This pleasant woman in her early fifties came to our Center from northern California for multiple severe sleep problems.
In childhood, she had suffered from sleepwalking and excessive sleepiness. Both the latter problem and attention deficit symptoms (which often result directly from sleepiness) continued into adulthood. Snoring was not noted until age 33. Her problems worsened during menopause, a frequent finding in sleep apnea patients.
She also moved to a high altitude. Her first sleep study at a center near her home--at an altitude of 6200 feet--showed repeated pauses in breathing as well as obstructive apneas, with severe drops in blood oxygen levels.
She was treated with bilevel PAP but repeated pauses in breathing were still noted by her bed partner. Home oximetry revealed continued severe drops in oxygen levels despite treatment.
She then was evaluated at a major California sleep center located at sea level. She was treated with CPAP, bilevel PAP and then, auto-adjusting bilevel PAP, but with worsening sleep quality. She was started on sleeping pills and was tried on both Provigil® (which caused even more sleep disruption) and Concerta® (which caused anxiety and agitation).
She contacted our Center to arrange an evaluation after she read about our use of adaptive servo-ventilation (ASV) on our web site. We agreed with her that ASV would seem a far more appropriate treatment for her severe altitude-aggravated central and obstructive sleep apnea than what she had been using. Also, the fact that her sleepiness began many years before any indications of sleep apnea suggested to us that she might also have narcolepsy. Narcolepsy is associated with increased risk of development of sleep apnea.
We found that ASV completely normalized her breathing, and her multiple sleep latency test was classic for narcolepsy. We recommended both home use of ASV and a trial of Xyrem® to treat both her sleepiness and insomnia.
She now takes Xyrem® and uses ASV successfully with normal breathing during sleep and marked improvement in her sleepiness and sleep quality.
COMMENTS: Living at high altitudes greatly increases the likelihood of central sleep apnea.
Adaptive servo-ventilation (ASV) has been an incredible advance in sleep medicine. Before its availability in 2006, our treatments for central sleep apnea were both difficult to use and often ineffective.
ASV is nothing short of amazing in its ability to normalize breathing during sleep. It also is far easier to tolerate than either CPAP or bilevel PAP--since it adapts to the patient, rather than forcing the patient to adjust to it.
If this patient's story reminds you of your own--or that of a loved one--please do not hesitate to contact us at flamenco@netexp.net with any questions that you may have. We are here to help.
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