Sudden Movement or Jerk When Falling Asleep

It was summertime, and I was sitting on a plane headed to Detroit from Orlando. It was an early morning flight, so I was still a little sleepy. I remember it was hot out. The air conditioning coming out of the vents on the plane felt good. With nothing else going on, I decided a little cat nap couldn't hurt. The next thing I know, my arms and legs jumped and I took in a quick breath. Once I looked around and realized nobody was trying to get my attention and that the plane wasn't crashing, I concluded that I dozed off for a moment. When I fell asleep, I had a sudden movement or jerk. I think most of us have experienced this at one time or another.

This is called a hypnic jerk or sleep start. This happens when somebody transitions from wake to sleep and is considered normal. If you don't do it, no worries that's normal too.

Here's a link with some more info:http://www.sleepdisordersguide.com/topics/hypnic-jerk.html

Questions and comments are welcome. Remember, a little research goes a long way when it comes to your health and health care. Reading what people have to offer when it comes to healthy sleep is a good idea. The more you know, the more comfortable you can be with your outcome(s) and treatment(s), especially when it comes to sleep.

Which mask is for me? (Conquering Demons)

In real estate, the saying is, "Location, location, location". When you are trying to find the right CPAP/BiPAP/xPAP mask for yourself, the saying is, "Experimentation, experimentation, experimentation". I had to try four different masks before I found the right one for me.

At first, I thought I knew what I wanted. I know I didn't want a Full Face Mask because I don't like to breathe through my mouth. I didn't want to use Nasal Pillows because I felt peculiar about something sticking into my nostrils. The thought was embarrassing to me for some reason. I was absolutely sure the Nasal Mask/Triangle Mask was for me and there was no need for further thought. Boy, was I wrong!!! It was like choosing my favorite book by only looking at the cover.

I started off with the Nasal/Triangle Mask. It felt good. I knew I had to get used to it and it wasn't going to be perfect the first night. I tried it for a few nights and noticed my nose and face were sore here and there. I began looking at other masks then. I found another Nasal/Triangle that was softer on my pressure points and it was more adjustable. Perfect! I gave that one a try for a few days with better results than the previous! I was sleeping better and better.

So, I found a comfortable Nasal/Triangle and I was able to wear it all night. Now I noticed that I'm not sleeping in the position that I am most comfortable in. I like to be on my side with my face more into the pillow than the Nasal/Triangle would allow. Once again, the search was on to find "the perfect mask". My quest then led me to re-visit my embarrassing demon, Nasal Pillows. The more I looked at the variety of Nasal Pillows, the more "acceptable" it was to me and they would allow me to sleep in the position I wanted.

I gave myself a pep talk which included: "you know what you're doing now", "things have gotten better with every try", "what have you got to lose?". Fast forward to my first night with nasal pillows. Things went well. I slept in the positions that I was more comfortable in. I did have to adjust the mask a few times because I was resting more heavily on the side of my face. But, no problem. It went better than I thought! After a couple of nights, I realized I had a recurring problem. The Nasal Pillows kept on popping out the front of my nose. No matter how I adjusted the headgear and the pillows it kept happening. In my head, the gears began turning once again. My research directed me towards a brand of Nasal Pillows that had a specific adjustment for my problem. I tried a set of "those", aka Swift FX, and obtained the balance I was looking for!

The morals of this story are: finding the right mask for you is an evolution, keep an open mind, and do your research for it will pay off. Have a look around the internet at all the suppliers and online stores for masks and gear. They advertise all over the place!

Have a look at my other blog. I'm reviewing and reporting on different masks from different companies. I'm trying to add at least 2 a week. If you don't see one that interests you, be sure to check back. You can find it at:http://www.cpapmaskreview.blogspot.com/

As always, questions and comments are welcome!

Deviated Septums and Sleep Apnea

I've performed literally thousands of sleep studies including titration studies. A recognizable portion of those diagnosed with Obstructive Sleep Apnea (OSA) also had a deviated septum. What is a deviated septum?

The septum is the divider inside your nose (between your nostrils roughly). When your septum is deviated, that means it is not in the normal position. This can be caused from trauma or could be a developmental abnormality. Take a look at the image below. Notice the septum (center of the nose) is not straight up and down directly in the middle of the nose. This constitutes a deviated septum. Does a deviated septum cause sleep apnea? I can't say for sure. But, I can offer some logic.

Looking at the term "Obstructive Sleep Apnea", the term obstruction stands out. Dictionary.com defines obstruction as "something that obstructs, blocks, or closes up with an obstacle or obstacles; obstacle or hindrance." Looking at the image, you can see how the deviation or bend in septum can hinder airflow. If the airflow is limited here, any other obstruction in the airway could reduce airflow that much further. Intuitively, it seems a deviated septum may make one more susceptible to OSA.

When is comes to xPAP treatment, OSA, and a deviated septum, it is no problem. XPAP works well when it comes to this. It is the perfect device to make sure enough air goes through the airway, no matter how small. I've seen many successful titrations on patients with deviated septums.

Your questions and comments are always welcome. Remember, education is the best way to make your treatment more successful. Have a surf around the Internet!

Expiratory Pressure Relief (EPR)

EPR is a way to make xPAP more tolerable by relieving pressure. Many xPAP users complain about the difficulty of exhaling. EPR works similarly to C-Flex, which is mentioned in a previous topic. Once the xPAP machine senses the patient exhaling, it turns the pressure down for an instant in order for the patient to exhale more easily. Once the person has the exhale started, the machine will go back to the original CPAP setting or EPAP setting depending on what kind of machine you have. The best word I can come up with for how it actually feels, is that it is softer or more smooth. You will have to try it to find out for yourself!

There are many companies that sell xPAP machines with the EPR feature. The manufacturer is Resmed. But, Resmed products can be purchased from many places online. There may be some listed on this page. Have a look around!

Here's a link to Resmed's page on EPR:

http://www.resmed.com/au/patients_and_families/improving_therapy/expiratory-pressure-relief.html?nc=patients

Central Apneas...normal?

The short answer is, yes! Let me provide an explanation, without going too far into detail.

When somebody falls asleep, they typically have what we call a "transitional event". That is a respiratory event which happens when somebody transitions from wake to sleep. This transitional event is usually a central apnea. Transitional events can even happen when somebody transitions from one sleep stage to another sleep stage.

People with untreated obstructive sleep apnea tend to have a high central apnea count. This is because they are transitioning from wake to sleep much more often than a normal person. This is because of the obstructive apneas and hypopneas fragmenting their sleep. So, with all the obstructive apneas, hypopneas, waking up and falling asleep, there will be more central apneas than usual. Once a person receives xPAP treatment, the central apneas usually subside to more acceptable levels. However, there are some instances when central apneas persist.

From observations in the sleep center concerning xPAP titrations and central apneas, I've found central apneas can be related to mask discomfort and leakage. Sometimes a person can't tolerate a certain mask the entire night. This can be from a few reasons ranging from a poor fit to the mask irritating his/her skin. Also, mask leaks can disturb a patients sleep. In general, being uncomfortable with the xPAP mask can fragment your sleep. This sleep fragmentation will result in transitional central apneas as the person transitions from wake to sleep during those troublesome times. Even though this discussion is about "normal" central apneas, there are times when it is not.

Make no mistake, central apneas can be serious too. Central apneas can be attributed to Congestive Heart Failure, COPD, and the list goes on.

As always, your comments and questions are always welcome. When you are in the market for anything from sleep studies to xPAP equipment, it pays to do research. The internet is a great place to start! Have a look around.

Alcohol As A Sleep Aid Q&A

Another good question from a reader which reads:

I feel as if I can't goto sleep unless I have a few drinks. My mind start to race and think to much. I dont really have the snoring issues, but would really like to know is there another way of relaxing my brain without having to drink a six pack before I can goto bed?

My response:

The Sleep Doctors I worked with in the past would recommend to some people to have a glass of wine or two in order to help get to sleep. Personally, I think this is a better way to get to sleep than taking any kind of pills. Let me add a caviot here: DON'T MIX SLEEPING PILLS(or any pills for that matter) AND ALCOHOL!!!

Considering today's fast paced, high stress, and generally busy way of life, it is understandable that people get stressed and have difficulty getting into a sleepy state of mind. To a certain extent, it's okay to have some alcohol to help unwind and let go a long day's toil.

This is a difficult subject to comment on in general. Only you know how alcohol effects you and if you should be drinking at all. Before you go open the wine bottle, have a look at the topic entitled, "Alcohol and Sleep Apnea".

As far as finding another way to relax your brain before you sleep, well that's a tough one. Some people read, some people watch TV, and some even sit quietly outside and look at the stars. Only you can find what makes you relax. Some experimentation may be in order.

As always, your comments and questions are welcome. As you can see the questions can be diverse around here.

C-Flex and Bi-Flex

C-Flex and Bi-Flex are pressure relief technologies. The pressure relief feature helps the user transition from inhale to exhale with less effort. This feature came about because a common complaint amongst xPAP users is it is difficult to exhale when you are using xPAP. Respironics developed the Flex technologies in order to make patients feel more comfortable when using PAP therapy and to increase compliance or PAP usage.

C-Flex was developed for CPAP machines. When a user is breathing on a CPAP machine with C-Flex, the machine will sense when the user exhales and adjust the pressure. The machine will drop the PAP pressure for an instant in order for the patient to start the exhalation process with more ease. "Softer" is a common description of how it feels.

Bi-Flex is similar to C-Flex but designed for BiPAP. When the Bi-Flex feature is initiated on a BiPAP machine, the machine senses the inhalation and exhalation process. Just like C-Flex, the machine will drop the pressure for an instant when an exhale is sensed or EPAP. When the inhale is detected, the machine will switch to the predetermined IPAP, but will start with a drop in the IPAP pressure for a quick instant so the user can start the inhale breath more "softly".

A-Flex is designed for APAP machines and works very similarly to C-Flex.

For more information on the Flex technologies, a surf around the web will probably reveal much more than what I mentioned here. Happy reading!

As always, questions and comments are welcomed.

What is APAP?

Another good question posed from a reader. If you haven't read "What's the difference between CPAP and BiPAP?", you may want to do that before continuing with this topic. Now, off to the topic at hand.

APAP stands for Auto Positive Airway Pressure. By the term "Auto", the manufacturer means self adjusting, self titrating, auto adjusting, etc. Modern APAP machines can be programmed to auto adjust in a pre-determined range. For example if it is found that the optimal range for a certain patient is 8 to 12, then the machine's output pressures will range from 8 to 12. This brings us to why it has a range and when will it "auto adjust".

We will continue with the patient example just mentioned. When the patient whose ideal PAP range is 8 to 12, turns on his/her machine at home, it will start at CPAP 8 (I'll get to BiPAP and APAP in a moment). As the person sleeps, if the APAP machine senses snoring or breathing events like apneas or hypopneas, the APAP machine will increase the pressure by 1. For our example, the APAP machine will increase to CPAP 9. If snoring, hypopneas, or apneas are continuing, then the machine will increase the pressure up to CPAP 10 and so on, up to the upper limit. The upper limit in our case is 12. The APAP machine will usually allow a few minutes to elapse before making each change. It takes a little time to see if the new pressure is effective. Now, suppose our example patient was auto adjusted to CPAP 12 and is now breathing freely for some time without snoring, hypopneas, or apneas.At this point, the APAP machine will decrease the pressure by 1. The new pressure is now CPAP 11. If the patient continues to breathe without snoring, apneas, or hypopneas, then the APAP machine will decrease the pressure by 1 again, bringing it down to CPAP 10. This process may continue, depending on the patients perfomance down to the minumum of CPAP 8.

Auto BiPAP machines are very similar. They have pre-set ranges for IPAP and EPAP typically with a spread of 3 or 4. As an example, say a patient's ideal BiPAP range is 10/6 (IPAP=10 EPAP=6) to 13/9 (IPAP=13 EPAP=9). When turned on, the machine will start at 10/6 and, if necessary, increase from there to 11/7. If warranted again, increase to 12/8. If snoring and breathing events continue, the maximum will be reached at 13/9. Just like the APAP machine, the AutoBiPAP will decrease pressure as needed.

There is much more to APAP and AutoBiPAP machines and their software. These were only very simple examples to illustrate the basics of what they do.

Keep the questions and comments coming!

What's the difference between CPAP and BiPAP?

A fellow PAP user asked me this the other day. The terms CPAP and BiPAP are used frequently in the sleep apnea world but rarely defined. I'll first define CPAP and then go into BiPAP.

CPAP stands for Continuous Positive Airway Pressure. That is, the machine pumps out the same pressure constantly. The user inhales at a predetermined air pressure and then exhales at the same pressure. This leads us to BiPAP.

BiPAP is almost the same as CPAP but with one difference. The user inhales at a certain predetermined pressure and when the user exhales, the BiPAP machine senses this and lowers the pressure to a predetermined pressure. Hence the "Bi" in BiPAP stands for bi-level or two pressures. The inhale pressure is termed IPAP ("I" is for inspiratory). The exhale pressure is termed EPAP ("E" is for expiratory). The spread or difference between IPAP and EPAP is usually 3 or 4 (cmH2O). I say "usually" because there are special circumstances when the spread is larger.

xPAP is another term used frequently on internet forums. xPAP refers to CPAP or BiPAP. It is just a simple and quick way to refer to CPAP or BiPAP when the distinction is not important for the idea at hand.

Some of the newer xPAP's out there include ASV, AVAPS, etc. These are more sophisticated CPAP's and BiPAP's, usually the latter.

Sleep Walking and Sleep Apnea Q&A

The following is a question sent to me. I actually hear this one frequently in the sleep lab.

Have you ever dealt with someone with sleepwalking caused by apnea? During my initial consultation, the doc said that the sleepwalking could be caused by "micro-arousals" which were triggered by the apnea, and subsequently scheduled my sleep test for next week. My reason for going to the sleep doc was constant fatigue, headaches, mental fog, and I'm just generally irritable. Is this doc just trying to blow sunshine, or is the "micro-arousals" line true? Also, am I going to wreck the equipment if I get up and start moving around during the test? Thanks for your help

My response:

Good questions. In my experience as a sleep tech, I've performed many studies on people with your same complaints. People with sleep apnea tend to be active in bed from rolling around often to arms and legs flailing like they are fighting. Some people that move like the latter say they sleep walk too. What the doctor says is true. Your sleep is so disturbed and you are so sleepy or half asleep at these times, you may not realize what you are doing. You sound like an excellent candidate for a sleep study. I think they will be able to help you out dramatically. I've seen the before and after of similar people myself. As far as the actual sleep study, you will be fine. It is normal for a wire or two to come off during the study on someone active. The tech probably has performed a sleep study on someone like yourself before. Good luck on your sleep study! Let me know how it goes.

Thank you for reading and keep your questions and comments coming!

Alcohol and Sleep Apnea

Has anyone noticed that you snore more when sleeping after a night with a couple of drinks? Well it's probably true! Alcohol makes your airway swell which may in turn cause you to snore. If you snore already, it may worsen your snore. If you have sleep apnea, it may worsen that too.

If you are currently using xPAP, be sure to use it after a night on the town. It is understandable why somebody would not want to after a fun night out. But this is a very important time to use it or else you may be in for a rough night!

A little research goes a long way when you are in the market for a mask or machine.