bees Wax on his nasal pillows. Try each of these depends on your skin type and preference, but give them a try.

2.) When you first adjust your mask, if you have CPAP equipped with a “Ramp” feature do not use this feature when adjusting your mask. Put you mask on, start the machine at “Full Prescribed Pressure.” If you adjust it for the smallest pressure, it will just blow out when it reaches the maximum.

3.) Being a normal man I never read the instructions, but every mask has a prescribed order for tightening the straps; use it! After struggling, reading the directions helped me a ton! It sounds so simple, but some “pointy-head” put them together in that order for a reason.

4.) Are you having trouble getting used to the fit and feel of your mask, or your prescribed pressure? You need to make friends with your mask and CAPA! IT IS your friend, not your enemy; it will lead you to better health, if you learn to work together!

To make friends with your mask, talk to it. No, I’m, just kidding. Start by getting used to it by wearing it around the house during your normal waking hours. Watch TV, read, knit or do some activity while wearing your mask. You will NEVER get comfortable enough to sleep with your CPAP and mask it can’t be comfortable with it during the daytime. I know I can’t wear my mask with glasses, so I can’t see the TV, but I can still cruse the internet with my iPhone at close range. Make friends with your equipment! (Unless you have small children like I do, then it is a good way to have them stop coming into your room at all hours of the night, as they are more scared of you than the monsters under their beds!)

It hasn’t been easy, but I have made it to week three. I have learned a lot about sleep apnea and have been thru a lot of experiences that I still cannot explain. I am sleeping thru the night and my seven day average for hours of sleep is now up to an exact nine hours and my thirty day average is at an exact eight hours. Only three weeks ago I was only sleeping four to six hours; what a change! My energy is up, my mood is up, I shoveled snow for only the second time since I started CPAP and only the second time in three years. My life is being restored in the night! I have become sleep addicted, spending most of my day thinking about sleeping. I get into bed as quickly as possible and stay sleeping as long as I can.

I have had some noteworthy mask difficulties. I have had to really clamp it down the past few nights and so tight it has left marks on my face for a few hours in the morning. My mask was leaking in the same place every night and blowing air right into my eye. I believe it to be a seal failure because there is a slight deformity in the seal when I examined it. Almost like it melted, stretched and then cooled. I might have used water that was to hot when I washed it, but it was below the temp I thought it would melt at.

My DME supplier said that “You need to expect leaks to happen, just go back to sleep,” “No, I expect this to be 100%.” This is medical equipment and being the cost is so high I don’t think it is beyond asking for superior results. What if I paid my bill to them in the same manner, you know, deduct 25% for leaks in my wallet. When they called about the balance I could just say, “You need to expect that sometimes people won’t pay their bills, just go back to your paperwork.” This is the same rep that gave my wife an auto-PAP for a titration study and didn’t bracket the pressure settings around her current prescription.

I want to try the Respironics Comfort Gel Full-Face Mask, but I confess it might end up as a Christmas gift because of tight finances. At over $150 even from discount internet suppliers these masks are a little too costly for just trying on a whim. I have heard great things about the Gel Masks fit and I am now desperate to try one. At my sleep study she had me try on a few, but they made my face feel like it was as long as a horse. Given the tradeoff between feeling big and not leaking, leaving unsightly lines or pressure sores on your face, I’d take the horse mask if it is comfortable.

I called the sleep lab to see about setting up a mask fit appointment, but was told the person who normally does the appointments left and has no expected return date. It sounds like they were fired, furloughed, or had a health or family issue. The person I spoke with said they would speak with their boss to see if someone was available to do an appointment and then return my call. That was several days ago and I have not heard a response. I hope this does not signal the end of their mask fit program, as it is a valuable service. At the end of the appointment they basically give you a loner mask to try out of their inventory. At a cost of several hundred dollars apiece, it is a rather expensive chore to test masks. Being that you cannot sell discarded masks on the used market, there is no way to recover the cost of a bad choice. Even using your insurance that only covers masks every six months or once per year, means you will be stuck with your failures for the same amount of time.

Personal Changes

I need a life! For the past three years all of my activities have been sedentary, to protect and save my body for the future, but now I have all this energy and limited places to spend it. I can put the effort into the house and as it is winter it is a good place to start, but by no means is it the end. I need more. Things have been changing: as I have gotten stronger I have begun to reclaim the household chores I once pushed over onto our teen age son Tyler; snow shoveling, grass cutting, grocery carrying and such a like. I haven’t been reading as much as I had been, haven’t been blogging or writing in my Personal Log as much as I had been. This has all been a great blessing and is not being met with complaint by me, but only observation.

I have had one major setback in one of my areas of personal change; I have relapsed to using tobacco. I have had precious few breaks from this habit since age thirteen, but I am gaining ground. I have been taking Zyban and I have made two attempts to quit in the past few weeks. The most successful was 5 days, but a life and death issue within my extended family threw me off the wagon and out of personal balance. I will make a fresh effort this weekend.
I have been checking by blood pressure and sugar very regularly and have watched it rise and fall with my tobacco use. I believe that I was trying to stimulate my metabolism with nicotine and coffee so fight the effects of sleep apnea. My hope is that because I am getting proper rest I can now back away from the stimulants. I have begun to cut my normal morning coffee with decaf. Starting first with a ratio of five to one and progressing to a full fifty-fifty. I don’t know how far I will progress, as I have noticed my consumption reach new heights in an effort to boost my caffeine intake. I think I will hold here until I see my volume decrease.

Improving Health?

I think I might be looking at my insulin resistance going away! Yesterday I was craving sugar bad, all day! After I had eaten a full dinner, two PayDay bars and thirty whoppers (the small malted milk balls not Burger King) I was still hunting for more sweets. I was a little apprehensive to check my blood sugar before bed, as it should have been thru the roof. Less than two hours after a full meal and with all that quick sugar, I thought it would be an out of sight reading, but it was only 106. I was not expecting it to be below 200, but what is this? No wonder I was craving sugar, I wonder how low it was before I consumed all that stuff? How accurate is this type of observation, as it is not a very scientific in method. Watching changes in me has become another sedentary hobby I will have to break. I think the observation is valid, but the conclusions in questionable. Yet, if I keep it general by saying my sugar was lower than I expected, the observation can remain valid.

As my RA symptoms have been resolving I have noticed that not all of my pain is gone. The ugly truth is that I still have the pain from damage done by the RA: I still have shoulder trouble from blowing out my shoulders lifting weights, still have a trigger finger and still have some nerve pain in my feet; it would be disingenuous of me to say otherwise. Yet, the inflammation and swelling is gone from it familiar places, the fatigue is nonexistent and there is zero morning stiffness. That is at least progress especially when accounting that I have not taken a Humira injection in 3 weeks.

I now face the challenge of explaining all of this to my Physicians in a way that is coherent and factual. I actually want to scream “God showed me how to get better!” but I haven’t even posted that on this Blog yet. Maybe that is my next step, to tell the whole story and what a story it is too! The story that stretches from my writing of “The Longest Day” until today, but I feel it is missing a dramatic climax. Telling the tale of “The Third Day” could be the ending I am looking for, but I don’t feel I can exclude the recovery process though it stretches before still. I might have to leave that out of the story, as those pages are not written in the days of the book of my life yet and I need not consider them as they will arrive in due time and Lord willing be less dramatic.

ManLoosed@Home

So, what’s a Good Night Sleep really all about? Sleep is food for the brain, get enough of it and get it when you need it .We need sleep to keep us happy, healthy and alert. While you sleep, your body and brain work together to prepare you for a new day. That is why it is so important to give yourself time to go through all of the Sleep Stages.

Sleep is an integral part of human existence, closely tied in with cosmic clock of internal and external circadian rhythm and we spend around one third of our total lives doing it.

When we don’t sleep in sync with this life giving pulse , we alter our biological rhythm that control hormones and neurotransmitters determining appetite, fertility, mental and physical health. When we sleep less then we are supposed to, Melatonin is not the only hormone affected.

There are at least ten different hormones as well as many neurotransmitters in the brain that go sideways when you do not get enough sleep. Melatonin is just the tip of the iceberg. It is all the other shifts that changes appetite, fertility mental , structural and cardiac health.

The consequence of sleep loss is bigger then falling sleep behind wheels, suffering depression, have chronic fatigue, heart disease, diabetics and poor learning and cognitive skills, It is death, according to sleep scientist around the world.

Why most people do not talk about sleep and hormones, posture, Chinese medicine, Yoga, trauma , chiropractic, Kinesiology, nutritional medicine , meditation and mental attitude? Most likely because the research is buried separately in 7 or 8 different disciplines in academia. It is like 10 blind men trying to describe the elephant based on what they are touching. Each discipline holds part of the puzzle and there is no magic bullet when it comes to treating sleep related disorders.

What are the Stages of Sleep?

Sleep is divided into 4 stages of Non REM sleep and REM sleep (Rapid Eye Movement). These are sometimes referred to as “sleep phases” or “sleep cycles“….

Dreaming occurs in both stages buy mostly during REM sleep. Each cycle of NREM and REM is repeated every 90 minutes, 4 to 5 times a night. 5-6 cycles is an ideal amount of sleep required for everyone after 15 years old.

State and Stages of Sleep

About Melatonin

Melatonin is the night hormone which down regulates catabolic enzymes and catabolic hormone secretion and activates enzyme systems involved in anabolism through its action on the hypothalamus. Melatonin helps adapt the timing of physiological processes and it promotes the promotion of restorative or anabolic physiological processes. Elevated melatonin levels have been associated with increased sleepiness, reduced core temperature, increase in heat loss, decreased cardiovascular output, and reduced alertness and enhanced immune responsiveness.

If you have answered yes to any part of the questions, you have sleep problem.If you have answered yes to any part of the questions, you have sleep problem.Analysis of urine sample during night has advantage over the daily urine for the diagnosis of Endocrine and Adrenal disorders( HPA) , because the difference between normal and disease state is augmented when urine is measured during night (every 4 hours ).Urinary Organic acids, also called carboxylic acids, comprise key intermediary compounds of many biochemical pathways as well as exogenous compounds.

The goal is to identify dysfunctions related to nutritional deficiencies and correct them before disease is allowed to develop. From a single urine specimen, we can assess:

• Fatty acid metabolism
• Neurotransmitter metabolism
• Carbohydrate metabolism
• Oxidative damage
• Energy production
• Detoxification status
• B-Complex sufficiency
• Intestinal dysbiosis due to bacteria and yeast
• Methylation co-factors
• Inflammatory reactions

Maintaining  sleep is important for growth , rejuvenation and detoxification!

There are a number of biochemical imbalances and conditions that may affect the maintenance of sleep, causing the patient to wake frequently during the night.There are a number of biochemical imbalances and conditions that may affect the maintenance of sleep, causing the patient to wake frequently during the night.Investigate the following underlying causes and contributing factors and refer to individual protocols for supplementation strategies to support these.

Other factors that may need to be considered include insulin resistance and/or irregular blood sugar control, hypoxia and vestibular imbalances.

If a patient awakes most during non-REM sleep  consider and support inflammation, liver and/or gut function, and status of anabolic hormones and serotonin.

When incomplete following conditions arises:

Does the following applies to you?:

• Nightmares

• Night sweets or getting very hot at night

• Night terrors

• Waking often during the night

• Waking up during the night going to toilet

• Sleep walking

• Sleep talking

• Bed wetting

• Snoring

• Sleep Apnoea

• Restless leg syndrome

• Mouth breathing

• Teeth grinding

• Irritable bowl syndrome

• Auto immune disease

• Poor recovery from sickness and or injury

• On medication for cholesterol, High blood pressure, depression, insomnia and pain relief

• Using recreational drugs

• Drink alcohol

If you have answered yes to any part of the questions, you have sleep maintenance difficulty.

Your body is not experiencing the healing power of deep sleep.The quality of sleep and maintenance of arousal depend on ability to fall sleep and maintain a good night sleep for at least 7-8 hours. If you wake up refreshed and alert and maintain the same level of arousal through most of the day then you have had a good night sleep.

Looking for more info on Sleep and Sleep Help?

Traveling with CAPA

There is a lot of things that go into making our CPAP function. We might have mastered this art at home, but on the road can be a little more difficult. As I said in the second installment of CPAP tips; one of the things you need to obtain is a letter from your prescribing physician stated that this is necessary medical equipment. This becomes important when traveling especially internationally and passing thru customs. For me, I would will be packing your CPAP in checked baggage, but for those who desire to “breeze” thru the airport without stopping at the luggage carousel, there is a steep learning curve! Below is a basic checklist for whatever you carry choice might be.

CPAP Travel Checklist:

 
-Travel letter from you prescribing Dr. certifying your need for CPAP treatment.

-A plastic bag large enough to fit your CPAP in. (See TSA link below)

-Make sure you have the right power adapter for your destination, especially internationally.

- Bring an extension cord, just in case an outlet is not close enough to your bed.(Very hard if you’re traveling internationally, to get the right one!)

-Check to make sure that all your CPAP equipment and accessories are packed.

-Make arrangements to get distilled water at your destination. (More on this below.)

Hotels and CPAP:

I have heard of cases in which the lamps and alarm clocks in hotel rooms are hard wired to the wall and there was no outlet by the bed. Outlets were supplied for laptops and cell phone chargers, but these are sometimes a great distance away, be prepared with an extension cord or be prepared to ask for one at the front desk.

Do hotels have distilled water available? I wanted to give you a good report that hotels are so concerned their service and our comfort that they would, but alas, service truly is dead. After calling a few hotels today to see if they had distilled water for their guests, EVERY phone call was negative. One lady seemed not to know what distilled water was, asking me, “Are you sure you don’t mean bottled water?” What a disappointment this is! I am not a business traveler, so I have never need to iron clothing while in a hotel; on vacation I don’t care if my shorts have a few creases in them. I understand no supplying waster for a CPAP, but so many people need a clothes iron I was sure they would have it! To be fair these were average hotels, not 5 start locations, which I suspect might go to the store for you if you needed distilled water.

In the TSA’s Own Words:

TSA’s Page on CPAP

TSA on Medical Liquids (Our Distilled Water)

It might be worth is to print this page, so you can give it to them in the event you carry on your CAPA. If the people at the security screening even know what a CPAP is I will be surprised, let alone to know THEIR OWN handling procedures. Do I expect this of them? Frankly yes, not only do I have OSA, but I am also on immune-suppressive therapy for RA; this makes me vulnerable to germs! With how many people pass thru security checkpoints in a day, I might as well attach the CPAP to the hose and drag the whole assembly thru the restroom floor!

CPAP and the Airlines:

Because a CPAP is considered necessary medical equipment, it supersedes any airline directive to allow only one carry on. Unless I am starved for space in my checked baggage I won’t be carrying my CPAP on the plane with me, as I said before. If it was an international flight lasting for >8 hours, I would consider carrying it on, but not wearing it. I would rather snore at everyone on the plane! Just looking at the amount of regulation and hoops for O2 is enough to make me buggy! Looking at the list of approved oxygen concentrators, it seems as if the flight attendants might not allow you to use it anyway. Here is what one airline has about “Medical Equipment” and specifically O2 concentrators.

United: Worst Explination! No Specific CPAP Statement.
Southwest One CPAP: SW On CPAP
Continental: On CPAP and Vents
Delta: Look under “Assisted Devices”
JetBlue: Best Policy So Far!

It seems that I must notify the airline two days in advance if I want to use it, not if I just carry it on. There is a loop hole there, but the thought of getting to the plane door only to be told I MUST check my CPAP in that flimsy bag, is horrifying! Print these policies out, so you have a chance to fight back if they try to break or ignore their own rules.

Summary:

I would check it. When I travel it usually isn’t just for an overnight, but an extended stay on a vacation. Normally I am traveling with my family and we have a ton of luggage anyway, so a little extra for my CPAP is worth it. If you still want to take your CPAP as a carry-on you are entitled to! Just make sure you are prepared. Even if it was OK on your flight to your destination, it doesn’t mean it will be just as OK going the other way! Prepare to be challenged, be ready to give an answer and hopefully you won’t have to teach the TSA and the Airlines about their own policies. Have a nice trip and sleep well on it!

Just curious how you’re sleeping.  Why would I be asking this?  Because I have a solution for you: move.  Get up, and get going.  Makes sense, right?  If you use more energy during the day, you’ll sleep better at night.  Chances are this isn’t anything new.  It’s certainly not a new concept to those of us in the Egoscue circle.  I talk to clients everyday who are struggling to fall asleep or stay asleep, and the majority are sedentary during their day.  Now we have new research proving what Egoscue and others have been saying for years.  If you are active during the day, you’ll rest better at night.  Here is a very interesting article from the NY Times that has accompanying research that breaks down just how much better you’ll sleep if you move during the day.  One of my clients, Joan Hampf (you can watch her testimony below) woke up every morning at 3:30 for two years.  The night after her first appointment, she slept until 5:30!  She moved in ways she hadn’t before, put her body in a better position, and her cardio-vascular system responded accordingly!  Her body was receiving more blood and oxygen and was in a more restful state for a longer period of time.  So for those of you dealing with sleep disorders or nights filled with tossing and turning, do your Egoscue menu before bed and let me know what changes.  If you don’t have an Egoscue menu, grab the book “Pain Free” by Pete Egoscue, read the first three chapters, and go to the chapter on Head Pain/Headaches.  The menu in that chapter will help reestablish proper head/shoulder position, putting your upper body in a more functional position.  This will allow the C-V system to operate more efficiently, and you will sleep better!  Email me and let me know the results.  Keep moving!

CPAP Tips #2: The Best Advice I Got!

The Best Advice- Starting off Right

The best advice I have ever gotten is to get a copy of your “Sleep Test” results AND a copy of your prescription for yourself and if you are a traveler a letter stating that this is  a prescription and medically necessary device. The test results from ANY medical test are your property! They are your results and your prescription and you by law have access to your medical records! You most likely will not understand all of the results, especially the raw data, but I will point you in the right direction for some help with this in a minute.

Results: Can Tell You More

A copy of your test results can tell you a lot more than just pass or fail! (Going into my sleep study it was my sincere hope to failed with grace!) This can tell you the average number of events you had every hour, the length and types of events, your lowest O2 readings during the night and what type of sleep they observed you to have. There are two parts of the sleep study you might need; the first is a summery page, written by the sleep Physician and the second is a graph of the whole sleep study and titration (if you had a split study.)

Useful information is not always communicated by your physician, but still can be very important. On my sleep study summery page there was a note, which my physicians never discussed with me: “No supine (on back) or REM sleep was observed during the test or titration. Titration pressure might not be adequate.” An important detail, as the most sever events occur on your back in REM sleep, don’t you think! That led me to request a data capable machine from the DME supplier so I could monitor if my AHI number increased to a place that I might need re-titrated. I can also use this one piece of information to convince my insurance company to pay for a titration study or home titration study sooner than they want to. I’ll just show them that note!

For help understanding this information I recommend seeking help from the American Sleep Apnea Association on their FORUM page. There is a section specifically for understanding your sleep study. Reading thru the information on others studies can help you understand yours. Feel free to ask any questions that remain, as their moderators are very knowable and ready to help you. These are great people who I can brag on enough for their role in educating me. (You can also find me there from time to time, but under a different name.)

Here is a link: ASAA FORUM

 Rx’s: Suppliers Need Them!

 A copy of your prescription is also vital! While your “sleep specialist” or GP might send your Rx to DME supplier of your or their choice; you can use this piece of paper (Rx) to SAVE MONEY! I have found that you local home medical companies cannot beat the prices that you can find from reputable suppliers on the internet. So if you are paying for this equipment out of pocket, this is a way to save major cash! Even on the internet a xPAP machine is still a prescription item, so you need your script! Some internet suppliers don’t require “proof” of a script for a mask, but some do.

This in a time saving piece of paper, as the other way for a supplier to obtain your Rx is to call the Physician’s Office and asks them to send them a copy of it. This can take a great deal of time, depending on how organized you Dr. Office is or is not. By having the script in hand, you can simply email them a photocopy. Most will keep your script on file and you will not need to send them a copy every time you place an order.

If your Doctor is to specific or not specific enough on the Rx, both could lead to later problems. The Sleep Lab I went to made a recommendation to the Dr. based on what mask I chose for the titration portion of the sleep study; if specified a specific mask. If your Dr. puts the specific mask on your prescription, all the suppliers must supply you with  that exact mask and can’t not change it; which can be good or bad. If a week after you start using this mask at home and begin to have difficulties, you need to get the physician to write a new script for the next exact mask you want to try. All this can be avoided if you ask the prescriber to write “a mask of their choice” when writing the Rx. There might be times that a DME supplied refused to give you a specific mask you request. Don’t be fooled they can order anything they want from any company, but at times just don’t want to. As with fixed $$ for machines, some don’t want to carry the more expensive masks because it cuts into their money. In this case get your prescriber to be specific and force their hand. The “interface” or mask is the most important thing that is “of your choosing”, so get it done right and don’t stop until you are satisfied! Most internet suppliers will also bill your insurance if they are not excluded, so don’t be afraid to go off and try new mask types. Just know your insurance might not cover another mask for 6-12 months.

My DME supplier has a  mask return program. If I am not satisfied with the mask in the first 30 days I can return it and choose another. This is excellent as masks are normally $150 and up. Some internet suppliers have similar programs that go out to 90 days, but usually you sign up and pay for this service. You must ask your DME supplier if they have a program such as this, they might not tell you up front and it is a pity to find out after that time has expired!

It is also important to know your titrated pressure as you might need this from time to time. Being admitted to a hospital on an emergency basis is one such time that is critical to know this information. Being that you have been admitted for something serious, you could make your situation worse by having apneas events while trying to recover. They can find this information, but usually it will be kept at you GP’s Office which isn’t open 24hrs a day.

( A note about outpatient surgeries: There are special procedures that need to be followed for outpatient surgery if you suffer from sleep apnea. The anesthesia used in “outpatient surgeries” can cause sleep apnea to become life threateningly. Even for a day surgery this might win you a tube down the throat or even an extra night in the hospital to monitor your breathing.)

Links to a Internet CPAP Suppliers:

CPAP Supply USA
CPAP Wholesale
CPAP Plus/Direct
(*These are only examples, I do not endorse one over the other, or guarantee your satisfaction with any of them.)

Dr. Letter: Medically Rx’d and Necessary Device

I will cover this later in the travel section, but this is an invaluable letter to have if you are business or international traveler. To get off to a great start, get a letter on the Dr. stationary and make plenty of copies. This letter is also useful to give to your electric company. Why your electric company? I’m glad you asked!

In the event that you have your electricity disconnected for non-payment or an outage occurs in your area, because you have “Durable Medical Equipment” as a medical necessity, your electric can not be turned off and must be at the top of the list to be restored in the event of a power failure. Before you need it, communicate with your electric company and give them the letter from your Dr. In the event that they lose your payment or there is a natural disaster, your lights will be first back on!

ManLoosed@Home

Not all CPAP machines are created equal! BUT Medicare and most insurance companies only have one billing code for them and pay a fixed amount to the equipment supplier for that code, not the specific machine. This means that DME (durable medical equipment) supplier can make more money by giving you the cheapest machine they can find and collecting the standard reimbursement from your insurance company. It is up to you to find what is the best machine for the money that you insurance will pay out! Some machines can be very expensive , but it might be worth a little out of pocket expense for the right equipment for you.

Some insurance companies, sleep labs or your sleep doctor sometimes contract and set the brands and quality levels of machines that the DME will supply to their patients. My insurance company, for instance, has specified the brand of machine they are to deliver, but not the exact model. My wife and I, who got our CPAPs only 30 days apart and with the same insurance, recieved 2 different machines. I negotiated with the DME supplier for a data capable machine because I am a technical guy and am interested in a machine that was able to measure my nightly AHI (Apnea Hypopnea Index).

My insurance company bought the humidifier, but, by contract, leases the CPAP from the DME. If I ever change insurance companies I can keep the humidifier but must return the CPAP unit. Some other insurance carries do a lease to purchase arrangement; this begins as a lease, but after they verify you have been using the machine (called a compliance check) they will purchase it for you.

Compliance checks are done via a smart card that slips into your CPAP, some transmit data over the internet or via a modem. On some CPAP machines only the hours of usage and number of sessions (CPAP use >4hrs) are recorded. On fully data capable machines enough information is recorded that your DME supplier, Sleep Doctor or even yourself can monitor your treatment by examining the data recorded on the card. For about $200 you can purchase the software and card reader to do this, but only if you have gotten the right machine.

If you are doing this all out of pocket and not insurance is involved, you can save a great deal of money by dealing with reputable dealers on the internet. These are dealers that offer warranties, have a return policy (especially on masks) and have great customer service. Because these are prescription items, especially CPAP machines, most will call you prescribing Physician and request a copy of your Rx. The best way streamline this I will talk about next time!

Last year I started this blog after seeing in the doctor’s office that I weighed over 300 pounds.  I decided that I needed to do something about it, and would start working out and chronicle my journey on the web.  Being a writer and a pastor I knew would probably write about some other things too.

When I started working out last year I went hard for about a month and then just got worn out.  I saw some quick results.  I got stronger and lost a little weight, but I was so tired.  I worked out in the morning and would be wiped for the rest of the day.  I kept thinking that my energy surge would come, but it didn’t, and working out became difficult to do.  Then I got sick, Advent came, and I just had plenty of excuses to not go back.

In the meantime, I went and did a sleep study. It turned out that I had severe sleep apnea.  During my study I learned that over the course of an hour of sleep, I would stop breathing more than once a minute.  This lack of breathing while sleeping is not conducive to a good night’s rest.  It was a main reason why I was so tired all the time.  Before the study, I would 1. snore like you wouldn’t believe, thus keeping my wife up, and 2. wake up feeling like I needed more sleep.

After my study i was given a CPAP machine.  My Constant Positive Airway Pressure machine has changed my life.  I sleep so much better.  It took some getting used to, but I have gotten to the point now that I cannot sleep without it.  It turns out sleep apnea causes a lot more than snoring.  The stress it creates, combined with the lack of REM sleep can cause or increase the risk of  fatigue, heart disease, high blood pressure, weight gain, diabetes, heart attack and stroke.

I know that sleep apnea is often caused by being overweight, but once you have it, it can also cause obesity.  Losing weight is the most important factor in fighting this disorder, but losing weight becomes very difficult with it.

For the last month and a half I have been back in the gym.  I have gained a lot of strength.  I have lost no weight, and am heavier than I was last year at this time.  But I feel so much better.  I’ve actually gotten to the point that I crave working out.  If I go more than three days without going to the gym, I don’t like it.  I have started to make excuses to go instead of excuses to stay away.

I still have a long way to go, but I like the road I’m on.  It only happened because someone I know told me about his machine.  So now I’m telling you.  If you snore, if you wake up feeling like you need more sleep, if you need to take naps during the middle of the day, if any exercise wipes you out – it could be more than just being “out of shape.”  It could be a sign of a serious condition.  Get a sleep study.  Get a CPAP.  Get used to using it, because its worth it

Breakfast-not later than 7 am,Lunch-not later than 1 pm,Dinner-not later than 10 pm.
Breakfast must be heavy;avoid drinking water during meals.Fill the stomach half part,1/4 water,leave 1/4 empty.Avoid oil in breakfast.
Lunch must have leafy vegetables,nothing should be deep fried,oil to be used minimally,use spice rarely,drink butter milk,minimal use of meat and root vegetables.
Dinner-avoid milk products and curds and desserts like ice cream.
Do not engage in conversation while eating.( Source;Indian food habits as per Smriti)
Take fruits in empty stomach.
ScienceDaily (Nov. 26, 2009) — When you eat may be just as vital to your health as what you eat, found researchers at the Salk Institute for Biological Studies. Their experiments in mice revealed that the daily waxing and waning of thousands of genes in the liver — the body’s metabolic clearinghouse — is mostly controlled by food intake and not by the body’s circadian clock as conventional wisdom had it.
See Also:

“If feeding time determines the activity of a large number of genes completely independent of the circadian clock, when you eat and fast each day will have a huge impact on your metabolism,” says the study’s leader Satchidananda (Satchin) Panda, Ph.D., an assistant professor in the Regulatory Biology Laboratory.
The Salk researchers’ findings, which will be published in a forthcoming issue of the Proceedings of the National Academy of Sciences, could explain why shift workers are unusually prone to metabolic syndrome, diabetes, high cholesterol levels and obesity.
“We believe that it is not shift work per se that wreaks havoc with the body’s metabolism but changing shifts and weekends, when workers switch back to a regular day-night cycle,” says Panda.
In mammals, the circadian timing system is composed of a central circadian clock in the brain and subsidiary oscillators in most peripheral tissues. The master clock in the brain is set by light and determines the overall diurnal or nocturnal preference of an animal, including sleep-wake cycles and feeding behavior. The clocks in peripheral organs are largely insensitive to changes in the light regime. Instead, their phase and amplitude are affected by many factors including feeding time.
The clocks themselves keep time through the fall and rise of gene activity on a roughly 24-hour schedule that anticipates environmental changes and adapts many of the body’s physiological function to the appropriate time of day.
“The liver oscillator in particular helps the organism to adapt to a daily pattern of food availability by temporally tuning the activity of thousands of genes regulating metabolism and physiology,” says Panda. “This regulation is very important, since the absence of a robust circadian clock predisposes the organism to various metabolic dysfunctions and diseases.”
Despite its importance, it wasn’t clear whether the circadian rhythms in hepatic transcription were solely controlled by the liver clock in anticipation of food or responded to actual food intake.
To investigate how much influence rhythmic food intake exerts over the hepatic circadian oscillator, graduate student and first author Christopher Vollmers put normal and clock-deficient mice on strictly controlled feeding and fasting schedules while monitoring gene expression across the whole genome.
He found that putting mice on a strict 8-hour feeding/16-hour fasting schedule restored the circadian transcription pattern of most metabolic genes in the liver of mice without a circadian clock. Conversely, during prolonged fasting, only a small subset of genes continued to be transcribed in a circadian pattern even with a functional circadian clock present.
“Food-induced transcription functions like a metabolic sand timer that runs for 24 hours and is continually reset by the feeding schedule while the central circadian clock is driven by self-sustaining rhythms that help us anticipate food, based on our usual eating schedule,” says Vollmers. “But in the real world we don’t eat at the same time every day and it makes perfect sense to increase the activity of metabolic genes when you need them the most.”
For example, genes that encode enzymes needed to break down sugars rise immediately after a meal, while the activity of genes encoding enzymes needed to break down fat is highest when we fast. Consequently a clearly defined daily feeding schedule puts the enzymes of metabolism in shift work and optimizes burning of sugar and fat.
“Our study represents a seminal shift in how we think about circadian cycles,” says Panda. “The circadian clock is no longer the sole driver of rhythms in gene function, instead the phase and amplitude of rhythmic gene function in the liver is determined by feeding and fasting periods — the more defined they are, the more robust the oscillations become.”
While the importance of robust metabolic rhythms for our health has been demonstrated by shift workers’ increased risk of developing metabolic syndrome, the underlying molecular reasons are still unclear. Panda speculates that the oscillations serve one big purpose: to separate incompatible processes, such as the generation of DNA-damaging reactive oxygen species and DNA replication.
Panda, for one, has stopped eating between 8 pm and 8 am and says he feels great. “I even lost weight, although I eat whatever I want during the day,” he says.
Researchers who also contributed the work include postdoctoral researcher Luciano DiTacchio, Ph.D., graduate students Sandhyarani Pulivarthy and Shubhrox Gill, as well as research assistant Hiep Le, all in the Regulatory Biology Laboratory.
The work was funded in part by the National Institutes of Health and the Pew Scholars
Story Source:
Adapted from materials provided by Salk Institute.
http://www.sciencedaily.com/releases/2009/11/091125094321.htm

Alternate work schedule sleep disorder is a type of sleep disorder that affects people with shift work or work at night. The work schedule of these people go against the body natural Circadian rhythm. Two of the general symptoms of alternate work schedule sleep disorder are disruption of sleep and excessive sleepiness.

Depression and sleep disorders

Children with fibromyalgia most often have sleep disorders and widespread pain. Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress. Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in strong people. People with fibromyalgia have been found to have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain. This reduced response might explain why fibromyalgia patients are apparent to have depression, and are less responsive to opioid painkillers.

Bibliography
A Woman’s Guide to Sleep Disorders, Meir H. Kryger, 2004
Clinical Manual for Evaluation and Treatment of Sleep Disorders, Martin Reite, Michael Weissberg, John Ruddy, 2008
Sleep and sleep disorders, Malcolm Harold Lader, Daniel P. Cardinali, S. R. Pandi-Perumal, 2006

Related external Links
Sleep and Sleep Disorders

Tags: sleep disorder fibromyalgia patients chronic pain

I think I’ve got it all down; I hope. It seems that learning to sleep with a mask on is easy when compared to the things the body needs to relearn. After having been sleep deprived and oxygen starved for years, there might have to be some retraining. I started sleeping thru the night for the most part, but there was still one thing waking me up; the need to “GO”. Yes I said, “GO.” When I first started to learn about the symptoms of sleep apnea the one that seemed like it had an obvious reason was “GO-ing several time during the night.”

I figured it was because I was wakening so many times during the night that the “super-hold-it” response during sleep was not being activated. I never thought I had hurt my body this badly by not getting my sleep apnea treated. Here is what the American Sleep Apnea Association says about “GO”-ing:

Nocturia, or nocturnal urination, is sometimes a symptom of sleep apnea. In fact, nocturia among younger individuals–who are less likely to have other medical causes of nocturia–is a strong indicator of sleep apnea. While the precise relationship has not been thoroughly studied, it appears that the most likely reason patients with untreated sleep apnea have more frequent urination at night is related to the increased pressure in the right side of the heart. This increased pressure is usually the result of low oxygen levels in the bloodstream caused by the apnea events: when oxygen levels fall, the heart works harder to get oxygen to the brain.

An increased pressure in the heart is a sign that there is too much liquid in the body: when the heart receives the stimulus of the increased pressure, higher levels of a hormone called atrial natriuretic peptide (ANP) are secreted. ANP is a diuretic that is associated with the increased need to urinate.

When sleep apnea is effectively treated, nighttime urination is also reduced. Studies have shown that ANP levels in patients with untreated sleep apnea are increased and levels reduced in patients using CPAP effectively. Remember, not all causes of frequent urination are related to untreated sleep apnea; prostrate problems, for example, may cause increased need for urination. Discuss any concerns you may have with your doctor.

To much pressure on the right side of my heart?! Good grief, that’s a little more serious than just not sleeping well! That blows my idea of just being “to awake to hold it” right out the window! I wonder if this also wasn’t the reason for my excessive sweating. How badly could this have screwed up my body?

It has taken me a full 2 weeks on CPAP for this to go away! After the first 7 days my body learned I wasn’t going to die in the night, but it took another 7 days for my heart to learn I wasn’t drowning and I could stop trying to “GO” my way to better sleep.

I have been sleeping thru the night! No waking up to GO! Just sleep from 10:30PM-5:45AM, yahoo.

One minute, I was sleeping peacefully. The next, I was awake and in a state of panic. I was unable to breathe. I felt this incredible pressure on my chest, like someone was sitting on me. Some force was pushing me onto the bed, and I couldn’t move any part of my body to help myself. The only thing I could hear was what sounded like a fan blowing directly in my ears. I tried to call out for help (my boyfriend was watching television in the living room), but I was unable to make a sound. This episode lasted for 15 seconds.

I was absolutely frightened and too afraid to move. I felt like I just had the worst nightmare of my life, except I knew for certain I was awake. Whatever happened, it felt demonic and paranormal. Immediately, I began to brainstorm. Who or what the hell did I disturb recently? I couldn’t think of a damn thing.

Two minutes later, it happened again. Couldn’t move. Couldn’t scream. The fans in my ears.  The choking. The incredible pressure on my chest. The only difference was this time, I could hear what sounded like someone/something running around the bedroom in the dark, rustling around in papers, clothes, the closet, etc. This lasted another 15-20 seconds, and then I was finally able to move again. I was too petrified to make a sound. I began crying, and after about 10 minutes, I braved reaching over to my night table to grab my cell phone. I had been too afraid to move, talk or yell for help. I thought that whatever held me down on the bed would come back. I texted my bf, who had been watching TV in the living room. “come to bedroom. emergency.”

He came in immediately and told me it had to have been a dream. I was convinced it wasn’t. Afterall, I woke up while this was happening. And I was completely awake while it happened a second time. Needless to say, I slept like shit all night.

I immediately did my research the next morning. Apparently, I had suffered from an episode of sleep paralysis, a phenomena that 15% of people will experience at least once in their lifetime.

Sleep paralysis occurs when the brain awakes from an REM state, but the body paralysis persists. This leaves the person fully conscious, but unable to move. The paralysis can last from several seconds to several minutes “after which the individual may experience panic symptoms and the realization that the distorted perceptions were false”. In addition, the paralysis state may be accompanied by terrifying hallucinations and an acute sense of danger. Sleep paralysis is particularly frightening to the individual because of the vividness of such hallucinations.

Possible causes:

• Sleeping in a face upwards or supine position (check)
• Irregular sleeping schedules; naps, sleeping in, sleep deprivation (check)
• Increased stress (check)
• Sudden environmental/lifestyle changes (check)
• A lucid dream that immediately precedes the episode (check)

I wasn’t too crazy to think this was a paranormal experience, either. Sleep paralysis is a phenomenon that stems back thousands of years. Such sleep paralysis was widely considered to be the work of demons and more specifically incubi, which were thought to sit on the chests of sleepers.

• In African culture, isolated sleep paralysis is commonly referred to as “the witch riding your back”.
• In Hmong culture, sleep paralysis describes an experience called “dab tsog” or “crushing demon.” Often the sufferer claims to be able to see a tiny figure, no larger than a child, sitting on his or her chest.
• In Chinese culture, sleep paralysis is widely known as (pinyin: guǐ yā shēn), which literally translate into “ghost pressing on body” or “ghost pressing on bed.”
• In Newfoundland and Labrador, it is known as the ‘Old Hag’. In island folklore, the Hag can be summoned to attack a third party, like a curse. In his 1982 book, The Terror that Comes in the Night, David J. Hufford writes that in local culture the way to call the Hag is to recite the Lord’s Prayer backwards. It is also common for believers to claim that those who are not wakened from this paralysis will die.
• Several studies have shown that African-Americans may be predisposed to isolated sleep paralysis also known as “the witch is riding you” or “the haint is riding you”.

I’m hoping this doesn’t happen to me again. I love scary movies, the paranormal, ghosts … you name it. But this was easily the most terrifying experience of my life. Will it, or has it happened to you?

-Michelle Kamali’i Rivera

Alternate work schedule sleep disorder is a type of sleep disorder that affects people with shift work or work at night. The work schedule of these people go against the body natural Circadian rhythm. Two of the general symptoms of alternate work schedule sleep disorder are disruption of sleep and excessive sleepiness.

Depression and sleep disorders

Children with fibromyalgia most often have sleep disorders and widespread pain. Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress. Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in strong people. People with fibromyalgia have been found to have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain. This reduced response might explain why fibromyalgia patients are apparent to have depression, and are less responsive to opioid painkillers. Patients with the condition have a higher-than-average rate of a sleep disorder called periodic limb movement mayhem.

Prior printed Publication
A Woman’s Guide to Sleep Disorders, Meir H. Kryger, 2004
Clinical Manual for Evaluation and Treatment of Sleep Disorders, Martin Reite, Michael Weissberg, John Ruddy, 2008
Sleep and sleep disorders, Malcolm Harold Lader, Daniel P. Cardinali, S. R. Pandi-Perumal, 2006

Suggested Links
Sleep and Sleep Disorders

Tags: sleep disorder fibromyalgia patients chronic pain

Alternate work schedule sleep disorder is a type of sleep disorder that affects people with shift work or work at night. The work schedule of these people go against the body natural Circadian rhythm. Two of the general symptoms of alternate work schedule sleep disorder are disruption of sleep and excessive sleepiness.

Depression and sleep disorders

Children with fibromyalgia most often have sleep disorders and widespread pain. Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress. Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in strong people. People with fibromyalgia have been found to have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain. This reduced response might explain why fibromyalgia patients are apparent to have depression, and are less responsive to opioid painkillers. Patients with the condition have a higher-than-average rate of a sleep disorder called periodic limb movement mayhem.

Indication of Source
A Woman’s Guide to Sleep Disorders, Meir H. Kryger, 2004
Clinical Manual for Evaluation and Treatment of Sleep Disorders, Martin Reite, Michael Weissberg, John Ruddy, 2008
Sleep and sleep disorders, Malcolm Harold Lader, Daniel P. Cardinali, S. R. Pandi-Perumal, 2006

Related external Links
Sleep and Sleep Disorders

Tags: sleep disorder fibromyalgia patients chronic pain

Well the sleep study results are in.  I don’t have sleep apnea!  YAY that part!  I do however, have something called Alpha Intrusion Disorder.  I have chronic pain and this condition is caused when someone has chronic pain and it changes their brain waves.  This causes them not to go into a deep REM sleep, which is what I have been experiencing for a few years now.  It’s not fun.  Some nights I wake up 12- 14 times.  I’m always hurting and I always need to move or turn to sleep better.  In my case, I finally get so exhuasted that I will need a night or a weekend day to just sleep for like 12 hours.  I’m beginning to explore some homeopathic paths to pain relief.  I’ve also stopped drinking caffeine after 3:00 in the afternoon.  This seems to be helping a bit.  I’m in love with blueberry herbal tea so that’s what I’ve been drinking at night.   If any of you want to leave comments about your sleeping disorders, please feel free to do so.  Just find all the tiny writing at the bottom of the posts and click on leave a comment.  We are all in this together. 

Okay!  On to more fun topics.  I cut two logs of soap yesterday.  The first one is a cucumber scent and it is so clean smelling.  I also played around a bit with the coloring.  It was fun!   So here are the cut bars. 

Handmade Cucumber Luxury Soap. Yummmm!

The second log I cut was the grapefruit/orange soap.  OMG y’all I am in LOVE with this soap.  I used a grapefruit/orange essential oil blend on this one.  It smells just like juicy ripe grapefruits and oranges.  It’s also a vegan bar.  I was kind of surprised at how long the recipe took to trace, but it was worth the effort.  I colored half the batch a light pink grapefruit color and added just a touch of yellow to the other half then mixed them.  I love the soft understated way the colors came out!  I hope y’all like these too. 

Grapefruit/Orange Handmade Vegan Luxury Soap w/ essential oils.

Tonight I’m going to work on completing a couple of birds.  I’ve got some cute ideas for bird hats and such so I’m going to try and get that done.   I’m working on getting myself organized.  Sometimes I feel like I’m running as fast as I can on the wheel and getting nowhere.  LOL   I hope you all have a day filled with peace, happiness, tons of smiles and more love than you can hold!

Yesterday I sat idly in the passenger seat, while my boyfriend was driving and watched in amazement as he approached an upcoming green light going 35 mph. He managed to just make it, only to get stuck at the next light a block ahead. This is the kinda thing that could send a heaping helping of anxiety right into my lap. It doesn’t phase him in the slightest. Unlike me he likes to mix up what vital organs he visits. I, on the other hand, have taken up permanent residency in my head. Most people will press an imaginary brake when a driver is going to fast, I push on an imaginary gas pedal. Because, you see, to me yellow means “go faster so you don’t catch the red”. I’m always in a huge hurray to get some where, regardless of whether I’m making good time, or if I even like where I’m going.
This is just a sample of how many things can bring up my tension level. Red lighta are just the tip of the ice berg. In the show Dexter, Dexter uses the metaphor of a dark passenger to explain the strong desire in him to take human lives. For me passenger wouldn’t really work, because my anxiety is behind the wheel. In the show Herman’s Head, which seriously needs a DVD release since it stars half of The Simpson’s cast pre Simpsons, but I digress Herman had four people who lived in his head. Each person represented a certain side of Herman’s total personality, while I find that a little too schizophrenic/DID, I do think that we all have a voice talking to us up there. People usually look at me like I’m insane when I refer to the voice in my head, but I try to assure them that; there’s only one voice, and it’s not telling me to do something evil to appease the devil. After the awkwardness subsides they can admit that they experience it too to some degree.
Some people call it a conscience, an angel on one shoulder and a devil on the other, or the voice of reason. I think it’s a mixture between my mother’s most shrill voice, and my own. Sometimes it’s my mom decked out in her halo arguing with a me-devil. But most of the time it’s just me giving out advice to me with a slightly higher percentage of good over bad advice. The problem is that she likes to talk as much as I do, she has the same trouble sleeping, and she can sometimes make very irresponsible decisions in favor of instant gratification. It’s not so much what my inner id wants, it’s the urgency in which it must get it. It constantly interferes with my life, and contradicts itself, i.e. it’s always telling me that we need to lose weight, but screams bloody murder when I am working out. My inner monologue, much like me, doesn’t ever want to shut the fuck up.
As I watch my boyfriend drive I realize that this isn’t happening to him. I seem to always date guys who are far more laid back then I am. We come together, cause opposites attract. There isn’t a second of my day that I’m not thinking. One would think it would make me smarter, but it’s making me function at a sub-par level. I analyze everything. Then I analyze what I just analyzed. I dissect a situation down to the last details, reason why people do what they do, and figure out why it makes me feel the way I feel about it. When all that is not enough I often must write it all down just to exorcise the thoughts out of my head. My drawers off filled to the brim with to do lists and monthly budgets. If scientists more studying cancer in the way I study every negative thing that happens to me a cure would have been found. If come to a moment in my life where I realize that I’m not thinking it is instantly ruined because I have to figure out why.
The only time I can shut down my brain when no one is around is through something deeply pleasurable, usually fattening food or shopping. I’m either making my pants or my budget tighter, either way it just adds to more neurosis. Reminding myself of the positive things in my life does little good, at it’s worse I have no recollection that anything in my life is going well. I often come home from work like this on the nights that I work with the people I don’t get along with. Venting my frustrations to some one is the best cure for my anxiety, and it used to be so easy to do before I worked third shift. I used to go out with friends after work and wind down.
This has forced me into doing something that I really don’t want to do, take medication. The idea of relying on drugs frightens me because my mother is a heavy prescription drug user. For some time now I have been taking Xanex on as needed basis, but it’s becoming a lot more needed. I have taken Prozac in the past to get me through some rough patches. I feel that it’s time I take it again to get me to the end of the school year. At no time in my life has my stress been worse then it is right now. I’m so worried that something will happen to throw me off course again now that I’m finally back on track. I also want so badly to get off this shift, but I will not be able to until school is over. I can only hope that once this period ends, so too will my overwhelming stress. I’ll have to wait and see, and unfortunately lean on a crutch I hoped would never need to support me again. I take comfort in the fact that I used to get to messed up about the terrible relationships I had before my current boyfriend, and I’m thankful that at least that drama ended prior to my financial life crippling me. The great thing about having a care free mate is that at least one aspect of my life is smooth sailing.

As promised, here is another of my recently (depending on your definition of “recently”) penned works. This piece was inspired by a segment of the “Fear of Sleep” episode of This American Life concerning – you guessed it – some of the terrors that come to us at night.

Naked Moment

There is nothing
on the screen
but a grainy image
of a Japanese man
in his metal-framed
bed.

He would later say
that in his bad dream,
he was fighting away
snakes of all shapes
and sizes, waiting for
none to latch onto him,
strangle him or poison him,
but flailing with all
his power.

But I could not see his
dream. All I could see
was him kick his metal bed frame
with a soft and rhythmic pang,
tear the tucked sheet out
from under the mattress,
pick up a pillow as a rock
and bash at the air
with murderous intent.

I felt as though
this bare moment should
not belong to anyone
but him, and that
I should not have seen
any of this,

and I clicked
off the TV.

Alternate work schedule sleep disorder is a type of sleep disorder that affects people with shift work or work at night. The work schedule of these people go against the body natural Circadian rhythm. Two of the general symptoms of alternate work schedule sleep disorder are disruption of sleep and excessive sleepiness.

Depression and sleep disorders

Children with fibromyalgia most often have sleep disorders and widespread pain. Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress. Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in strong people. People with fibromyalgia have been found to have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain. This reduced response might explain why fibromyalgia patients are apparent to have depression, and are less responsive to opioid painkillers. Patients with the condition have a higher-than-average rate of a sleep disorder called periodic limb movement mayhem. Some researchers believe that fibromyalgia does not lead to poor sleeping patterns, but that sleep disturbances come most basic. Many abnormalities of hormonal, and brain chemical activity have been described in studies of fibromyalgia patients. Changes appear to occur in several brain chemicals, although no regular pattern has emerged that fits most patients.

List of Literature
A Woman’s Guide to Sleep Disorders, Meir H. Kryger, 2004
Clinical Manual for Evaluation and Treatment of Sleep Disorders, Martin Reite, Michael Weissberg, John Ruddy, 2008
Sleep and sleep disorders, Malcolm Harold Lader, Daniel P. Cardinali, S. R. Pandi-Perumal, 2006

Recommended Links
Sleep and Sleep Disorders

Tags: sleep disturbance sleep disorder poor sleep fibromyalgia patients chronic pain

Morning should be really lucky that it’s not a human being, because if it was, there is no doubt that it would get its ass kicked regularly!  Oh Morning, how you are unloved by many, especially by me! 

For some, morning is a dawn of a new day and hope for a fresh start.  However to others, myself included, it’s a big old bully who likes to play mean jokes.  Well I’ve come to tell you Morning, the jokes on you!  I’m going to give you the top 20 reasons why I would kick your ass and 20 ways how I’d do it.

Dear Morning, if you were a person:

(1) I would sumo-wrestle you to the ground for waking me up at the crack of dawn.  _________________________________________________________

(2) I would karate chop you in the back of your neck for biting me with a cold chill as soon as I open my eyes to the first ray of light.  _________________________________________________________

(3) I would throw bleached water balloons at you for making me wake up from the best dream ever to change dirty diapers.  Trust me, waking up to sh*t is never a good thing.  _________________________________________________________

(4) I would force feed you salty toe jam for inviting construction workers to jack hammer the pavement right in front of my bedroom window.  _________________________________________________________

(5) I would scotch tape your wrists and ankles together for reminding all my bill collectors that I haven’t paid my overdue balances. _________________________________________________________

(6) I would clobber you with a bag full of nickels for sending Jehovah’s Witnesses to my door before I’ve wiped the crud out of my eyes.  _________________________________________________________

(7) I would pinch you with crab claws for hiding my keys just as I’m rushing out the door.  _________________________________________________________

(8) I would punch you in the face for dragging me into the heart of rush hour traffic.

_________________________________________________________

(9) I would run over your toes with a tricycle for inviting the guy in the suit & bowtie to come over and sell me bean pies and incense.  _________________________________________________________

(10) I would horse whip you with Shaniqua’s bad weave for telling the homeless lady that I have spare change. 

_________________________________________________________

(11) I would clip you up with clown shoes for supporting McDonald’s decision to stop serving pancakes after a certain time. 

_________________________________________________________

(12) I would stick you with push pins for cooling off my waffles before the steam finishes rising from my chicken wings.

_________________________________________________________

(13) I would slap you like a two-bit hoe for signaling the lady with the bad breath to come over and talk to me.  _________________________________________________________

(14) I would violently blame you for Starbucks running out of espresso shots.

_________________________________________________________

(15) I would kick you in the shin with steel-toed boots for convincing the school crossing guard to take her job way too seriously.  Now she’s stopping traffic and giving out tickets like a traffic cop.

_________________________________________________________

(16) I would put freshly chewed gum in your hair for being just as rowdy as those bad ass kids on the metro bus.

_________________________________________________________

(17) I would cannon-ball dive on your forehead for hiding all the coffee in the cafeteria.

_________________________________________________________

(18) I would put you in a headlock for advising my supervisor to call an 8am staff meeting. 

_________________________________________________________

(19) I would ram you in the stomach like a raging bull for drinking all the water from the water cooler just as soon as my mouth feels like I’ve swallowed a bag full of cotton.

_________________________________________________________

(20) I would douse you with llama spit for directing the senior choir to sing off pitch during the entire church service. 

_________________________________________________________

I’m sure, Morning, if I had a little more time to sleep on it without you interrupting me, I could think of 20 more reasons to kick your ass.  But if you aren’t scared by now, then you are a bad mamma jamma!  At any rate, I need to put my head on my desk so I can steal a moment away from Afternoon.  Afternoon is my friend, unlike you. 

Before I go I’ll leave you with this: I better not catch your ass out on the street.  If I do, you’d better run in the opposite direction.  I have no doubt that I would pummel you.  All it takes is a little creativity and  effort.  And I’m smart enough to know that 90% of any effort is getting started! 

So Morning, now that night is creeping upon us, I would strongly advise you to sleep with one eye open. 

Quote of the week:   “I may be drunk now but in the morning I will be sober and you will still be ugly.”

Follow me on Twitter at http://twitter.com/mrhollywood2009

111809

           After the first 3 days I would have said “Awesome.” The last 2 days I was thinking that it wasn’t going well, but after some reflection and seeing what my real stats were I’m back to saying it is going “very well.” The machine stats say that my average night of sleep with the machine on is 7h 45min; I know that only 6.5-7hrs of that is sleep, but the sleep seems to be redemptive sleep so I am not concerned.

                I have heard that for a time you fight “the instinct to survive,” as your mind has learned that sleeping is a brush with death and it refuses to “go gently into that goodnight.” I think that is why it takes an hour or better to get to sleep. I am not dragging into bed ready to pass out any longer; it is more gentile now, like a nudge that tells me I am tired. I reminds me of the Dylan Thomas a poem,  

“Do not go gentle into that good night.
Rage, rage against the dying of the light.”

As if this isn’t the very feeling from deep within me. Set at odds against these words is the promise of the scriptures:

Pr 3:24                   

When thou liest down, thou shalt not be afraid: yea, thou shalt lie down, and thy sleep shall be sweet.

And again,

Jer 31:26             

Upon this I awaked, and beheld; and my sleep was sweet unto me.

                The next day this is what I find, “my sleep was sweet unto me.” How long oho heart will you not remember the lessons of the last night? How long will you choose to remember the nine years before, of the war in the night? Be comforted and take rest oho heart, fear not, for the Lord had removed your terror in the night, he has brought life in the hours that death once reigned and he shall turn back the clock, He shall not hold back the sun as in times past, but he shall return unto you the years that the locusts and cankerworm have eaten, and you shall delight yourself in the abundance of peace.

                At righting this I am in tears. Yesterday, as I read testimonials of successful CPAP treatments it was the same. How did something so simple and quiet sap my strength, throw me into depression and threaten my life.

Surely it is the “little foxes that spoil the vine.” (Song 2:15)

                I want to yell, but will they think I am crazy if I scream, “I’m alive!!!” That is what I feel, but I have no one to share it with. I want to write about it, but who is there to read it? Can I tell this story well? Can I tell this story with all my heart? Should I take an aside to tell this story? Or is this the big story? I am alive…

WTF!

Warning to anyone sleeping with someone with a sleep disorder, keep one eye open at all times. Brian Thomas is on trial charged with the murder of his wife, who he allegedly killed while he was dreaming of “boy racers”. The couple had pulled their camper van into a carpark in Wales when they were harassed by some young men in hotted up cars. After moving to another location Mr Thomas went to sleep  only to wake up and find his wife dead. He told police he had been dreaming about the men and thought they had followed them. The last thing he remembers is putting one in a headlock but when he woke he realized it was his wife Christine. Bummer.

            Nine years ago my newly-wed wife April were just getting comfortable in married life. We had not been spending the night together before we were married, so there were a few surprises. The first observation was I was a bad snorer, but the second would become more important; I would stop breathing at night. I had never heard of sleep apnea before, but my wife, an RN was fully versed in what it was. Breathing sussation is common for people with sleep apnea, but it was news to me.

            We were newly-weds, our family was growing from 3-4 and didn’t have good insurance, so money was tight.  After discussing the options, the testing and treatments we discovered that after insurance our cost would still be over a $1000, plus a monthly charge for equipment. How could I take money from the household just to get a good night’s sleep? This seemed outrageous and absurd! April was insistent that if I needed it, it would happen. We were newlyweds and the thought of introducing such an unsightly piece of equipment into our bedroom was out of the question.

            I learned to sleep on my side, and for the next nine years this worked well for us. I was hopelessly addicted to sleeping in a stone cold room with no covers because I was sweating the bed so frequently. Two years ago I developed Rheumatoid Arthritis and this condition would change everything. I began to have shoulder pain and in order to sleep I was taking pain killers. I started waking up on my back a lot, having snored myself awake and most mornings feeling like someone had scrubbed my throat with something the size of a chimney sweeping brush. With all this you would think I would be begging for change and a good night’s sleep, but ironically it would not be me who would take the first step.

Hard Lessons

                April began having difficulty with sleep apnea; typical daytime sleepiness, bad snoring at night and during the night I would hear her stop breathing (because I was awake). She went to the Dr. Office to make some life changes; one of the things he ordered was a sleep study for her. She went and found that she had sever sleep apnea; with over 50 events per hour. Yet, there was one more thing that was going to push me toward a sleep study of my own.

                The same week my wife’s CPAP arrived, my Rheumatologist who was treating me for RA, put me on yet another new medication in attempt to get control of this disease. I experienced every side effect listed; including the most horrific, insomnia. I went for nearly five days with sleeping only two to three hours a night after only taking the medication for two days. My insides turned to goop; personality changes, moodiness and nervousness are only a few side effects from a very long list. I only took the medication for two days and I could not sleep for five. 

            A week after being off the medication the insomnia had passed, but still was not sleeping well. I just was not able to catch my sleep up. It began to get worse: I was waking up multiple times during the night drenched in sweat worse than it had ever been, my heart pounding out of my chest and feeling as if I had just run a mile and jumped into bed with no memory. I was trying to sleep, but I was being scared to death at what was happening. I wondered if I would wake up the next morning and if I would ever be right again.

               After several weeks of not being able to ketch up on sleep, I made an appointment with my family doctor and requested that he send me to a sleep study; after taking some history he agreed. I went home to do some research of my own on the topic and it soon became obvious to me that I had been dealing with sleep apnea for quite some time. The insomnia was what threw me past the point of no return without intervention and revealed just how poorly I had been sleeping.

I discovered that many of my unexplained health difficulties, which we assumed were part of RA could actually be caused by untreated apnea. I had dealt with unexplained heart arrhythmia, a deadly sign of sleep apnea! I also learned that some studies have found that 50% of people with RA also have sleep apnea; why wasn’t I warned of this by my RD and Family Dr?

            After several weeks I was only marginally better, I wasn’t having the horrible symptoms of sever night sweats, but I was so tired during the day that I was rapidly becoming dysfunctional. Even after getting back to a normal sleep cycle, I was still becoming extremely tired during the day. I was barely living; my emotions were all over the place. In the weeks ahead I fell asleep driving twice and started limiting my driving, I stopped doing homeschool with the kids as I was falling asleep at 10AM and the house was rapidly becoming a disaster. My life was grinding to a halt. I can fully understand why sleep deprivation is a primary method of interrogation, it shatters every aspect of your soul; mind, will and emotions. 

Sleeping Away from Home

            It took 4 weeks for my appointment at the sleep lab to come. I had been warned by April and Tom, my father in law, that a sleep study was actually an anti-sleep study. My experience was not quite what I was expecting; I slept as well, if not better than I had been doing at home. They did a split study night during the test; a procedure that is enacted when it becomes obvious that apnea is present and they go ahead with titration of the CPAP machine. It would still take another week for the “official results” to be given to my family Dr. When they were in, the result was as expected; moderate sleep apnea. (I am going to get re-titrated soon, as no REM was observed and I was only titrated on my side.) If that was only moderate I hate to see severe! Granted, mine was exacerbated by sleep deprivation and from insomnia, but what would happen next I didn’t expect.

Getting Results

            The day that my GP called with the results I called the DME office requesting that they move my appointment to the desperate pile. They made a same day appointment with me, but it still wasn’t fast enough, so I showed up 45 minutes early. I was successful in negotiating for a RemStar M Pro, which was data capable, so I could see if my AHI went up later after I got into REM sleep one I had adjusted.

I started off very well, the first night sleeping nine and a half hours without waking up. The next day I felt as if I was not longer getting worse, but only marginally better. I began to fall asleep in the chair at 3PM, rather than 10AM or on a good day 1PM. The second night I slept seven and a half hours and felt better rested. I didn’t even begin to feel the slightest bit sleepy until 10PM. I had a busy day and I didn’t feel tired? This was strange! I wondered if I was tired enough to go to sleep? Usually I waited until I could barely walk up the staircase to get to bed, but now I still felt like I could go all night, compared to the normal. This third night I slept seven and half hour’s strait again. Considering I hadn’t slept more than six hours a night for years, I was amazed that I could stay in bed that long. This third morning after was radically different and I was forever changed.

            When I woke up I didn’t feel my normal morning stiffness from RA. I noticed I was full of energy, my thoughts were clear and my emotions were under control. I was shocked; I had energy and strength, real changes! I had to make an AM run to the grocery store for coffee creamer and I discovered how radically different this was. I was walking full stride, something I hadn’t been able to do for nearly three years; I was also pain free and I had the biggest and most genuine smile on my face I could remember. When I recognized this I almost wept.  What happened to me? Could this really be the difference the CPAP had made? I felt as if I had been dead before and suddenly been made alive! In my best estimation and this is no exaggeration, I felt as if I had three times the physical strength I had only the day before. In the three days since this happened the entire house had been cleaned, the laundry is caught up and today I was able to shovel the snow from the driveway. I haven’t shoveled snow for three years.

Concluding Exhortation

            If you believe you have sleep apnea, get tested. If you are not sleeping well, if you snore loudly, feel tired during the day after a full night of sleep; get tested. Nine years after first hearing my wife say, “I think you quit breathing during the night,” I finally got treated. God only knows the things I have been unable or unwilling to do during that time that I could have done. The last six weeks before CPAP were the worst days of my life and the days since starting CPAP have been the best.

               Sleep apnea moves in slowly, like a dark cloud in the night, it gains ground while you are sleeping until this invisible killer makes a home in your bedroom. I let it stay thru apathy and fear and I never even realized this was choking the life out of me in the night and figured I would get it treated if it got any worse, but I never noticed it getting any worse until it was VERY BAD. I understand that the remedy of a CPAP machine and mask seem disproportionate to the problem. You are likely asking what I asked nine years ago, “How can I ever live with that?” I warn you, if you take nine years as I did, and survive; you will say, “How did I ever live without this?”

               It is approaching three weeks since starting CPAP; I have not had joint pain from the third day of CPAP until now. On Thanksgiving this year I was able to throw the football with my son, something else I haven’t been able to do in three years. I continue to adjust to the machine, learn new things and grow each day. I am considering approaching my Dr and asking him to back me off of the RA meds to see if I was misdiagnosed. Time will tell, but even if I cannot I still day say this had improved my quality of life considerably! My wife and I are now hose heads together; we help keep each other compliant and help one another thru the hard spots. We have thrown our yellow lab out of our bedroom because she was the last one in the room who still snored.

ManLoosed@Home