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Respiratory Disorders (Expert Forum)
Horrible Sleep Disorder/Nocturnal Asthma: Please Help.
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Horrible Sleep Disorder/Nocturnal Asthma: Please Help.
by Royler, Aug 07, 2004 12:00AM
I am a 26 year old male of average height and weight. (5'8" and 160 lbs.) My medical history was unexceptional until 1997, when I contracted mononucleosis. When my energy levels and appetite returned, I began to notice that my body was reacting in odd ways to allergens that I had previously not had a problem with. If I was around a dog - even if I just saw one and then went home - I found my sleep to be completely unrestorative. I would move my legs and wake up feeling as though I had not slept at all. The fatigue was noticeable in my appearance and behavior.
In 2002, I finally saw a sleep physican and was scheduled for a sleep study. After recording apeaneic events in the first half of the night, I was titrated on CPAP to 3cm. This began an arduous and contentious relationship with the specialist, as I complained that CPAP was not helping at all. I went on to try 4cm, 5cm, 8cm, an AutoPAP, and three more studies, all of which showed mild apnea and "unexplained arousals."
My "amateur" hypothesis is this: the mono triggered some sort of immune system dysfunction that has my body reacting harshly to trace amounts of allergens in the air. This manifests itself as some kind of nocturnal asthma in the evening, and CPAP is ill-equipped to help because the apnea is caused by an allergic reaction and not muscle relaxation. Has anyone ever heard of allergy-induced apnea? I get no deep sleep at all. Benadryl helped for a short time, but no longer. Prednisone helped only briefly. I have tried several inhalers to no benefit. Please advise if possible. Thank you.
In 2002, I finally saw a sleep physican and was scheduled for a sleep study. After recording apeaneic events in the first half of the night, I was titrated on CPAP to 3cm. This began an arduous and contentious relationship with the specialist, as I complained that CPAP was not helping at all. I went on to try 4cm, 5cm, 8cm, an AutoPAP, and three more studies, all of which showed mild apnea and "unexplained arousals."
My "amateur" hypothesis is this: the mono triggered some sort of immune system dysfunction that has my body reacting harshly to trace amounts of allergens in the air. This manifests itself as some kind of nocturnal asthma in the evening, and CPAP is ill-equipped to help because the apnea is caused by an allergic reaction and not muscle relaxation. Has anyone ever heard of allergy-induced apnea? I get no deep sleep at all. Benadryl helped for a short time, but no longer. Prednisone helped only briefly. I have tried several inhalers to no benefit. Please advise if possible. Thank you.
Doctor's Answer
by National Jewish, Aug 12, 2004 12:00AM
, Aug 12, 2004 12:00AM
Herrhausen
First off, a CPAP setting of 3cmH2O is a joke. ITs not nearly enough pressure to maintain a patent airway if you have documented OSA. I'm glad to see you escalated your CPAP settings, but sorry to see they didn't work. Even 8cmH20 isn't all that theraputic. I have patients on as much as 15cmH20 of CPAP. Even higher!
I would recommend you getting ANOTHER sleep study in another facility. I feel that you need a higher setting. Another thing that needs to be addressed is if your sleep apnea is not obstructive but Central based. If it is central based...the nSPAP isnt going to do a thing for you.
Andy, RRT, CPFT
Thank you for commenting.
I did not find out until later that 3cm of CPAP was barely even enough to expel Co2 (?) from the mask, and that no machine even GOES down to 3cm! Needless to say, my faith in this practicioner went down quite a bit after that.
I have had a total of four studies, with the last indicating that 8cm of pressure resolved my few apneic events while leaving the "spontaneous" arousals untouched. I attribute these to UARS and do not know how to address them. No central apnea was indicated during the studies. If the apnea is caused by allergic swelling, CPAP is useless, correct? Can any test discern between a breathing cessation due to muscle relaxation and one due to allergic inflammation?
My own experience is that allergies [rhinitis] and asthma can sometimes produce an apnea like condition. I had the symptoms of sleep apnea, as verified by people who slept in the same room;
ie gasping etc. My GP referred me to an ENT who had me fill out a questionaire including numerous questions on snoring. I don't snore!. He ran a scope up my nose, mentioned there was a lot of mucus there, and prescribed a steroid nasal spray, to control the rhinitis and post nasal drip. [my nose tends to clog up at night from tree pollen and cold air, thus contributing to breathing problems]
I also have asthma, treated with long acting bronchodilators and steroid nasal spray. Asthma is worse at night, and contributes to another breathing problem.
And suspected GE reflux, which can get into the lungs, worsening the asthma--also postnasal drip can do that. I now sleep on a MedSlant foam cushion, which elevates the upper part of my body 6", to minimize GERD at night.
So you might benefit from making sure your asthma, rhinitis, and any GE reflux is under good control; before putting all your eggs in the sleep apnea diagnosis. Also might be worth a 2nd opinion from a major teaching hospital.
The Restless Leg Syndrome is something else that may bear investigation. http://www.rls.org/
I'm assuming you are using a nsal CPAP unit. Are you a mouth breather? Don't forget, if your mouth is ope when you sleep...the CPAP is completely useless. There are special chin-straps available to help keep your mouth closed while sleeping. Also, there are full-face masks available. I am not particularly fond of using these in the home setting however. Especially if you have a history of GERD. Reflux can actually be aspirated into the lung while you sleep, and that would be bad....
Try elevating the back of your head a bit. Try and tuck your chin twards your chest just a tad to keep your mouth