Questions my doc can't answer.

[synonymous]

Alright, I went into my doctor after 2 months of not going in (Work was tough). He said my CPAP scores are great, averaging 7 with the machine set at 4-10 with no leaks.

Question 1:

Some days I want to take a nap in the afternoon but can't actually sleep. I don't know if it's just me getting out of the habit taking naps or not. When I do nap what normally happens is as follows: I start to fall asleep but at the base/back of my skull, it feels like electric shocks are zapping my brain. I can feel the sleep paralysis hit, takes about 3 to 5 seconds to actually move. It's like I'm having a stroke (Although I've never had a stroke). It takes a bit of energy out of me and for whatever reason, I go through this process for about an hour, each time saying to myself "You just have to stay awake." By the end of an hour, I've got a headache and just not feeling good. I've felt my tongue go from being able to keep the pressure in my mouth to it falling back in on itself causing the air to gush out. Again, has this happened to you? My sleep doctor says it's probably the benzos/SSRI's I've been taking for 10+ years. My mental health doctor says not likely. Both are no real help.

Question 2:

I've been tested for diabetes several times over the past couple of years. I've had gym related injuries and because I'm larger than my Japanese friends the doctors always assume something is wrong. Well, in the summer just as I was starting CPAP I have a H1ac level of 5.3 (Well in the safe zone). Then 3 months later I was hit with a score of 6.3 (The first time it's ever gone up that high). And now 3 months later it's at 7.4.

My doctor suggested 2 possibilities: First, my body may have been burning more calories since I was never really resting properly before CPAP. Now that I am, my diet may need to change (Which is something I've started doing). Another reason for the high levels is that I thought my episodes of feeling faint were hypoglycemia and was eating more closer to stressful work hours to keep my blood sugar up. Now, I don't need to do that because I'm not at that end of the diabetic spectrum. I was expecting to lose weight but haven't. I've gained muscle (I'm at the gym 3 days a week, strength training.) But I think with these numbers, muscle/figure are going to take a backburner to overall health.

Again, anyone with opinions/advice? My doctor said "Eat like we Japanese do." Which is a high carb (Rice) diet with low protein...A drastic change like that would cause me serious fatigue.

[jasoncostello]

Ouch. Those are very interesting issues. While I can't speak to them specifically, have you tried seeing another doctor to get a second opinion? He or she will hopefully look at your symptoms from a different direction.

[Spirit]

Question 2: I've been tested for diabetes several times over the past couple of years. I've had gym related injuries and because I'm larger than my Japanese friends the doctors always assume something is wrong. Well, in the summer just as I was starting CPAP I have a H1ac level of 5.3 (Well in the safe zone). Then 3 months later I was hit with a score of 6.3 (The first time it's ever gone up that high). And now 3 months later it's at 7.4.

Hello friend, I am diabetic. High carb is a not appropriate to control diabetes, low carb diet is best. I went on low carb diet, my A1c went from 8.1 down to 4.2, I completely elimated sugar. I also lost 40 lbs,. Type II diabetes can make a person tired, very sleepy, in the afternoon or after each meal. Once I got my diet under control, I stop taking afternoon naps.

My sleep doctor says it's probably the benzos/SSRI's I've been taking for 10+ years.

Every doctor has a different opinon on sedatives. My sleep doc is against them, referring to them as poison for apnea patients. Benzo is a tranquiler (sedative), which relaxes the muscles in the throat, making apnea worse. Wishing you well on your journey.

[Slartybartfast]

Re: Question 1, you might consider seeing a neurologist or sleep doc.

Re: Question 2: Rising A1c levels indicate that your average glycosylated hemoglobin level is increasing with time, which indicates that your average blood sugar is also increasing. Your doctor should be the one to tell you, not someone over the internet, but you're heading for trouble. Time to become educated on how your body is reacting to carbs. The wild swings in blood sugar that leave you feeling weak a few hours after eating a meal and induce you to feel the need to consume more carbs to feel normal again indicate that you are insulin resistant, a condition that is said to be a precursor to developing Type 2 diabetes.

Your body is putting out massive amounts of insulin in an attempt to force toxic levels of glucose into your fat cells where it will be stored and thereby removed from the blood. But your fat cells are becoming insulin resistant, requiring more insulin to enter the cells. Once glucose from the digestion of your meal has stopped entering your blood stream, the insulin remains, and it continues packing away the glucose, which falls lower and lower, until you become hypoglycemic and wobbly-kneed, light headed, cold/clammy, grouchy/irritable, feeling like you need to eat something sweet/starchy to feel better. And then the cycle repeats. Ultimately your pancreas, exhausted at having to deal with your bad eating behavior essentially says "I quit!" and refuses to produce enough insulin and you're facing the wrong end of a hypodermic needle. There are some real card-carrying diabetics here who know far more than I do; I've only read a lot about the subject.

I gather you're a Gaijin living in Japan. If that's the case, you (and your doctor) should be aware that there are genetic differences among people who come from different parts of the world that affect how they react to certain foods. For instance, in studies normalized for diet, lactose intolerance is very common among Asians, while it is less common among Europeans. Another example is that Asians seem to do well on a high complex carb diet, but once they begin consuming sugar and suddenly they experience an epidemic of obesity and diabetes. http://www.medicalnewstoday.com/releases/56361.php There are other examples that Gary Taubes discusses in his excellent book, "Why We Get Fat (and what we can do about it). http://www.amazon.com/Why-We-Get-Fat-Vi ... 730&sr=8-1 Taubes also discusses the physiology of glucose metabolism and how insulin levels affect our overall health. If you're not a book reader, you can learn all you need to know by getting Fat Head the Movie by Tom Naughton. Tom is a comedian and writer who has put together a feature length video that discusses the effects of diet on our health in a very comprehensive, yet entertaining way. You can find the video trailers on his website and I think the entire video is available if you can stomach the commercials. Or you can just pony up $17 for the video, which I think you'll say is a bargain after you see it. http://www.fathead-movie.com/index.php/about/ Looks like it's on Hulu for free: http://www.hulu.com/watch/196879/fat-head

If you have the time, have a look at any of Dr. Robert Lustig's lectures on Sugar: The Bitter Truth. http://www.youtube.com/watch?v=dBnniua6-oM He also mentions the ethnic/genetic component.

Hope this helps you.

[Janknitz]

Ditto what Slartybartfast said! Good post!

In the US, diabetes isn't diagnosed until it's fairly well advanced and a lot of damage is already done. Don't wait!

Another good source of information is the Diabetes 101 site at http://www.phlaunt.com/diabetes/index.php

Since you enjoy working out and are in good physical shape, you might really find a lot of good info on the Paleo sites. Check out Mark's Daily Apple: http://www.marksdailyapple.com/, and Robb Wolf's Paleo Solution blog http://www.robbwolf.com/

In Japan, it's probably challenging to get some of the things we can find easily in US markets, like full-fat dairy products and large servings of meat. But you can get plenty of fresh fish, vegetables, fermented pickled veggies and salads, smaller servings of meat. Lay off the rice, bean, and soy products as much as possible. Try to avoid MSG used in cooking and added Ajino Moto, as well as added sugar in various forms which is often used in Japanese cooking.

[synonymous]

My diet is actually really good. I have had an allergy to sugar (I get itchy skin) and haven't had sugar in my diet for years. No cake, cookies, pastries etc. Well, I shouldn't say never, the occasional birthday cake maybe, but I've come to like living without it.

As for carbs, I'm already on a 150 grams or less type diet. 50-75 grams in the morning, 50-75 in the afternoon and whatever is left in the evening. Those are the carbs I count, brown rice (In small portions) and sweet potato (In small portions). The rest of my carbs are made up of veggies like spinach, broccoli, asparagus, salads (Which in Japan is expensive to make). My protein comes from chicken mostly. Fish is also expensive in Japan. 2 weeks ago I adjusted my diet to eliminate the evening carbs and keep my daily carbs under 100 grams. I've allowed myself to keep my protein at a maintenance level (So I won't lose muscle) and my dietary fats are the same. Total calories have dropped. Hopefully in 3 months so will my h1ac count.

My benzo and another tranquilizer are definitely bad for apnea (The reason for it I think). However, I'm addicted and on a slow taper to get off them. Quitting cold-turkey would throw me into seizures I'm sure. I wish I had never been put on these meds. However, by the afternoon, the meds should have cleared my system and shouldn't be acting as a muscle relaxant anymore so I don't know if that is the reason for being able to feel the tongue drop as I sleep. I'll see about getting an appointment with a neurologist.

Thanks for all the advice/help. Japanese doctors aren't as helpful as Canadian doctors (Being from Canada).

[archangle]

If you think carbs have something to do with it, experiment.

Eat a lot of protein and little or no carbs for a while. Then try a larger but reasonable dose of carbs for a few days.

I wouldn't think your jolt has anything to do with carbs. What's different between naps and sleeping? Position, noise, light, time, etc.?

[synonymous]

The naps are afternoon so more noise, light. That's about it. I took a nap today and had no 'zaps'. Today's naps was one well deserved though since I had a serious issue with my live-in mother-in-law that had my blood pressure up for about 2 hours...not fun.

[jnk]

Answer 1:

"Sleep researchers conclude that, in most cases, sleep paralysis is simply a sign that your body is not moving smoothly through the stages of sleep. Rarely is sleep paralysis linked to deep underlying psychiatric problems."-- http://www.webmd.com/sleep-disorders/gu ... -paralysis

Any drug can affect sleep staging. When drug side-effect is suspected, there are ways to figure that out, if the docs are willing to work with you to take the time to do that.

Answer 2:

Overall health is ALWAYS the goal. Never address one problem to the exclusion of overall health unless your docs (as in, more than one) convince you otherwise, as a short-term appoach, with science, logic, and respected printed matter to back that strategy up.

[napstress]

I gather you're a Gaijin living in Japan. If that's the case, you (and your doctor) should be aware that there are genetic differences among people who come from different parts of the world that affect how they react to certain foods.

Exactly so. Someone please correct me or fine-tune this if I am wrong, but I vaguely recall reading somewhere that people of Asian descent have a larger gland (in their mouths? the pancreas?) for breaking down rice than people of European descent do.

[Matty332]

Hi synonymous,

I believe I know what could be causing your problem. It is your meds I believe - and your sleep doctor is right over your mental health professional.

Here's how I figure it:

Firstly I should tell you that I suffer from OCD and have been on many psychiatric drugs in the past but mainly SSRI's. I have been on Benzo's too and they are bad news. For me they almost sent me psychotic.

I think it is your SSRI's, even if you have been on them for years and the symptoms have only just started (or they may have always been there), sometimes SSRI's sort of burn out your neurotransmitters a little bit and the drug loses effectiveness a bit and you may need a higher dose. When I stop taking my SSRI's abruptly, three days later of not taking them I get weird electric zap/shock feelings in my brain when I move my eyes left or right. Upon taking the drug again the symptom disappears. I have NEVER had the brain zap symptom before - even when going of other kinds of psych meds. I have only had them with the SSRI and have read anecdotal stories of other people taking them and getting various forms of brain zaps on SSRI - sometimes when not even withdrawing - sometimes constantly on the drug.

Now you said "it feels like electric shocks are zapping my brain", that to me points this to the SSRI. Perhaps your drugs are losing effectiveness and your brain is screaming to either get a slightly higher dose or to go off the meds because they have lost there effectiveness and became detrimental (I have found when that happens just ask the doctor to try you on another brand of SSRI after he carefully takes you off them and leaves you off for a while to get it out of your system before trying another brand - ie prozac, zoloft etc).

Somehow the SSRI might be screwing your sleep somehow because the brain zaps shouldn't be happening. You probably are completely aware of this but always get the advice of your doctor before going off, decreasing or increasing your SSRI. If he tells you to go off it and just stop taking it - go to another doctor. Abruptly stopping SSRI's has been known to sometimes cause suicide in younger people. He should ween you off slowly if he decides to try another drug. Also I should throw this in (For all I know you might know more than me on this subject - I am not patronizing you, just sharing info in case you didn't know). Depending on whatever your condition is that the SSRI is treating, sometimes the SSRI can take 3 weeks to work and your psych symptoms might worsen temporarily before dropping down and stabilizing.

I am no doctor but would advise going back to the sleep doc and just telling him straight up that you want a solution and what should you do with your meds. Even a sleep doctor should be able to advise and give you a different prescription if needed.

Good luck man, I would be interested to know how it goes. Please post an update.

[synonymous]

Thanks again for the replies.

I'm aware of the 'zaps' with coming off of SSRI's. I've never had them during waking times or during regular sleep times, just naps. I do use head gear to keep my mouth from opening but sometimes the air can slip by my lips with little 'burps'...

[Matty332]

It's gotta be the SSRI I reckon, they can do some weird shit to you being psychotropic drugs. They are also life saving in some cases so it is all about weighing the pros and cons..

Just on an Off topic subject,

I noticed you mentioned that fish is expensive in Japan? We have quite a few awesome japanese resturants and lunch bars here in Canberra, and I eat at them so often - the main content of the menus is various kinds of fish (yum), I presumed it must be cheap in Japan. Also strangely I noticed that the bento boxes that I often get for lunch aren't THAT carb heavy as people have suggested. They contain seaweed, veges and fish, with some fried items with delicious sauces. So fresh and healthy. The best restaurants and bars are the ones that are run by actual Japanese chefs and there are quite a few of them now which is great. Oh man my mouth is watering just thinking about it.

[BlackSpinner]

Thanks again for the replies.

I'm aware of the 'zaps' with coming off of SSRI's. I've never had them during waking times or during regular sleep times, just naps. I do use head gear to keep my mouth from opening but sometimes the air can slip by my lips with little 'burps'...

One thing people haven't mentioned is that when your sleep apnea is addressed and you are sleeping properly, your body processes drugs differently then before. One innocuous drug is caffeine. Most people who are on cpap find that at max 2 cups before noon is all they can handle while before they were drinking 4 cups up to 6pm. Many find they have to reduce the amount of their medications in general.

[jnk]

And with some medications, the reduction should only occur under a doc's direct instructions and supervision.