Sleep apnea can cause serious brain injury

[roster]

He has started a regimen of Vitamin B-1, used by physicians to treat memory loss in alcoholics. Harper said he and his team are exploring whether B-1 can help restore memory of sleep-apnea patients.

That was in the lead-off post about brain damage from apnea. Is B-1 treatment usually oral or injectable?

[lifeartist]

Hi Slinky and other who replied to my post.
Thanks for helping me, I would be lost without this board.
First off, I should remention that I did not have any sleep problems when I was told to get tested. I did so on the advise of a family doctor who I told I was trying to lose weight. That is what prompted the testing. As for the sleep doctor, I have never met him or her, the report was sent to my family doctor to do the ordering of the machine etc. I have given some thought to going to a better testing center, probably in a bigger city. But time, distance, insurance and cost to me will put that on the back burner till I am due for another test. I think that is why I feel so frustrated, I was sleeping fine before and now find my sleep very broken up by readjusting the hose and mask when I turn over or move. I also still experience a sort of claustrophobia when I put the mask on some nights. And to make matters worse, I have gained back 5 pounds of the 30 I lost before the whole thing was started. I know I snored, but it did not disrupt my sleep so this is why I am still trying to adjust to the machine, I feel I have apnea. I am not sure how much or what it was doing to me, but I feel a lot worse now than before. Has anyone else taken this long to adjust? It seems like I make a little progress and then go backward.
Thanks again for the help, I reallllllly appreciate it!

[roster]

...... Has anyone else taken this long to adjust? ....

Just stating my opinion based on my experience, my reading and my talking to other patients: More than half of the time the sleep labs don't titrate the optimal pressure. You need a data capable machine and software to do it right over some weeks at home. One will not sleep well and feel better until the pressure is right.

[mellabella]

...... Has anyone else taken this long to adjust? ....

Just stating my opinion based on my experience, my reading and my talking to other patients: More than half of the time the sleep labs don't titrate the optimal pressure. You need a data capable machine and software to do it right over some weeks at home. One will not sleep well and feel better until the pressure is right.

I can second this--I wasted 2 years at a pressure that was too low, and with a doctor that refused to retitrate...even though it was covered by my insurance.

I started at 7....and it turned out (after a new sleep doc "humored" me and ordered a second titration) I needed to be at 13. It's still not a total solution at all because of some other health problems and probably the nature of my diagnosis (UARS--and I also don't have a data-capable machine at this point to totally know what goes on night to night), but let me tell you, I can finally feel SOME difference, and that's been enough to give me back a little bit of my life, and to keep me strapping on all that equipment every night.

Also, can I just say I love it when people make the typo, "sleep depravation" (instead of "deprivation")? Because I don't know about you guys but I have definitely experienced being "sleep depraved."

[lifeartist]

I can understand what Rooster and other have replied about getting a good titration by using a readable machine for a week. I have apap, and the numbers that I do see are well lower than what was originally perscribed. I am glad I fought for an apap because of this alone, but it still does not explain why I am sleep much worse since it auto adjusts to what pressure I need. I generally run at about 7, well below the 11 that the study suggested I should use on a cpap. The only time I get that high is when I lay on my back, and I seldom sleep on my back, only when I wake up and lay there decided what to do ( get up or try to go back to sleep). From all the hassles I have had with the sleep study etc, I generally wonder about my treatment and its effectiveness. I hope to get a better study the next time insurance allows. Our insurance has been dropping coverage for many things, and now we are only allowed 5 office visits a year per family, then it is completely out of pocket. I ( if I have NO illnesses) have to see a doctor 5 times a year myself so my husband's yearly is already out of pocket. We have co-pays for the 5 but used to have those for any visit. Guess it is just the way of health care these days, but I choose my checkups wisely and feel as a cancer survivor, the mammo that checkup is more important than pushing for more help with the sleep apnea right now. Thanks everyone, once again this board is the best advise anywhere

[Guest]

Life Artist - some thoughts come to mind:

Have you tried another mask? I had to try EIGHT before I found one that worked for me, and allowed me to sleep all night. That period of time took me six weeks, with only two being provided to me by the DME. Everything else was out of pocket - but all were found on this forum. My life was HELL until I found the last mask.

Have you tried PurSleep aromatherapy oils? They really DO help combat the "claustrophobia" feeling and help you learn to love your mask. http://www.pur-sleep.com.

I would suffocate if I was set so low as 7. Some people on this board (and I guess I'm among them) feel that a setting below 10 is just not a good idea. You get better air without a mask at such a low setting. Have you tried running straight CPAP at 10 or 11?

I find that APAP and I don't get along. I can't sleep with it. It keeps me up and fighting it all night long. I sleep MUCH BETTER with straight CPAP, 10 cm, CFlex at 3. YOUR MILEAGE WILL VARY!

But, if you're this uncomfortable on the AUTO setting, maybe you should TRY the straight CPAP? Or narrow your range more?

Just some thoughts.

Good luck!!!!
Babs

[roster]

I can understand what Rooster and other have replied about getting a good titration by using a readable machine for a week. I have apap, and the numbers that I do see are well lower than what was originally perscribed. I am glad I fought for an apap because of this alone, but it still does not explain why I am sleep much worse since it auto adjusts to what pressure I need. I generally run at about 7, well below the 11 that the study suggested I should use on a cpap. The only time I get that high is when I lay on my back, and I seldom sleep on my back, only when I wake up and lay there decided what to do ( get up or try to go back to sleep). ......

LifeArtist,

What pressure range are you using?

Note that many of us have found a single pressure (cpap) to give us better therapy that apap. You might want to try titrating at home to a single pressure and see how you feel.

Also watch out for position sensitive apnea. I require a pressure of 19 on my back but only 8.5 on either side. So I rig myself at night to force side sleeping and use the lower pressure.

Good luck.

[dsm]

I can understand what Rooster and other have replied about getting a good titration by using a readable machine for a week. I have apap, and the numbers that I do see are well lower than what was originally perscribed. I am glad I fought for an apap because of this alone, but it still does not explain why I am sleep much worse since it auto adjusts to what pressure I need. I generally run at about 7, well below the 11 that the study suggested I should use on a cpap. The only time I get that high is when I lay on my back, and I seldom sleep on my back, only when I wake up and lay there decided what to do ( get up or try to go back to sleep). ......

LifeArtist,

What pressure range are you using?

Note that many of us have found a single pressure (cpap) to give us better therapy that apap. You might want to try titrating at home to a single pressure and see how you feel.

Also watch out for position sensitive apnea. I require a pressure of 19 on my back but only 8.5 on either side. So I rig myself at night to force side sleeping and use the lower pressure.

Good luck.

[Guest]

Hi Rooster & All,

On the Vitamin B-complex....to help on CVD, I consume the Vegemine and Promite on my daily multi-grain breads (don not eat white breads is not good for health). Nicin etc on vitamin B is good for blood threrapy. Hope it help.

Mckooi

[ozij]

I just want to add my voice to the pressure range issue. The pressure changes while the machine is doing its automatic adaptation may actually be waking you up - its worth trying a constant pressure at what your machine states pressure recommended 95% of the time

An alternative woud be a very narrow range about that pressue - e.g 1 below and 1 above.

I have to disagrees with Babbette's "one pressure suits all" statement. While it is true that the majority needs pressure around 10, some need less, and some need more. Just like with masks, you need to find the right pressure for you - the majority is irrelevant.

You also have to be aware that some people do not respond well to one company's automatic adjustment rules (altgorithm) and do very well with another company's.

O.

[roster]

[

_________________


DSM,

I am six feet tall and weigh 170 - slim by almost everyone's standards. The ENT says my tongue is only slightly thick at the base so I assume my airway is narrow.

This forum is wonderful and I have few complaints about it. One that I do have is that the effect of sleep position on apnea and pressure requirements doesn't get much coverage here. Maybe the solution to get more coverage is as simple as having a good term to describe the condition.

I would support a campaign to get "position sensitive apnea" entrenched on this forum (and elsewhere). If anyone has a better term, please come forward.

BTW, brain damage caused me to forget many rules of English, but should it be "position-sensitive apnea"? I seem to remember some rule about needing a hyphen when you use a noun to modify another noun.

I have started another thread to pursue this topic: viewtopic/t32057/Position-Sensitive-Apnea.html

[MrRandom]

I'm also bipolar, which has been shown to cause brain damage in the areas of memory, particularly short-term memory.

Whomever told you this is feeding you lies. Bipolar has not even been shown to exist as a biological disease in its own right let alone one that causes brain damage. Sleep deprivation shows the same symptoms of bipolar disorder, and is a more likely causation.

[roster]

Source: http://www.journalsleep.org/ViewAbstrac ... ionid=3610

Brain Structural Changes in Obstructive Sleep Apnea

Volume : 31
Issue : 07
Pages : 967-977

Paul M. Macey, PhD1,2; Rajesh Kumar, PhD3; Mary A. Woo, DNSc2; Edwin M. Valladares, BS3; Frisca L. Yan-Go, MD4; Ronald M. Harper, PhD1,3

1Brain Research Institute, 2UCLA School of Nursing, Departments of 3Neurobiology and 4Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA


Study Objectives:

Determine whether obstructive sleep apnea (OSA) subjects show indications of axonal injury.

Design:

We assessed fiber integrity in OSA and control subjects with diffusion tensor imaging (DTI). We acquired four whole-brain DTI series from each subject. The four series were realigned, and the diffusion tensor calculated at each voxel. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA “map.” The FA maps were spatially normalized, smoothed, and compared using voxel-based statistics to determine differences between OSA and control groups, with age as a covariate (P < 0.05, corrected for multiple comparisons).

Setting:

University medical center.

Subjects:

We studied 41 patients with untreated OSA (mean age ± SD: 46.3 ± 8.9 years; female/male: 7/34) with apnea-hypopnea index 15 to 101 (mean ± SD: 35.7 ± 18.1 events/hour), and 69 control subjects (mean age ± SD: 47.5 ± 8.79 years; female/male: 25/44).

Measurements and Results:

Multiple regions of lower FA appeared within white matter in the OSA group, and included fibers of the anterior corpus callosum, anterior and posterior cingulate cortex and cingulum bundle, right column of the fornix, portions of the frontal, ventral prefrontal, parietal and insular cortices, bilateral internal capsule, left cerebral peduncle, middle cerebellar peduncle and corticospinal tract, and deep cerebellar nuclei.

Conclusions:

White matter is extensively affected in OSA patients; the alterations include axons linking major structures within the limbic system, pons, frontal, temporal and parietal cortices, and projections to and from the cerebellum.

[DreamStalker]

Source: http://www.journalsleep.org/ViewAbstrac ... ionid=3610

Brain Structural Changes in Obstructive Sleep Apnea

Volume : 31
Issue : 07
Pages : 967-977

Paul M. Macey, PhD1,2; Rajesh Kumar, PhD3; Mary A. Woo, DNSc2; Edwin M. Valladares, BS3; Frisca L. Yan-Go, MD4; Ronald M. Harper, PhD1,3

Conclusions:

White matter is extensively affected in OSA patients; the alterations include axons linking major structures within the limbic system, pons, frontal, temporal and parietal cortices, and projections to and from the cerebellum.

Does that mean I'm a nitwit?

[echo]

5. It has been noted that very minor injuries in some people cause massive loss of function however extreme trauma in others can be almost undetectable from a functional point of view. One case I read, unconfirmed perhaps since it was on the net and I am working from my memory - touted a 40% or so loss in mass from a vehicle injury or similar and supposedly showed no signs of functional loss or very little. I found this hard to believe personally. I take it though that there are many unknowns.

6. It is generally accepted that brains do not repair themselves and that brain damage is permanent, but I thought this perception was changing. There is certainly always hope.

It is now known that the brain can compensate for injury by re-routing the connections and recruiting new areas to do the function of the lost areas - this is termed "brain plasticity." And it does occur in adults. Brain plasticity is why people with stroke can eventually recover some function. This is not the same as the brain repairing the brain damage - neurons that are damaged may eventually die, and they will not "grow back". Sometimes damaged neurons are able to recover e.g. in stroke, but that is still an area of open investigation.

The reason that some people can have extreme brain trauma and not lose functionality is twofold, one relating to gray matter, and the other relating to white matter. (1) there are dedicated brain areas that control specific functions, and if they are not injured, you won't see any functional deficits; so if the motor areas aren't harmed, you won't see post-stroke paralysis. Same for language, vision, etc. There are also areas of higher function which integrate the motor/language/vision funcitons, but again these are in specific areas of the brain. These are all gray matter areas. (2) some people's brains are able to better redistribute funcitonality than others', but it's not really known which brains are better at this than others. Connections are made through the white matter tissue.

The OSA-memory loss area also interests me (both personally and professionally). It would be interesting to see the results of CPAP-follow-up studies to see how the structural changes evolved in long-term "compliant" patients ... if there isn't one already i would hope there would be research on it in the near future. In Alzheimer's, they are not able to reverse the memory loss but that is because the drugs do not address the root cause of the disease (thought to be accumulation of tau proteins; current drugs target beta-amyloid accumulation). So in that sense you can't compare the disease processes of Alzheimer's and OSA-memory loss directly. That is, that the memory loss might be reversible in OSA.... (I hope so, cause I've got it too!).

Note that the study cited by rooster shows damage (by tracking the white matter fibers), but they don't talk about the disease process itself (limbic system = memory formation). Same goes for the study on the mamillary bodies - those are gray matter regions, but we don't really know why they are affected. (and also, what is cause and what is effect?!)

I'd like to see the same analysis on long-term CPAP compliant users.

Thanks for the info!