New drug!

Question:

There is now a new disorder (well, I’m not positive that it’s "new", but I hadn’t heard it yet) and of course there is a new drug for it. The disorder is EDS which stands for "excessive daytime sleepiness".  Is that anything like "being tired" ? It is an acronym for a term used in relation to a syndrome of EDS and cataplexy in narcoleptic patients, and the drug is called Xyrem, which is sodium oxybate, and is the very same thing as GHB, a popular "rave" drug, with reasonably high abuse potential.  It is a controlled substance, DEA schedule III, and has a black-box warning about its potential for abuse, and that doctors should watch for "feigned cataplexy". So, if you are narcoleptic (fall asleep easily) and you are too tired during the day, you can now take a highly abusable CNS depressant at night.  It’s a liquid, and you can take from 3000 to 9000 milligrams of it.  I’m not sure how this would help, but they seem to say it does. Xyrem is only available through the "Xyrem Success Program", using a centralized pharmacy.  They provide educational materials to the prescriber and the patient explaining the risks and proper use of sodium oxybate (GHB). I thought I’d point out, just for fun, that part of the success program with this drug, which even the manufacturer admits, is urinary incontinence while sleeping, and less often, fecal incontinence…(hey, at least it’s only while sleeping….) Oh, and most fun:  It’s made by a company called "Jazz Pharmaceuticals" !! www.xyrem.com G

Response:

garyI thought your that Dr guy sorry if I mistookyou for someone else. .

– Hide quoted text — Show quoted text – There is now a new disorder (well, I’m not positive that it’s "new", but I hadn’t heard it yet) and of course there is a new drug for it. The disorder is EDS which stands for "excessive daytime sleepiness".  Is that anything like "being tired" ? It is an acronym for a term used in relation to a syndrome of EDS and cataplexy in narcoleptic patients, and the drug is called Xyrem, which is sodium oxybate, and is the very same thing as GHB, a popular "rave" drug, with reasonably high abuse potential.  It is a controlled substance, DEA schedule III, and has a black-box warning about its potential for abuse, and that doctors should watch for "feigned cataplexy". So, if you are narcoleptic (fall asleep easily) and you are too tired during the day, you can now take a highly abusable CNS depressant at night.  It’s a liquid, and you can take from 3000 to 9000 milligrams of it.  I’m not sure how this would help, but they seem to say it does. Xyrem is only available through the "Xyrem Success Program", using a centralized pharmacy.  They provide educational materials to the prescriber and the patient explaining the risks and proper use of sodium oxybate (GHB). I thought I’d point out, just for fun, that part of the success program with this drug, which even the manufacturer admits, is urinary incontinence while sleeping, and less often, fecal incontinence…(hey, at least it’s only while sleeping….) Oh, and most fun:  It’s made by a company called "Jazz Pharmaceuticals" !! www.xyrem.com G

Response:

Sleep apnea is a manifestation of obesity: Penn State Study

Question:

Obstructive sleep apnea (OSA) is a prevalent disorder particularly among middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnea has been treated as a ‘local abnormality’ of the respiratory track rather than as a ’systemic illness.’ In 1997, we first reported that the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFalpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNFalpha plasma levels and the body-mass-index (BMI). In subsequent studies, we showed that IL-6, TNFalpha, and insulin levels were elevated in sleep apnea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnea. Furthermore, our findings that women with the polycystic ovary syndrome (PCOS) (a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness, suggests a pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnea and sleepiness in obese patients may be manifestations of the Metabolic Syndrome, include: obesity without sleep apnea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity, and age; increased prevalence of sleep apnea in post-menopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA; lack of effect of continuous positive airway pressure (CPAP) in obese patients with apnea on hypercytokinemia and insulin resistance indices; and that the prevalence of the metabolic syndrome in the US population from the Third National Health and Nutrition Examination Survey (1988-1994) parallels the prevalence of symptomatic sleep apnea in general random samples. Finally, the beneficial effect of a cytokine antagonist on EDS in obese, male apneics and that of exercise on SDB in a general random sample, supports the hypothesis that cytokines and insulin resistance are mediators of EDS and sleep apnea in humans. In conclusion, accumulating evidence provides support to our model of the bi-directional, feed forward, pernicious association between sleep apnea, sleepiness, inflammation, and insulin resistance, all promoting atherosclerosis and cardiovascular disease.  Sleep Med Rev. 2005 Jun;9(3):211-24.Sleep apnea is a manifestation of the metabolic syndrome.Vgontzas AN, Bixler EO, Chrousos GP. Department of Psychiatry H073, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.

Response:

Excellent post thank you. – Hide quoted text — Show quoted text – Obstructive sleep apnea (OSA) is a prevalent disorder particularly among middle-aged, obese men, although its existence in women as well as in lean individuals is increasingly recognized. Despite the early recognition of the strong association between OSA and obesity, and OSA and cardiovascular problems, sleep apnea has been treated as a ‘local abnormality’ of the respiratory track rather than as a ’systemic illness.’ In 1997, we first reported that the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFalpha) were elevated in patients with disorders of excessive daytime sleepiness (EDS) and proposed that these cytokines were mediators of daytime sleepiness. Also, we reported a positive correlation between IL-6 or TNFalpha plasma levels and the body-mass-index (BMI). In subsequent studies, we showed that IL-6, TNFalpha, and insulin levels were elevated in sleep apnea independently of obesity and that visceral fat, was the primary parameter linked with sleep apnea. Furthermore, our findings that women with the polycystic ovary syndrome (PCOS) (a condition associated with hyperandrogenism and insulin resistance) were much more likely than controls to have sleep disordered breathing (SDB) and daytime sleepiness, suggests a pathogenetic role of insulin resistance in OSA. Other findings that support the view that sleep apnea and sleepiness in obese patients may be manifestations of the Metabolic Syndrome, include: obesity without sleep apnea is associated with daytime sleepiness; PCOS and diabetes type 2 are independently associated with EDS after controlling for SDB, obesity, and age; increased prevalence of sleep apnea in post-menopausal women, with hormonal replacement therapy associated with a significantly reduced risk for OSA; lack of effect of continuous positive airway pressure (CPAP) in obese patients with apnea on hypercytokinemia and insulin resistance indices; and that the prevalence of the metabolic syndrome in the US population from the Third National Health and Nutrition Examination Survey (1988-1994) parallels the prevalence of symptomatic sleep apnea in general random samples. Finally, the beneficial effect of a cytokine antagonist on EDS in obese, male apneics and that of exercise on SDB in a general random sample, supports the hypothesis that cytokines and insulin resistance are mediators of EDS and sleep apnea in humans. In conclusion, accumulating evidence provides support to our model of the bi-directional, feed forward, pernicious association between sleep apnea, sleepiness, inflammation, and insulin resistance, all promoting atherosclerosis and cardiovascular disease. Sleep Med Rev. 2005 Jun;9(3):211-24.Sleep apnea is a manifestation of the metabolic syndrome.Vgontzas AN, Bixler EO, Chrousos GP. Department of Psychiatry H073, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.

Response:

alternatives to Zoloft/Paxil

Question:

Hello, I am trying to research alternatives to SSRIs for social phobia.  I have found that Zoloft and Paxil work for me, but only at relatively high dosages (150mg and 40mg, respectively – these were not taken at the same time of course).  Both caused significant side effects such as excessive daytime sleepiness, forgetfulness and sexual side effects and I was forced to stop using them. I can use Xanax + a beta blocker for occasional intense situations, but do not want to take a benzodiazepine regularly. Everything I have read says to take an SSRI or maybe a benzodiazepine. Have you had success with anything else that I may ask my doctor about? Thanks in advance, Al —   Group info and charter at:  http://readystump.algebra.com/~asapm

Response:

<Gently snipped …Everything I have read says to take an SSRI or maybe a benzodiazepine. …Have you had success with anything else that I may ask my doctor about? … …Thanks in advance, Dear Al, Welcome to ASAPM! Being you are looking for alternitives……I was wondering if you ever tried cognitive behavioral therapy? It "can" be quite effective for anxiety disorders, including social anxiety. It surely can`t hurt to look into it…… and CBT doesn`t cause side-effects like meds can http://www.socialanxietyinstitute.org/ccbtherapy.html http://panicdisorder.about.com

Oh boy…DMV problems

Question:

Tim, Pretty crappy situation.  I would say its like driving to a bar.  EVERYBODY does it.  And probably most diink more than the allowable limit.  AND everybody drives home.  But its not looked upon as what it is, wrong. Same holds true with sleep apnena.  All of us who have it are at risk.  But IF everyone who had it was reported, very few of us would get the relief that we do have.  I am a long time OSA paitent.  And I have not had a accident in 25 years or so(knock on wood).  But if I did, I would not tell my MD about it, as what happend to you would be exactly what would happen to me.  I think the fine line of knowing your limitations and your condition is the deciding factor.  If your accident was as described, anyone at all could have had it, and its not because of the apnea.  AND the DOT folks should know that.  I can’t see the benifits of stoping someone who had a mishap in a parking lot from driving.  IF your apnea is severe enough that your having problems that would put others at risk, then by all means follow your concience.  But your incident is another "nice guys finish last" problem. I think the responsibility of the MD to make the judgement should be the clear factor in "turning you in". And it sounds like that common sense factor has been removed by someone.  (asshats in the legal/government). My opinion only here. take it for what its worth. Dave "Tim" <Tim_is_h…@lords.com> wrote in message

news:1107215411.929686.100080@f14g2000cwb.googlegroups.com… – Hide quoted text — Show quoted text -> Hi all, > I have sleep apnea and I am currently being treated via CPAP with only > partial success (like most here, possibly).  I still have some daytime > sleepiness, worse on some days than others.  Usually I am quite fine to > drive, but for the first time in my life (I’m 37) I had a slight > accident in my car (it was one of my worst days alterness-wise).  Never > before have I had any kind of accident, and the accident in question > couldn’t have been any more minor.  I was in stop-and-go traffic, and I > accidentally bumped the car in front of me.  No damage to either car > whatsoever, and nothing was reported to insurance. > Well, I had an appointment with my sleep doctor today and out of the > blue he asked me if I had any accidents recently.  Trying to give him > an accurate picture of my health, I related the above to him.  Pretty > stupid on my part I guess — he proceeded to tell me that he is > required by law to tell PennDOT (PA’s DMV department) about the > "accident"…and he made me sign something stating that I will no > longer drive anymore unless I get medical clearance in the future to do > so again.  Uggh!  I can’t afford to lose my driving privileges, and I > mean that literally.  I don’t know what I’m going to do. > Can anyone tell me what I should expect from PennDoT now?  I’m assuming > my license will be suspended.  How can I get my driving privileges > back, and will my insurance go up if I’m allowed to return to the road? > Will this suspension forever be a black mark on my driving record, > even if my situation improves medically?  Could it hurt my chances of > getting work as a driver? > This really does suck. > Tim

Response:

Hi guys…once again thanks for the replies. Dave J. (Scoop0901) wrote: > PennDOT may take up to six weeks to notify you — once they make a > determination based on your healthcare provider’s recommendation that > your driving privileges be revoked.

Dave, thank you for this info.  I guess I shouldn’t get my hopes up if I don’t hear from them for a couple of weeks.  More importantly, do you know if there’s anything I can do in the interim to better my chances? And once a determination is made, could I appeal? Thanks again, Tim

Response:

Consider moving out of Penn before your license is revoked? Consider an attorney? Consider being proactive and have your sleep doc send PennDot a statement that your treatment is effective? If there is no adverse ruling, there is no need to hassle with appeal. regards, eric pearson nonono.ericp1.non…@nonono.fuse.net On 6 Feb 2005 15:00:13 -0800, "Tim" <Tim_is_h…@lords.com> wrote: – Hide quoted text — Show quoted text ->Hi guys…once again thanks for the replies. >Dave J. (Scoop0901) wrote: >> PennDOT may take up to six weeks to notify you — once they make a >> determination based on your healthcare provider’s recommendation that >> your driving privileges be revoked. >Dave, thank you for this info.  I guess I shouldn’t get my hopes up if >I don’t hear from them for a couple of weeks.  More importantly, do you >know if there’s anything I can do in the interim to better my chances? >And once a determination is made, could I appeal? >Thanks again, >Tim

Response:

Good luck with PennDOT they never make sense. A few years ago they did nothing to a man, in the Pittsburgh area, who cause a number of accidents because he passed out at the wheel. They finally pulled his license after the last accident in which he killed someone. Last year, a man in this area lost his license when his doctor disclosed to PennDOT, he drank two beers a day. The fact he drank them at night in his home before bed, no DUIs, no traffic violations, and no accidents had no effect on PennDOT’s judgement. – Hide quoted text — Show quoted text -eric pearson wrote: > Consider moving out of Penn before your license is revoked? > Consider an attorney? > Consider being proactive and have your sleep doc send PennDot a > statement that your treatment is effective? If there is no adverse > ruling, there is no need to hassle with appeal. > regards, > eric pearson > nonono.ericp1.non…@nonono.fuse.net > On 6 Feb 2005 15:00:13 -0800, "Tim" <Tim_is_h…@lords.com> wrote: >>Hi guys…once again thanks for the replies. >>Dave J. (Scoop0901) wrote: >>>PennDOT may take up to six weeks to notify you — once they make a >>>determination based on your healthcare provider’s recommendation that >>>your driving privileges be revoked. >>Dave, thank you for this info.  I guess I shouldn’t get my hopes up if >>I don’t hear from them for a couple of weeks.  More importantly, do you >>know if there’s anything I can do in the interim to better my chances? >>And once a determination is made, could I appeal? >>Thanks again, >>Tim

Response:

On 6 Feb 2005 15:00:13 -0800, "Tim" <Tim_is_h…@lords.com> wrote: >Dave, thank you for this info.  I guess I shouldn’t get my hopes up if >I don’t hear from them for a couple of weeks.  

Nope, not at all. >More importantly, do you >know if there’s anything I can do in the interim to better my chances?

Become compliant on your machine.  Talk OPENLY and HONESTLY with your sleep specialist.  You make no mention of what part of PA, or what town you are in, but hopefully you are in an area where there is a board-certified sleep specialist.  I am in Philly. By being open and honest with your sleep specialist, he makes notes in your chart.  PennDOT will look at those notes.  Progress goes up and down, and PennDOT, as well as your sleep specialist (please, please, PLEASE note, I am NOT saying your family doctor, internist, etc.!!!), all know this.  Don’t try to "fake" getting better because PennDOT may want to do an MSLT or a MWT on you just to see if the notes are accurate — and if you do pose a threat on the roadway. >And once a determination is made, could I appeal?

You can appeal, but during the appeal process you will not be driving. The revokation lasts six months, typically, and is then reviewed.  The review would be based on your request. Bear in mind, PA is one of the better states in which to have your license revoked for this problem, from what I have heard.  California is one of the worst in some cities. -dave

Response:

On Mon, 07 Feb 2005 03:11:36 GMT, ronlin <ron…@verizon.net> wrote: >Last year, a man in this area lost his license when his doctor disclosed >to PennDOT, he drank two beers a day. The fact he drank them at night in >his home before bed, no DUIs, no traffic violations, and no accidents >had no effect on PennDOT’s judgement.

The thing that matters to PennDOT is ***how*** the info is presented to them, and what documentation can be obtained by them after the initial report. -dave

Response:

License suspension for cell-phone drivers is insufficient. There should be permanent license revocation. On Wed,  9 Feb 2005 19:29:06 -0800 (PST), A.Melon – Hide quoted text — Show quoted text -<ju…@melontraffickers.com> wrote: >>On 4 Feb 2005 15:57:22 -0800, "Tim" <Tim_is_h…@lords.com> wrote: >>>Hi guys…thanks for the replies.  I haven’t heard anything from >>>PennDOT yet, but it’s only been 4 days since my doctor’s appointment. >>>I’m hoping the severity of the "accident" — or to be more precise, the >>>lack thereof — will help me prevent suspension of my license.  Really, >>>I only hit the guy about as hard as one might when parallel parking and >>>misjudging a little.  I’m not sure how likely it is I’ll be successful >>>with this battle, but I appreciate you advising me of the importance of >>>the first few weeks of this, Pete. >Personally, I think I would sleep better at night if they suspended the >licenses of vehicular cell phone users rather than those of treated apnea >patients. A suggested add-on to the doctor’s questions would be "Do you use >a cell phone while driving?" Then the doctor could report these patients to >the proper authorities as very high risk drivers. >On a more serious note, your post serves as a good reminder about what we >in general can safely say and to who.

regards, eric pearson nonono.ericp1.non…@nonono.fuse.net

Response:

Just a quck update here.  Still haven’t heard from PennDot, but my doctor (yes, a certified sleep doc) is going to schedule a MWT for me. Hopefully, the resutls will be good and will satisfy PennDot. Dave, in what way is PA a good state for this to happen?  You seem to know quite a bit about this process.  Have you been through this yourself, or maybe you know someone who did?  Or maybe you are a DMV industry "insider"?  Just curious.  Thanks for the great info. Regards, Tim

Response:

On 15 Feb 2005 16:34:41 -0800, "Tim" <Tim_is_h…@lords.com> wrote: >Just a quck update here.  Still haven’t heard from PennDot, but my >doctor (yes, a certified sleep doc) is going to schedule a MWT for me. >Hopefully, the resutls will be good and will satisfy PennDot. >Dave, in what way is PA a good state for this to happen?  You seem to >know quite a bit about this process.  Have you been through this >yourself, or maybe you know someone who did?  Or maybe you are a DMV >industry "insider"?  Just curious.  Thanks for the great info.

I run Awake In Philly (http://www.AwakeInPhilly.org/), do a few other things on the side in the sleep field and advocacy, helped launch Awake In America (http://www.AwakeInAmerica.org/), and have been involved in many fights for people around the country over the past five years over driving, insurance, etc.  But what do I know?

Response:

I have no doubt you know a lot  I also have a lot of admiration for your apparent devotion to your causes, and am impressed by the comprehensiveness of those web sites (and probably, the organizations themselves).  Way to go — we apneics are very lucky to have you on our side, I’m sure. Thanks again for the great advice you’ve given me in this thread. Regards, Tim

Response:

On 4 Feb 2005 15:57:22 -0800, "Tim" <Tim_is_h…@lords.com> wrote: >Hi guys…thanks for the replies.  I haven’t heard anything from >PennDOT yet, but it’s only been 4 days since my doctor’s appointment. >I’m hoping the severity of the "accident" — or to be more precise, the >lack thereof — will help me prevent suspension of my license.  Really, >I only hit the guy about as hard as one might when parallel parking and >misjudging a little.  I’m not sure how likely it is I’ll be successful >with this battle, but I appreciate you advising me of the importance of >the first few weeks of this, Pete.

PennDOT may take up to six weeks to notify you — once they make a determination based on your healthcare provider’s recommendation that your driving privileges be revoked. The extent of the damage, as well as the strength of impact have no real bearing on the matter.  The issue is your alertness behind the wheel of a vehicle.

Response:

Hi Tim, > And, Dan, to answer your questions — first off I should probably > mention that I’m not really new to apnea.  I’ve gone through the usual > learning curve with it, and found this group to be quite a help with > that several years ago.  At this point though, I could probably quite > literally write a book about apnea and its treatments.  It’s the > legal/DMV side of it that I’m pretty ignorant about, and I will admit > feeling pretty vulnerable there.

I’m not up to date with the situation in the US. I attended a number of Conferences in the UK over the past few years, one of which was addressed by a doctor from the DVLA (UK Government Licencing Agency). For Commercial drivers with sleep apnoea they must prove that they do not pose a risk on the roads (excessive daytime sleepiness) and this must be signed off by their sleep doctor. Pending this, actually on diagnosis, they must cease driving. The driver must then produce this ‘proof’ annually thereafter. I can only assume that it is similar in the US. It should not affect your right to work. > Apnea-wise though, here is a short summary of my situation:  Diagnosed > in 1999 with mild apnea, quickly proceeded to moderate and on to > severe.  I’ve been on xPAP ever since then, first CPAP and then BiPAP. > BiPAP was better, but since I still could not tolerate the pressure > required, for good or for bad — mostly bad — I opted for surgery. > First I tried losing weight though — I lost 40 pounds which made me > thin as a rail (I wasn’t that overweight to begin with) but this had no > effect.  So I ended up getting a whole slew of surgeries over time: a > couple coblation sessions to the tongue, UPPP, hyoid suspension, > genioglossus advancement, turbinate reduction, septoplasty, MMA.  After > all that I am still not cured.

And I thought the UPPP was bad (VBG)……..   I am better though — the number of > apneas per hour dropped a fair amount.  Unfortunately though, the > pressure required to treat the rest has not dropped at all…so I still > have the same problems with pressure.

Unfortunately the level of pressure required does not indicate the severity of the apnoea.   So to answer your question, yes > I am compliant — every night — but the pressure I’m using is what I > can handle, not what I need.  So I’m not sure there’s much else I can > do medically to "heed the warning" — although another operation is > being discussed.  And Dan, I really have no idea what prompted my > doctor to ask about accidents…he probably does this with a lot of his > patients.

Unfortunately Tim I don’t think so. If you can’t handle the pressure that is required, then I believe that CPAP is doing you no good whatsoever, and if you mentioned this to your sleep doctor I believe that that is the reason he asked the question and also the reason that he reported you. Usually the pressure prescribed is 95% of that required to clear all apnoea events, to allow for some comfort. In short I believe that your sleep doctor believes that you are not in fact compliant. > If by some miracle I am successfully treated one day, does anyone know > if this black mark on my driving record (assuming I really am > suspended) will prevent me from getting a job as a driver?  It doesn’t > exactly seem fair that it should last, if I really am cured.

Tim, at the moment (I say this hopefully) there is no cure for moderate/severe sleep apnoea (except of course a traceotomy). I do voluntary work for a sleep apnoea patient support group here in Ireland, and we always tell newly diagnosed sufferers that they have a disorder rather than a disease/illness and that disorders can’t be cured, but can be managed successfully. If you successfully manage your disorder (like wearing glasses for driving) then there is no reason to have a black mark on your record. If however you cause a serious accident through EDS then the black mark will stick.  Also, if > anyone has any more specifics on what I should expect from the DMV in > the coming days I really would appreciate it.

Can’t help you there…….sorry. Kindest regards, Dan.

Response:

Hi Tim, Sorry to hear about your problems. In Ireland things are not as strict, but in the UK they are. It might be more helpful to answer some of the questions below. > I have sleep apnea and I am currently being treated via CPAP with only > partial success (like most here, possibly).  I still have some daytime > sleepiness, worse on some days than others.

How severe is your apnoea? How long are you on CPAP? How compliant are you? (how many hours per night do you use CPAP)   Usually I am quite fine to > drive, but for the first time in my life (I’m 37) I had a slight > accident in my car (it was one of my worst days alterness-wise).  Never > before have I had any kind of accident, and the accident in question > couldn’t have been any more minor.  I was in stop-and-go traffic, and I > accidentally bumped the car in front of me.  No damage to either car > whatsoever, and nothing was reported to insurance.

It was a warning. You should heed it. > Well, I had an appointment with my sleep doctor today and out of the > blue he asked me if I had any accidents recently.

Why did he ask you this?   Trying to give him > an accurate picture of my health, I related the above to him.  Pretty > stupid on my part I guess — he proceeded to tell me that he is > required by law to tell PennDOT (PA’s DMV department) about the > "accident"…and he made me sign something stating that I will no > longer drive anymore unless I get medical clearance in the future to do > so again.  Uggh!  I can’t afford to lose my driving privileges, and I > mean that literally.  I don’t know what I’m going to do.

What did your sleep doctor say about the excessive daytime sleepiness? Can it be controlled? > Can anyone tell me what I should expect from PennDoT now?  I’m assuming > my license will be suspended.  How can I get my driving privileges > back, and will my insurance go up if I’m allowed to return to the road? > Will this suspension forever be a black mark on my driving record, > even if my situation improves medically?  Could it hurt my chances of > getting work as a driver?

Can’t speak for Ireland, but in the UK it is illegal to drive until such time as it can be confirmed that you do not pose a danger to others. I assume it is the same where you are. It most certainly will hurt your chances of getting work as a commercial driver, unless you get your situation under control. Please answer the questions above and I am sure you will get good advice from the group. Dan.

Response:

Hi guys…thanks for the replies.  I haven’t heard anything from PennDOT yet, but it’s only been 4 days since my doctor’s appointment. I’m hoping the severity of the "accident" — or to be more precise, the lack thereof — will help me prevent suspension of my license.  Really, I only hit the guy about as hard as one might when parallel parking and misjudging a little.  I’m not sure how likely it is I’ll be successful with this battle, but I appreciate you advising me of the importance of the first few weeks of this, Pete. And, Dan, to answer your questions — first off I should probably mention that I’m not really new to apnea.  I’ve gone through the usual learning curve with it, and found this group to be quite a help with that several years ago.  At this point though, I could probably quite literally write a book about apnea and its treatments.  It’s the legal/DMV side of it that I’m pretty ignorant about, and I will admit feeling pretty vulnerable there. Apnea-wise though, here is a short summary of my situation:  Diagnosed in 1999 with mild apnea, quickly proceeded to moderate and on to severe.  I’ve been on xPAP ever since then, first CPAP and then BiPAP. BiPAP was better, but since I still could not tolerate the pressure required, for good or for bad — mostly bad — I opted for surgery. First I tried losing weight though — I lost 40 pounds which made me thin as a rail (I wasn’t that overweight to begin with) but this had no effect.  So I ended up getting a whole slew of surgeries over time: a couple coblation sessions to the tongue, UPPP, hyoid suspension, genioglossus advancement, turbinate reduction, septoplasty, MMA.  After all that I am still not cured.  I am better though — the number of apneas per hour dropped a fair amount.  Unfortunately though, the pressure required to treat the rest has not dropped at all…so I still have the same problems with pressure.  So to answer your question, yes I am compliant — every night — but the pressure I’m using is what I can handle, not what I need.  So I’m not sure there’s much else I can do medically to "heed the warning" — although another operation is being discussed.  And Dan, I really have no idea what prompted my doctor to ask about accidents…he probably does this with a lot of his patients. If by some miracle I am successfully treated one day, does anyone know if this black mark on my driving record (assuming I really am suspended) will prevent me from getting a job as a driver?  It doesn’t exactly seem fair that it should last, if I really am cured.  Also, if anyone has any more specifics on what I should expect from the DMV in the coming days I really would appreciate it. Best Regards, Tim P.S. — Good luck with those medical bills and also dealing with your employer, Pete.  I know those definitely can be trying issues as well. If only medical problems could remain "just" a health issue!

Response:

"Tim" <Tim_is_h…@lords.com> wrote in message

news:1107215411.929686.100080@f14g2000cwb.googlegroups.com… – Hide quoted text — Show quoted text -> Hi all, > I have sleep apnea and I am currently being treated via CPAP with only > partial success (like most here, possibly).  I still have some daytime > sleepiness, worse on some days than others.  Usually I am quite fine to > drive, but for the first time in my life (I’m 37) I had a slight > accident in my car (it was one of my worst days alterness-wise).  Never > before have I had any kind of accident, and the accident in question > couldn’t have been any more minor.  I was in stop-and-go traffic, and I > accidentally bumped the car in front of me.  No damage to either car > whatsoever, and nothing was reported to insurance. > Well, I had an appointment with my sleep doctor today and out of the > blue he asked me if I had any accidents recently.  Trying to give him > an accurate picture of my health, I related the above to him.  Pretty > stupid on my part I guess — he proceeded to tell me that he is > required by law to tell PennDOT (PA’s DMV department) about the > "accident"…and he made me sign something stating that I will no > longer drive anymore unless I get medical clearance in the future to do > so again.  Uggh!  I can’t afford to lose my driving privileges, and I > mean that literally.  I don’t know what I’m going to do. > Can anyone tell me what I should expect from PennDoT now?  I’m assuming > my license will be suspended.  How can I get my driving privileges > back, and will my insurance go up if I’m allowed to return to the road? > Will this suspension forever be a black mark on my driving record, > even if my situation improves medically?  Could it hurt my chances of > getting work as a driver? > This really does suck.

You have my deepest sympathies – I’ve been through it here in the UK, too. My neurologist felt obliged to report my narcolepsy to the DVLA, and, after about 5 weeks, my license was suspended. If I can get medical clearance, I can get it back, but that means either a) lying to my doctor about my condition and not getting the help I need, or b) managing to go for at least six months without a narcoleptic attack, which isn’t going to happen. I said goodbye to my car last Saturday – I’m not going to be needing that any time soon. It’s busses, trains, and the kindness of friends and family for the forseeable future. So, to answer your questions directly, based on the UK situation: Yes, your license will probably be suspended. You will have about 5-6 weeks to convince your doctor to convince them not to suspend it. Once it has been suspended, it’s a nightmare to get it un-suspended, even if you go via the same doctor. You can get your driving privileges back if you can convince a doctor to convince the authorities that there is less than 1% of a chance of your driving being affected by your condition.It’s a lot easier said than done. Your insurance will go up, guaranteed. The only bright side to that, from a very warped perspective, is that you might not need that insurance… You will not be able to get work as a driver. Ever. Anyone with this type of disability is apparently banned from any form of commercial or professional driving, by law. One of the first things my doctor asked me was what role driving played in my career. Thankfully, you don’t really need to drive to program computers – but falling asleep on the keyboard can be just as hazardous to any kind of job security. Keep in mind that all of this is, as I said, based on my own situation, and the laws where you are may differ. So, on the plus side, I’m not paying for petrol and car services as regularly as I was, and I don’t have to wash the car anymore. On the down side, I’ve been hit by large medical bills because my idiot employer put me between a rock and a hard place and convinced me to go privately, and then ‘forgot’ to pay my medical aid contributions, I can’t drive any more, and the debts are now piling upwards, and I’m living in daily fear of my employer thinking that they’ve come up with a way around the disability discrimination act, to kick me out. Yes, it really does suck. I couldn’t agree more. I really do know what you’re going through.

Response:

Hi all, I have sleep apnea and I am currently being treated via CPAP with only partial success (like most here, possibly).  I still have some daytime sleepiness, worse on some days than others.  Usually I am quite fine to drive, but for the first time in my life (I’m 37) I had a slight accident in my car (it was one of my worst days alterness-wise).  Never before have I had any kind of accident, and the accident in question couldn’t have been any more minor.  I was in stop-and-go traffic, and I accidentally bumped the car in front of me.  No damage to either car whatsoever, and nothing was reported to insurance. Well, I had an appointment with my sleep doctor today and out of the blue he asked me if I had any accidents recently.  Trying to give him an accurate picture of my health, I related the above to him.  Pretty stupid on my part I guess — he proceeded to tell me that he is required by law to tell PennDOT (PA’s DMV department) about the "accident"…and he made me sign something stating that I will no longer drive anymore unless I get medical clearance in the future to do so again.  Uggh!  I can’t afford to lose my driving privileges, and I mean that literally.  I don’t know what I’m going to do. Can anyone tell me what I should expect from PennDoT now?  I’m assuming my license will be suspended.  How can I get my driving privileges back, and will my insurance go up if I’m allowed to return to the road? Will this suspension forever be a black mark on my driving record, even if my situation improves medically?  Could it hurt my chances of getting work as a driver? This really does suck. Tim

Response:

Anyone with hypersomnia ?? Daytime sleepiness.

Question:

My husband just wants to sleep all the time. He finally had to take a leave of absence from work because he was falling alseep on his feet and in danger of having a major accident. On holidays he just sleeps and sleeps. Over Labor Day long week end he slept 90% of the time day and night. When He does get up he says he is sooooooooo sleepy and is soon right back in bed. He has been through one sleep study about 5 years ago and they put him on Proigil but it only made him irritable and he was still sleepy. He forced himself to go to work until this week when he finally gave up and said I can not do it any more.He falls asleep at red lights!! He is to go to a Neuroligist tomorrow and hopefully to the local sleep clinic for a sleep study. He is taking a leave of absence under the Medical leave Act but this is cutting our income down a lot. I hope he can get help soon with the holidays coming up. I am disabled with fibromyalgia and on SSD so I can not go out and get a even a part time job. From what I have read online in research the only treatment for excessive daytime sleepiness is stimulants like Ritlan, Adderall,  Cyler. Every stimulant he has ever taken including caffine just makes him irritable, neverous, and still sleepy under neath. If you have this problem please write to me and let me know what has helped you. Please write to jjubbs…@aol.com

Response:

Has your husband ever tested for sleep apnea? Does he snore?  One of the symptoms is excessive daytime sleepiness.  And the majority of people with sleep apnea don’t even know they have it.  He may benefit from the use of a CPAP machine if he has sleep apnea.  Watch him sleep – if he has it, you’ll notice him stop breathing.

Response:

> Has your husband ever tested for sleep apnea? Does he snore?  One of the > symptoms is excessive daytime sleepiness.  And the majority of people with > sleep apnea don’t even know they have it.  He may benefit from the use of > a > CPAP machine if he has sleep apnea.  Watch him sleep – if he has it, > you’ll > notice him stop breathing.

5 years ago one would assume this person wasn’t diagnosed with apnea when they had a sleep study done – one would also assume that this person had a sleep study done 5 years ago because of excessive sleepiness – the fact that no apnea was discovered back then is a fair indication that in this case, apnea isn’t the cause of the excessive sleepiness …….  but either way, one would hope the new study which this person is planning on getting will show that either way guess my point is it seems like you didn’t really read the first post well enough to notice that A.. they have had a sleep study done already and B.. they’re going to get another one done

Response:

Uncontrollable sleep apnea

Question:

About 2 years before my surgery I tried Somnuplasty on an outpatient basis. The fee included unlimited follow up treatments so the one fee covered the 3 attempts I endured and the doc certainley wasn’t making anything on the follow-ups. The benefits of the uvula somnuplasty were slightly reduced snoring but not a help for the apnea.  During my recent surgery for the genioglossus tongue advancement, done under general anesthesia, somnuplasty was done on the tongue base while I was under.  So, apparently it can be done both ways. "D. Smyth" <dannospa…@eircom.net> wrote in message

news:cg4jtl$4fq$1@kermit.esat.net… – Hide quoted text — Show quoted text -> "Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message > news:evdVc.28455$cT6.22031@fe2.columbus.rr.com… > > D. Smyth wrote: > > > Hi Brian, > > > Tonsillectomy, if they are large and causing problems will certainly do > you > > > know harm (except that all surgery can be dangerous). For me the UPPP is > a > > > big no no, as is somnoplasty which is purely a means to have you back to > his > > > surgery a couple of times with a nice fat fee for each visit. > > Actually, because I’d be having all three at once, I’d be under general > > anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t > > have to go back. > (SNIP) > Brian, > I think that you may have been misled. Somnoplasty is seldom a one off > treatment and is usually carried out at the Doctor’s surgery rather than > under general anaesthetic. I am 99% certain that you will have to go back. > It’s a real money spinner for the doctor. If you check out the following > link you will find that it is an outpatient procedure. > http://www.somnoplasty.com/MDframePC.html > You can also find who their accredited practitioners are. The procedure is > to reduce and tighten the tissue. Always remember that weak tissue grows > back. This procedure will not help you long-term. > Having all these procedures carried out in one go is going to be very severe > on you, also your pocket. > I suggest also that you check out the archives under ‘UPPP’ and you will > find that there have been some terrific reports immediately post UPPP, > however the situation worsens as time goes on. There are no peer reviewed > statistics for the success of UPPP for the post op period of 12/18 months. > Ask your surgeon if he can produce such figures, not his figures but those > that have been properly reviewed. > Brian, you are an adult and can make up your own mind, but at least research > it first. After surgery there’s no going back. > Best of luck, > Dan.

Response:

- Hide quoted text — Show quoted text -"D. Smyth" <dannospa…@eircom.net> wrote in message <news:cg4jtl$4fq$1@kermit.esat.net>… > "Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message > news:evdVc.28455$cT6.22031@fe2.columbus.rr.com… > > D. Smyth wrote: > > > Hi Brian, > > > Tonsillectomy, if they are large and causing problems will certainly do >  you > > > know harm (except that all surgery can be dangerous). For me the UPPP is >  a > > > big no no, as is somnoplasty which is purely a means to have you back to >  his > > > surgery a couple of times with a nice fat fee for each visit. > > Actually, because I’d be having all three at once, I’d be under general > > anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t > > have to go back. > (SNIP) > Brian, > I think that you may have been misled. Somnoplasty is seldom a one off > treatment and is usually carried out at the Doctor’s surgery rather than > under general anaesthetic. I am 99% certain that you will have to go back. > It’s a real money spinner for the doctor. If you check out the following > link you will find that it is an outpatient procedure. > http://www.somnoplasty.com/MDframePC.html > You can also find who their accredited practitioners are. The procedure is > to reduce and tighten the tissue. Always remember that weak tissue grows > back. This procedure will not help you long-term. > Having all these procedures carried out in one go is going to be very severe > on you, also your pocket. > I suggest also that you check out the archives under ‘UPPP’ and you will > find that there have been some terrific reports immediately post UPPP, > however the situation worsens as time goes on. There are no peer reviewed > statistics for the success of UPPP for the post op period of 12/18 months. > Ask your surgeon if he can produce such figures, not his figures but those > that have been properly reviewed. > Brian, you are an adult and can make up your own mind, but at least research > it first. After surgery there’s no going back. > Best of luck, > Dan.

Brain,      I’ve had 2 somnoplasty treatments (on both tongue and soft palate) and can tell quite a bit of difference. It is an outpatient procedure, which doesn’t leave the external scarring that a uppp does (and is supposedly the reason for apnea relapse.) I would recommend trying somnoplasty first, as it is the least invasive procedure with the fewest risks as well. If you want to know more about it, feel free to email me.                                Good Luck,                                         Don

Response:

"Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message

news:evdVc.28455$cT6.22031@fe2.columbus.rr.com… – Hide quoted text — Show quoted text -> D. Smyth wrote: > > Hi Brian, > > Tonsillectomy, if they are large and causing problems will certainly do you > > know harm (except that all surgery can be dangerous). For me the UPPP is a > > big no no, as is somnoplasty which is purely a means to have you back to his > > surgery a couple of times with a nice fat fee for each visit. > Actually, because I’d be having all three at once, I’d be under general > anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t > have to go back.

(SNIP) Brian, I think that you may have been misled. Somnoplasty is seldom a one off treatment and is usually carried out at the Doctor’s surgery rather than under general anaesthetic. I am 99% certain that you will have to go back. It’s a real money spinner for the doctor. If you check out the following link you will find that it is an outpatient procedure. http://www.somnoplasty.com/MDframePC.html You can also find who their accredited practitioners are. The procedure is to reduce and tighten the tissue. Always remember that weak tissue grows back. This procedure will not help you long-term. Having all these procedures carried out in one go is going to be very severe on you, also your pocket. I suggest also that you check out the archives under ‘UPPP’ and you will find that there have been some terrific reports immediately post UPPP, however the situation worsens as time goes on. There are no peer reviewed statistics for the success of UPPP for the post op period of 12/18 months. Ask your surgeon if he can produce such figures, not his figures but those that have been properly reviewed. Brian, you are an adult and can make up your own mind, but at least research it first. After surgery there’s no going back. Best of luck, Dan.

Response:

> Actually, because I’d be having all three at once, I’d be under general > anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t > have to go back.

chances are you would have to go back for "revisions" when it doesn’t work as well as they say it will > I’ll definitely be calling my sleep doctor for his opinion.  I remember > some > people on this group saying autopap doesn’t actually work too well. > Does anyone have direct experience with one?

I don’t recall people saying that as a general statement, it’s true that different autopaps work differently for different people and there are pros and cons to using all three types of xPAP machine.  For some people autopap is an excellent solution, for others (eg, those who have apnea but don’t snore) certain types of autopap are pretty much useless – so you can’t place it in one "basket" it needs to be addressed on an individual level. > Thanks for the link, very interesting.  The thing I’ve noticed though, > is that most sites that mention UPPP or other surgeries approach it from > the position the patient wants to get rid of or have an alternative to > CPAP. That’s not my case, I don’t care if I still have to use CPAP after > it, I just want it to make the CPAP work *better*.

unfortunately UPPP isn’t a way to make sure cpap works better and carries with it the risk that cpap will no longer work at all. — Beth in Australia (I am not a qualified medical professional and unless I quote sources anything posted by me is my opinion only and you should always check with your doctor) ============================================= Sleep Disorders Newsgroup FAQ Website http://talhost.net/sleep Newsgroup archives http://www.talhost.net/sleep/archives.htm =============================================

Response:

Operations like the UPPP make CPAP work WORSE, and make them harder to tolerate, so says my sleep doctor. AutoPAP or retitration make a whole lot more sense than surgery, especially since you tolerate CPAP well.  Further, if you’re having problems ("it just doesn’t do enough for me"), then I’d check into other problems.  How does this issue manifest for you?  How do you describe the problems you’re still having?     Gary (like I said elsewhere tonight, we’ll help as much as we can) Rimar "Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message

news:evdVc.28455$cT6.22031@fe2.columbus.rr.com… – Hide quoted text — Show quoted text -> D. Smyth wrote: > > Hi Brian, > > Tonsillectomy, if they are large and causing problems will certainly do you > > know harm (except that all surgery can be dangerous). For me the UPPP is a > > big no no, as is somnoplasty which is purely a means to have you back to his > > surgery a couple of times with a nice fat fee for each visit. > Actually, because I’d be having all three at once, I’d be under general > anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t > have to go back. > >>Now keep in mind that I use a CPAP and don’t mind it. I have very > >>good compliance, it just doesn’t do enough for me. > > If it does some of the job, would a fresh look at this therapy, say autoPAP, > > BiPAP do any good? > I’ll definitely be calling my sleep doctor for his opinion.  I remember some > people on this group saying autopap doesn’t actually work too well. > Does anyone have direct experience with one? >   > In Ireland Provigil is in use with patients who are CPAP compliant > and still > > suffer from Excessive Daytime Sleepiness, until such time as they can sort > > out that problem. In the short term it might help. > That sounds about right. It does help, but I really don’t want to take > it for a long time. >   > Try  http://www.isat.ie/isat_faqs.htm > >     There is a good section on most forms of surgery, with approx success > > rates. > Thanks for the link, very interesting.  The thing I’ve noticed though, > is that most sites that mention UPPP or other surgeries approach it from > the position the patient wants to get rid of or have an alternative to > CPAP. That’s not my case, I don’t care if I still have to use CPAP after > it, I just want it to make the CPAP work *better*. > > Best of luck, > > Dan. > Thanks for the suggestions. All the responses have been informative. > Brian Bebeau

Response:

D. Smyth wrote: > Hi Brian, > Tonsillectomy, if they are large and causing problems will certainly do you > know harm (except that all surgery can be dangerous). For me the UPPP is a > big no no, as is somnoplasty which is purely a means to have you back to his > surgery a couple of times with a nice fat fee for each visit.

Actually, because I’d be having all three at once, I’d be under general anesthesia, so he’d be able to do all 5 treatments at once. I wouldn’t have to go back. >>Now keep in mind that I use a CPAP and don’t mind it. I have very >>good compliance, it just doesn’t do enough for me. > If it does some of the job, would a fresh look at this therapy, say autoPAP, > BiPAP do any good?

I’ll definitely be calling my sleep doctor for his opinion.  I remember some people on this group saying autopap doesn’t actually work too well. Does anyone have direct experience with one?   > In Ireland Provigil is in use with patients who are CPAP compliant and still > suffer from Excessive Daytime Sleepiness, until such time as they can sort > out that problem. In the short term it might help.

That sounds about right. It does help, but I really don’t want to take it for a long time.   > Try  http://www.isat.ie/isat_faqs.htm >     There is a good section on most forms of surgery, with approx success > rates.

Thanks for the link, very interesting.  The thing I’ve noticed though, is that most sites that mention UPPP or other surgeries approach it from the position the patient wants to get rid of or have an alternative to CPAP. That’s not my case, I don’t care if I still have to use CPAP after it, I just want it to make the CPAP work *better*. > Best of luck, > Dan.

Thanks for the suggestions. All the responses have been informative. Brian Bebeau

Response:

Hi Brian, "Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message

news:MpSUc.23900$cT6.20084@fe2.columbus.rr.com… – Hide quoted text — Show quoted text -> Hi all, >    I haven’t had time to keep up with this group much lately, but you > gave me good advice before, and I’m hoping you can do so again. > I’ve had my CPAP since 1996. I have a severe case of sleep apnea and RLS > to boot.  The CPAP has helped, enough to make it worth using, but it’s > never been the panacea for me as it seems to be for some people.  I’m > still having major problems with daytime sleepiness.  I tried a bunch > of medications to calm the RLS, because that’s what my sleep doctor > thought was the problem.  Nothing worked.  I changed doctors last year, > and this one has been trying other things. I had a sleep study a couple > months ago, and my sleep doctor has declared that I have "uncontrollable > sleep apnea".  I still seem to have about 15-20 apnea events an hour > no matter what the pressure (it’s currently 13).  He sent me to an ENTa > because I couldn’t get my nasal passages unclogged with Flonase or > Rhinocort. > I saw the ENT today.  After looking at my throat for 30 seconds, he > wants to do a UPPP/tonsillectomy/somnoplasty.

A very quick decision on his part, particularly when its your body he’s making the decision on. I would be very afraid of anyone making that type of decision after a quick glance down your throat. Tonsillectomy, if they are large and causing problems will certainly do you know harm (except that all surgery can be dangerous). For me the UPPP is a big no no, as is somnoplasty which is purely a means to have you back to his surgery a couple of times with a nice fat fee for each visit. The only published figures that I can come up with on the UPPP is a 50% improvement in 50% of the cases. A friend of mine puts that at about 18/20% success, and these successes appear to be most prevalent in sufferers of mild apnoea. If your apnoea (as you stated in the 2nd paragraph) is severe then if you are one of the lucky ones with a 50% improvement, then you will still need CPAP pot operatively and there is a real danger that you will not be able to use CPAP. The other problem with the UPPP is that you may feel terrific relief for a number of months post operatively. This relief can last for up to and over 12 months in some cases, but unfortunately the apnoea comes back, in some cases it never goes away, just the snoring stops. I had this procedure carried out in 1994, by a very eminent ENT surgeon. It didn’t work and thankfully he referred me to a sleep specialist and I was able to use CPAP. The procedure hasn’t changed that much in 10 years, maybe the method, but it still involves the same tissue being removed. If UPPP doesn’t work you could be looking at a tracheotomy, if you can’t use CPAP.  The UPPP is because he > can’t even see my uvula, because I have "hooding" on my upper palate. > The tonsillectomy is because I have unually large tonsils (doctors > have commented on this before). The somnoplasty is because I have an > unusually large tongue (my dentists always complain about this). > They’ve already scheduled the surgery for next Wedsnesday unless I > cancel.

While having the UPPP my surgeon also took ‘a few slices’ off the base of my tongue, as I too have a large tongue. Didn’t work either. Somnoplasty is unsuccessful (I believe) also. Consider that Somnus tecnologies ‘licence’ certain practitioners, who purchase’ their machines to carry out this procedure. On this side of the pond it is only in use in private medicine. Can they give you any guarantees, or will they refund your fees if it doesn’t work….I think not. > Now keep in mind that I use a CPAP and don’t mind it. I have very > good compliance, it just doesn’t do enough for me.

If it does some of the job, would a fresh look at this therapy, say autoPAP, BiPAP do any good?  Surgery is not > the first resort.  Will the surgery actually do anything for me, > considering my circumstances? Even if I still have to keep using > the CPAP, that’s okay, as long as I *stop falling asleep during the > day*.

In Ireland Provigil is in use with patients who are CPAP compliant and still suffer from Excessive Daytime Sleepiness, until such time as they can sort out that problem. In the short term it might help.  I had remembered reading here some time ago, people saying > the tissue would grow back, but he says it won’t. Is there a > particular type of person this surgery would actually be good for?

UPPP has proved successful in stopping snoring in patients who do not have sleep disordered breathing, and maybe in those with very mild apnoea. > I’m thinking of getting a second opinion because he seemed to be > in quite a hurry to do this.

Once again I doubt if they will refund your fees in the event of failure. I don’t know your age, but a tonsilectomy on its own gets tougher the older you get.  Any advice, tips, URLS, opinions, > whatever, are welcome.

Try  http://www.isat.ie/isat_faqs.htm     There is a good section on most forms of surgery, with approx success rates.  FWIW, and I am anti surgery (and don’t apologise for it) I would suggest having the tonsillectomy and if your septum is any way deviated or blocked to have it straightened. Allow yourself time to heal and try the CPAP route again. Possibly another sleep study when the swelling etc has gone down and have your sleep doc give you something to help the EDS while you are sorting out that problem. If going down this road you must give firm written instructions to the cutter to leave your uvula and soft palate alone. Just the tonsils. Personally, from what you have said, I don’t like his attitude. Rushing something like this is not a good idea. Keep us informed, one way or the other. We won’t bite………….well at least I won’t Best of luck, Dan.

Response:

"Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message

news:MpSUc.23900$cT6.20084@fe2.columbus.rr.com… – Hide quoted text — Show quoted text -> Hi all, >    I haven’t had time to keep up with this group much lately, but you > gave me good advice before, and I’m hoping you can do so again. > I’ve had my CPAP since 1996. I have a severe case of sleep apnea and RLS > to boot.  The CPAP has helped, enough to make it worth using, but it’s > never been the panacea for me as it seems to be for some people.  I’m > still having major problems with daytime sleepiness.  I tried a bunch > of medications to calm the RLS, because that’s what my sleep doctor > thought was the problem.  Nothing worked.  I changed doctors last year, > and this one has been trying other things. I had a sleep study a couple > months ago, and my sleep doctor has declared that I have "uncontrollable > sleep apnea".  I still seem to have about 15-20 apnea events an hour > no matter what the pressure (it’s currently 13).  He sent me to an ENTa > because I couldn’t get my nasal passages unclogged with Flonase or > Rhinocort. > I saw the ENT today.  After looking at my throat for 30 seconds, he > wants to do a UPPP/tonsillectomy/somnoplasty.  The UPPP is because he > can’t even see my uvula, because I have "hooding" on my upper palate. > The tonsillectomy is because I have unually large tonsils (doctors > have commented on this before). The somnoplasty is because I have an > unusually large tongue (my dentists always complain about this). > They’ve already scheduled the surgery for next Wedsnesday unless I > cancel. > Now keep in mind that I use a CPAP and don’t mind it. I have very > good compliance, it just doesn’t do enough for me. Surgery is not > the first resort.  Will the surgery actually do anything for me, > considering my circumstances? Even if I still have to keep using > the CPAP, that’s okay, as long as I *stop falling asleep during the > day*.  I had remembered reading here some time ago, people saying > the tissue would grow back, but he says it won’t. Is there a > particular type of person this surgery would actually be good for? > I’m thinking of getting a second opinion because he seemed to be > in quite a hurry to do this. Any advice, tips, URLS, opinions, > whatever, are welcome. You all gave me good advice about switching > to the Breeze headgear a couple years ago, so I’m hoping for more. > Thanks. > Brian Bebeau > Remove NOSPAM from addr to reply.

The chances are good that if you go through with the UPPP you wont be able to use a CPAP later. I don’t care for those odds, do you? One thing you ought to be doing is asking for an autopap. Resmed make good ones for example. You may find that the autopap, which ramps pressure up per event and thus changes to meet the need of individual events is exactly the ticket. Try that before an operation. If it doesn’t work, your only other viable choice is a tracheostomy but learn about what can happen when you have one before getting it done.

Response:

Brian, I have had all three of those procedures and the results were excellent for ME. YMMV. About 18 months ago I did the UPPP, tonsils and had a deviated septum corrected with nasal polyps removed and tubinates shrunken.  When I woke up in recovery I could already feel the difference and over time it got even better. The only painful post op part of the procedure was the tonsils which hurt for a couple of weeks but was manageable. The UPPP and nasal work were virtually painless.  I sleet better and longer, do not feel tired or spaced out during the day and my snoring was significantly reduced. That being said, A sleep study at the 1 year mark showed substantial improvement except during REM sleep when apnea episodes still occured at a potentially dangerous level.  To work on that, I underwent a genioglossus tongue advancement plus somnoplasty about 10 days ago.  Very little post op discomfort.  Within a couple of days my wife reported that I am not snoring at all and at most have a little heavy breathing at times.  I am sleeping well and feel good all day.  I know that some in this group are dead set against these procedures and their opinions have merit too. However, if a pipe (airway) is clogged as mine was and yours is, the best way to open it is to unclog it.  That’s what surgery can do. Keep in mind that there is no cure for sleep apnea – just steps for improvement.  In my case the improvement has been excellent and I sleep well without the use of an appliance. As I travel a lot the CPAP was not an attractive alternative for me.  I felt that the risks associated with surgery were worth the chance that I would get substantial improvement to at least get out of the "danger zone." My wife is sleeping better too. It was definitely worth it and I would do it again! "Brian Bebeau" <BrianBeb…@worldnet.NOSPAMatt.net> wrote in message

news:MpSUc.23900$cT6.20084@fe2.columbus.rr.com… – Hide quoted text — Show quoted text -> Hi all, >    I haven’t had time to keep up with this group much lately, but you > gave me good advice before, and I’m hoping you can do so again. > I’ve had my CPAP since 1996. I have a severe case of sleep apnea and RLS > to boot.  The CPAP has helped, enough to make it worth using, but it’s > never been the panacea for me as it seems to be for some people.  I’m > still having major problems with daytime sleepiness.  I tried a bunch > of medications to calm the RLS, because that’s what my sleep doctor > thought was the problem.  Nothing worked.  I changed doctors last year, > and this one has been trying other things. I had a sleep study a couple > months ago, and my sleep doctor has declared that I have "uncontrollable > sleep apnea".  I still seem to have about 15-20 apnea events an hour > no matter what the pressure (it’s currently 13).  He sent me to an ENTa > because I couldn’t get my nasal passages unclogged with Flonase or > Rhinocort. > I saw the ENT today.  After looking at my throat for 30 seconds, he > wants to do a UPPP/tonsillectomy/somnoplasty.  The UPPP is because he > can’t even see my uvula, because I have "hooding" on my upper palate. > The tonsillectomy is because I have unually large tonsils (doctors > have commented on this before). The somnoplasty is because I have an > unusually large tongue (my dentists always complain about this). > They’ve already scheduled the surgery for next Wedsnesday unless I > cancel. > Now keep in mind that I use a CPAP and don’t mind it. I have very > good compliance, it just doesn’t do enough for me. Surgery is not > the first resort.  Will the surgery actually do anything for me, > considering my circumstances? Even if I still have to keep using > the CPAP, that’s okay, as long as I *stop falling asleep during the > day*.  I had remembered reading here some time ago, people saying > the tissue would grow back, but he says it won’t. Is there a > particular type of person this surgery would actually be good for? > I’m thinking of getting a second opinion because he seemed to be > in quite a hurry to do this. Any advice, tips, URLS, opinions, > whatever, are welcome. You all gave me good advice about switching > to the Breeze headgear a couple years ago, so I’m hoping for more. > Thanks. > Brian Bebeau > Remove NOSPAM from addr to reply.

Response:

Hi all,    I haven’t had time to keep up with this group much lately, but you gave me good advice before, and I’m hoping you can do so again. I’ve had my CPAP since 1996. I have a severe case of sleep apnea and RLS to boot.  The CPAP has helped, enough to make it worth using, but it’s never been the panacea for me as it seems to be for some people.  I’m still having major problems with daytime sleepiness.  I tried a bunch of medications to calm the RLS, because that’s what my sleep doctor thought was the problem.  Nothing worked.  I changed doctors last year, and this one has been trying other things. I had a sleep study a couple months ago, and my sleep doctor has declared that I have "uncontrollable sleep apnea".  I still seem to have about 15-20 apnea events an hour no matter what the pressure (it’s currently 13).  He sent me to an ENTa because I couldn’t get my nasal passages unclogged with Flonase or Rhinocort. I saw the ENT today.  After looking at my throat for 30 seconds, he wants to do a UPPP/tonsillectomy/somnoplasty.  The UPPP is because he can’t even see my uvula, because I have "hooding" on my upper palate. The tonsillectomy is because I have unually large tonsils (doctors have commented on this before). The somnoplasty is because I have an unusually large tongue (my dentists always complain about this). They’ve already scheduled the surgery for next Wedsnesday unless I cancel. Now keep in mind that I use a CPAP and don’t mind it. I have very good compliance, it just doesn’t do enough for me. Surgery is not the first resort.  Will the surgery actually do anything for me, considering my circumstances? Even if I still have to keep using the CPAP, that’s okay, as long as I *stop falling asleep during the day*.  I had remembered reading here some time ago, people saying the tissue would grow back, but he says it won’t. Is there a particular type of person this surgery would actually be good for? I’m thinking of getting a second opinion because he seemed to be in quite a hurry to do this. Any advice, tips, URLS, opinions, whatever, are welcome. You all gave me good advice about switching to the Breeze headgear a couple years ago, so I’m hoping for more. Thanks. Brian Bebeau Remove NOSPAM from addr to reply.

Response:

sleep disorder connections..

Question:

Hello all, I might only pop in once or twice a year, but there’s always someone here that has an answer  I’d like to think my anxiety has been under control for a few years. Sure, I’d consider myself high strung, but nothing like I used to be during the full blown panic and anxiety years. My major complaint to my primary doc for the last three years has been what I can best describe as excessive day time sleepiness – nearly dibilitating during the months of September – February when there is less sunlight. We’ve looked at several possibilities from Seasonal Affective Disorder (but I don’t have the depression) to Chronic Fatigue Syndrome (I don’t have the joint pain) and we’re making some headway now that I’ve given in and consented to have a sleep disorder evalution next month. Several sites I’ve come across refer to an anxiety and sleep disorder connection. I’ve put myself on a mega supplement and dietary regimin about 4 weeks ago in hopes of warding off what I know is inevitable come autumn. I  eat a lot of fish, yogurt, wheat germ, raw fruits and veggies, etc. I’ve combined various supplements for stress/smoking/anxiety/CFS/poor appetite/and low energy and am now on everything from free form amino acids, to Vit A, 100mgs of each Vit B. Vit C, Coenzyme Q10, Omega 3 fatty acid, Calcium and I’m starting GABA in about two weeks. As a sidenote, I was surprised to learn L-tryptophan is not available in the US – I remember hearing about it in my search for *cures* for anxiety a few years ago. Anyway, I’m trying to gather info on the connection between neuro-transmitters and sleep disorders. Getting down to the nitty gritty, I’m trying to figure out what is really going on when I think I’m sleeping soundly, but apparently I am not (accounting for the day time exhaustion.) Any thoughts anyone? Thanks as always, Kath — The charter is available at:

Does sleep apnea mean an automatic driving ban in the UK?

Question:

I don’t know if it’s automatic – it most likely depends on the symptoms your friend is displaying, and the good news is that once it’s successfully treated (which IS possible) it won’t be considered a problem at all. Regardless of the driving problems, it’s vitally important your friend gets tested, and if diagnosed, treated.  Long term, if left untreated, apnea can be fatal – it affects your heart and your brain – as any method of oxygen deprivation would – especially long term. Do whatever it takes to get her to a sleep doc. Beth in Australia "Alasdair Baxter" <l…@llb.me.uk> wrote in message

news:kp0ga0lgkunqaldsfr87mq8f38pd3h957a@4ax.com… – Hide quoted text — Show quoted text ->A friend of mine suffers from sleep apnea, or so she claims, but she > refuses to visit her GP because she claims that a positive diagnosis > means an automatic disqualification from driving. > Is this the case, anyone? > — > Alasdair Baxter, Nottingham, UK.Tel +44 115 9705100; Fax +44 115 9423263 >        "It’s not what you say that matters but how you say it. >         It’s not what you do that matters but how you do it"

Response:

On Mon, 17 May 2004 01:13:50 +0100, Alasdair Baxter <l…@llb.me.uk> wrote: >A friend of mine suffers from sleep apnea, or so she claims, but she >refuses to visit her GP because she claims that a positive diagnosis >means an automatic disqualification from driving. >Is this the case, anyone?

I live in the UK, have OSA and went through this issue a few months ago. A positive diagnosis of OSA, as well as other sleep disorders does *not* mean an automatic disqualification from driving. However, after a diagnosis it is a legal requirement to inform the DVLA – not doing so is a criminal offence which can carry a custodial sentence. There is a lot of information on this on the DVLA web site in the medical section. The important point is that the DVLA will only withdraw a license if the condition is untreated.    If it is treated, then they do not. For a person who does not drive professionally, they will often accept a written declaration from the patient, but may check with the consultant.   For a professional driver (e.g. lorry, bus, taxi etc), they may require follow up on a regular basis. The situation is not as bad as it sounds and the DVLA is simply acting in the public interest. In practical terms, events run as follows: – Patient visits GP and discusses condition. Asks for NHS or private referral.  Almost invariably in the UK, this is going to be a pulmonologist (respiratory specialist).    If the person is driving for their job, it may be possible to get an early NHS referral. Private medical insurance will cover consultation and an overnight sleep study. – Patient sees consultant who will typically arrange sleep study, but will also do some basic respiratory tests such as flow.   They may also do an Epworth Sleepiness Test.   this is a questionnaire tha tcan be downloaded from the internet and done oneself.  If honestly answered, it is not a bad indicator. – Patient undergoes overnight study and follow up with consultant. At this point, if OSA is diagnosed, the typical treatment is nasal Continuous Positive Airway Pressure equipment (CPAP or nCPAP). This is considered by most pulmonologists to be the gold standard because it is normally effective and is noninvasive.   Surgery in the throat area such as UPPP is now pretty much deprecated in the UK. CPAP equipment is available through the NHS but can be purchased as well – cost is in the

Haven't Been Dreaming

Question:

I didn’t even realize it until I finally had a dream – that I hadn’t had one in quite a while! Is it possible my pressure needs to go up?  I just saw my doctor in January….I’ve been stressed a lot and hadn’t realized until now… I know I never dreamt pre-CPAP…..I’ve been losing weight could this be a factor?  Thinking maybe with the neck muscles, tighter, it takes more pressure to force the air through…. Any thoughts?

Response:

"Nuala" <Nu…@nobody.com> wrote in message

news:FJHec.134411$Bk31.43920@twister01.bloor.is.net.cable.rogers.com… > I didn’t even realize it until I finally had a dream – that I hadn’t had one > in quite a while! > Is it possible my pressure needs to go up?  I just saw my doctor in > January….I’ve been stressed a lot and hadn’t realized until now… > I know I never dreamt pre-CPAP…..I’ve been losing weight could this be a > factor?  Thinking maybe with the neck muscles, tighter, it takes more > pressure to force the air through…. > Any thoughts?

     Everyone dreams every night.  It’s essental to your’e health so you have been dreaming.  Sleep apnea sufferers get their REM (dream sleep) inturrupted alot which is one great thing about CPAP.  I know that weight loss can decrease snoring just as gaining weight can increase it. Dean

Response:

You won’t remember your dreams unless you wake up during one. Before cpap, you probably had little REM sleep, the part of sleep when dreams occur. When I first started CPCP, I was amazed at the number of dreams I had while getting caught up on sleep debt. Now that I am getting used to CPAP (4 months), I am sleeping better and not waking as often during REM. As a result, I don’t remember the dreams. I know I’m sleeping better, because I no longer have excessive daytime sleepiness or other symptoms of OSA. Mention your observation to your sleep doc. Good work on the weight loss! Although it probably won’t cure your OSA, it may make it less severe, or reduce your pressure requirement. Like sleep, excess weight is related to many health issues. Mention your weight loss to your sleep doc, too. It may warrant an additional sleep study. You’ll probably get some well-deserved congratulations from the doc as well. – Hide quoted text — Show quoted text -Nuala wrote: > I didn’t even realize it until I finally had a dream – that I hadn’t had one > in quite a while! > Is it possible my pressure needs to go up?  I just saw my doctor in > January….I’ve been stressed a lot and hadn’t realized until now… > I know I never dreamt pre-CPAP…..I’ve been losing weight could this be a > factor?  Thinking maybe with the neck muscles, tighter, it takes more > pressure to force the air through…. > Any thoughts?

Response:

actually, that’s not strictly true, we see plenty people here who have a sleep study and are diagnosed with apnea or some other sleep disorder who don’t get any REM sleep, of course, that’s not "normal" You’re right in that people who don’t have sleep disorders (and plenty who do) do dream every night – it’s only when we wake up in the middle of a dream we remember it. Beth — "Killroy97" <killro…@yahoo.com> wrote in message

news:uUJec.25374$hd3.21235@nwrddc03.gnilink.net… – Hide quoted text — Show quoted text -> "Nuala" <Nu…@nobody.com> wrote in message > news:FJHec.134411$Bk31.43920@twister01.bloor.is.net.cable.rogers.com… > > I didn’t even realize it until I finally had a dream – that I hadn’t had > one > > in quite a while! > > Is it possible my pressure needs to go up?  I just saw my doctor in > > January….I’ve been stressed a lot and hadn’t realized until now… > > I know I never dreamt pre-CPAP…..I’ve been losing weight could this be a > > factor?  Thinking maybe with the neck muscles, tighter, it takes more > > pressure to force the air through…. > > Any thoughts? >      Everyone dreams every night.  It’s essental to your’e health so you > have been dreaming.  Sleep apnea sufferers get their REM (dream sleep) > inturrupted alot which is one great thing about CPAP.  I know that weight > loss can decrease snoring just as gaining weight can increase it. > Dean

Response:

dexa-rhinaspray

Question:

Hi folks, I’m hoping some of you kind people may be able to give me the benifit of your experience… I saw my gp for the first time about my snoring/lack of sleep. I explained that I was feeling continually tired and that I was concerned because of the resulting stress. I told my gp that I am a snorer, and that I had tried to ease the situation myself, with limited success. I don’t smoke (gave up 18months ago)  and am not overweight. I snore when I breath through my mouth, and my wife reported that I snore less when I have used a nasal decongestant spray, and used breath-right strips, although I still feel tired. Most nights I wake up around about 2-3am, and wonder wether I have woken myself snoring, but have no way of telling, sometimes I get back to sleep quickly, often not). I have checked with my wife to see if I stop breathing at all, but she says I don’t (she’s still waiting :-0) My gp asked if I had hay fever, which I don’t. I was then given a prescription for Dexa-Rhinaspray Duo, a nasal spray, and told I would probably have to take it (one puff in each nostril, twice a day) for upto a year. I’ve taken this stuff for two days now and have snored badly both nights (early days I realise). Also everything I’ve read about this stuff makes great play about not using it long term . I think (know) I should have asked my gp more questions, instead of meekly being rushed through as usual. I will continue with the dexa-rhinaspray for the time being to see if it really can help me and my long suffering wife. Has anyone else any experience of this stuff to treat snoring? Did or are you using it long term? Any comments, help or advice much appreciated. best wishes and many thanks in advance, Onki

Response:

On Thu, 8 Apr 2004 18:31:54 +0100, "Onki" <o…@dsl.pipex.com> wrote: >Hi folks, >I’m hoping some of you kind people may be able to give me the benifit of >your experience… >I saw my gp for the first time about my snoring/lack of sleep.

It is possible that you are experiencing a level of obstructive sleep apnoea. >I explained that I was feeling continually tired and that I was concerned >because of the resulting stress.

This is one symptom but one can’t say that there is a 100% correlation each way. >I told my gp that I am a snorer, and that I >had tried to ease the situation myself, with limited success.

This can be another factor, but it is possible to have OSA and not snore and vice versa. > I don’t smoke >(gave up 18months ago)  and am not overweight.

Another indicator but again not completely causative. >I snore when I breath through >my mouth, and my wife reported that I snore less when I have used a nasal >decongestant spray, and used breath-right strips, although I still feel >tired.

There’s a clue there.   If you are feeling tired that is a strong indicator whether or not you snore. >Most nights I wake up around about 2-3am, and wonder wether I have >woken myself snoring, but have no way of telling, sometimes I get back to >sleep quickly, often not). I have checked with my wife to see if I stop >breathing at all, but she says I don’t (she’s still waiting :-0)

Do you need to take a leak when you wake up in the middle of the night?   This again is an OSA indicator.   Basically the frequent arousals from sleep result in the body behaving in this area as though it’s daytime. >My gp asked if I had hay fever, which I don’t. I was then given a >prescription for Dexa-Rhinaspray Duo, a nasal spray, and told I would >probably have to take it (one puff in each nostril, twice a day) for upto a >year. >I’ve taken this stuff for two days now and have snored badly both nights >(early days I realise). Also everything I’ve read about this stuff makes >great play about not using it long term .

Decongestant drugs generally are bad news, especially for long term use.     A decongestant may help clear the nose, but obstructive apnoea is as a result of the soft tissues in the airway collapsing during sleep. >I think (know) I should have asked my gp more questions, instead of meekly >being rushed through as usual.

Ask for a longer appointment and a referral to a sleep clinic.  Don’t accept no for an answer. This is no joke.    OSA is a potentially serious medical condition. The poor sleep situation can lead to excessive daytime sleepiness. This is an obvious danger for driving and operating machinery.    In fact in the UK it is illegal to drive with untreated sleep disorders and can carry a prison sentence.    Insurances can be voided. Moreover, on a longer term basis, the oxygen desaturation substantially increases risk of stroke and heart diseases as well as hypertension.    Do some Googling and you will find plenty of references. One thing that you can do as a simple test at home is an Epworth Sleepiness Test.    This sounds a bit of a joke when you read it, but it is a surprisingly good indication of whether investigation is needed.   There are multiple reasons for daytime sleepiness, but from what you are describing it sounds all too familiar. Do this test without thinking about it too much and also ask your wife to score you separately as best she can.  Then compare notes.  Be honest. http://www.stanford.edu/~dement/epworth.html > I will continue with the dexa-rhinaspray for >the time being to see if it really can help me and my long suffering wife. >Has anyone else any experience of this stuff to treat snoring? Did or are >you using it long term? Any comments, help or advice much appreciated.

Basically don’t.  Try it for a week or two and see if sleepiness improves.   I hope it does, but I’d be willing to almost bet that it won’t make a big difference. Don’t waste time on snake oil treatments like chinstraps that purport to cure snoring,    They are not at all a good plan. Unfortunately sleep disordered breathing is not sexy medicine so in the decrepit NHS it does not get the funding it deserves. If improvement is not happening, then squeeze the GP very hard on this and seek an early appointment with a sleep specialist or if not a pulmonologist doing work in this area.     Don’t look at any surgical interventions that might be suggested by an ENT specialist without researching very throughly.   These have a very poor success rate. >best wishes and many thanks in advance, >Onki

.andy To email, substitute .nospam with .gl

Response:

- Hide quoted text — Show quoted text -On Sat, 10 Apr 2004 22:13:39 +0100, "Onki" <o…@dsl.pipex.com> wrote: >"Quick" <dhorw…@NOSPAMcisco.com> wrote in message >news:1081471934.517381@sj-nntpcache-3… >> "Andy Hall" <an…@hall.nospam> wrote >> > Do you need to take a leak when you wake up in the middle of the >> > night?   This again is an OSA indicator.   Basically the frequent >> > arousals from sleep result in the body behaving in this area as though >> > it’s daytime. >> I was going to ask the same question. >> I think the reason is a bit more sinister though. A pulmonologist >> told me that it is due to the heart being stressed. >> Lack of O2 stresses the heart. >> Your body responds by dumping fluids to reduce the >> stress on the heart. >> -Quick >Hi folks, >thanks Andy and Quick for your help. >The need to take a leak when I wake during the night is not usual for me, >only about 20% time. Often I feel thirsty though, which I’ve always put down >to breathing through my mouth. >I tried the Epworth test, then asked my wife to see how she rated me. I >scored me at 8 and my wife scored me at 7.

Hmm.   Average but not brilliant. >Driving is a concern, as it makes up a considerable chunk of my working >life, though I have never felt in danger of nodding off, I do feel that my >reactions must be slower than if I were better rested. I did tell my GP that >this concerned me as I cover about 30k miles a year.

OK. One thing to be aware about is that if you are diagnosed with a sleeping disorder, you *must* tell the DVLA (criminal offence if you don’t).         You can do this once you have seen a specialist and treatment is organised if needed . There is a form on the DVLA web site in the medical section which you can fill in and send to them. THey may contact the specialist, but will then write back confirming all is OK.    Obviously don’t do this unless/until there is a diagnosis.    As long as any symptoms of daytime sleepiness are controlled they will be OK. Another important thing is then to inform your motor insurers.    I have two insurances and both insurers said that they were OK as long as the DVLA is OK. I don’t trust insurance companies, so I made both write a confirming letter. – Hide quoted text — Show quoted text ->I have had a look at some web sites, which have raised a few things for me. >Although she says I dont stop breathing, my wife has told me that my snoring >gets progressively louder then sometimes I "snort and snuffle like a pig >looking for truffles" then shut up or wake up, which makes me wonder if >perhaps I am working to get some air at that point. She will pay careful >attention where possible to see if I am stopping breathing or not – usually >she’s too busy kicking or shaking me to get me to face away from her to >reduce the volume a bit (I can be heard all around the house, and prob. by >neighbours). >Another interesting thing I came across were several references to night >sweats. Sometimes my legs sweat so badly that my side of the bed is soaked. >The rest of me doesn’t suffer (this is definately sweat people!), but I’ve >always put it down to being too warm. On a hot day my legs will drip with >sweat while the rest of me is okay, and as such I never mentioned this to my >GP.

When you see a specialist, I would mention it then.     I had the same problem, but it was fairly generic.   >anyhow, it would seem that a sleep study would be a very good thing, and >hopefully will show what I’m dealing with here.

Yes it would.   At a guess, based on what you’ve said and comparison you might have a fairly mild sleep apnoea. Do you have private medical insurance?    Typically they will pay for diagnosis but normally not for treatment.       If you have to rely on the NHS, then I would enlist the help of the GP that early diagnosis and possible treatment is important for your job… >Incidently, I forgot (too tired?) to take the dexa-rhinaspray last night but >will stick with it for the time being (upto 14 day max) and insist on sleep >study referal from my GP. >many thanks and best wishes to all,

You’re very welcome, and do come back and say how you got on or ask again if you need help/pointers. >Onki

.andy To email, substitute .nospam with .gl

Response:

"Andy Hall" <an…@hall.nospam> wrote > Do you need to take a leak when you wake up in the middle of the > night?   This again is an OSA indicator.   Basically the frequent > arousals from sleep result in the body behaving in this area as though > it’s daytime.

I was going to ask the same question. I think the reason is a bit more sinister though. A pulmonologist told me that it is due to the heart being stressed. Lack of O2 stresses the heart. Your body responds by dumping fluids to reduce the stress on the heart. -Quick

Response:

"Quick" <dhorw…@NOSPAMcisco.com> wrote in message

news:1081471934.517381@sj-nntpcache-3… – Hide quoted text — Show quoted text -> "Andy Hall" <an…@hall.nospam> wrote > > Do you need to take a leak when you wake up in the middle of the > > night?   This again is an OSA indicator.   Basically the frequent > > arousals from sleep result in the body behaving in this area as though > > it’s daytime. > I was going to ask the same question. > I think the reason is a bit more sinister though. A pulmonologist > told me that it is due to the heart being stressed. > Lack of O2 stresses the heart. > Your body responds by dumping fluids to reduce the > stress on the heart. > -Quick

Hi folks, thanks Andy and Quick for your help. The need to take a leak when I wake during the night is not usual for me, only about 20% time. Often I feel thirsty though, which I’ve always put down to breathing through my mouth. I tried the Epworth test, then asked my wife to see how she rated me. I scored me at 8 and my wife scored me at 7. Driving is a concern, as it makes up a considerable chunk of my working life, though I have never felt in danger of nodding off, I do feel that my reactions must be slower than if I were better rested. I did tell my GP that this concerned me as I cover about 30k miles a year. I have had a look at some web sites, which have raised a few things for me. Although she says I dont stop breathing, my wife has told me that my snoring gets progressively louder then sometimes I "snort and snuffle like a pig looking for truffles" then shut up or wake up, which makes me wonder if perhaps I am working to get some air at that point. She will pay careful attention where possible to see if I am stopping breathing or not – usually she’s too busy kicking or shaking me to get me to face away from her to reduce the volume a bit (I can be heard all around the house, and prob. by neighbours). Another interesting thing I came across were several references to night sweats. Sometimes my legs sweat so badly that my side of the bed is soaked. The rest of me doesn’t suffer (this is definately sweat people!), but I’ve always put it down to being too warm. On a hot day my legs will drip with sweat while the rest of me is okay, and as such I never mentioned this to my GP. anyhow, it would seem that a sleep study would be a very good thing, and hopefully will show what I’m dealing with here. Incidently, I forgot (too tired?) to take the dexa-rhinaspray last night but will stick with it for the time being (upto 14 day max) and insist on sleep study referal from my GP. many thanks and best wishes to all, Onki

Response: