Intermittent Hypoxia During Sleep

[bawild]

Home oximetry indicates I'm having hypoxic events during the night with oxygen saturations going from baseline (97%) down into the low 80's for short periods of time. This is usually followed by an adrenalin surge and hyperventilating. I will be getting this checked in formal sleep study and they will likely suggest CPAP or an oral device (if obstructive).

In the meantime, any suggestions for improved brain energetics or neuroprotective substances I should consider before going to sleep?

I usually have some salted ice cream, milk or OJ around 9pm.

 

[lindsay]

You could try Pregnenolone :)

 

[Blossom]

Have you ever tried sleeping in a recliner, using a wedge pillow or sewing a tennis ball in the back of your pajama top? These are things that some people use to help reduce the time spent sleeping flat on their backs as avoiding that position can sometimes help reduce oxygen desaturations from upper airway obstruction.
Are you a mouth breather when you sleep? If so the jaw can fall back and obstruct the airway so a chin strap or taping your mouth closed is something else you can try that might possibly help too. Sorry if you already know all of this but I thought it might be worth mentioning.

You could try Pregnenolone :)

I was thinking that too.

 

[bawild]

Have you ever tried sleeping in a recliner, using a wedge pillow or sewing a tennis ball in the back of your pajama top? These are things that some people use to help reduce the time spent sleeping flat on their backs as avoiding that position can sometimes help reduce oxygen desaturations from upper airway obstruction.
Are you a mouth breather when you sleep? If so the jaw can fall back and obstruct the airway so a chin strap or taping your mouth closed is something else you can try that might possibly help too. Sorry if you already know all of this but I thought it might be worth mentioning.

I was thinking that too.

Blossom & Linsay, Yes, I've tried both the recliner and the tennis ball. Both definitely help. However, I still measured some desaturation events while I was on my stomach so it might be partially central sleep apnea. I'm not overweight but do sometimes snore when I'm on my back.

Searching the forum for neuroprotectants came up with progesterone, pregnenalone, DHEA, niacinamide, caffeine and Vitamin E. I will try each of these one at a time then in combination and measure the effect on desaturation frequency and degree.

 

[Koveras]

Blossom & Linsay, Yes, I've tried both the recliner and the tennis ball. Both definitely help. However, I still measured some desaturation events while I was on my stomach so it might be partially central sleep apnea. I'm not overweight but do sometimes snore when I'm on my back.

Searching the forum for neuroprotectants came up with progesterone, pregnenalone, DHEA, niacinamide, caffeine and Vitamin E. I will try each of these one at a time then in combination and measure the effect on desaturation frequency and degree.

Acetazolamide is used in some instances for sleep apnea. Anything that increases CO2 production may help open the airways. Thiamine maybe.

 

[Blossom]

I'm not overweight but do sometimes snore when I'm on my back.

Some people have combined sleep apnea (both obstructive and central) and some people have internal airway obstructions such as large uvulas that can be seen on examination with a laryngoscope. Good luck to you bawild, it sounds like you are on top of the situation.

 

[Blossom]

Acetazolamide is used in some instances for sleep apnea. Anything that increases CO2 production may help open the airways. Thiamine maybe.

I still think that's worth a try with all the usual precautions for avoiding drug/supplement interactions of course.

 

[Koveras]

"The low carbon dioxide production of hypothyroidism (e.g., Lee and Levine, 1999), and the respiratory alkalosis of estrogen excess, are often overlooked. An adequate supply of calcium, and sometimes supplementation of salt and baking soda, can increase the tissue content of CO2."

"Acta Neurobiol Exp (Wars). 2007;67(2):197-206.
Role of hypercapnia in brain oxygenation in sleep-disordered breathing.
Brzecka A. Adaptive mechanisms may diminish the detrimental effects of recurrent nocturnal hypoxia in obstructive sleep apnea (OSA). The potential role of elevated carbon dioxide (CO2) in improving brain oxygenation in the patients with severe OSA syndrome is discussed. CO2 increases oxygen uptake by its influence on the regulation of alveolar ventilation and ventilation-perfusion matching, facilitates oxygen delivery to the tissues by changing the affinity of oxygen to hemoglobin, and increases cerebral blood flow by effects on arterial blood pressure and on cerebral vessels. Recent clinical studies show improved brain oxygenation when hypoxia is combined with hypercapnia. Anti-inflammatory and protective against organ injury properties of CO2 may also have therapeutic importance. These biological effects of hypercapnia may improve brain oxygenation under hypoxic conditions. This may be especially important in patients with severe OSA syndrome."

"
Q: When we breathe through mouth rather than nose at night, this can get rid of
too much CO2 and this is a problem.
RP: yes the medical analysis is that people don’t breathe enough at night, but
when you look at the blood chemistry the usual thing is that they hyperventilate
during the night, because as their blood sugar is pushed down to sleep, their
adrenaline comes up periodically and this makes them have in effect higher
estrogen, higher inflammatory hormones which drives hyperventilation and
blows off too much Carbon Dioxide. Then they don’t breathe for a while so they
wake up feeling like they have died or have not been breathing enough . The best
chemical for this is Diamox (Acetazolamide ) that causes the body to retain more
carbon dioxide, it prevents the body from losing too much carbon dioxide which
keeps it in the blood.
It’s well established as a cure for sleep Apnea, also used by skiers to prevent
altitude sickness, because altitude sickness is a lack of CO2 not oxygen.

Q: is it more of a treatment than cure?
RP: Sometimes 2-3 days of a thyroid supplement is all a person needs, and their
own gland will take over. Same with sleep apnea, sometimes they can get out of
the stress, and reset. Usually though you have to work on finding why the
hormones are going bad, especially at night, and get your blood sugar stabilized,
get a good diet of enough protein and fruit and supplement the Thyroid as long
as it’s needed.
"

 

[Blossom]

Great quotes @Koveras!
ETA:

 

[keith]

I have had diagnosed sleep apnea. Had surgery for it that helped some, but not greatly. I haven't had a sleep study since, because I live in the U.S. and my insurance has a high deductable, meaning it would be very expensive, and since I'm quite certain that it is still sleep apnea, and an official confirmation wouldn't change my approach, I don't bother.

I have been using a device called Aveo TSD, the TSD part standing for tonue stabilization device. There are other brands as well, some I have tried, some not, but I like this one a lot. It pulls my tongue forward, clearing some necessary space in my throat. Your challenge may not be the same, but you can get a good idea by sticking your tongue out and seeing if it makes you breathe better through your nose. I can actually feel that my throat is too narrow as I relax when falling asleep, so if that isn't the case for you, it may not work, but it is a big help for me.

The final piece for me, though, has been thiamine, which apparently works like acetazolamide to increase CO2 levels. I take 300-500 mg 3x per day (900-1500 total). It really makes a huge difference for me, especially the dose before bed. I have thought about trying acetazolamide, and may at some point, but the thiamine /TSD combo has worked so well for me, that I haven't bothered.

I would recommend starting there. The dental devices (not a good fit for my particular issues, because I don't have enough jaw movement to clear the space in my throat) can work better than CPAP for a lot of people, and Ray has spoken negatively about CPAP (not sure where he stands on dental devices or TSDs). If you can fix the CO2 issues without a device at all (with thiamine or acetazolamide), that might be your best bet. The TSD I use requires me to sleep with my tongue sticking out between my front teeth, which took some getting used to, and isn't for everybody, but it has been a life saver for me.

I tried the CPAP years ago, and it was not for me, that's for sure. the doctor I saw really pushed it, but it was horrible. Not only was my sleep terrible when using it, but i ended up swallowing large amounts of air, which made my stomach swell up like a balloon, which was extremely painful. Even after that, I had to really push to get to talk to someone about surgery. Wish I knew then what I know now; probably all I really needed was the $100 device I use now, and some thiamine.

 

[bawild]

I have had diagnosed sleep apnea. Had surgery for it that helped some, but not greatly. I haven't had a sleep study since, because I live in the U.S. and my insurance has a high deductable, meaning it would be very expensive, and since I'm quite certain that it is still sleep apnea, and an official confirmation wouldn't change my approach, I don't bother.

I have been using a device called Aveo TSD, the TSD part standing for tonue stabilization device. There are other brands as well, some I have tried, some not, but I like this one a lot. It pulls my tongue forward, clearing some necessary space in my throat. Your challenge may not be the same, but you can get a good idea by sticking your tongue out and seeing if it makes you breathe better through your nose. I can actually feel that my throat is too narrow as I relax when falling asleep, so if that isn't the case for you, it may not work, but it is a big help for me.

The final piece for me, though, has been thiamine, which apparently works like acetazolamide to increase CO2 levels. I take 300-500 mg 3x per day (900-1500 total). It really makes a huge difference for me, especially the dose before bed. I have thought about trying acetazolamide, and may at some point, but the thiamine /TSD combo has worked so well for me, that I haven't bothered.

I would recommend starting there. The dental devices (not a good fit for my particular issues, because I don't have enough jaw movement to clear the space in my throat) can work better than CPAP for a lot of people, and Ray has spoken negatively about CPAP (not sure where he stands on dental devices or TSDs). If you can fix the CO2 issues without a device at all (with thiamine or acetazolamide), that might be your best bet. The TSD I use requires me to sleep with my tongue sticking out between my front teeth, which took some getting used to, and isn't for everybody, but it has been a life saver for me.

I tried the CPAP years ago, and it was not for me, that's for sure. the doctor I saw really pushed it, but it was horrible. Not only was my sleep terrible when using it, but i ended up swallowing large amounts of air, which made my stomach swell up like a balloon, which was extremely painful. Even after that, I had to really push to get to talk to someone about surgery. Wish I knew then what I know now; probably all I really needed was the $100 device I use now, and some thiamine.

Koveras and Keith, thanks for the additional ideas. I will definitely try thiamine and will look into TSDs. I'd like to avoid the CPAP route as well if possible. I Think the sleep study might be useful to determine if it's OSA, CSA or a combination. Based on comments by Peat and Haidut, hypoxic states are very dangerous for tissues and probably more so for the brain. I'd like to find a Peat inspired sleep Dr but my guess is they don't exist.

 

[keith]

Koveras and Keith, thanks for the additional ideas. I will definitely try thiamine and will look into TSDs. I'd like to avoid the CPAP route as well if possible. I Think the sleep study might be useful to determine if it's OSA, CSA or a combination. Based on comments by Peat and Haidut, hypoxic states are very dangerous for tissues and probably more so for the brain. I'd like to find a Peat inspired sleep Dr but my guess is they don't exist.

Glad to help. The reason I actually tries the TSD first myself was that they are relatively cheap and require no customization, so I could just try it out on my own without a sleep study or getting a doctor involved. Later, when i talked to my dentist about trying a dental device, it would have been much more expensive, would have required anotger sleep study, and after doing an examination of my jaw movement, he concluded a dental device probably wouldnt be a good fit for me anyway.

The.first one i tried was called the Good Morning Snore Solution and is over the counter in the U.S. It worked fine, but rubbed uncomfortably on my gums; most people don't seem to have that problem. I also didn't like the material it was made from as well, but that is a personal choice. It is a little thinner and lower profile as well, which is a plus.

The Aveo that I use is actually a sleep apnea device (the GMSS is officially only for snoring, although I found them comparable), so a prescription is technically required in the U.S., however I had no issues buying one from an online New Zealand pharmacy. I've actually bought two because I lost one, but found it before.the other arrived, so now I have a spare for when I need it, but the original is still going strong after at least two years. Let me know if you want the name of the New Zealand pharmacy.

 

[bawild]

Ok, I did some additional labs... Thoughts?
- 24 hr salivary cortisol - fairly low & flat cortisol curve. Morning - 0.33 (L), Noon - 0.34, Dinner - 0.41 (H), Bedtime - 0.06
- Morning DHEA - 63 pg/mL (L)
- Estradiol - 42 (H)
- Prolactin - 5.5
- LH - 3.4
- FSH - 7.5
- T/FreeT - 733/81
- TSH/t3/t4/t3tot/rt3 - 1.0/3.8/1.3/126/15
- ferritin 19 (L)
- Fe(tot)/%sat - 129/45%
- Ceruloplasmin - 19 (L)
- MG (RBC) - 4.7
- LD - 150
- B12 - 662
- Cu - 80 (lowish)
- Zn - 75 (lowish)
- Carbon Dioxide - 24

So,
- Insomnia/low mood/anxiety/fatigue
- Low ferritin
- Low DHEA-s
- High cholesterol (265)
- Low morning cortisol
- High estradiol
- Desaturations during sleep as low as 75%

Experimenting with carbonic Anhydrase inhibitors before bedtime (pomegranate juice, B1, famotidine), Pansterone
Lower GI - no issue
Sleep study
other thoughts would be helpful @haidut @gboldeuv and others

 

[PakPik]

Hi! I wonder if you've tried sodium bicarbonate, especially right before bed? It is very protective in many ways and helps both oxygenate tissues and raise CO2.
Niacinamide also helps to improve tissue oxygenation greatly and is regarded as one of the most neuroprotective agents clinically used nowadays. I can personally tell those claims to be true. :)
Sleep apnea is frequently tied to vascular leakiness, so it would be worth to look into strategies and agents that would help. Ray's website and this forum has lots of info on it (sodium bicarb. and niacinamide happen to be excellent for blood vessels BTW).

 

[bawild]

Hi! I wonder if you've tried sodium bicarbonate, especially right before bed? It is very protective in many ways and helps both oxygenate tissues and raise CO2.
Niacinamide also helps to improve tissue oxygenation greatly and is regarded as one of the most neuroprotective agents clinically used nowadays. I can personally tell those claims to be true. :)
Sleep apnea is frequently tied to vascular leakiness, so it would be worth to look into strategies and agents that would help. Ray's website and this forum has lots of info on it (sodium bicarb. and niacinamide happen to be excellent for blood vessels BTW).

Thanks PakPik!

 

[ecstatichamster]

best thing I've found are:

1. taping mouth closed (after your CO2 levels rise, you don't need to...the brain naturally closes the mouth during sleep)

2. sleep sitting up. I still do this, and sleep MUCH better sitting up. I do angle a recliner so I'm not in a regular chair, but this makes a HUGE difference.

 

[bawild]

best thing I've found are:

1. taping mouth closed (after your CO2 levels rise, you don't need to...the brain naturally closes the mouth during sleep)

2. sleep sitting up. I still do this, and sleep MUCH better sitting up. I do angle a recliner so I'm not in a regular chair, but this makes a HUGE difference.

Thanks Ecstatic, I'll measure my desaturations in a recliner to see if they go down. Something tells me part of my problem is central sleep apnea, my brain seems to lose the tight control over CO2/O2 during REM sleep, especially around 4am. I'm curious if increased CO2 or a reclined position will correct this. I've not slept a full 8 hours since December. Having a tough time breaking this cycle.

 

[Blossom]

Ritanserin Restores Energetic Function (metabolism) During The Night
I thought I'd link this post from haidut on sleep apnea incase you didn't see it.

 

[ecstatichamster]

Thanks Ecstatic, I'll measure my desaturations in a recliner to see if they go down. Something tells me part of my problem is central sleep apnea, my brain seems to lose the tight control over CO2/O2 during REM sleep, especially around 4am. I'm curious if increased CO2 or a reclined position will correct this. I've not slept a full 8 hours since December. Having a tough time breaking this cycle.

everyone is more likely to hyperventilate during those hours. Taping your mouth can really help a lot too.

 

[bawild]

Still searching for non-CPAP methods to reduce obstructive sleep apnea. Here's a list of things I've tried alone and in combination;
- acetazolamide (250mg) plus thiamine (400mg)
- lower jaw advancement mouthpiece
- tongue stabilization device (would fall off during the night)
- mouth taping
- sleeping in a recliner
- avoiding back sleeping

All of these in combination still resulted in a moderate to severe Apnea Hypopnea Index (AHI = 27). O2 levels as low as 82. Choking 27 times per hour at night takes a tremendous toll on your body and quality of life. I had to stop this.

So I bought a CPAP machine yesterday (bypassing the sleep medicine profession) and while I didn't get a great night of sleep, my AHI dropped to 2.5 and the lowest recorded SpO2 was 94. Much better. No headache/flu-like symptoms this morning.

My plan is to use CPAP for a few months, reverse the chronic stress response I'm in, slowly lose about 20-25 lbs (current BMI of 27), implement a tongue/soft palate/vagal nerve exercise program and try to wean off CPAP.

Any other thoughts or experiences to share on this problem? Seems impervious to Peat approaches.