Do you fall asleep easily during the day (e.g. watching TV or even driving)? Called hypersomnolence, this is an important marker for sleep apnea. Other signs?
2. high blood pressure
3. being more than 20 pounds overweight
4. having a shirt collar size of 16 ½ inches or higher will
If you have these symptoms, it is worth looking for sleep apnea.
Sleep apnea is a condition in which you repeatedly stop breathing during the night. This contributes to non-refreshing sleep, just as if somebody tried to suffocate you a hundred times a night with your pillow.
There are two main types of apnea:
- Obstructive sleep apnea (OSA). In this condition, the pipe that carries air into the lungs gets blocked intermittently. This is most often associated with being overweight, and snoring. If you have high blood pressure along with CFS/FMS (where most people usually have low blood pressure) it is especially important to consider sleep apnea. OSA is the most common form.
- Central, where the brain trigger that controls breathing stops working intermittently. This is more common in people with a history of traumatic brain injury, those living at high altitudes, or the need for narcotics for pain management. It is not associated with being overweight or snoring
In OSA, the pharynx (throat) repeatedly collapses during sleep. The person with OSA fights to breathe against a blocked airway, resulting in decreased oxygen levels in the blood. Eventually, the sense of suffocation wakes the person, the throat muscles contract, the airway opens, and air rushes in under high pressure. When the airway is opened, the rushing air allows the patient to once again drift back into sleep, but creates a loud gasping sound. People with OSA are generally not aware that this is happening, although their partners often have severely disrupted sleep from the snoring and gasping. This cycle repeats itself many times throughout the night, and this constant waking from deep sleep, as well as the loss of oxygen in the blood, can cause next-day sleepiness, brain fog, poor concentration, and mood changes.
I generally recommend that anyone with CFS/FMS who has high blood pressure and is overweight consider testing for sleep apnea. I do this by having them videotape themselves sleeping (simply by using their cell phone) at night to see if they had repeated periods where they snore and then stop breathing. An hour or two of taping is often enough. If the video suggestive, then they should do a formal sleep study.
Sleep apnea is present in about 17% of the population, and is more common in CFS. It can accentuate pain as well as fatigue, and may also be associated with diabetes (metabolic syndrome).
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The most common treatment for sleep apnea is a sleep mask called CPAP. This gently blows into your nose, keeping your airway from collapsing. Although only about a third of people tolerated the old machines, the newer ones are smaller, gentler, and much better tolerated. They also have monitors that can help adjust the pressure.
Another way to prevent the airway from collapsing is by moving the lower jaw forward. There are dentists who specialize in making a device that does this, and it is usually much better tolerated.
Losing weight, even 10 – 15 pounds, can also be very helpful. The average weight gain in fibromyalgia is 32 pounds, and it is near impossible to lose this weight until the metabolic problems are corrected. Fortunately, using the SHINE protocol makes this much easier.
Although most doctors will recommend avoiding any sleep medications and muscle relaxants in those with sleep apnea, in fibromyalgia the sleep treatments are more important. Because of this, I recommend that people do the sleep study on the medications and supplements that they need to get their eight hours sleep a night, and then adjust the CPAP to compensate for the medications.
Another helpful tip? Avoid sleeping in positions that cause you to snore and have sleep apnea, especially lying on your back. Sleep apnea can often be decreased by taking a tennis ball, putting it into a cloth pocket and then sewing it into the mid-back of your pajama shirt. The tennis ball makes lying on your back uncomfortable, forcing you to roll onto your side or stomach without waking you.
Avoid excessive bedtime alcohol which can aggravate sleep apnea.
Another possibility is surgery to reshape the throat so it stays open during sleep. Removing the tonsils, nasal surgery, and surgically trimming back the soft palate and the uvula (the tiny thing that hangs down in the back of your throat) are the most common treatments performed. Although these surgeries can be very helpful for snoring, they are less likely to help resolve sleep apnea.
It is controversial whether using more aggressive treatments for sleep apnea are worthwhile for people who have fewer than fifteen episodes of apnea per hour. The more conservative approaches (for example, weight loss and avoiding sleeping on your back) are a more reasonable way for those with mild apnea to begin treatment.
Jacob Teitelbaum, M.D is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome.