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Fri, April 26

'Pap-Nap' helps patients adjust to CPAP machine

Dear Dr. Rosenberg:

My husband has severe sleep apnea. He was diagnosed and placed on CPAP. He cannot use it. He has trouble with the mask and the pressure. The company that supplies the equipment has tried several masks but to no avail. We are at our wits' end as our doctor has told us that, because of the severity of his sleep apnea, he is not a good candidate for other forms of therapy such as surgery or dental appliances. My husband has already had one heart attack and we don't want him to have another. Do you have any suggestions for us?

A: Yes, I do. First of all, find out if any sleep centers in your area do a daytime procedure called a Pap-Nap. It is a method of desensitization and acclimation to CPAP and CPAP masks that we have found to be very successful in patients such as your husband. If that fails, a dental appliance may still be worth a try. Although not as successful in severe disease, that is not always the case. Finally, there is a surgical procedure called a Maxillo-Mandibular Advancement being performed at select centers that has a very high success rate in severe sleep apnea.

Dear Dr. Rosenberg:

My wife and I have been married for 40 years. We are in our late 70s. During this past year she has been unable to stay up past 7 p.m. She sleeps seven to eight hours, but wakes up at three to four o'clock in the morning. This is driving us both crazy. Any ideas?

A: What you are describing is called advanced sleep phase syndrome. It is a circadian disorder that primarily effects the elderly. Basically, your wife's clock genes have drifted to a much earlier sleep and wake time. It can, of course, lead to numerous social problems, although it is not dangerous to one's health. The best treatment is exposure to bright light at night. That will tend to delay the onset of sleep. There are light boxes and visors available online that can be used for this purpose.

Dear Dr. Rosenberg:

I am a very poor sleeper. I get no more than four hours of sleep a night. My health care provider sent me to a sleep lab because of this. I had my usual poor night of sleep. However, they said in the report that I slept for seven hours. I am in disbelief. How is this possible?

A: Actually, that is a common occurrence in sleep labs. Most patients with insomnia tend to underestimate their actual time asleep. One reason is that they tend to spend more times in lighter stages of sleep. In fact, several studies have shown that, when awoken from lighter stages of sleep, many people will swear they were not asleep. Others, regardless of stages of sleep, feel that they have not slept. This is a disorder called Paradoxical Sleep or Sleep State Misperception. I have had patients with this disorder tell me they have not slept at all for three weeks. This is physiologically impossible. Education and cognitive therapy can be helpful.

Dear Dr. Rosenberg:

When I become angry or laugh, I get weak in my legs. This started about two years ago. I literally need to hold on to something or lean up against a wall to keep from falling. It usually last no longer than a half minute. My doctor said it could be something called cataplexy and wants me to see a neurologist. I looked it up on the internet and it is a symptom of narcolepsy.

I am not sleepy at all, so how can this be?

A: There are several reasons. First of all, what you describe is classic of cataplexy, which is a sudden onset of bilateral weakness, usually brought on by emotion associated with the disease narcolepsy. Cataplexy may precede the major symptom of sleepiness in narcolepsy by several years. In addition, rarely, one may have cataplexy without narcolepsy. Finally, this may not be cataplexy, so it is a good idea to get this investigated by a neurologist or sleep specialist.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.


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