Primary Care asking for Second Opinion

[WearyJen]

Now if I could only learn to keep my mouth shut during the day, at work.

jeff

[roster]

I do have a deviated septum.

A good ENT who is also an allergist could advise you well. Many ENTs today are also allergists.

They should scope your nasal airway looking at your septum and also checking your turbinates for enlargement. The scope is long enough to examine your vocal cords. All of this needs to be looked at.

The scope is very easy, quick and just causes a little tickling feeling for most people. I highly recommend it for all SDB patients.

[WearyJen]

They should scope your nasal airway looking at your septum and also checking your turbinates for enlargement. The scope is long enough to examine your vocal cords. All of this needs to be looked at.
I highly recommend it for all SDB patients.

Should my sleep doctor have recommended all of this? Because he didn't. Maybe I need that second opinion after all. My sleep doctor seemed more concerned about me starting physical therapy to ease my sore neck which he thought would help my headaches. I had to ask him to look in my mouth to tell me what he thought might be the cause of the sleep disordered breathing, "yep, tongue's a little big, soft palate a little floppy." He didn't look in my nose. Or recommend that I have someone else look in my nose.

So if the septum's deviated enough and/or the turbinates are enlarged enough - is that causing the SDB? Or just aggravating it?

Do I need to find an ENT who knows something about UARS? Or should they all?

[jnk]

They should scope your nasal airway looking at your septum and also checking your turbinates for enlargement. The scope is long enough to examine your vocal cords. All of this needs to be looked at.
I highly recommend it for all SDB patients.

Should my sleep doctor have recommended all of this? Because he didn't. Maybe I need that second opinion after all. My sleep doctor seemed more concerned about me starting physical therapy to ease my sore neck which he thought would help my headaches. I had to ask him to look in my mouth to tell me what he thought might be the cause of the sleep disordered breathing, "yep, tongue's a little big, soft palate a little floppy." He didn't look in my nose. Or recommend that I have someone else look in my nose.

So if the septum's deviated enough and/or the turbinates are enlarged enough - is that causing the SDB? Or just aggravating it?

Do I need to find an ENT who knows something about UARS? Or should they all?

EVERYONE'S septum is deviated. The SDB patients who get surgery for that fall into two categories: (1) those whose septum is deviated so much that it hinders PAP therapy or (2) those whose ENT surgeon needs some money to put his kid through school.

If you can make PAP work for you, you don't need surgery for sleep-breathing disorders.

My viewpoints may be a little extreme and opinionated, though. And not just when it comes to the subject at hand. My hope is that one day I too can be as measured and balanced in my opinions as ro(o)ster.

jeff

[Uncle_Bob]

How was your mask selected?

It's so complicated. I tried a number of masks at the office - many did not seem like candidates. I brought home two that seemed most likely to work - the Mirage Liberty and the Mirage Swift nasal pillows.

I have mild rosacea, so what I tested during the sleep study that went around my nose and on my cheek left a deep mark that lasted for hours.
My mouth guard for bruxism makes it a little hard to keep my mouth shut, plus I get mouth ulcers, so there are times when I'm definitely a mouth breather.
The Mirage Liberty left a nasty mark above my upper lip and a swollen upper lip that lasted all day. I tried a few workarounds with tape on my upper lip for padding, but the mask leaked as my cheeks puffed out and as I moved. Kept waking me up.
I do have a deviated septum.
I've been using the Mirage Swift nasal pillows. Works best out of what I've tried so far. I've been alternately trying homemade remedies for keeping my mouth closed - ace bandage wrapped around my chin/head with my mouth cut out, chin-up strips. Don't want to tape my mouth shut though.

I highly recommend septoplasty surgery for your deviated septum, my therapy took a downturn when the allergy season hit i was waking up with congestion and suffocation feelings. I have had no congestion issues since my surgery and therapy has improved significantly.

I tried several ways of not mouth breathing but finally settled on the PapCap

http://www.pur-sleep.com/products/produ ... category=6

I wonder what kind of breathing through the mouth issue you have? Does your jaw just drop resulting in a gush of air? you may not notice this as it can happen gradually but you can experiment with your nasal mask and machine on to see what i mean. Just open your mouth wide trying to open up your jaw and you will notice the air gushes out your mouth and no longer passes through your nose. If this is your kind of mouth breathing then the PapCap does a great job in supporting the jaw so it does not drop.

If you mouth leak by making periodic mouth puffs it may not help and mouth taping or full face mask would be an option.

[roster]

sleep doc said, "yep, tongue's a little big, soft palate a little floppy."

That crap has been said to me and it was proven wrong. Any time I hear that I think the doc doesn’t know what he is talking about – and probably the majority are ill informed. A few people have large tongues and/or large soft palates, but narrow jaws are the far more common source of our problem.

My problem is a narrow jaw. Early symptoms which should have been obvious were overcrowding of a few teeth and necessity to extract the wisdom teeth. The jaw was not well developed enough to accommodate all the teeth.

Quite a few posts, but here is a good thread about the narrow jaw problem: viewtopic.php?f=1&t=50168&start=0.

So if the septum's deviated enough and/or the turbinates are enlarged enough - is that causing the SDB? Or just aggravating it?

It is unlikely to cause the fundamental problem because the blockage is typically further into the airway. I had correction of a badly deviated septum and resectioning/reduction of all six enlarged turbinates but it did not change the severity of my apnea or the pressure settings on my CPAP. But the results were wonderful because I can breathe through my nose like never before. Congestion became less of a problem.

But definitely you should undergo the easy endoscopy.

What does your chin and jaw look like. From the profile, is your chin well advanced or does it regress some? From the front, does your jaw look boxy or more like a triangle tapering down to a point at the chin? Narrrowness front-to-back or side-to-side indicates a narrow airway where the back of the tongue and the soft palate near each other. That is the typical fundamental problem of SDB.

Do I need to find an ENT who knows something about UARS? Or should they all?

I will tell you about the fantastic ENT I had which is near ideal. This doc was a top rate ENT surgeon, an allergist and practiced surgery for sleep apnea. He is also well-studied in SDB and has been a member of the FDA committee on new devices for SDB. He was in a practice which included sleep doctors. To top it all off, he considered surgery for sleep apnea to be a last resort and he was a pediatric surgeon (used to getting into those tiny noses and throats and doing delicate cutting).

This guy scoped me, tested me for allergies, brought the sleep doc in to discuss my case with us, treated the turbinates for six weeks with corticosteroid spray to see if they would shrink and when they would not he performed the surgery for the turbinates and the septum.

So that is the ideal. If you can find an ENT who has close to those characterics, go for him/her.

I would not be too rough on the current doctors. This is something that the medical field has missed by a mile and are now playing catch up. Some will never catch up.

[Muse-Inc]

Now, some different thoughts. You might be more comfortable with a different manufacturor's breathing design. You might be more comfortable with the original Hybrid mask https://www.cpap.com/productpage/RespCa ... -Mask.html. My sleep doc thinks it's a better design than ResMed's.

Many of us have fragile sleep, fall asleep easily but waken often...it's exasperating. With good adjustment to CPAP therapy, sleep deepens and sleep tends to become less fragile. My sleep was good, things changed as they are wont to do, I backslide into apnea, and now I have fragile sleep...again. I am now dealing with tree pollens, my baddy .

You have lots of company with SDB, all of us trying different approaches to achieve restful sleep.

[jules]

Restoril used to work, but that's a muscle relaxer.

check your facts

[jnk]

Restoril used to work, but that's a muscle relaxer.

check your facts

http://resources.metapress.com/pdf-prev ... ze=largest

See first sentence under "Introduction."

[jules]

http://www.rxlist.com/restoril-drug.htm


Restoril™ (temazepam) is indicated for the short-term treatment of insomnia (generally 7 to 10 days).


http://www.drugs.com/restoril.html


What is Restoril?

Restoril belongs to a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause sleep problems (insomnia).

Restoril is used to treat insomnia symptoms, such as trouble falling or staying asleep.

Restoril may also be used for other purposes not listed in this medication guide.


I am not saying it doesn't have the propensity to also relax muscles as benzos tend to be able to do that as well as control seizures but ........... it is for insomnia

[WearyJen]

http://www.rxlist.com/restoril-drug.htm


I am not saying it doesn't have the propensity to also relax muscles as benzos tend to be able to do that as well as control seizures but ........... it is for insomnia

Sorry, guess I should have quoted my source for that one.

I found a study entitled, "Zopiclone and zaleplon vs benzodiazepines in the treatment of insomnia: Canadian consensus statement", published in Human Psychopharmacology in 2003.

What it said was this: "Benzodiazepines may also aggravate other conditions, especially respiratory impairments as seen in patients with chronic obstructive pulmonary diseases (COPD), upper airway resistance syndrome (UARS) or sleep apnoea syndrome (SAS)."
"The difference between benzodiazepines and zopiclone on UARS is most likely attributable to the myorelaxant effect of these drugs which is 10-40 times greater with benzodiazepines than with zopiclone."

I'm not a doctor, but when I looked up myorelaxant in the medical dictionary, it said "a drug that causes relaxation of muscle."

So after reading that, I was nervous about using Restoril and asked to switch to a zopiclone. Fearful that perhaps the Restoril was making my sleep disordered breathing worse? Again, I'm not a doctor.

[jnk]

Jules' point, as I read it, is a very important one--that it is important to get as much informatin as we can before choosing which drug to use and for how long.

Many drugs have possible side-effects that are not, by definition, what the drugs are for, so the listing of a possible side-effect might not be an automatic deal-breaker, just as Jules so succintly indicated. ALL drugs affect how we sleep. And I do mean ALL. So the facts become important for those of us with sleep problems.

But I'm no doc, either.

jeff

[gpk111]

WearyJen,
I resonate with you. I'm also a researcher with an insomniac stricken active mind. I was diagnosed with OSA about 4 years ago.

My cocktail:
1. Get encouragement from this Board. - Doing it.
2. Improve sleep hygiene. - Trying, but NOT doing it.
3. Exercise. - Did it until 3 years ago, but definitely not doing it now.
4. Find great sleep docs, since my deductibles are met. - On the way. I'm on #5 and think I've hit paydirt.
5. Get the best CPAP machine and mask known to man. - Resmed S9 with a new nasal pillow. Made a world of difference from old CPAP.
6. Use best software known to man to tarck things. Doing it with ResScan. Great motivator, I find.
7. Experiment with slepeing pills. - Still doing it, but no magic solution. Lorazepam (0.5mg - not coverd by my drug plan) best candidate so far. Ambien didn't do the job. Ambien CR gave me hangovers.

Keep us posted

[belia]

The concern of primary care are diseases such as women’s health problem, chronic fatigue syndrome, diabetes, cholesterol, hypertension, hypothyroidism, and weight management. The goal here is to provide the optimum health and wellness that we need. Good to know that physicians here are committed in providing us with highest level of health and not just to treat the disease.

[Meeta]

The odds are very slim that pharmeceuticals of any type will help you become healthy. They should be a last (likely failing) attempt.

Here are the first things you need to do:

1) Practice immaculate sleep hygiene. Nothing fancy, just the basics followed strictly. Mayo Clinic site is a good resource.

2) Exercise. Again, just the basics, you don't have to be a fanatic (like me ) .

3) Healthy diet. Basics here - portion control, lots of fresh vegetables, some fruits, lean meats and eggs, limited grains, supplements but limited. Make sure bowel is regular.

4) Take a different attitude about CPAP and take control of your therapy - use CPAP, don't let it use you. CPAP is not a damn machine. CPAP is the only process that stands between us and our damned deficient airways and a damned poor life. Let's use CPAP to deal with the bad hand (airway) we were dealt and carve out a good life.

I like your attitude! Want to be a motivational speaker at one of our cpap support groups?