Daniella Goldenberg

AutoPAP allows the pressure to adjust with position, back vs side sleeping and REM vs NREM sleep where apneas can worsen. It also avoids an in-lab sleep study with CPAP to find the right pressure that would treat your apnea appropriately.

Sleep apnea is the most common cause. The best place to start is a sleep study.

It sounds like you have been struggling and I am very sorry to hear that. There are so many more reasons than sleep apnea to be tired. Have you spoken to your primary care provider? Have you done blood work lately? It looks like you have atrial fibrillation, is your rate controlled? If you were my patient, I would inquire about your actual sleep structure and schedule. Sleep hygiene and stimulus control should be optimized. Depending

It sounds like you have been struggling and I am very sorry to hear that. There are so many more reasons than sleep apnea to be tired. Have you spoken to your primary care provider? Have you done blood work lately? It looks like you have atrial fibrillation, is your rate controlled? If you were my patient, I would inquire about your actual sleep structure and schedule. Sleep hygiene and stimulus control should be optimized. Depending on our conversation, at a minimum, I would get a titration study because are you on the best setting? A lot can change in 5 years. Have you had weight loss or gain? Why are you not a candidate for surgery? And which surgery? Are you talking about Inspire or palate/tongue surgery performed by ENT? If it is the latter, why are you not a candidate for that? If you have a large tongue then that can often be addressed by an ENT physician trained in those types of procedures. I definitely encourage you to pursue this further because no one should be brushed off. If everything has been worked up appropriately then it may be an expectations conversation. Sometimes realizing that despite optimizing everything in your control, stress and/or anxiety can be exhausting. I hope you are able to get to the bottom of your exhaustion and wish you the best of luck.

Dr. Goldenberg

Oral appliance devices are only appropriate for mild to moderate sleep apnea. Once your sleep physician writes you a prescription for an OAD, a sleep dentist would discuss the options with you.

Yes, you can technically buy a CPAP yourself though I don't recommend that. Some sites do require a prescription and the machines can be pretty expensive. I have had patient's come in using their friends of family members' old machine. Sometimes it works out and other times, it doesn't. You are correct that lack of treatment can make your a.fib worse. It sounds like you are close to a formal diagnosis, I would try to stick it out and in the meantime sleep with your head elevated.

Insomnia itself cannot. Sleep deprivation can. Sleep deprivation can cause cognitive, emotional, and physical symptoms. Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Most common cause is stress and anxiety. Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia. Cognitive Behavioral Therapy for Insomnia is the gold standard for treatment of insomnia, better than medication.

**I am not affiliated with this app.

It depends on how long the problem has been going on. I believe it takes about 3 weeks of consistency to change a habit. If it has been going on for yearS, it may take some time though I think you may feel some relief sooner than that if you are consistent and realistic. Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

It usually does not. Acute or short term insomnia can easily turn into chronic insomnia. Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Medications are best used short term with CBT-I. Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

No, medications are more of a "band aid." Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

Try downloading the CBT-I coach app (purple background with a moon). It is a great resource for insomnia.

**I am not affiliated with this app.

I don't recommend getting a CPAP machine without a prescription or a diagnosis. If you do have sleep apnea, Ativan will be safer with a CPAP. Please see a sleep physician or at least a pulmonologist who can order a sleep study.

I understand your issue is a little different, but try downloading the CBT-I coach app (purple background with a moon). It will help optimize your sleep and make sure you are not sleeping/spending more than 8 hours in bed.

**I am not affiliated with this app.