At-home relief for possible sleep apnea
April 5, 2020 6:02 PM Subscribe
My partner possibly has sleep apnea. They were referred for a sleep study but those aren't being done right now due to COVID-19. Daytime sleepiness is making them miserable. What can they do at home to get some relief?
Partner snores, I've observed them stop breathing/choke or gasp. Their weight places them in the at-risk category. They're always sleepy and constantly feel like napping (but have been resisting it). Doctor agreed it could be sleep apnea and referred them for a sleep study... and then COVID-19 happened. My understanding from what the doctor said is an at-home sleep study is just used as a screener, and sleep apnea wouldn't be diagnosed without the full sleep study at the hospital. So it seems like actually getting assessed is out right now.
What can they do at home that might help? Obviously a C-PAP is the best treatment and they'll be pursuing that as soon as it's feasible if it turns out they have sleep apnea. But in the meantime, the sleepiness is making them miserable. I know exercise can help, but that's really hard when they're so tired. We have a Gazelle (elliptical w/resistance) that they do about 5 minutes on most mornings. They're considering trying the tennis ball trick. They don't drink or smoke. Is there anything else that can either help them get better sleep or wake them up more? Caffeine doesn't work for them. They always stay very well-hydrated. They're on Ritalin for ADHD and even that doesn't seem to help. Please don't suggest weight loss--they've been trying to lose weight for years to no avail.
What has helped you?
Partner snores, I've observed them stop breathing/choke or gasp. Their weight places them in the at-risk category. They're always sleepy and constantly feel like napping (but have been resisting it). Doctor agreed it could be sleep apnea and referred them for a sleep study... and then COVID-19 happened. My understanding from what the doctor said is an at-home sleep study is just used as a screener, and sleep apnea wouldn't be diagnosed without the full sleep study at the hospital. So it seems like actually getting assessed is out right now.
What can they do at home that might help? Obviously a C-PAP is the best treatment and they'll be pursuing that as soon as it's feasible if it turns out they have sleep apnea. But in the meantime, the sleepiness is making them miserable. I know exercise can help, but that's really hard when they're so tired. We have a Gazelle (elliptical w/resistance) that they do about 5 minutes on most mornings. They're considering trying the tennis ball trick. They don't drink or smoke. Is there anything else that can either help them get better sleep or wake them up more? Caffeine doesn't work for them. They always stay very well-hydrated. They're on Ritalin for ADHD and even that doesn't seem to help. Please don't suggest weight loss--they've been trying to lose weight for years to no avail.
What has helped you?
They don't take any sleep aid medications, do they? Some sleep medications can make sleep apnea worse if you don't have a CPAP machine.
(So if they do take a sleep medication perhaps try not taking it, or switching to a different one, ideally with a doctor's advice.)
posted by XMLicious at 6:30 PM on April 5, 2020
(So if they do take a sleep medication perhaps try not taking it, or switching to a different one, ideally with a doctor's advice.)
posted by XMLicious at 6:30 PM on April 5, 2020
Under the circumstances, would the doctor consider a short-term script for Provigil/Nuvigil?
posted by praemunire at 6:34 PM on April 5, 2020
posted by praemunire at 6:34 PM on April 5, 2020
If I were your neighbor I'd loan you my backup CPAP machine. Modern ones are self adjusting and I can't think of a way to actually hurt yourself with one unless you have pre-existing lung damage.
Failing that, I have noticed over the years that I have what I think of as mild allergies to certain foods. My tongue will swell a bit or my throat slightly close, both of which exacerbate apnea. It's probably worth starting a daily food/exercise/sleep log to see if some nights are better than other and tracking why.
posted by Tell Me No Lies at 6:48 PM on April 5, 2020 [3 favorites]
Failing that, I have noticed over the years that I have what I think of as mild allergies to certain foods. My tongue will swell a bit or my throat slightly close, both of which exacerbate apnea. It's probably worth starting a daily food/exercise/sleep log to see if some nights are better than other and tracking why.
posted by Tell Me No Lies at 6:48 PM on April 5, 2020 [3 favorites]
Best answer: Don't necessarily assume that the sleep study isn't doable.
My primary care doctor gave me a prescription for a home sleep study, and all the gear and instructions were sent to me by mail. The study confirmed that I had obstructive sleep apnea, and that was enough for the doctor to prescribe CPAP therapy. I ordered the machine online. I did the whole process without ever leaving the house. I've been using my wonderful CPAP machine for ~6 months, and life is much better.
Maybe you could start with a telemedicine consultation to get a prescription for a home sleep study, and take it from there. Good luck and sweet dreams!
posted by Corvid at 6:49 PM on April 5, 2020 [16 favorites]
My primary care doctor gave me a prescription for a home sleep study, and all the gear and instructions were sent to me by mail. The study confirmed that I had obstructive sleep apnea, and that was enough for the doctor to prescribe CPAP therapy. I ordered the machine online. I did the whole process without ever leaving the house. I've been using my wonderful CPAP machine for ~6 months, and life is much better.
Maybe you could start with a telemedicine consultation to get a prescription for a home sleep study, and take it from there. Good luck and sweet dreams!
posted by Corvid at 6:49 PM on April 5, 2020 [16 favorites]
Best answer: Caffeine doesn't work for them.
Do they still try? I spent a lot of years thinking I was caffeine resistant. Turns out that I wasn't, my sleep was terrible (for non apnea related reasons, we found out when I did the home study), and partly that was because of my regular and large caffeine intake (multiple cups of coffee, multiple diet cokes a day). Cutting that back and limiting it to mornings had a real positive impact on my sleep quality even before the related medical issue was diagnosed.
posted by solotoro at 6:55 PM on April 5, 2020 [2 favorites]
Do they still try? I spent a lot of years thinking I was caffeine resistant. Turns out that I wasn't, my sleep was terrible (for non apnea related reasons, we found out when I did the home study), and partly that was because of my regular and large caffeine intake (multiple cups of coffee, multiple diet cokes a day). Cutting that back and limiting it to mornings had a real positive impact on my sleep quality even before the related medical issue was diagnosed.
posted by solotoro at 6:55 PM on April 5, 2020 [2 favorites]
Sleeping while sitting upright is a short term fix. Depending on how bad they have it, and what exactly is the cause, sleeping while pushing their lower jaw forward may help. There are a couple of brands that make what are essentially mouthguards, that a person molds to their teeth. They can then push the lower part forward of the upper. It works by opening the soft palate, a collapsed one of which is sometimes the culprit. I can confirm that it works, but also that it causes chapped lips, drool, and some teeth movement. But just about anything is better than sleep deprivation.
posted by dbx at 6:56 PM on April 5, 2020 [1 favorite]
posted by dbx at 6:56 PM on April 5, 2020 [1 favorite]
Best answer: FWIW my experience was the same as Corvid's - I never met anyone from the sleep lab, I simply stopped at the office to pick up the gear and dropped it off again a few days later. Based on the data they wrote a script for a CPAP machine, which I picked up from my local medical device supplier. I did sit with a tech there who configured the machine but it wasn't anything that couldn't be done online or even via phone.
posted by Banky_Edwards at 7:52 PM on April 5, 2020 [4 favorites]
posted by Banky_Edwards at 7:52 PM on April 5, 2020 [4 favorites]
Best answer: I used to sleep face-down with my head turned to one side or the other. I had no symptoms of sleep apnea. When I was hospitalized for an unrelated infection, and made to sleep on my back so as not to disturb the IV antibiotics and various sensors, my oxygen was falling into the 80s with regularity. So trying different sleeping positions seems like a reasonable thing until your partner can get a CPAP.
posted by in278s at 8:13 PM on April 5, 2020 [3 favorites]
posted by in278s at 8:13 PM on April 5, 2020 [3 favorites]
Best answer: It will most likely be better for them to sleep on their side or their stomach if they can - I highly recommend the tennis ball trick.
If you have a recliner, your partner might try sleeping in that, tilted back to a comfortable extent but not so far it's like sleeping on their back. Wedging pillows around can make it more comfortable.
But mostly they need the sleep study. A home study can be done by mail or pickup. Definitely work toward a telemedicine visit to get this underway.
posted by invincible summer at 8:43 PM on April 5, 2020 [1 favorite]
If you have a recliner, your partner might try sleeping in that, tilted back to a comfortable extent but not so far it's like sleeping on their back. Wedging pillows around can make it more comfortable.
But mostly they need the sleep study. A home study can be done by mail or pickup. Definitely work toward a telemedicine visit to get this underway.
posted by invincible summer at 8:43 PM on April 5, 2020 [1 favorite]
Best answer: As someone who used to have sleep apnea, I also nth doing a take-home sleep study If it’s possible. . In the interim, sleeping upright as much as possible (wedged shape pillow definitely helps If you’re a back sleeper), avoid alcohol, caffeine. A cool mist humidifier might help. It really sucks, I had undiagnosed sleep apnea throughout college.
posted by WedgedPiano at 9:08 PM on April 5, 2020 [1 favorite]
posted by WedgedPiano at 9:08 PM on April 5, 2020 [1 favorite]
There are online companies that can facilitate a CPAP prescription via telemedicine (pick your machine, place “order” and their doc calls you), but as I haven’t personally used them I’m going to refrain from linking directly. However, a possible option?
posted by aramaic at 9:55 PM on April 5, 2020 [1 favorite]
posted by aramaic at 9:55 PM on April 5, 2020 [1 favorite]
Nth-ing the at home sleep study. At my provider's office I am pretty sure nearly all of the sleep studies are done at home anyway, with an in-office one only if the results show something more complex than obstructive sleep apnea. I did mine last March and picked up a kit from the office, did it at home, and brought everything back to them the next day.
posted by augustimagination at 10:46 PM on April 5, 2020
posted by augustimagination at 10:46 PM on April 5, 2020
nth-ing "Raise the head of the bed a foot or two." It helps me a lot, as someone with probable apnea that hasn't quite reached the level of bothering with CPAP machines.
posted by mmoncur at 4:31 AM on April 6, 2020
posted by mmoncur at 4:31 AM on April 6, 2020
Best answer: I would second trying to sleep sitting up, trying Breathe-Rite strips (get the extra-strength and if at all possible, get the brand-name -- the generic aren't quite the same and the lack of stickiness makes a difference), and trying to sleep on their side or stomach. All of that can help.
Also, pillows. It sounds dumb, but sleeping on my side while surrounded by pillows on each side (king-sized or body pillows, ideally) was a big help for me.
The at-home sleep study is worth pursuing, but be aware that not everyone will be able to go directly to effective CPAP from that point. If your partner has e.g. nasal valve collapse either causing or exacerbating the issue, that would have to be dealt with before CPAP could be successful.
posted by pie ninja at 4:33 AM on April 6, 2020 [2 favorites]
Also, pillows. It sounds dumb, but sleeping on my side while surrounded by pillows on each side (king-sized or body pillows, ideally) was a big help for me.
The at-home sleep study is worth pursuing, but be aware that not everyone will be able to go directly to effective CPAP from that point. If your partner has e.g. nasal valve collapse either causing or exacerbating the issue, that would have to be dealt with before CPAP could be successful.
posted by pie ninja at 4:33 AM on April 6, 2020 [2 favorites]
If sleeping on their back is part of it and the tennis ball trick doesn't work (I've heard it can be tricky to keep things in the right place), this blog post outlines how to make a similar but easier to use contraption out of a pool noodle.
posted by gideonfrog at 6:37 AM on April 6, 2020 [1 favorite]
posted by gideonfrog at 6:37 AM on April 6, 2020 [1 favorite]
Response by poster: Thanks all, they’ll reach out to their PCP and see if they can get an at home sleep study! She made it sound like the home study was just to screen out people who didn’t have sleep apnea (and she was pretty sure partner does), but maybe we misunderstood.
Also, they were able to sleep on their side most of the night last night, but it ended up hurting their hips a lot. Any suggestions for that?
posted by brook horse at 8:19 AM on April 6, 2020
Also, they were able to sleep on their side most of the night last night, but it ended up hurting their hips a lot. Any suggestions for that?
posted by brook horse at 8:19 AM on April 6, 2020
Best answer: Pillow between the knees, works for the hip issue.
posted by tinymegalo at 9:24 AM on April 6, 2020
posted by tinymegalo at 9:24 AM on April 6, 2020
Using a neck collar when you sleep has proven effective for some. It keeps your jaw from dropping down to your chest. See this for example.
posted by Rad_Boy at 10:14 AM on April 6, 2020
posted by Rad_Boy at 10:14 AM on April 6, 2020
I don't normally post specific products but the Nora pillow has been pretty life changing for me. I've had to sleep with multiple pillows to prop myself up ever since I was a kid (20+) years...which isn't always convenient...and it's revolutionized my sleep so much I'm considering purchasing at least one more. It took a little getting used to, but it was worth it.
posted by AnneShirley at 4:30 PM on April 6, 2020
posted by AnneShirley at 4:30 PM on April 6, 2020
Best answer: Make a wedge out of 3 pillows.
Number one is your anchor. I use a shredded memory foam pillow which is the consistency of damp sand. Place number one pillow next to the headboard at the top of the bed.
Put a head cradling pillow on top of that. It's important for the number 2 Pillow to support your neck when you are lying on your side.
The THIRD pillow forms a ramp leading up to the main structure. When sleep on your side, it elevates your ribcage and shoulders. BONUS: place your arm between the ramp and the main structure! (Between pillows 1 and 3)
So in unicode:
22222222
2oooooo2
22222222
11111111 33333333
1oooooo1 3ooooooo3
11111111 33333333
posted by ohshenandoah at 5:20 PM on April 6, 2020 [1 favorite]
Number one is your anchor. I use a shredded memory foam pillow which is the consistency of damp sand. Place number one pillow next to the headboard at the top of the bed.
Put a head cradling pillow on top of that. It's important for the number 2 Pillow to support your neck when you are lying on your side.
The THIRD pillow forms a ramp leading up to the main structure. When sleep on your side, it elevates your ribcage and shoulders. BONUS: place your arm between the ramp and the main structure! (Between pillows 1 and 3)
So in unicode:
22222222
2oooooo2
22222222
11111111 33333333
1oooooo1 3ooooooo3
11111111 33333333
posted by ohshenandoah at 5:20 PM on April 6, 2020 [1 favorite]
Best answer: 2nding BreatheRight. I recently took a trip and accidentally forgot my CPAP. I found that the strips really helped.
posted by Miko at 6:46 AM on April 7, 2020
posted by Miko at 6:46 AM on April 7, 2020
Best answer: Before I got my APAP (that’s a CPAP that auto adjusts — can’t recommend it highly enough) I tried every single mouth and tongue positioning device you can buy without a prescription. Basically they move the jaw forward or retain your tongue in a position to prevent the soft tissue collapse that blocks your airway.
Here’s a list of such devices, this site is no doubt recommending whatever company pays to be listed but nonetheless their top pick was my favorite, the SnoreRX, because you can adjust it very easily.
Note this solution is incredibly inferior to an actual CPAP. I wish I had gotten mine 20 years ago. I used the mouthpieces for two years and my teeth and jaws ached. They moved my teeth, which thankfully wasn’t permanent. But they did help somewhat. My dentist makes mouthpieces for sleep apnea and he was supportive with me going the cheap route with the ones I bought online because he said even the professionally fitted ones can have the same issues and just don’t work as well as a CPAP.
Also, just to make sure there’s no self blame happening by your partner: sleep apnea occurs in people of all shapes and sizes, it’s not something anyone causes by virtue of their weight (personally I think it’s a blessing larger people get tested more often and too bad thinner folks aren’t screened for it when they should be. Sleep apnea is pretty dang common.) Two sleep specialist doctors told me, their fat patient, that the shape of your throat isn’t going to change even with drastic weight loss and that they don’t recommend it as a treatment. (As an anecdote to this, my partner’s friend with severe sleep apnea decided to try to lose weight instead of using a CPAP. 100 pounds lighter than his first test, the second sleep test came back with worse results and his doctor told him the same thing mine had.)
If your partner wants to exercise more that will of course likely make him feel better and will improve his sleep in some way, but if you can, make sure he knows he didn’t cause this condition and that losing weight wouldn’t have solved it. So often people think they should be able to cure themselves and get into a loop of shame and blame that keeps them from getting the damn CPAP they need.
I think it’s actually a good time to get tested because the in lab tests are not fun and it should be easier to get authorized for an at home test now! Definitely see if he can get one! I did look into the online services that send the kit to you and don’t take insurance and they seem perfectly legit. If you get an APAP then you really don’t need any more interaction with a specialist after you get the initial Rx unless you run into problems down the line. If you don’t have an auto-adjusting machine usually you interact a lot more with the sleep lab to get the right settings. You need a prescription to buy a machine but you do not need to buy it anywhere in particular and you can buy one online. You can buy all other supplies without a prescription. Note you can harm yourself using a CPAP so I am not suggesting he try to just find a machine secondhand for now. It’s important to get tested to get the correct pressure range. But annoyingly it’s often cheaper and more convenient to buy out of pocket and not involve insurance.
Also if he’s so-inclined, there’s a great Facebook support group called Fat-Positive Sleep Apnea. It’s essentially like any other advice group geared towards sleep apnea but body shaming isn’t allowed, you don’t have to be a self identified fat positive person like myself! People of all sizes belong to the group. It’s very supportive and has a ton of info about affordable equipment and getting tested. I bet there are posts about online places that send in home tests out.
posted by the thorn bushes have roses at 8:53 AM on April 7, 2020 [4 favorites]
Here’s a list of such devices, this site is no doubt recommending whatever company pays to be listed but nonetheless their top pick was my favorite, the SnoreRX, because you can adjust it very easily.
Note this solution is incredibly inferior to an actual CPAP. I wish I had gotten mine 20 years ago. I used the mouthpieces for two years and my teeth and jaws ached. They moved my teeth, which thankfully wasn’t permanent. But they did help somewhat. My dentist makes mouthpieces for sleep apnea and he was supportive with me going the cheap route with the ones I bought online because he said even the professionally fitted ones can have the same issues and just don’t work as well as a CPAP.
Also, just to make sure there’s no self blame happening by your partner: sleep apnea occurs in people of all shapes and sizes, it’s not something anyone causes by virtue of their weight (personally I think it’s a blessing larger people get tested more often and too bad thinner folks aren’t screened for it when they should be. Sleep apnea is pretty dang common.) Two sleep specialist doctors told me, their fat patient, that the shape of your throat isn’t going to change even with drastic weight loss and that they don’t recommend it as a treatment. (As an anecdote to this, my partner’s friend with severe sleep apnea decided to try to lose weight instead of using a CPAP. 100 pounds lighter than his first test, the second sleep test came back with worse results and his doctor told him the same thing mine had.)
If your partner wants to exercise more that will of course likely make him feel better and will improve his sleep in some way, but if you can, make sure he knows he didn’t cause this condition and that losing weight wouldn’t have solved it. So often people think they should be able to cure themselves and get into a loop of shame and blame that keeps them from getting the damn CPAP they need.
I think it’s actually a good time to get tested because the in lab tests are not fun and it should be easier to get authorized for an at home test now! Definitely see if he can get one! I did look into the online services that send the kit to you and don’t take insurance and they seem perfectly legit. If you get an APAP then you really don’t need any more interaction with a specialist after you get the initial Rx unless you run into problems down the line. If you don’t have an auto-adjusting machine usually you interact a lot more with the sleep lab to get the right settings. You need a prescription to buy a machine but you do not need to buy it anywhere in particular and you can buy one online. You can buy all other supplies without a prescription. Note you can harm yourself using a CPAP so I am not suggesting he try to just find a machine secondhand for now. It’s important to get tested to get the correct pressure range. But annoyingly it’s often cheaper and more convenient to buy out of pocket and not involve insurance.
Also if he’s so-inclined, there’s a great Facebook support group called Fat-Positive Sleep Apnea. It’s essentially like any other advice group geared towards sleep apnea but body shaming isn’t allowed, you don’t have to be a self identified fat positive person like myself! People of all sizes belong to the group. It’s very supportive and has a ton of info about affordable equipment and getting tested. I bet there are posts about online places that send in home tests out.
posted by the thorn bushes have roses at 8:53 AM on April 7, 2020 [4 favorites]
Response by poster: Good news! Their GP put in a referral for a in-clinic sleep study about a month ago, and the sleep clinic just called to let us know that they aren't doing in-clinic studies but they reviewed my partner's chart and the director approved them for an at-home sleep study! Didn't even have to ask!
Sleeping with the pillow between their legs has helped the hip pain from sleeping on their side, but new problem is neck pain. They have a contoured memory foam pillow (like this) and I'm wondering if that's the problem? It seems like that wouldn't work well for side sleeping. Gonna do some pillow experimenting.
posted by brook horse at 2:45 PM on April 9, 2020 [2 favorites]
Sleeping with the pillow between their legs has helped the hip pain from sleeping on their side, but new problem is neck pain. They have a contoured memory foam pillow (like this) and I'm wondering if that's the problem? It seems like that wouldn't work well for side sleeping. Gonna do some pillow experimenting.
posted by brook horse at 2:45 PM on April 9, 2020 [2 favorites]
the memory foam contour pillow is kind of a crock. It's good for opening your airway while falling asleep, but once I'm actually asleep, honestly I do better with no pillow under the head at all.
posted by Miko at 8:27 PM on April 9, 2020
posted by Miko at 8:27 PM on April 9, 2020
This thread is closed to new comments.
posted by I_count_crows at 6:14 PM on April 5, 2020 [4 favorites]