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Spontaneous Arousals And Sleep Apnea

Posted Sep 24 2010 3:23pm

You just got your brand new CPAP machine for your newly diagnosed severe sleep apnea diagnosis. You use it religiously for one month every night, but you don’t feel any better. If anything, you may feel worse. You take your CPAP data card to your sleep doctor that tells you that your numbers are perfect: It shows that your AHI went from 35 to .9, you had no leaks and you used it 8 hours every night.

Although I have many people who swear by CPAP, there will always be some others that just can’t either tolerate or benefit from it. The problem with CPAP is that during titration in a sleep lab, for the most part, it only addresses apneas and hypopneas. Some sleep labs treat the lesser forms of obstruction and arousals, but in general, most only titrate the pressure to treat apneas or hypopneas.

What this means is that everything else that can cause you to wake up doesn’t get treated, including snoring, flow limitations, and RERAs (respiratory event related arousals). Studies have shown that even if you’re about to stop breathing, pressure sensors in your throat pick up the fact that the airways are beginning to collapse, and it’ll send signals to your brain to wake you up to a lighter stage of sleep, to prevent your muscles from relaxing. Most of these signals stay in the deeper levels of the brain, so you won’t be able to detect any “cortical arousals” through your EEG scalp leads on a sleep study.

If you have an apnea, it’s also likely that you’ll suction up normal stomach juices into your throat. The presence of acid in your throat is enough to activate chemoreceptors which sends signals to your brain to wake you up to a lighter stage of sleep, so that you can swallow your stomach juices and prevent aspiration into your lungs. Many of the “spontaneous” arousals are probably reflux related.

Furthermore, not sleeping effectively can cause your entire nervous system to become en garde, edgy,hypersensitive, and over-reactive. Having any acid in the throat or impending obstruction is enough reason to keep waking you up often throughout the night. Sometimes, having a mask on your face is enough stimulation to keep waking you up, especially if you’re in a lighter stage of sleep.

Are you fully compliant with CPAP, but don’t feel any better? Please enter your responses in the text box below.

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