Vicki Cohn

  • 7 Midnight Snacks That RDs Say Can Help Lull You Back To Sleep

    Original Post | Well + Good Food and Nutrition

    We’ve all had those nights where we inexplicably wake up in the middle of the night with a grumbling belly. Maybe it was that HIIT workout you braved for the first time, your marathon of meetings-slash-evening-errands that left you with little time to eat an adequate dinner, or maybe you were just dreaming about delicious pasta (the best type of reverie).

    While you could certainly go forth and eat gobs of Nutella straight from the jar—convenience and tastiness are both extremely key, after all—you don’t need to be an registered dietitian to conclude that the sugar content isn’t exactly a recipe for sound sleep the rest of the night. “High fat and high sugar foods like ice cream and cookies are a double whammy of not helping you sleep well, because fat takes a long time to digest,” says Dawn Blatner, RDN, author of The Superfood Swap. “Giving your gut foods that are difficult to digest distracts your body from sleep, and then sugar causes spikes and crashes of blood sugar and those will interrupt sleep, too.”

    Blatner also suggests avoiding alcohol since, even though your nightcap can make you feel sleepy, it will disrupt your sleep cycle later in the night and lead to lower quality sleep. Caffeinated teas or too much of anything liquid should also be consumed in moderation, she adds, as having to use the bathroom can keep you awake.

    So what should you eat if you’re in the mood for a mid-snooze nosh? Read on for these RD-approved suggestions for healthy midnight snacks that will help you get right back to your REM cycle.

    7 healthy midnight snacks that will help lull you back to sleep

    1. Tart Cherries

    Tart cherries are a natural source of melatonin, a hormone that regulates the body’s internal clock and sleep-wake cycle,” says Blatner. If you can’t find tart cherries at the supermarket, she suggests opting for tart cherry concentrate, which is the super-charged version of tart cherry juice with two tablespoons packing in the equivalent of a whopping 60-plus cherries. Instead of guzzling it (remember that sugar and excessive amounts of liquid can keep you awake), create yourself a little ‘natural’ jello shot before bed. “All you do is mix two tablespoons of tart cherry concentrate with a tablespoon of chia seeds and chill it in the fridge. Try topping it with greek yogurt to combat the tartness,” Blatner says.RELATED STORIES‘I’m a Registered Dietitian, and This Is the One Food I Always…Why Snacking on Hemp Seeds Can Help You Sleep More Soundly

    2. Pumpkin Seeds

    “Pumpkin seeds are an excellent source of magnesium, and studies have found that magnesium improves insomnia and sleep efficiency,” says Blatner. Almonds, cashews, and peanuts are other good sources of magnesium that all make for ideal healthy midnight snacks.

    3. Cottage Cheese

    Cottage cheese contains the amino acid L-tryptophan. “Tryptophan plays a role in the production of serotonin, a neurotransmitter that’s associated with healthy sleep,” says Blatner. “Research has found people who ate cottage cheese about 30 minutes to an hour before going to bed experienced better metabolic health, muscle quality, and overall health than people who didn’t.”https://79dbc014217aa09ddae4500b65493fc3.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

    We know it’s no cheesy mozzarella pizza or ricotta cheesecake, but you can optimize your enjoyment of cottage cheese with a sprinkle of cinnamon (which has its own sleep benefits). “You can also try topping it with tahini or sunflower seed butter, which both contain tryptophan as well,” says Blatner.

    4. Warm Milk

    New research suggests that the casein protein in cow’s milk interacts with trypsin, a digestive enzyme in the stomach, to produce a sleep-enhancing peptide complex called CTH, or casein tryptic hydrolysate,” says Blatner. “The added vitamin D in milk may also play a role in maintaining healthful sleep.”

    5. Kiwi

    Research suggests that the antioxidants and natural serotonin in kiwis can improve both sleep quality and quantity,” says Blatner. Kiwis are naturally sweet and delicious as-is, but you can jazz them up by lightly dipping them in dark chocolate. “Dark chocolate has magnesium, a helpful sleep mineral, but it also has a little caffeine, so go easy on it.”

    6. Banana with Peanut Butter

    “Foods that contain unsaturated fats, like peanut butter, can help improve serotonin levels and boost satiety to keep you feeling satisfied and full during sleep,” says Carissa Galloway, RDN, a nutrition consultant at Premier Protein. “Eating bananas with peanut butter can also be helpful before bed, as bananas contain magnesium which, as mentioned, help support good sleep.” The combination of bananas plus peanut butter makes for one of the most delicious healthy midnight snacks out there.

    7. Chamomile Tea

    “There are numerous studies that support the benefits of chamomile tea in promoting a healthy nighttime routine,” says Galloway. Chamomile tea contains flavonoids, which are compounds found in certain foods, including one called apigenin. “Apigenin connects with receptors in our brains to help reduce insomnia and promote a state of steady sleep.”

    So when you find yourself wide awake in the wee hours, sip a cup of chamomile tea with a splash of steamed almond milk, or have a batch of Blatner’s chamomile cookies on hand.

    All that said, bear in mind that more important than what you eat before bed, is the amount. “Having a large amount of any food will take too much effort for your body to digest instead of resting,” says Blatner. A light nosh of one of the foods recommended here, on the other hand, will send you right into the sweetest of dreams.

  • Menopause and insomnia: What is the link?

    Original Post | Medical News Today

    After menopause, a person’s ovaries produce much lower amounts of certain hormones, including estrogen and progesterone. For some, this transition comes with sleep disturbances.

    Insomnia refers to the difficulty falling or staying asleep. It is a commonTrusted Source experience in menopause and may occur as a result of hormonal changes.

    It may also be a secondary result of the other symptoms of menopause, such as hot flashes.

    Read on for more information on menopause and insomnia, including why it happens, how long it may last, and what medical treatments and complementary therapies are available.

    Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

    Can menopause cause insomnia?

    The exterior of a large apartment building at night. Bright light illuminates one of the windows.
    Colin Anderson/Stocksy

    Yes – insomnia is a frequent occurrence during perimenopause and menopause. Some people only experience mild or occasional sleep disturbances, but for others, the insomnia can be severe.

    According to a 2018 article, 26%Trusted Source of people going through perimenopause and menopause experience insomnia that affects their daily activities.

    In females, the rate of insomnia increases with age. According to the Study of Women’s Health Across the Nation (SWAN)Trusted Source, the prevalence of sleep disorders is as follows:

    • 16–42% in premenopause
    • 39–47% in perimenopause
    • 35–60% in postmenopause

    Why does menopause cause insomnia?

    Research on the exact cause of insomnia during menopause does not point to one clear cause. Several things may contribute to it, including:

    Hormonal changes

    Some evidence suggests that low hormone levels can increase the likelihood of insomnia during menopause.

    According to the SWANTrusted Source, previous longitudinal studies have found a correlation between lower levels of estradiol and poorer sleep. This is especially true if the decline in hormones happens quickly, as it does after a person undergoes surgery to remove the ovaries.

    Hot flashes

    Sometimes, insomnia happens during menopause because of hot flashes or night sweats. These symptoms can disrupt sleep, causing frequent waking.

    Hot flashes, which are one of the so-called vasomotor symptoms, are common in menopause, affecting 75–85%Trusted Source of people going through menopause.

    Hot flashes cause a sudden sense of heat around the face and neck and often occur with sweating and a fast heartbeat.

    Reduction in melatonin

    Melatonin is a hormone that plays a key role in the sleep-wake cycle, helping keep people asleep. It is especially important at the start of sleep.

    However, melatonin levels appear to decrease with age, which may cause sleep disturbances.

    It is not clear whether there is a link between menopause and a decline in melatonin. Some evidenceTrusted Source suggests that there is and that individuals during postmenopause have less melatonin than those during premenopause.

    Mental health

    For many people, menopause signals a major change. It is also a sign that a person is getting older. This, along with the symptoms of menopause, can have an impact on an individual’s mental health.

    Many mental health conditions, including anxiety and depression, affect sleep. However, insomnia can also make depression more likelyTrusted Source. The relationship between sleep and mood is bidirectional, and changing hormone levels can also play a role.https://a76fa006e565d376844b91a5d5a8864a.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

    How long will insomnia last?

    How long insomnia lasts during and after menopause depends on many factors. Every person who goes through menopause has a different experience. Some will find that the symptoms last longer than they do for others.

    A person’s hormone levels can start to change 7–10 yearsTrusted Source before a person’s last period. After this point, people can continue to have symptoms such as hot flashes for several years.

    Estradiol levels continue to decline for the first 1–6 years in early postmenopause, which may result in continued symptoms.

    It is of note, however, that there are treatments and therapies available that can reduce sleep difficulties. It is also important to address any other factors that may be contributing to poor sleep quality.powered by Rubicon Project

    Medical treatments for insomnia during menopause

    The main treatment for menopause-related insomnia is hormone therapy. This works by replacing the lost hormones, which can improve many menopause symptoms. People may find that they sleep better and experience fewer hot flashes while using this treatment.

    Hormone therapy is available in topical gels, creams, and patches. People can also take it internally via tablets or an implant.

    Another potential treatment is a low-dose selective serotonin reuptake inhibitor (SSRI).

    Doctors typically prescribe SSRIs for mental health conditions, but these medications can also reduce the frequency of hot flashes, which may help with sleep. However, it is of note that insomnia can also occur as a side effect of SSRIs.

    For those who are experiencing mood changes, anxiety, or depression, talk therapy may help them understand and cope with these feelings. Lessening the impact of mental health conditions may also benefit sleep.

    Doctors rarely prescribe sleeping pills to treat insomnia, as these can have serious side effects. Many are also addictive and are not suitable for managing a long-term sleep problem.

    Natural and complementary therapies

    According to a 2019 review, no study has found that herbal or dietary supplements consistently help with menopause symptoms. However, there are many other ways people can try to make sleep easier during menopause.

    Below are some evidence-based approaches:

    Avoiding caffeine, nicotine, and alcohol

    Smoking, consuming caffeine, and drinking alcohol can all make it more difficult to sleep. While it may seem that alcohol makes people drowsy, even a small amount reduces overall sleep quality.

    A person can try to reduce or avoid any of these, especially in the afternoon and evening.

    Aromatherapy

    Aromatherapy may be helpful in inducing relaxation and reducing hot flashes.

    In a clinical trial involving 100 women, researchers found that after 12 weeks of lavender essential oil inhalation, the participants had 50% fewer hot flashes.

    Other studies have also found that aromatherapy together with massage was more effective than massage or aromatherapy by themselves.

    Hypnosis

    A 2019 review notes that there is evidence that hypnosis may reduce the frequency and severity of hot flashes by up to 50%.

    Moreover, for people whose insomnia results from hot flashes, hypnosis may be a helpful complementary treatment.

    Yoga

    Some studies have found that yoga has a beneficial impact on the psychological symptoms of menopause. If a person is having difficulty sleeping due to stress or anxiety, yoga practice may help reduce these symptoms.

    However, the results of other studies on yoga have been mixed. This is partly because there are many styles of yoga and numerous ways of practicing, which may lead to inconsistent results.

  • The Effects of Sleep Deprivation on Your Body

    Original Post | Healthline May 15 2020

    The following is a fantastic article describing the effects of sleep deprivation on your body, broken down by system. Medically reviewed by Stacy Sampson, D.O., Family Medicine — Written by Stephanie Watson and Kristeen Cherney on May 15, 2020


    If you’ve ever spent a night tossing and turning, you already know how you’ll feel the next day — tired, cranky, and out of sorts. But missing out on the recommended 7 to 9 hours of shut-eye nightly does more than make you feel groggy and grumpy.

    The long-term effects of sleep deprivation are real.

    It drains your mental abilities and puts your physical health at real risk. Science has linked poor slumber with a number of health problems, from weight gain to a weakened immune system.

    Read on to learn the causes of sleep deprivation and exactly how it affects specific body functions and systems.

    Causes of sleep deprivation

    In a nutshell, sleep deprivation is caused by consistent lack of sleep or reduced quality of sleep. Getting less than 7 hours of sleep on a regular basis can eventually lead to health consequences that affect your entire body. This may also be caused by an underlying sleep disorder.

    Your body needs sleep, just as it needs air and food to function at its best. During sleep, your body heals itself and restores its chemical balance. Your brain forges new thought connections and helps memory retention.

    Without enough sleep, your brain and body systems won’t function normally. It can also dramatically lower your quality of life.

    review of studies in 2010Trusted Source found that sleeping too little at night increases the risk of early death.

    Noticeable signs of sleep deprivation include:

    Stimulants, such as caffeine, aren’t enough to override your body’s profound need for sleep. In fact, these can make sleep deprivation worse by making it harder to fall asleep at night.

    This, in turn, may lead to a cycle of nighttime insomnia followed by daytime caffeine consumption to combat the tiredness caused by the lost hours of shut-eye.

    Behind the scenes, chronic sleep deprivation can interfere with your body’s internal systems and cause more than just the initial signs and symptoms listed above.

    Central nervous system

    Your central nervous system is the main information highway of your body. Sleep is necessary to keep it functioning properly, but chronic insomnia can disrupt how your body usually sends and processes information.

    During sleep, pathways form between nerve cells (neurons) in your brain that help you remember new information you’ve learned. Sleep deprivation leaves your brain exhausted, so it can’t perform its duties as well.

    You may also find it more difficult to concentrate or learn new things. The signals your body sends may also be delayed, decreasing your coordination and increasing your risk for accidents.

    Sleep deprivation also negatively affects your mental abilities and emotional state. You may feel more impatient or prone to mood swings. It can also compromise decision-making processes and creativity.

    If sleep deprivation continues long enough, you could start having hallucinations — seeing or hearing things that aren’t really there. A lack of sleep can also trigger mania in people who have bipolar mood disorder. Other psychological risks include:

    You may also end up experiencing microsleep during the day. During these episodes, you’ll fall asleep for a few to several seconds without realizing it.

    Microsleep is out of your control and can be extremely dangerous if you’re driving. It can also make you more prone to injury if you operate heavy machinery at work and have a microsleep episode.

    Immune system

    While you sleep, your immune system produces protective, infection-fighting substances like antibodies and cytokines. It uses these substances to combat foreign invaders such as bacteria and viruses.

    Certain cytokines also help you to sleep, giving your immune system more efficiency to defend your body against illness.

    Sleep deprivation prevents your immune system from building up its forces. If you don’t get enough sleep, your body may not be able to fend off invaders, and it may also take you longer to recover from illness.

    Long-term sleep deprivation also increases your risk for chronic conditions, such as diabetes mellitus and heart disease.powered by Rubicon Project

    Respiratory system

    The relationship between sleep and the respiratory system goes both ways. A nighttime breathing disorder called obstructive sleep apnea (OSA) can interrupt your sleep and lower sleep quality.

    As you wake up throughout the night, this can cause sleep deprivation, which leaves you more vulnerable to respiratory infections like the common cold and flu. Sleep deprivation can also make existing respiratory diseases worse, such as chronic lung illness.

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    Digestive system

    Along with eating too much and not exercising, sleep deprivation is another risk factor for becoming overweight and obese. Sleep affects the levels of two hormones, leptin and ghrelin, which control feelings of hunger and fullness.

    Leptin tells your brain that you’ve had enough to eat. Without enough sleep, your brain reduces leptin and raises ghrelin, which is an appetite stimulant. The flux of these hormones could explain nighttime snacking or why someone may overeat later in the night.

    A lack of sleep can also make you feel too tired to exercise. Over time, reduced physical activity can make you gain weight because you’re not burning enough calories and not building muscle mass.

    Sleep deprivation also causes your body to release less insulin after you eat. Insulin helps to reduce your blood sugar (glucose) level.

    Sleep deprivation also lowers the body’s tolerance for glucose and is associated with insulin resistance. These disruptions can lead to diabetes mellitus and obesity.

    Cardiovascular system

    Sleep affects processes that keep your heart and blood vessels healthy, including those that affect your blood sugar, blood pressure, and inflammation levels. It also plays a vital role in your body’s ability to heal and repair the blood vessels and heart.

    People who don’t sleep enough are more likely to get cardiovascular disease. One analysis linked insomnia to an increased risk of heart attack and stroke.

    Endocrine system

    Hormone production is dependent on your sleep. For testosterone production, you need at least 3 hours of uninterrupted sleep, which is about the time of your first R.E.M. episode. Waking up throughout the night could affect hormone production.

    This interruption can also affect growth hormone production, especially in children and adolescents. These hormones help the body build muscle mass and repair cells and tissues, in addition to other growth functions.

    The pituitary gland releases growth hormone throughout each day, but adequate sleep and exercise also help the release of this hormone.

    Treatment for sleep deprivation

    The most basic form of sleep deprivation treatment is getting an adequate amount of sleep, typically 7 to 9 hours each night.

    This is often easier said than done, especially if you’ve been deprived of precious shut-eye for several weeks or longer. After this point, you may need help from your doctor or a sleep specialist who, if needed, can diagnose and treat a possible sleep disorder.

    Sleep disorders may make it difficult to get quality sleep at night. They may also increase your risk for the above effects of sleep deprivation on the body.

    The following are some of the most common types of sleep disorders:

    To diagnose these conditions, your doctor may order a sleep study. This is traditionally conducted at a formal sleep center, but now there are options to measure your sleep quality at home, too.

    If you’re diagnosed with a sleep disorder, you may be given medication or a device to keep your airway open at night (in the case of obstructive sleep apnea) to help combat the disorder so you can get a better night’s sleep on a regular basis.

    Prevention

    The best way to prevent sleep deprivation is to make sure you get adequate sleep. Follow the recommended guidelines for your age group, which is 7 to 9 hours for most adults ages 18 to 64.

    Other ways you can get back on track with a healthy sleep schedule include:

    • limiting daytime naps (or avoiding them altogether)
    • refraining from caffeine past noon or at least a few hours prior to bedtime
    • going to bed at the same time each night
    • waking up at the same time every morning
    • sticking to your bedtime schedule during weekends and holidays
    • spending an hour before bed doing relaxing activities, such as reading, meditating, or taking a bath
    • avoiding heavy meals within a few hours before bedtime
    • refraining from using electronic devices right before bed
    • exercising regularly, but not in the evening hours close to bedtime
    • reducing alcohol intake

    If you continue to have problems sleeping at night and are fighting daytime fatigue, talk to your doctor. They can test for underlying health conditions that might be getting in the way of your sleep schedule.

  • Can Sleep Apnea Cause Erectile Dysfuntion?

    Original Post | Posted by Sleep Review Staff | Sep 16, 2021 | Obstructive Sleep Apnea 

    VeryWell: Sleep apnea can take a toll on the hormonal balances in the male body, leading to problems including erectile dysfunction. 

    Numerous studies have linked healthy sleep to healthy sex. While sleep deprivation can cause mood and relationship problems, the bigger issue is how sleep disorders can affect the production of hormones like testosterone. Sleep disorders are a leading cause of sexual problems.

    Sleep Apnea and Erectile Dysfunction

    Sleep apnea causes you to stop breathing when you are sleeping. When this happens, it may disturb you enough to wake you up completely, but your sleep is usually disturbed whether you fully wake up or not. Testosterone production rises when you fall asleep and peaks during rapid eye movement (REM) sleep. Research points to the fragmented sleep of people who suffer from sleep apnea as being a contributor to sexual problems like erectile dysfunction.

    Around 4% of men ages 30–60 experience erectile dysfunction. Erectile dysfunction is more common in men with obstructive sleep apnea (OSA) than those without OSA.

    Get the full story at verywellhealth.com.

  • What Is Sleep Apnea?

    Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired, even after a full night’s sleep, you may have sleep apnea.

    Woman with Sleep Apnea Snoring

    There are two types of sleep apnea:

    Obstructive Sleep Apnea

    The more common form of sleep apnea is obstructive sleep apnea. This occurs when the throat muscles relax. It is an anatomical and neurological problem. During sleep, your airway collapses and blocks air from passing through. Some sleep apnea patients may gasp, snore or choke. Some are completely silent. Not all people who have sleep apnea snore. Not all people who snore have sleep apnea.

    Central Sleep Apnea

    The lesser common form of sleep apnea, central sleep apnea, occurs when the brain fails to send important signals to the breathing muscles during sleep. Your body essentially “forgets to breathe”.

    What are the effects?

    This roller coaster sleep pattern leads to a loss of energy, concentration, productivity and an inability to stay awake during less active tasks. This may include reading, watching television and driving. In severe cases, the continuous oxygen deprivation caused by sleep apnea can lead to high blood pressure, heart attacks, strokes and even sudden death. There may be a genetic component to this disorder as it often occurs within families.

    Can Sleep Apnea Be Resolved?

    Generally, in cases of very mild sleep apnea, symptoms have been resolved with weight loss, a reduction of alcohol intake, or a change in sleep position. Sleep experts suggest that most people with sleep apnea should not sleep on their backs, but instead on their left side.

    In more serious cases, oral appliance therapy which repositions the lower jaw and the tongue are very helpful to many patients and also those whose only problem is disruptive snoring. These devices gently keep your jaw forward during sleep to open your airway. For the vast majority of patients, the oral appliances are far more comfortable than CPAP therapy. In fact, experience shows that 83% of patients who try oral appliance therapy sleep comfortably for an average of almost 7 hours per night.

    CPAP machines offer continuous positive airway pressure (CPAP) through a mask. Although this treatment helps many people, some cannot tolerate this method and may benefit from oral devices.

    Many people benefit from combination therapy; the use of an oral appliance and the CPAP machine.

    Seeking Treatment

    We recommend you seek treatment from an American Board of Dental Sleep Medicine Diplomate. Diagnosing sleep apnea currently involves a physician prescribed sleep test. These tests can be performed at home or at a sleep lab.  For more information on sleep apnea and resources, you can visit American Alliance for Healthy Sleep, 2510 North Frontage Road
    Darien, IL 60561 or National Sleep Foundation, 1367 Connecticut Avenue, NW, Washington, D.C. 20036

  • Are You A CPAP Dropout?

    Many of our clients come to us because of their intolerance to the CPAP machine. There is a multitude of reasons that people are unable to tolerate CPAP therapy. We stumbled upon this article and thought it was worth the share. It nicely articulates many of the reasons CPAP is not always the solution for the treatment of sleep apnea.

    Original Post | By Victoria Knight, Kaiser Health News

    When doctors told Frances Faulkenburg she had sleep apnea, she was more than ready for relief from her tired-all-the-time existence. She used to fall asleep at red lights while behind the wheel. At night, she’d wake up gasping for air, heart pounding. Her husband told her she snored.

    But Faulkenburg, 47, couldn’t tolerate the CPAP machine her doctor prescribed.

    “I just could not get used to the face mask covering both my nose and mouth,” said Faulkenburg, who lives in Oviedo, Fla.

    It was claustrophobic. I felt more like I was suffocating than getting breathing relief.

    Frances Faulkenburg

    CPAP, or continuous positive airway pressure, is often one of the first solutions doctors suggest for sleep apnea. With this disorder, a person’s breathing stops and starts so frequently during the night that it can lead to or exacerbate health problems. The National Sleep Foundation estimates that more than 18 million American adults have sleep apnea.

    A CPAP machine blows a stream of air into the back of the throat to let people breathe easier. It prevents muscles in the back of the throat from narrowing, which can constrict the airway, causing snoring or disturbed sleep.

    Yet Faulkenburg quit using her CPAP and went back to feeling sleepy and tired all the time.

    Many people have a negative reaction to the machines and are tempted to do the same. The big whoosh of air in your throat. The restrictive mask on your face. It can be a lot to adjust to. Studies suggest that from one-third to more than 50% of patients either stop using their CPAP machine or never bother to fill their prescription. They quit for a variety of reasons, but mostly because the device can be cumbersome and uncomfortable. Sometimes, they quit because of confusing or stringent health insurance restrictions.

    But the health effects of untreated sleep apnea can be serious. People struggle with anxiety, tiredness, and low productivity. There’s even an increased risk of high blood pressure, heart attack, and stroke.

    Mary Mertens, a respiratory therapist at the Cleveland Clinic, helps patients work through problems with their CPAP machine. Patients often complain that the volume of air the machine puts out feels too intense.

    “Think about it as sticking your head out of a car window with your mouth open at 60 mph versus 25 mph,” said Mertens. “The high pressure can be very overwhelming.”

    So Mertens’ team goes to people’s homes to help troubleshoot problems. That includes explaining sleep apnea and how a CPAP can help.

    “Picture the air passage at the back of their throat like a garden hose with no water in it. The hose collapses down,” said Mertens. That’s what happens when a person with sleep apnea is sleeping.

    “When we put a CPAP on somebody, it’s like turning the water on for the garden hose,” she said. “The hose then pops open and stays open.”

    At the Cleveland Clinic, about 70% of patients in the Respiratory Home Care program keep using their CPAP, Mertens said.

    Follow-up is key. Mertens’ team checks in with patients during the first three to five days, again between 30 and 45 days and again between 60 and 90 days.

    Faulkenburg, the patient in Florida, first tried a CPAP 15 years ago but never checked back with her pulmonologist when she was struggling. And, she said, the physician never contacted her. Then several people in her social circle died in their sleep—all of them right around her age. Those stories shook Faulkenburg, and she decided to try her CPAP again.

    “I got a mask that covered just my nose, which let my mouth stay closed. That ended up being the whole issue,” she said. “I sleep so well, I can’t sleep without my CPAP now.”

    Dr. Indira Gurubhagavatula, a sleep medicine physician at the University of Pennsylvania Health System, said the look of the device alone can be alarming.

    “One of the first things that I hear is that the thing itself is intimidating—they see the tubing and mask and it’s blowing air in their face—they have real concerns: ‘Am I actually going to sleep better with that thing?’

    It is a big ask to go to bed with this thing strapped to their faces.

    Gurubhagavatula said people who feel claustrophobic should wear their CPAP mask during the day while reading or watching TV. That can help the nerve endings in the face get used to the mask.

    “It’s just like breaking in new shoes or new jeans,” said Gurubhagavatula. “Once it’s broken in, it’s less of an issue.”

    Pulmonologist James Rowley, a sleep medicine physician at Detroit Medical Center, said the air pressure from the CPAP can cause a runny nose, nasal congestion or dry mouth. He said he can help by adjusting humidity settings on the machine or prescribing an antihistamine.

    Medicare and private insurance companies require patients to use their CPAP very consistently—often at least four hours every night and for 70% of nights each month. Sometimes the usage is monitored.

    Patients who don’t comply may end up paying out-of-pocket. That’s the topic of this week’s episode of the podcast “An Arm and a Leg.” Kaiser Health News co-produces the podcast.

    Prices vary, but a fully equipped machine typically costs from $500 to $3,000, with the national average around $850. After that initial investment, masks, hoses and filters need to be replaced two or three times a year. And users have the ongoing cost of maintenance supplies—wipes and brushes to keep the machine parts clean.

    Patients whose machines have been taken away because they couldn’t follow the insurance company rules.

    “They may have child care or elder responsibilities that make their sleep disrupted. Or they sleep in chunks of time because they work certain shifts,” she said. “The rule is arbitrary because using the machine, even if part-time, is beneficial.”

    Nate Wymer, 44, said his machine is lying around his home somewhere in Holly Springs, N.C., but he hasn’t seen it in years.

    “When I had the mask on I had to think about breathing out of my nose,” said Wymer. “That’s not something I normally do. After a couple of nights, I just couldn’t do it.”

    “My doctor never really followed up from what I can remember, so I back-burnered it,” said Wymer. “But, if you get in front of somebody, actually talk to them and make sure everything is going OK, that would have been nice.”

    Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.