Sleep/Neurological Physical Therapist?

Sleep/Neurological Physical Therapist...

Is there such a thing? Even with much lower AHI's, I still find myself tossing and turning after the initial four hours of sleep, trying to find a comfortable position. Sleep is always tentative after that. Sometimes I just get up and read. Sleep centers seem to focus more on respiratory processes, AHI and O2 levels than comfort, and I'm certainly not going to get that kind of information from a DME. For a typical PSG, the eeg data seems only to be a baseline for their breathing data and diagnosing narcolepsy. After that, they don't seem to care about it. All I get from the sleep doc is that the unusual circumstances of sleep labs often creates an environment where they don't see any recuperative stages in the eeg data. Is that the real cause? Who's followed up on that? Is there any eeg data on sleep apneacs living in their normal environment and recuperative sleep stages? I'm beginning to doubt it. I wonder if having sleep apnea since childhood causes a certain amount of hard-wiring in the brain that makes the body constantly wake up or sleep lightly as a survival mechanism. If so, I wonder if there is a way to retrain the brain to sleep normally after so many years. How many SID cases are really ill-resolved infant sleep apnea? The whole domain seems entirely under-studied. Am I wrong?

The whole idea behind the xPAP machine is to get the body back into a semblance of normal sleep regime. That should include a certain amount of time in true recuperative stages, right? If I could buy a "home eeg monitoring kit" that would record my sleep states, I would consider it.

Are there sleep physical therapists out there who correlate brain waves and body position? Will my insurance cover that? Questions questions...

Well, the unfortunate thing is that our (as human beings) understanding of the human brain is really quite limited. So our understanding (and treatment) of those sleep disorders that are believed to originate somewhere in the brain is limited to what we know, which is not much. I do agree that it is vastly understudied and underdetected/underdiagnosed. It seems many doctors are very quick to go right for the psychiatric diagnosis' and throwing pills at people (including kids) rather than investigating sleep problems. And BTW I have the same problem. It doesn't matter how well I'm doing with the CPAP, I wake up frequently during the night on most nights.

Regarding SIDS, I read a study a month or so ago that stated it is now estimated that apnea could be the cause of more than 50% of SIDS cases. I'm pretty sure, knowing what I know now, that my youngest son had apnea as an infant, he used to wake up from his naps very cyanotic, his arms and legs especially were mottled blue when waking up. Our pediatrician at the time (1978) said he believed it was caused by the baby "forgetting to breathe" while he was sleeping, he had seen it in other infants, and that as a result, he was high risk for SIDS. He told me to keep his crib in our bedroom, since it appeared that the noises we would make during sleep, moving around, snoring, etc...would "jar" the baby awake and he would breathe again. It was about a year after that that they came out with SIDS monitors, that strapped to the baby and sounded an alarm if the baby stopped breathing.....it was used on infants deemed to be high risk.

Sounds alot like apnea to me....

At the sleep center where I was tested, they also hosted an "Insomnia Clinic", which was a 6 week workshop teaching a mixture of cognitive behavioral therapy (CBT) techniques and sleep hygiene. This is the closest I've heard to a "sleep physical therapist" for unlearning bad habits; you might try asking your doctor/clinic if they run something similar (it's billable to insurance).

DreamDiver wrote: ......... Even with much lower AHI's, I still find myself tossing and turning after the initial four hours of sleep, trying to find a comfortable position. Sleep is always tentative after that. .........

DD,

I have the same problem. It is called "premature awakening". I get three to five hours (average four hours) of good sleep and then the going gets tough.

In the last two months there has been some improvement for me. Cold weather helps with my sleeping. Also, I have changed some things. My exercise program has been stepped up to a level I never thought was achievable again in this life.

Also, when I have that premature awakening, I take 2 x 500 mg acetaminophen which I keep in a little dosed container on the nightstand (don't want to have to fumble around or think too much and get even more wide awake). The acetaminophen seems to allow another two to three hours of sleep.

Before I tried the acetaminophen, I tried 3 mg melatonin at my premature awakening. This also allowed two to three hours of additional sleep. This may have helped to break a bad cycle of not being able to go back to sleep. Eventually I switched off the melatonin to the acetaminophen because the melatonin leaves a somewhat groggy effect for a good part of the next day.

Best regards,

Have you looked into getting a new bed? Seriously, you might be used to an old one, but it may not be doing you much good, and could be contributing to your problem. There's no such thing as a neuro. physio of course, though there are exercises used (like biofeedback) for certain conditions unrelated to OSA.

DreamDiver, "Behavioral Sleep Medicine" is receiving much attention as an independent specialty.

AASM lists certified BSM practitioners here: http://www.aasmnet.org/BSMSpecialists.aspx

I think this is along the lines of what you're trying to find?

Wow, thanks for all the responses.

@nobody, @Debjax,
The SIDS thing seems like a common thread, then. Thanks for confirming in my mind that it might be worth further study.

@mellabella,
The insomnia clinic might be worth looking into. I've read some of the literature on sleep hygiene, and it all seems sensible, but a couple things I have noticed. I seem to sleep better when there is something going on in the background. It's like the guy who wakes up because he didn't hear the 4:00am train rumble by his house on time, you know? While some of what they say is sensible, I wonder how much of it is retraining habits, and how much of it is about how your brain is wired. Maybe some people need a little noise. Along the lines of the SIDS thing, the times I've usually woken up gasping as a child was when there was complete and utter silence in the room where I feel asleep.

@rooster
The fact that there is a label for it - premature awakening - seems to indicate someone is studying that, at least. I too have been using acetominophen and melatonin with nearly identical results. 2 x 500 acetominophen for the inevitable morning headache, and a couple crumbs from a broken 3mg tablet of melatonin - less than a third of a tablet. Like you, I might take an extra crumb of melatonin after the first four hours with a couple extra hours of sleep as the result. But like you, when I wake in the morning, I'm groggy for the rest of the day. It's a forced sleep that doesn't seem to give real replenishment. So if I have to get up early, I don't do the extra melatonin. I'm noticing the blood pressure at waking is going back up as well. So there is still something I need to be doing, but I don't know what.

@Julie
You could be right about the bed. We just bought it a year and a half ago, and I hate it. But I hated our prior bed too. We cannot afford to buy a new one right now. My wife loves it. We had a bed she hated before that for many years. So compromise is all we can do on that front for now. Regardless of what bed I'm sleeping in, I have to elevate my feet if I'm on my back and elevate my elbows or my arms go numb. I usually find myself in the morning with both arms raised above my head, hands covering my forehead or crown. My abdomen feels better that way. I use a pillow on either side of my head to block out the noise of the machine. If I'm on my belly or lying on my left, I invariably get aerophagia and end up trying to burp the air out of my esophagus repeatedly for the rest of the night. I'm certainly not sleeping, but at least it's a comfortable position for a little while. If I face right or on my belly facing right, I can get some extra sleep, but I get a splitting headache and my AHI goes up for the period I'm in that position. I should try sleeping in one of the guest beds for a few nights to see how that works, but I'm not sure the results will be any different.

@SleepGuy
Thanks for the link! That's an intriguing website. I'd be interested in learning how much they do with sleep retraining via eeg feedback. I'd been considering seeing a neurofeedback specialist to get a QEEG - I think I wrote about it here a few months ago. Insurance won't cover it, so that's not currently an option. I suspect any qualitative study of eeg sleep patterns would have to be done over a course of a number of nights. A single, dual or split night study for that purpose would be about as useful as touching a finger to the window to guage the outdoor temperature - only vaguely helpful. That's why I think a multi-night home eeg system would be the best course for study. Just casually looking through the site and searching on "EEG" brought up this result. The study is getting close to what I'm talking about. However, there are many causes of insomnia, and what I'm talking about is actually sleep apnea and 'premature awakening' may not have the same roots as other forms of insomnia.

I know there are scientists who are having success using neurofeedback to work on everything from epilepsy to ADHD. If it were possible to use neurofeeback tools while we are awake to retrain that part of the brain that keeps us breathing while we are asleep, that would be the ideal permanent solution. Conceivably, such a treatment could cure central sleep apnea, if not obstructive. It would be interesting to find out why my arms go numb and why I end up with my hands over my head in the morning. That's where the PT part comes in. To try and study one part of the equation without the other seems like two steps backward. So much specialization has been great for the business of health care but not necessarily better for patients' personal state of health.

Whoops - did no one ever tell you that sleeping on your back is the worst position for apneas? Plus if your feet are raised, you are likely to aggravate GERD if you have it like so many of the rest of us do? A lot of us have the head (end) of our beds raised by 4-6" to alleviate that, and sleep on our sides or tummies. And maybe you need an exam of your back by an orthopod or even neuro. guy.

DreamDiver,

A couple times on here the topic has come up of if our brains after years of fractured sleep become hardwired to follow that pattern. It makes sense to me. Just recently I was musing and wondering if there would some day be "rehab" for this as with other times when the brain needs retraining, such as after a stroke. I'd be one of the first to try to get in to such a program. There have been times I was so utterly desperate for some deep sleep I wondered if they'd ever give someone anesthesia just so they could rest. I'm gonna go to that link and see what they are talking about.

Kathy

P.S. Just checked and two of the doctors listed in that specialty are local. If I get any info from them of interest, I'll post back.

@Julie,
Yes, I'm familiar with that. I have actually been diagnosed with GERD just recently. The only symptoms have been chest pain. Sleeping on an incline is very uncomfortable to me. You're right - I probably should get checked out regarding my back. I can't afford the neuro QEEG yet, since insurance won't cover it.

@kteague - Good luck! Looking forward to learning how it turns out.

rooster wrote:
Also, when I have that premature awakening, I take 2 x 500 mg acetaminophen which I keep in a little dosed container on the nightstand (don't want to have to fumble around or think too much and get even more wide awake). The acetaminophen seems to allow another two to three hours of sleep.

How does acetaminophen make you sleepy? And isn't that bad for your liver?

kteague wrote:There have been times I was so utterly desperate for some deep sleep I wondered if they'd ever give someone anesthesia just so they could rest.

There's Xyrem.

nobody wrote: ...
How does acetaminophen make you sleepy?

"Acetaminophen reduces the production of prostaglandins; reduces the oxidized form of cyclooxygenase (COX) family of enzymes preventing it from forming pro-inflammatory chemicals; inhibits the uptake of the endogenous cannabinoid/vanilloid anandamide by neurons; and inhibits sodium channels."

I don't think science knows the answer to your question. Less inflammation might help with sleep and of course I don't know, but I suspect that in addition to the anti-inflammatory effects, acetaminophen is doing something even more significant that helps with sleep.

There has not been much work on acetaminophen and sleep but one study of rats found, "acetaminophen decreased wakefulness and increased NREM sleep and paradoxical sleep during the light hours (the hours of maximal sleep in the normal rat)."

The same study found aspirin had the opposite effect. So if you take a daily aspirin, you might want to take it in the morning to avoid any negative effects on sleeping at night.

nobody wrote: ...
And isn't that (acetaminophen) bad for your liver?

There are many studies of acetaminophen's effect on the liver when taken in recommended doses (6 grams per day). There is no evidence of any damage at these levels (no you won't hear that on television news). Large overdoses have been known to cause liver damage.

But chronic use can GIVE you headaches, honestly (and that's from various neurologists, not my own opinion).