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Concussions (Post-Concussion Syndrome) and Sleep Apnea


#1

Hi there. I was wondering if anyone here has suffered from any concussions and, if so, how this influenced the outcome of your sleep apnea treatment concerning specific machines and medications. I have my initial doctor’s appointment with a pulmonologist/sleep apnea specialist in only five short days (on January 24), so I want to be able to receive a least a little bit of feedback (but really, as much feedback as possible) in only the short amount of time allotted. But by all means, if you see this message sometime AFTER January 24 and would like to respond, PLEASE do.

Just to fill you in, I have had a couple of major automobile accidents in which I was hit by two eighteen wheelers (one almost twenty years ago, and one ten years after that). I also had another auto accident in 2014, in which someone pulled out of a parking spot and hit me. In addition, I hit myself in the head with a door in 2005 (don’t ask me how THAT happened). Needless to say, I have had severe sleeping problems ever since – namely, delayed-phase insomnia, fragmented sleep, and having to sleep until 11:00 every single morning. Of course, being recently diagnosed with sleep apnea only made matters worse for me.

The medications that doctors put me on over the years either produced bad side effects, didn’t work, or only worked for a certain amount of time before I built up a tolerance to them. These particular medications really may have not been the BEST ones for me, either, due to a couple of lawsuits that I wound up filing (they may have simply been medications that “ambulance chasers” thought would “win a lawsuit,” so to speak); these lawsuits were “closed out” some time ago.
Also, I was told by a sleep coordinator that CPAP may not be the BEST machine for me – due to the concussions I had sustained, and the problems I have endured as a result of these concussions.

I would appreciate any and all advice from anyone. Thank you so very much.


#2

I’m sorry to hear about your struggles. Most certainly you must be frustrated trying to deal with all of this.

I wrote this article recently, it may help:

Specifically:

"Sleep apnea
A 2007 study published in the Archives of Physical Medicine and Rehabilitation showed associations between sleep apnea and increased impairment to both memory and sustained attention in those suffering from TBIs.

Injury to the brain can damage to the mechanisms buried deep inside which regulate breathing while asleep. This can lead to the occurrence of apneas, or pauses in breathing, that result in critical drops in blood oxygen. Untreated sleep apnea is a dangerous, chronic health condition with avoidable consequences.

It’s worth noting that these apneas could be central, caused by a miscommunication between the brain and the respiratory system that is the result of a TBI, or obstructive, caused by mechanical dysfunction of the upper airway while breathing during sleep, which could also be caused by physical damage from the TBI, such as whiplash."

As for your treatment, I would not discount CPAP until you know exactly what kind of apneas you are having. You may need a variation on PAP therapy instead (such as BiPAP) if your sleep physician thinks it would be more effective.

As for medications, there aren’t any that are suitable for treating sleep apnea, so I’m assuming you mean the meds you took for PCS issues. If so, this should be a big part of your discussion with your doctor, as medications for other problems might be overlooked when talking about sleep disorders. Sleep is complex, and all the factors should be weighed.

Finally I urge you as a patient to ask for ALL of your options for treatment. Sometimes MDs have favorite go-to first-line therapies, but these aren’t necessarily the only options. You have a right to this information however, including its benefits and risks.

Good luck at your appointment and do let us know how it all works out!


#3

Same person with other long post! Video 411, my name is Rae. My husband is a Vietnam veteran, and has subsequent concussions. He uses BIPAP. He received validation of PTSD only about 2 years ago, when he started seeing a psychiatrist (not the same as my doc) due to Parkinson’s Disease. I feel the concussions (call it what it is, brain damage, traumatic brain injury) are definitely a part of the sleep problem.

My feeling is this, you can’t catch up after 24 hours have elapsed. Depends if your husband has a day-job, but mine has been around me pretty much round-the-clock, we are very close. But my point, we feel the best for us is to rise at the same time every day, usually 6:46 AM (we like to catch local TV news and “Today Show”) and bedtime not later than 11 PM. That being said, he will go to sleep before that, maybe 8:30 PM and frequently gets up, uses his computer for downloads and Photoshop, he says it helps him fight pain by occupying his mind. Whenever I awake, he may or not be in the bed beside me.

Because of our experience, and my pulmonologist’s advice (again my pulmonologist), I would suggest that you get up sooner and set a firm bedtime. Current research for avoiding sleep deprivation stresses retiring earlier instead of sleeping later. Also, with CPAP, the advice is not to nap at all. Once I overheard him chewing out this woman in her 80’s in the hallway as she was leaving his other exam room. He quizzed her about napping. She said after church on Sunday, she usually took an hour nap. He told her that might take 5 days to make up for that. It made an impression on me.

Be glad your insurance will cover CPAP therapy! Once you get pressure, mask style, all will fall into place. But give some thought along the way into adjusting sleep parameters so you get away from prolonging your sleep till 11 AM.


#4

Go to a neurologist. Have. MRI. Head


#5

Hi Rae, part of his sleepiness may be caused by the fact he’s using his computer. All electronic devices emit blue spectrum light which shuts down the brain’s production of melatonin (the “sleep” hormone). I understand his desire to preoccupy himself to deal with the pain, but he may need to rethink his tasks so he doesn’t contribute to his own sleep deprivation by accident.

Some ideas:

  • He can read a book using soft warm household light (avoid LEDs) to relax and preoccupy himself.

  • He can buy some blueblocking eyewear to use while he’s on his computer (I’m using my pair of blueblocking glasses right now, as it’s after 10pm here). This helps cut the glare and prevents the blue light from shutting down melatonin production, so important to sleep.

  • He can invest in laptop light filtering or blueblocking software that blocks the blue light internally to help with this.

  • He might also find some strategies for managing his pain and sleeplessness by seeking out a practitioner of CBTI-i (cognitive behavioral therapy for insomnia)… there might be some breathing or relaxation techniques or other kinds of activities he can do to help him get through the night.

Naps are a bit more controversial. I will tell you this, however. Your need for sleep at night is determined by a number of things, one of which is known as “sleep drive” or “sleep pressure.”

Just as you have a “hunger,” “thirst,” or “sex” drive, you also have a “sleep” drive which builds on the length of time between periods of sleep. In the morning you have very little to no sleep pressure because you just slept, but by the afternoon, you will have accumulated more sleep pressure/drive. If you take a nap at that time, it might reduce your sleep drive and make it harder to fall asleep later.

Something to think about, though I would most certainly inquire into napping with the sleep specialist you see to get their professional opinion.

I hope this helps!

Tamara


#6

Talk directly to doc


#7

Make yerself. One w machine. Sniff air in. No easy solutions. Be patient w this. Change can. Save ya


#8

Hello Tamara,

I am sorry it has taken so long to get back to you. I may not be able to type a long reply right now, since I am presently fighting an upper respiratory infection – for which I have an appointment with yet ANOTHER doctor (my family doctor, who is also an integrative physician) for this tomorrow. Believe it or not, HE is the doctor who wrote me the original script for my initial sleep study to rule out sleep apnea; of course, I now know that I indeed suffer from this problem. Since I will be seeing him re: my illness (and a way/ways to expedite my healing, and get rid of all of this phlegm production – hopefully ASAP), I will also keep him in the loop regarding my recent (and initial) pulmonologist’s appointment; my ear problems both during and after use of the CPAP machine; and perhaps having to have a dentist or another individual fit me for a dental device for the sleep apnea. This alternative doctor also treats “neurotransmitter imbalances” and, in the past, he told me I was indeed suffering from one or more of them; based on both your sleep article that you were kind enough to share with me, as well as both my doctor’s treatment of quite a few patients with these imbalances and my own research into this subject, I might not be TOO quick to rule THAT out, either. If he can treat my neurotransmitter imbalance (s) and how it relates to sleep DIRECTLY, then I can do that treatment for sleep – as well as wear a dental device, etc. for the sleep apnea.

I did see my pulmonologist approximately one week ago; I brought my husband along with me, along with a list of questions, and my CPAP machine (upon their request). After explaining to the doctor that I have had a handful of concussions after the last twenty years and my sleep became tremendously messed up directly AFTER my auto accidents (etc.) which caused these concussions, and after explaining to him that my ears TRULY seemed unable to tolerate the constant noise and pressure of the CPAP machine (both during the use of it, and after the use of it), the pulmonologist told me that he believed it would be an extreme uphill battle for me to try to FORCE myself to use it despite my increasingly torturous ear pain and pressure; my ENT already diagnosed me with pulsatile tinnitus and a possible ear infection because of all of this.

My pulmonologist did suggest the use of a dental device but told me that it would NOT work for me if I had TMJ. Thus, I must rule TMJ out – via the MRI that my ENT wants me to do. Hopefully and prayerfully, I do NOT have TMJ. To my pleasant surprise, though, I managed to stumble upon a dental device (over the internet) that helps the patient in FOUR areas: with sleep apnea; with migraines and headaches; with bruxism; and with TMJ (and I suffer from all of these, also – whether I include or disclude the TMJ). After I stumbled upon this, I joyfully shared it with my husband. The only thing is that I must now get better from this upper respiratory infection before I actually go for a very long MRI (both with and without contrast). Also, I must find out (either from the company on the internet and/or from a dentist who makes these dental devices) how to approach the “dental device” routes; should I assume that my holistic dentist (who ALSO wears a dental device for sleeping) automatically knows about this dental device, and this specific company – or is it up to ME to provide him with this information – as well as ALL information that I find out about dental devices over the internet, etc.?

Also, I am going to reply to another message I left – and that you replied to (under a DIFFERENT subject).


#9

Tamara,

My pulmonologist told me that I have to use VERY strict “sleep hygiene,” especially in relation to how I literally feel the need to “sleep in” until 11:00 am EVERY morning; either that, or I get migraines and bad headaches if I get out of bed earlier than this. I have woken up to eat a snack at different times (since I do have hypoglycemia), and then went back to bed again. I may try to wake up at least a LITTLE earlier, and do so a little bit at a time (for example, perhaps waking up at 10:30 INSTEAD of 10:00 for the first week, and so on). I go to bed around 10:00 - 11:00 pm and, at certain times, I am in bed by 9:30 pm; I find that if I go to bed TOO early, I am not tired – and I struggle even MORE to get to sleep (combined with the fact that it usually takes me AT LEAST two hours or so to even GET to sleep).


#10

Lots of questions and comments here… I’ll take the dental device ones in this post.

Oral appliances for the treatment of sleep apnea are prescribed medical equipment that must be built by (or through the lab of) and dentist who is professionally trained and certified in dental sleep medicine.

None of the devices available online will do the job and are not appropriate for sleep apnea (despite their promises). You need one that is unique to your bite and which has a prescription from a sleep physician. You cannot order these without a prescription.

A holistic dentist probably does not have this training and will not be able to do this work for you.

At any rate, your sleep physician is the one who determines if you even qualify for an oral appliance; they would then refer you to the specific sleep medicine dentist they work with, who would construct your device, fit you with it, and help you along as you are using it with advice about cleaning it, check ups etc. to ensure it’s working right, etc.

So ultimately this is a question for your sleep physician; there are protocols they follow to determine if this is the right treatment for you. However, if they want you to pursue this route, you need to work with them and not go to the internet for devices.

I hope that makes sense.


#11

Other comments or answers:

RE: Neurotransmitter imbalances: I can’t properly comment on treatments for brain chemistry as they relate to any sleep disorders, as I’m not a medical professional. They certainly can happen as a result of concussions but as for treatments, that should remain a dialog between you and your doctor. I’m assuming you are also seeing a neurologist along with the pulmonologist/primary care provider? They would be the best medical professional to speak to regarding these kinds of issues.

RE: Sleep hygiene: This is a big part of helping to correct one’s course when sleep has become a problem. Getting up in the morning AND going to bed at the same time consistently seems like such simple advice, but it really makes a huge difference for one’s circadian rhythms. If you are going to bed at 10pm, lying there for 2 hours, and rising at 11am, then that is concerning. Oversleep can be as dangerous to one’s overall health as not getting enough sleep.

If you want to reset your sleep schedule, your sleep physician can provide you with an actual plan for making these adjustments over time. But because of your history with concussions etc, this may also be challenging (as with using CPAP). You appear to have multiple obstacles for getting good sleep that are well beyond the range of what we can do here (or the internet, for that matter). You are best advised to continue discussions with your various specialists to uncover the root causes for each of them.