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Thursday, February 20, 2014

Brain Congestion and Sleep Apnea

For the last 3 months, or so, I have had random frightening episodes, where my lungs simply don't take a breath as I am going to sleep.  I do not have obstructive sleep apnea.  I'm just slightly overweight, but my throat does not close up and I am not gasping for breath due to feeling smothered.  I just seem to "forget" to take a breath as I am drifting away to sleep.  This, then, wakes me up into a startle and then it takes two more hours to calm down enough to get to sleep.

First I looked into anxiety as being the possible cause, and it still could be.

However, so far, I have found a solution that works.

The reason I am writing about this on my "heart health" blog is because the type of sleep apnea I suffer from seems to be more related to "central sleep apnea" and not obstructive sleep apnea, and very often this is blamed on congestive heart failure.

Well,  I don't think I have heart failure.  I'm only 47 and only slightly overweight, and I can run up two flights of stairs without getting breathless and can jog without feeling short of breath.  I have a lot of energy.  My understanding of heart failure is that a person feels fatigue.  I don't. 

I also do not have any edema in my legs, which is also a heart failure symptom.

I am also writing about this on my heart health blog because sleep apnea puts a strain on the heart, and for people like me who suffer from SVT's and PVC's, lack of sleep is one of the triggers for these heart arrhythmias of mine.

One morning after suffering from a very anxiety filled night of no sleep due to not being able to breath, I prayed with my whole soul to find a solution to my problem.

I know that the safest route for me is to get a sleep study and consider doctor recommendations, but I can't afford the $1000's of dollars of testing to find out what I already know, that I am having breathing troubles, and that I need a solution.  Sleep studies are very expensive, and getting a CPAP is very expensive, so I prayed hard for ideas on how to approach this problem.

The answer came to be conservative and look up what I could find on Google about the relationship between "central sleep apnea" and sleep positions.

What I found, so far seems to be an answer to prayer
.  Here I interrupt myself for my readers to say that if this does not continue to work, I will get a sleep study and talk to a doctor and follow his recommendations.  I also interrupt myself here to say that if you have sleep apnea, I am not giving you advice, I am only telling you a story about myself and the story is not over yet.  I still may have a doctor visit in my future.

Anyway, I found the following article which seemed to explain my problem exactly......

This statement first caught my eye.....

"Sometimes, the practices taught by our culture can impact on the way our bodies function. As medical anthropologists, we research ways our cultural practices may be affecting our health. And we have found that the way we have been trained to sleep may be one of the most important causes of various diseases plaguing our society."

The next four paragraphs seemed to explain what was happening to me.....

"We all have had a time of experiencing dizziness or lightheadedness when getting out of bed too quickly. This effect is called orthostatic hypotension, and results from the fact that blood pressure falls when you lie down, and sudden raising of the head may temporarily deprive the brain of sufficient blood pressure, resulting in the dizziness or lightheadedness. The blood pressure soon rises, increasing the blood supply to the brain, as you feel normal again."

"This phenomenon shows that the body's position, relative to gravity, influences head and brain circulation. You can also demonstrate this by doing a head stand, which many yoga practitioners do daily. Intracranial pressure rises dramatically, as blood rushes to the head, which becomes beet red, and the neck veins swell out, as blood pools in the venous system."

"But apart from these examples, very little, if anything, is mentioned in medical physiology textbooks about gravity and its impact on circulation. Yet, you cannot fully understand brain circulation without considering gravity."

"The effect of gravity on brain circulation is purely mechanical, and relates to the position of the head relative to the pumping heart. When we are standing up, the head is above the heart, so blood must pump against the force of gravity -- from the heart to the brain -- lowering the effective pressure with which the arterial blood is delivered to the brain. Meanwhile, drainage of blood from the brain to the heart is facilitated by the pull of gravity."

As I read this, I begin to understand something, that my lying flat in bed, is not only causing problem with my digestive system, but also contributing congestion to my brain.

Another cause of "central sleep apnea" is brainstem malfunction.  Because I can lie on my back awake for a long time without feeling breathless, I had a hard time believing that my heart was the main problem here, and my feeling was that something was not fully functioning in my brain either.  My feeling was that something was missing in the communication of my brain to my lungs when my breathing was totally dependent on an involuntary function.

My layman's or laywoman's theory was the breathing trouble started as my consciousness transfered to the subsconcious in drifting off.

Continuing on with the article, it seemed to explain what was occuring with the breathing center of my brain while trying to sleep that didn't seem to be a problem for me while I was awake, because that was the question, "Why does my breathing seem to be great while I'm awake, and deathly dystfunctional while I'm trying to fall asleep?"

Here was the sensible explanation, "There are two ways by which sleep position can cause sleep apnea. First, if you are on your back and flat, this unnatural position allows the tongue to fall back and block the throat, causing snoring and obstruction of the airways. This is the cause of obstructive sleep apnea.""

"Second, brain edema from sleeping too flat for too long may make the brain stem sluggish and slightly dysfunctional. (I like this term, slightly dysfunctional) The brain stem is the part of the brain that controls breathing. This leads to difficulties in breathing, especially when the head is down while sleeping and getting further congested."

"This is the cause of central sleep apnea. Head elevation has already been used to treat obstructive sleep apnea, although it has been underutilized as a therapy in favor of more costly alternatives, such as the surgical removal of parts of the throat.

We believe head elevation should be tried first for all forms of sleep apnea, including central sleep apnea."

This made so much sense to me, because it seemed to fit my situation exactly.  They didn't say that heart failure was the cause, but inability of the body to rid the head of the extra blood pooling into the brainstem putting pressure on the nerves of the breathing center of the brain.  Could it be that the heart is damaged and can no longer push the blood out of the brainstem area?  

That was the first question I asked myself. But, the article states that the atrium is assisted by gravity to suck the fluids from the brain.

Here's further information from the article.....

"Of course, the body is intelligent and has mechanisms for controlling brain pressure under different gravity situations. When the brain gets pressurized from lying down, there are various pressure receptors in the head and neck designed to lower blood pressure, thereby preventing too much brain pressure and the possibility of blowing a blood vessel or creating a cerebral aneurysm. This is why blood pressure is lower when we are sleeping, and horizontal."

"But these brain mechanisms for adjusting pressure have their limits. As we go through the day in a vertical position, gravity relentlessly pulls our body's fluids downwards, which is why many people have swollen feet and ankles by day's end. Once we lie down, the gravity effect is lost, as fluid leaves the legs and returns to the head. So despite our brains normal defense mechanisms, throughout the night intracranial pressure increases and is highest in the morning, after hours of lying flat, and lowest at the end of the day, after hours of being vertical."

"What happens when intracranial pressure is high from long periods of lying flat? The increased arterial pressure causes extra cerebral spinal fluid to form in the brain's ventricles, increasing intracranial fluid pressure. The ventricles swell and the cells of the brain become bathed in excess fluid, essentially causing brain edema. This edema would lower the available oxygen and sugar for brain cells. "

"The lack of gravity assisted drainage from the brain would cause a back-up of blood in the venous system and collecting sinuses in the brain. The brain's circulation would become relatively stagnant, as the only force moving blood through would be the pushing force of the arterial pressure (which is greatly reduced after going through the cerebral circulation) and the sucking force of the heart's right atrium. And in addition to the brain swelling under the pressure, the eyes, ears, face, sinuses, gums -- the entire head -- will become pressurized and the tissues congested with fluid!"

The authors put their theories to work in studying 100 people who have migraines as they theorized also that migraine sufferers are impacted by lying flat, as well.  They studied their sufferers by having the sleep with there upper body elevated at a 30% angle.  Most of the sufferers experienced relief.  

After their study in migraine patients they started to theorize how many common problems like hypoglycemia, ADHD, and even effects caused by autoimmune disorders in relationship to the blood/brain barrier could be lessened by decreasing intracranial pressure by an inclined sleeping position.  I was amazed at the list, and could see how lying flat could actually be the cause of some of my children's health issues.  

So, I have been lying flat for 6 days now and here are the benefits I have already experienced....

1.  24 of the six nights I have slept 6 - 8 hours with uninterrupted sleep.  (2 of those 6 nights were interrupted by family members needing me in the middle of the night)

2.  My nightmares have been transformed into pleasant dreams.

3.  I have not had a night-time panic attack since the first night (I usually wake up around 12:00 or so with my heart pounding and a panic attack.

4.  My husband, who is also sleeping on the same incline has stopped snoring.

5.  Neither one of us are getting up in the night to go to the bathroom.

6.  Increased daytime feeling of wellness.

7.  A marked decrease in premature ventricular contractions of my heart (PVC's)

8.  Last but not least, no waking up gasping for air, or feeling oxygen starved as I drift off to sleep, and no notice of my breath ceasing.

If this didn't work my next step was to buy a recliner to sleep in.  If that didn't work, I was on my way to the doctor.

I figured that the sleep apnea had not killed me in the 3 or so months I have randomly experienced it, so I felt I could put off seeing the doctor (can't get into to see her anyway due to her busy schedule) for a couple weeks.

This experiment is only under a week long, but it seems to be working and in any case, I am glad to have had six nights of peace of mind.

So, how did we accomplish this incline?

Since we view this as an experiment, my husband put two 2 x 6 boards under the legs of the bed.  If it continues to work we will put in a more permanent solution.  
I am not using any more than just my regular one pillow, and I feel as I am still lying flat, even though I am now sleeping at an incline.  I am even able to roll over and sleep on my stomach.

It seems to be working and I will report on my further findings in a few weeks!  

If this helps me to ease some of my anxiety, and my heart arrhythmias, I would be really grateful!  I will let you all know how it all goes after I have a good length of time to test it out.

Hmmmm....maybe if I get more sleep, I'll lose more weight too!  We'll see.  I'll let you know!



Falling Asleep at the Wheel? You Might Want to Have Your Heart Checked

Ever since 1996, DH has had trouble staying awake while he's driving.  My daughter and I have spent many a road trip scratching Daddy's back, talking to him "until we're blue in the face", and sprinkling water on his neck to keep him awake while he's driving.

Of course, we would switch off with him, but, he being the primary driver of the family would start to shake his head within an hour of the drive to wake himself up.

Well, that problem no longer exists.  Yesterday was the first time we have taken a long road trip since his heart surgeries, and he was able to drive the whole way without getting sleepy.

Now, I'm not saying that just because a person gets sleepy behind the wheel, he has heart disease.  I get sleepy behind the wheel too, but I rarely get more than four hours of sleep being a mom of seven kids.

He gets a full night of sleep, and he's still sleepy.  If I have my full night's sleep I can drive for a couple hours before I get sleepy.

But, this sleepiness that he did have before his stents were placed was only minutes into the drive and in the middle of the day, not hours into the drive and in the evening hours.  It was an unusual problem compared to the sleepiness of most people.

Yesterday, he mentioned how happy he was that he no longer feels it.  And he never complained about it, during the first five hours of our trip yesterday.

After five hours of driving, my son finally gave him a spell, but 30 minutes later, after a brief nap, he was offering to drive again.

We see a lot more road trips in our future!