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Thread: Sleep apnea update

  1. #1
    WindOnHisNose's Avatar
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    Sleep apnea update

    OK, I spoke at the International Federation of Natural Resource Pilots annual meeting on how to become an old pilot...concentrating on things we can do to keep our health good. Spent a considerable amount of time reviewing the issue of sleep apnea and sleep deprivation.

    For those of you who snore vigorously (geez, I know this hits home with most of those who camped out at New Holstein this summer), you most likely have a form of partial airway obstruction, which in turn is associated with sleep apnea.

    The FAA doesn't like this as a diagnosis, since it is associated with sudden death, so you don't really want to list this on your medical application form! This puts those of us who MIGHT have it at a distinct disadvantage, since the methods of treating it include surgery (a pretty danged painful one at that) or a CPAP machine...both of which require a physician's order...which in turn should be reported to the FAA on the form. Pretty much a catch 22!

    So, I happened to get my hands on a CPAP machine a couple years ago, and it makes me sleep much better, makes me feel well-rested, but the price is that you have to have this danged mask on, with it's attendant hose, so you have to sleep on your back, or on your side.

    I ran across a dentist friend of mine who told me about a mouth "appliance" that you can be fit for that essentially moves your lower jaw forward, substantially eliminating snoring and it's accompanying sleep apnea! Problem....you have to go to a dentist who does this sort of fitting, and it isn't cheap...plus, it goes into your medical/dental record.

    I am watching TV a couple weeks ago, and saw this ad for Puresleep.com, a product which looks pretty much identical to the appliance the dentist fits you for. It is $60, so I ordered one (and a second backup one for $35, to be used for travel...or to give to one's brother, who also definitely has sleep apnea). It came, and resembles those mouthguards we used to use for football....submerge in boiling H2O for a minute, remove momentarily, then put into your mouth (jaw a bit forward) and bite down.

    I have used it for 5 days (as has my brother down on the farm in KS), and it is absolutely terrific! Snoring is gone, I wake up refreshed, feeling well-rested! No blasted CPAP machine!

    I am recommending it to my patients who suffer from this, and thought it might be a good thing for you folks. Heck, it will quiet down New Holstein a great bit! ...and help make you all live to be old pilots!

    for what it's worth.

    Randy

  2. #2
    Coyote Ugly's Avatar
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    Talked me into it, just ordered for me and the wife...
    "Pops Dory"
    They used to say there are no old, bold pilots, Hell, looka here...

  3. #3
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    snoring is like being ugly......(pun intended) you don't have to look at yourself and if you're first asleep you don't have to listen to your own snoring, No Problem....But big problem when camping, there is a certain Lady Pilot I know that likes to go airplane camping and at the risk of hot glue in my hanger lock for telling this, she snores with the best I mean the champions of the lumber jacks....it's an amazing thing to hear a delicate flower make such a roar....sixty bucks would be money well spent I'm thinkin

  4. #4
    Bill Ingerson's Avatar
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    Snoring

    You guys have it all wrong... Snoring is just a throw back to the Cave Man days. They would all sleep in that cave and anything going passed that cave would not dare go in there, because of all the GROWLING...
    For example, did one person get attacked at New Holsten from bears or other four legged critters ? Think about it.

    I went through all the tests also, tried that machine and scared my cats to death. For me, it was a scam, didn't need that machine at all. found that if I stay on my side I would be fine and no more breathing problems. There is a flapper valve of some kind that keep food from going into your lungs. When you sleep on your back, when your older that flapper gets weaker and blocks off your breathing. You hold your breath, your heart speed is racing then your wife jabs you in the ribs and tells you to roll over and start breathing again. That happens over 100 times during the night on the graph chart. Just sleep on your side, no more problem. By all means don't tell you insurance company you have sleep apnea, you just might get grounded.

    No name

  5. #5
    39-J3's Avatar
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    My wife punches me in the head and elbows me in the ribs trying to get me to wake up and stop snoring. I always blame it on Piper our yellow lab.

    I now use breath right strips and it helps.

  6. #6
    WindOnHisNose's Avatar
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    Have had numerous off-line emails from prominent individuals on the supercub.org website who confirm that they have very close friends (not them!) who have sleep apnea and who are excited about this product.

    I continue (after yet another night of great sleep) to believe this is a good solution (puresleep.com).

    I have a proposal. I would propose to the mayor of New Holstein that she provide a financial incentive that would pay for ALL pilots flying into the GREAT SUPERCUB FLYIN to have an onsite provision and fitting of the mouthpiece. She can justify this as an effective means of quelling the complaints of noise pollution by the residents of New Holstein. In fact, perhaps we might want to get together and buy one for that assxxxx who lives near the approach end of the grass runway and enjoys taking potshots as us as we fly in!

    Hey, maybe this would rid the world of a few assxxxxx!

    Merry Christmas!!!

    Randy

  7. #7
    180Marty's Avatar
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    because of all the GROWLING.
    Good one Bill!!!!

  8. #8
    Snert's Avatar
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    I suspect giving one of these to your spouse for Christmas would be like giving a gym membership or a thighmaster.

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    Roger Peterson's Avatar
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    "The FAA doesn't like the diagnosis of sleep apnea, since it is associated with sudden death."
    I thought the sudden death was always while you were asleep. Don't most pilots stay awake while they fly.

  11. #11
    WindOnHisNose's Avatar
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    Nope. Sudden death can be anything that causes, like, the ultimate insult. Heart attacks, strokes, cardiac arrythmias...and all are associated with sleep apnea.

    Randy

  12. #12
    www.SkupTech.com mike mcs repair's Avatar
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    Quote Originally Posted by fly_cubs

    Oh that was great!!.......

    I try to stay out of there if possible....

  13. #13
    Marty57's Avatar
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    Last year I had the flu real bad, upper respiratory for weeks. Went to my wife's ENT doc and he went crazy with tests when I told him I was dizzy at times with this flu. He ordered up every test in the book that did not use a knife. They all came up negative (every cardio test also). He wanted a sleep study and I said NO! Have you ever found someone who has passed a sleep study? Any way, the ENT did say snoring was caused also by excess weight. My wife concurred with the fact that I snored very loud. So, after a 40+ lb weight loss (still going) my wife did her own "sleep study" and tells me the snoring is way down as is the volume. The weight loss is through my doc who is also an AME. He said he will go through the paper work with me on my next physical to properly deal with the weight loss and all the visits so everything will be in order. Needless to say, he is not the ENT. Oh, and I sleep on my side now also.
    Marty57

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    Last March I declared an obstructive sleep apnea diagnosis on my flight physical.

    I had a sleep study done to rule out sleep apnea in prep for a procedure called a pillar treatment (anti-snoring procedure). I didn't believe that I had sleep apnea, but it turned out that I did and it went into my medical records

    I had nearly a year of CPAP prior to my flight physical. My blood pressure went from marginal (from a flight physical standpoint) to a really good level (from a health standpoint as well as physical) almost over night.

    So far, I have not heard back from the FAA any question of the information my doctor submitted. I realize they are a slow moving body, but im really hoping that I would have heard something in the last 9-10 months if they were going to question the results.

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    Marty57 and others........a few observations about this thread. First and most importantly,avoiding a sleep study when you clearly have "indicators"is not recommended.Would you ignore a burning smell in the cockpit?Cannot get anywhere close to full RPM on the run-up? I think you get my point.Here's the thing with sleep apnea,it's not the snoring that is the issue in itself.It is the periods of apnea and decreased oxygen to your heart,brain and the rest of your organs that is the problem.Thing is, everyone just blows off the snoring as a minor thing the wife complains about.In reality you are setting yourself up for: heart attack,high blood pressure,sleep deprivation to name a few.Most folks are surprised when they read how long they go without breathing during a sleep study.Over time this takes it's toll on the body.So what to do?Have the sleep study and see what the numbers are and if a CPAP is necessary.If so,get the most comfortable unit and go about your business.You will feel alot better.Ignoring the problem and "hoping"it will get better is taking a big risk.Also what may correct the problem today,i.e.laying on side,mouth pieces,surgery etc.may not work next week.Another point about AME's.As was noted in a previous thread about Dr.s,do not mix your personal health issues with your flying issues.Meaning your AME shouldn't be your personal Dr.This puts you at a big disadvantage.Keep them separate.There are some ridiculous dis-qualifiers for a medical in the FAA books.Your AME is bound by them.Now the disclaimer.......I am sharing my thoughts and info.about this subject and not judging anyone.Some here will agree and some not.Fair enough.As far as my qualifications on the sleep apnea goes,let's just say I have been in the medical field for over 20 yrs. and sharing some insight could possibly help in this thread.As always, we all make our own choices in life and in our flying.It's just better to have as much info.as poss.to make good decisions.........Herman.

  16. #16
    Marty57's Avatar
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    Hermen,
    I could not agree with you more about ignoring warning signs. In my case, the ENT used a scope to check things out. His recommendations for the sleep study were not ignored. In my case, he also indicated that my weight was an issue. I decided that the weight needed to be taken care of for over all health as a possible alternative to any surgery. Often times, there are different ways to a medical solution. As an example, Meds for high blood pressure are a good idea if need but if exercise, better diet and weight loss will also work, your have a choice. Same with cholesterol meds. Too ofter in America, we seek the easy way to a medical solution rather than better over all health. So, for me, I decided the over all better health of loosing the weight to see what effect that has; this has been with my primary doctor's blessing. It happens that he is an AME but not the doctor I have gone to for FAA physicals. So, after 6 months of this approach, my weight is down over 40 lbs, I am off all cholesterol medications and have cut back on blood pressure meds to 1/4 of previous level. Lets see what another 40 lbs off my weight will do and then, if a sleep study is needed, great. I guess an aviation analogy would be that if your compression is low on one cylinder (500 hours SMO) you could ignore it and hope for the best, pull the cylinder and replace the bad valve, buy a new complete cylinder, or overhaul the entire engine. Except for ignoring the problem, the other three ways could take care of the problem. If you simply replace the bad valve than you would keep a very close watch on that cylinder over the next 50 hours to see if everything is ok. We ofter get a second opinion on the health of our engines because their are different ways to correct the problem; same with our bodies. My previous doctor only treated problems with meds and never confronted me on my weight issue. I guess I decided on the "overhaul" rather than the meds in this case. Each of us need to be very careful with our health; we only get one shot at this. I see a bigger problem here in that the FAA system pushes some pilots to either lie or ignore symptoms for fear of not passing the medical. We should be able to work with the FAA on medical issues rather than the us vs them mentality as it now stands. So, in February, I have an appointment with my ENT as he suggested when I said I wanted to wait on the sleep study. By then, my weight will be down a bit more and I will be very interested in what he recommends. Please, do not ignore symptoms of your health but be an informed consumer and a partner with your doctor. Same goes for your engine; understand what your A&P is recommending and get a second opinion if necessary; don't just get out the check book after the first check up. Thanks Hermen for your incite, it is very appreciated.

    Marty57

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    I think I was parked next to you at NH this past year and I don't remember snoring so it must have been my wife. Breath Rite strips work for me.

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    Marty57.....thanks for the details.Sounds like your approach suits well to your particular situation.The important thing is you have a plan and the sound advice of other medical professionals.Keep up the good work on losing the weight,we all could benefit from your example.I also appreciate your positive attitude in regards to this thread.We all can help and learn alot from each other.Cheers........Herman.

  19. #19
    WindOnHisNose's Avatar
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    I appreciate the input, Herman and Marty57, and pretty much agree with what you wrote. Noone is suggesting that you ignore warning signs, at least I wasn't. I am suggesting that a pilot must be very careful in discussing problems with the AME. As you are aware, once you get into the loop of a diagnosis which is disqualifying, it is difficult and sometimes impossible to get out.

    Obesity is certainly a problem, and can contribute to sleep apnea as well as the metabolic syndrome and many other medical problems. Frankly, the most common problem I see is a pilot who is considerably overweight and has a borderline blood pressure. I would bet partial airway obstruction and sleep apnea is also part of the problem. I strongly suggest they lose weight before their next physical, or risk being disqualified by hypertension.

    I think something as simple as the device I introduced to this thread would improve one's health and quality of life, at minimal cost and no significant risk.

    I agree with keeping your personal physician as someone different than your AME, if you can. But let's face it, the only contact many of us have with a physician IS our flight physical. I know that many AME's are cognizant of that fact and are very careful in making suggestions for care with another physician to take care of a problem. As an AME myself, I am very judicious in dealing with medical problems and preventative care of these pilots. But if you put on your form that you have sleep apnea, or have been seen for chest pain (even if it turned out to be just heartburn) you are at significant risk with the FAA! That is NOT to say that I am suggesting for a minute that you should VERBALIZE your concerns to me, as your AME, if I am the one you entrust your care for your healthcare. At least with a verbal interaction I can make suggestions to make sure you are well taken care of.

    for what it's worth...

    Randy

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    Randy......sounds like we're all on the same page.Good info.for all......Herman.

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    Thumbs up I Agree Sleep Positions Can Make A Big Difference

    Quote Originally Posted by Bill Ingerson View Post
    You guys have it all wrong... Snoring is just a throw back to the Cave Man days. They would all sleep in that cave and anything going passed that cave would not dare go in there, because of all the GROWLING...

    For example, did one person get attacked at New Holsten from bears or other four legged critters ? Think about it.

    I went through all the tests also, tried that machine and scared my cats to death. For me, it was a scam, didn't need that machine at all. found that if I stay on my side I would be fine and no more breathing problems. There is a flapper valve of some kind that keep food from going into your lungs. When you sleep on your back, when your older that flapper gets weaker and blocks off your breathing. You hold your breath, your heart speed is racing then your wife jabs you in the ribs and tells you to roll over and start breathing again. That happens over 100 times during the night on the graph chart. Just sleep on your side, no more problem. By all means don't tell you insurance company you have sleep apnea, you just might get grounded.

    No name
    Have you tried the Falcon Position or originally called the Partial Swastika sleeping position? The Falcon Position can be found on Google for free and is a great sleeping position that is a modified version of sleeping on your side. Also when sleeping on your side are you using a good body pillow to support in between thighs and knees as well as using a firmer mattress to even out the body. In mild to moderate sleep apnea situations sleeping on your side can really help and many sew a tennis ball in the back pockets of some pajamas and or try a positional therapy belt and It can help to keep from rolling on your back. That is interesting about the cave men as snoring it doesn't always mean sleep apnea just like being overweight is not the only reason for sleep apnea as many that are at a somewhat healthy weight and are still suffering from this condition. I also believe that a CPAP will just enable you to not change so that if that machine is not working you would be at a way more serious risk as the body is relying on it and is weaker than before.

    That's awesome to hear that sleeping on your side fixed you apnea.

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    Hi all -

    Any long term reviews/feedback on the device from Puresleep.com? I am contemplating the purchase of one to supplement the "blasted" cpap


    Also, has anyone had a had a SI for Sleep Apnea and then had it reversed by showing that it was no longer necessary. I would imagine by doing another Sleep Study and having demonstrated improvements.

    And I mean legitimate... I was diagnosed with severe sleep apnea - 90 lbs ago... had a second sleep study done 90 lbs lighter and now the sleep apnea is very mild - but enough to still require cpap and yearly reporting...

    I am targeting to loose a few more pounds and give it another shot... curious if anyone has had a SI reversed by getting their condition corrected...


    Mike

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    I was also diagnosed with severe sleep apnea, 50+ times per hour and up to 2 1/2 minutes. I had gone to the doctor because I was always tired and getting to sleep has always been a struggle, hence why I'm typing at this hour of the morning... After getting the CPAP and trying half a dozen masks and nasal pillows I pretty much gave up on it and tried some other methods like the breath right strips and mouth pieces with limited results. Pretty disappointing all around, when you don't ever get good sleep. My employer (railroad) was aware of my sleep apnea because I have to take a physical every 3 years and the questionnaire I had to fill out directly asked if I had ever been diagnosed with sleep apnea, I'd rather risk my job telling the truth than my career telling a lie, so I marked the yes box. A couple weeks later I get my certification in the mail and don't think anything else of it. Fast forward 3 more years and I get my packet in the mail that it's time to renew my physical, at this time I'm no longer in the same job and don't require any medical certification for what I do, but still work for the same company and have to remain certified in my previous craft. Same story, couple weeks later I get a piece of mail, file it away without opening it and don't give it another thought. Two weeks later I get a call from the company medical department asking if I'd had a chance to get the requested/required information from my doctor?? I went back and opened what I thought was my certification letter and found it was a laundry list of information that they had requested I get from my sleep medicine doctor. They wanted documents from my original diagnosis up through current condition including downloads of the previous 3 weeks from my CPAP to prove I was adhering to the prescribed treatment X hours a night at, iirc, 70% of the nights. If I was found non-compliant, I was going to get pulled out of service for medical even though I now sat at a desk... gotta love corporate America! To make it more complicated, I had just taken a promotion and moved 500 miles away from my doctor. They gave me a 30 day extension to get my paperwork in order. I knocked the dust off the ol' CPAP and tried to use it every night, even if I just sat there watching tv with it on to get my required time in. Towards the end of the 30 days I actually started getting used to it, it was not comfortable by any means, but I'd wake up in the morning feeling much more rested. For the past couple years I've used it religiously, doesn't feel right going to sleep without it even though the mask I'd resigned to using was uncomfortable and had to be cinched down so tight I'd have red lines around my nose and mouth for the first hour after waking up. I always had to use a full mask because breathing through my nose was like trying to breath through a coffee stirrer.

    Last year I decided that it was time to do something about the problem so I went to see an ENT that was suggested by a good friend. I sit down in the chair and he takes this tiny fiber optic camera and tries to look up my nose with it, goes about half way and the camera can't fit any further. A ct scan showed there was pretty significant blockages in my sinuses and nasal airway. He told me that it wasn't likely that nasal surgery would help the apnea problem since that was caused by tissue in the throat obstructing my airway, but it would make breathing much better and would likely make treatment of sleep apnea better as well. I elected to have the surgery and all I can tell you about it is that I remember waking up in the recovery room, my eyes opened and I took my first breath through my nose and couldn't believe that I was able to fill my lungs so easily without having to breath through my mouth.

    At this time I'm about 6-7 years after being diagnosed with obstructive sleep apnea. I decided to test out some different masks to maybe find something that wasn't so intrusive. At the recommendation of another friend, I tried out another nasal pillow since I could now breath through my nose in high def! I have come to love the one I use now (Airfit P10) and have recommended it to several others including my dad who loves his.

    I know this is getting a bit long winded, but just thought I'd toss my sleep apnea story out there and hope it'd help someone out. I'd urge anyone who thinks they might have sleep apnea to go to a sleep specialist and get checked out. Self diagnosing and then self treatment can be a deadly combination. A friend of mine since high school died in his sleep from heart complications this past November at the age of 36. Having shared a cabin with him on many hunting and fishing trips over the years there is no doubt in my mind he had sleep apnea and wasn't doing anything about it. My step-mother's niece died in her sleep at the age of 33 from heart complications, was diagnosed with sleep apnea but didn't use her CPAP. Never met her, but from what I'm told she was an avid runner and in top shape. Heck, when I was diagnosed I was 27 years old ran 30 miles a week and had no fat on me. So if you think you might have it go get checked out, take care of your medical condition first and worry about medical the paper work later, it'd be tough to fly a plane if you're dead.

    I'll step down from my pulpit now...
    Last edited by Bryan27; 02-06-2016 at 05:25 AM.

  24. #24
    WindOnHisNose's Avatar
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    Folks, I had a pilot tell me that a friend of his has not had a flight physical for many, many moons but in the meantime he was diagnosed with obstructive sleep apnea, based upon a sleep study (he thinks), and he wears a CPAP every night. He wants to get back into the cockpit and wants to know what he might need to do. I sent off a note to our trusty Regional Flight Surgeon's office and here is the reply:

    Hi Dr. Corfman!

    Following is the protocol for Obstructive Sleep Apnea. Please note that if the airman is otherwise qualified, you can issue at the time of the exam and you do not have to add a time limitation to the medical certificate. The airman will receive a letter outlining what he needs to provide and has 90 days to provide the data.


    • If the applicant has had a prior OSA assessment, select Group 2 on the AME Action Tab
    • If the airman is under treatment and the OSA is adequately treated, advise the airman that they will be considered for an Authorization of Special Issuance issued by the FAA
    • Give the applicant OSA Specification Sheet A (available online with the OSA Reference Documents in the AME Guide) and advise that a letter will be sent from the FAA requesting more information. (The letter will state that the applicant has 90 days to provide the information to the FAA.)
    • Notate in Box 60 that the airman has OSA and was given Specification Sheet A
    • Issue, if otherwise qualified



    Here is my response for this gentleman's friend:

    Sir, here is the link to the OSA Specification Sheet: http://www.faa.gov/about/office_org/...0sheet%20b.pdf

    This looks doable, from the little I know about you. Read it over and see what you think.

    Best case scenario:
    1. You pass the physical exam
    2. You bring in a note from your treating physician that your OSA is well-controlled, that you are compliant with CPAP treatment
    3. You sign the following form (http://www.faa.gov/about/office_org/...0signature.pdf)
    4. Your AME issues your medical certificate on the spot

    Worst case scenario:
    1. You pass the physical exam
    2. You bring in a note from your treating physician stating that your OSA is well-controlled, but that you have not had a sleep study
    3. You are issued a medical by the AME
    4. You receive a letter from the FAA which states you have 90 days to have a sleep study performed, and that upon receipt of that you will have a Special Issuance.

    I hope that helps.

    Take care.

    Randy

    There you have it, for those who might be in a similar predicament.

    Randy

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    Randy,
    Do you have any updated information about mouth guards to prevent snoring? Your first post mentioned Puresleep, I was wondering if it is still effective or if you have gone to something else?

    Thanks

  26. #26
    WindOnHisNose's Avatar
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    Quote Originally Posted by sburg58 View Post
    Randy,
    Do you have any updated information about mouth guards to prevent snoring? Your first post mentioned Puresleep, I was wondering if it is still effective or if you have gone to something else?

    Thanks
    I am still a strong proponent of Puresleep. There are similar devices out there now, all that do the same sort of thing...moving the mandible forward thereby opening the airway in the back of our throats. Easily transportable, easily cleaned.

    Otherwise, CPAP machines have become smaller, quieter and definitely are the most effective non-surgical approach to obstructive sleep apnea.

    Losing weight (decreasing body mass index) and eliminating alcohol intake before bedtime also continue to be the method of choice for those whose obstructive sleep apnea is related to obesity and alcohol intake.

    Randy
    Likes super stol liked this post

  27. #27
    WindOnHisNose's Avatar
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    It is important to note that sleep apnea is not one of the conditions requiring SI under the new BasicMed rule!

    Having written that, please don't dismiss the seriousness of long term sleep apnea on myriad medical conditions that significantly increase the risk of sudden death and other medical conditions which will shorten your life (diabetes, hypertension, myocardial infarction). If you think you have a sleep disorder, sleep apnea, etc, please go get it checked out!

    Randy

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    Thanks for your timely response,

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