Peripheral Neuropathy and Obstructive Sleep Apnea

Therapist · Post by **Therapist** » Sun Mar 16, 2014 8:35 pm

Peripheral Neuropathy and Obstructive Sleep Apnea
March 16, 2014
I just saw a patient 5 months after major upper tongue and soft palate surgery for obstructive sleep apnea, and as expected more often than not, his sleep quality was significantly improved. He did not suffer from brain fog anymore, and was able to think clearly again, something he was not able to do for more than 30 years. He was very happy with the results. As he was leaving the exam room, he wanted to show me something. He took off his shoes, and then his socks, and asked me what I thought.
I was a bit confused by his request, but then I remembered that he showed me his feet many months prior to his procedures. Compared to his right foot at that time, his left foot was more dusky, red and scaly, and not too healthy looking. He had peripheral neuropathy with pain, burring and numbness, for which he was being treated by another doctor. On the post-operative visit, his left foot looked much healthier. He also noted proudly that although he still had some numbness, his burning and pain was completely gone.
Peripheral neuropathy is a common condition, seen usually in diabetics, but can occur in non-diabetics as well. I wasn’t surprised by his result, but it was a bit unexpected. It not something that’s routinely described as a potential benefit of treating obstructive sleep apnea. We know that sleep apnea causes a stress response that clamps down on blood vessels of the distant extremities.
I did a quick literature search of the connection between obstructive sleep apnea and peripheral neuropathy and found a few handful of studies. One report found that patients with obstructive sleep apnea without any symptoms in the feet had objective measures of diminished nerve function, which improved significantly after CPAP therapy. Another paper described resolution of peripheral neuropathy pain (but not numbness) in a non-diabetic after CPAP.
Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.
If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?

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Steven Park Steven Park
Written by Steven Park · Filed Under Blog

http://doctorstevenpark.com/peripheral- ... leep-apnea

MaxDarkside · Post by **MaxDarkside** » Sun Mar 16, 2014 10:09 pm

I commented on Dr. Park's blog post:

In part: I have progressive peripheral (and maybe central) polyneuropathy, likely CMT2, affecting numerous parts of my body (eye, bowel, feet, legs and now the right hand), and have moderate to severe obstructive sleep apnea. After treatment for obstructive sleep apnea my polyneuropathy was unabated, continued to progress, no difference. It may be possible that the peripheral polyneuropathy causes the obstructive sleep apnea, rather than the other way around, or they might be in my case coincidental. Good questions, though and worthy of some research to sort out the entanglement of maladies and the causal relations.

I was just reading some extensive literature last night on Charcot-Marie-Tooth (CMT) and found that in at least some sub-types of CMT sleep apnea was noted as a correlated malady. And you are looking at one

kaiasgram · Post by **kaiasgram** » Sun Mar 16, 2014 11:07 pm

Max, it's good to see you.

Goofproof · Post by **Goofproof** » Sun Mar 16, 2014 11:15 pm

I feel as we age we all have physical problems, more each day. It doesn't concern me much why, my concern is abatement and relief. Writing papers aren't going to stop aging, unless wecan roll them up and beat our failing DNA and turn off the genes that fail to repair our cells.

avi123 · Post by **avi123** » Mon Mar 17, 2014 7:27 am

Therapist wrote:
Peripheral Neuropathy and Obstructive Sleep Apnea
March 16, 2014
.
Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.
If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?

Google+
Steven Park Steven Park
Written by Steven Park · Filed Under Blog

http://doctorstevenpark.com/peripheral- ... leep-apnea

Reply,

Most of the above is nonsense b/c Peripheral Neuropathy (which I happened to have) has no treatment or cure. Both OSA and Peripheral Neuropathy depend on my Vestibular system being NOT healthy. My Peripheral Neuropathy is also known as Diabetic Feet, and I am wondering if lumbar stenosis has also to do with it.

avi123 · Post by **avi123** » Mon Mar 17, 2014 7:28 am

In a couple of weeks after I undergo a three vertebrae laminectemies, in my lower back, I'll be able to tell if fixing my lower back it also took away the neuropathy from the soles of my feet. I hope so.

MaxDarkside · Post by **MaxDarkside** » Mon Mar 17, 2014 7:52 am

kaiasgram: Thanks! It's been a while, eh?

Avi: Yes, I was told there is no cure to my peripheral / polyneuropathy. However, based on my research, depending on the cause / type, there may be some treatments that might slow its progression. I'm seeing a new neurologist Thursday to get another opinion on mine. I'm pretty sure mine is from my mom, who has fairly severe late onset Charcot-Marie-Tooth, but I have some differing symptoms than her, so maybe a mutated subtype. It also could be CIDP (chronic inflammatory) and the slow progressive MS. I'm pretty sure mine is CMT2, hers is CMT2J based on her symptoms. Maybe some steroids might help, anti-inflammatory drugs.

Goofproof: My (former) neurologist said our warranties ran out at 50 years of age. Maladies don't improve, just accumulate.

avi123 · Post by **avi123** » Mon Mar 17, 2014 12:38 pm

Max, neuropathy stands for destruction of nerves. How do we regenerate our nerves?

Julie · Post by **Julie** » Mon Mar 17, 2014 12:41 pm

If peripheral neuropathy is caused by cervical spinal problems, and they are addressed, the neuropathy should abate, if not disappear. It depends on what's causing the problem, and we should not use blanket absolutes to cover individual conditions.

Todzo · Post by **Todzo** » Mon Mar 17, 2014 12:43 pm

Therapist wrote:
Peripheral Neuropathy and Obstructive Sleep Apnea
March 16, 2014
I just saw a patient 5 months after major upper tongue and soft palate surgery for obstructive sleep apnea, and as expected more often than not, his sleep quality was significantly improved. He did not suffer from brain fog anymore, and was able to think clearly again, something he was not able to do for more than 30 years. He was very happy with the results. As he was leaving the exam room, he wanted to show me something. He took off his shoes, and then his socks, and asked me what I thought.
I was a bit confused by his request, but then I remembered that he showed me his feet many months prior to his procedures. Compared to his right foot at that time, his left foot was more dusky, red and scaly, and not too healthy looking. He had peripheral neuropathy with pain, burring and numbness, for which he was being treated by another doctor. On the post-operative visit, his left foot looked much healthier. He also noted proudly that although he still had some numbness, his burning and pain was completely gone.
Peripheral neuropathy is a common condition, seen usually in diabetics, but can occur in non-diabetics as well. I wasn’t surprised by his result, but it was a bit unexpected. It not something that’s routinely described as a potential benefit of treating obstructive sleep apnea. We know that sleep apnea causes a stress response that clamps down on blood vessels of the distant extremities.
I did a quick literature search of the connection between obstructive sleep apnea and peripheral neuropathy and found a few handful of studies. One report found that patients with obstructive sleep apnea without any symptoms in the feet had objective measures of diminished nerve function, which improved significantly after CPAP therapy. Another paper described resolution of peripheral neuropathy pain (but not numbness) in a non-diabetic after CPAP.
Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.
If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?

Google+
Steven Park Steven Park
Written by Steven Park · Filed Under Blog

http://doctorstevenpark.com/peripheral- ... leep-apnea

My experience is similar. In my case CPAP therapy was affected by added stress from Post Traumatic Stress(PTS). My feet already had some of the dreaded “yellow stuff” going on which had been improving with CPAP. But the added PTS apparently caused enough added arousals from the increased respiratory gain to cause my feet to loose part of a nail to the dread yellows and to loose most of the feeling on the bottom of the foot to the point where I could barely feel the “whisker” probe the doctor used to determine how bad it was.

I am remembering now how the first time I tried eucapnic breathing how I could literally feel the blood move back into my feet and my feet become warm. It is part of why I have worked so hard to establish breathing stability while using CPAP.

It has paid off. My feet are indeed very ticklish again and the nails get better month by month.

Yes the stress response from any apnea event will pull blood from your extremities. As well the amount of sugar in your blood will increase. If that were not enough high breathing levels can become long term facilitated and the reduced H+ levels will tend one toward vascular constriction for an even longer period. I do believe there are several direct physiologic connections between sleep apnea and peripheral neuropathy.

All the more reason to manage our treatment well!!!

MaxDarkside · Post by **MaxDarkside** » Mon Mar 17, 2014 12:50 pm

avi123 wrote:Max, neuropathy stands for destruction of nerves. How do we regenerate our nerves?

Well, generally they don't. Ever.

BUT, in some cases, not often, they do rewire and repair. Demyelination is the loss of the sheath around the nerve and the body [does]/[can]/[is seen to] try to fix that. This damage/repair/damage/... can cause nodules on the nerve, sometimes able to be felt by an experienced neurologist. Some nerves will "re-route" around the damage. But generally, no. My neurologist says my neuropathy will only progress. In the best case might be stopped as-is, not repairable. My niece with MS on interferon has seen some reduction in the size of her nerve lesions, her body trying to repair, but symptomatically is merely "paused". In the case of axon loss (the center of the nerve is gone) only "rerouting" is possible I suppose, but not likely on a larger nerve. I have axon loss (zero conduction) on one major motor nerve in my left foot and the muscle, with no signal to move, is atrophying. I don't think that is coming back.

unsuspected severe obstructive apnea · Post by **unsuspected severe obstructive apnea** » Mon Mar 17, 2014 1:45 pm

The split study night that PAP was started, my feet immediately began to warm up. Before PAP, I was wearing double wool socks to bed. After PAP, no socks, no painful toes. I have to think that continued desats would have eventually contributed to nerve damage. My mother, age 96, snores and has mild peripheral neuropathy with cold feet.

MaxDarkside · Post by **MaxDarkside** » Mon Mar 17, 2014 1:52 pm

unsuspected severe obstructive apnea wrote:The split study night that PAP was started, my feet immediately began to warm up. Before PAP, I was wearing double wool socks to bed. After PAP, no socks, no painful toes. I have to think that continued desats would have eventually contributed to nerve damage. My mother, age 96, snores and has mild peripheral neuropathy with cold feet.

(Directed somewhat to Avi): Yes, I think this is what what Dr. Park may be referring to; people with peripheral neuropathy due to poor circulation to the extremities, adding in situations exacerbated also perhaps by diabetic tendencies. And, on the other hand, those with significant neuro-destructive diseases are not helped, such as in my case, and what Avi is possibly considering.

avi123 · Post by **avi123** » Mon Mar 17, 2014 4:40 pm

avi123 wrote:
Therapist wrote:
Peripheral Neuropathy and Obstructive Sleep Apnea
March 16, 2014
.
Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.
If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?

Google+
Steven Park Steven Park
Written by Steven Park · Filed Under Blog

http://doctorstevenpark.com/peripheral- ... leep-apnea

Reply,

Most of the above is nonsense b/c Peripheral Neuropathy (which I happened to have) has no treatment or cure. Both OSA and Peripheral Neuropathy are related and depend on my Vestibular system being NOT healthy. My Peripheral Neuropathy is also known as Diabetic Feet, and I am wondering if lumbar stenosis has also to do with it.

ANDREW NYCE · Post by **ANDREW NYCE** » Mon May 12, 2014 4:10 pm

Hello,
I have both sleep apnea and peripheral neuropathy, but I am not diabetic. On some nights, I am awakened by a burning in my hands, feet, and legs including my knees even though I am wearing my cpap. If I attempt to sleep in a recliner without my cpap, I eventually, after many apneas, begin to have the same burning sensations. One possibility is that even with cpap, the mouth drops open and apnea begins. What are your thoughts? Is it possible to create a national study of this relationship between sleep apnea and peripheral neuropathy?
Andrew Nyce, PhD

Peripheral Neuropathy and Obstructive Sleep Apnea

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