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HBP Treatment #4: Sleep Apnea April 2021 – October 2022

Looking Back

My disastrous journey into treating my high blood pressure (HBP) with prescription medications and alternative medicine drugs began in April of 2018 and ended in July of 2021, but the seemingly hopeless quest to fend-off a stroke continues. My last update about the ensuing nightmare closed on a happy note in 2020 with the diagnosis of the genetic condition, Liddle Syndrome, and the initiation of the best drug for it, amilioride, a diuretic.

What I wrote then proved to be wrong: there was no happy ending. Ultimately, like with the other 9 antihypertensive drugs, I couldn’t tolerate a therapeutic dose of amilioride for more than a few weeks and my subsequent nephrologist dismissed the Liddle diagnosis, so I was back to Square 1: sick as a dog from antihypertensives that didn’t control my HBP when taking amounts, I could almost tolerate.

Once I started having side-effects from the amiliorde in 2020, I was stuck in the same loop: being sick all the time while watching the quality of my life degrade. Since 2018, I had gradually abandoned learning to operate new appliances and gadgets because even simple instructions were beyond my level of mental functioning. I increasingly relied on Bill to ‘do for me’ with such things as making changes to my Apple Watch, phone, and tablet because they overwhelmed me.

While on the drugs, I steeled my nerves when cycling narrow, winding, mountain roads with sheer drop-offs because I was chronically, mildly dizzy, and carefully anticipated a collapse on a hiking trail when I sensed that using my poles wasn’t enough to keep my feet under me. Bill patiently waited while I had daily “sinking spells” when the GI distress from the antihypertensive medications ground me to a halt; there was nothing I could do but wait the 30-90 minutes for the ‘spell’ to pass. Except for during the sinking spells, sitting didn’t improve how I felt so I turned to my lifelong default, which is to move. I desperately clung to the threads of my life, of my identity, as best that I could.

The Crazy Quest
Just Maybe…
“Cast a wide net” is often my strategy for tackling problems that are resistant to being solved and my hypertension certainly qualified for it. A recent version of this favorite strategy actually worked for solving a different problem than the targeted one. The quest, and its effectiveness, had us rolling in the aisles with laughter because of its absurdity.

After a domino-like tumbling of thoughts, I impulsively slept all night with a child-sized, silicon ear plug in my right nostril, hoping to eventually improve my hypertension. It was too soon to know if it would achieve that treasured goal, but the trick instantly improved my sleep-apnea-like, nocturnal breathing problems and significantly improved my antihypertensive-medication-caused GI discomfort. Bizarre and hilarious, but there was a logical thread that linked employing this novel treatment and the effects.

While still living in our trailer for the first 18 months of the pandemic, in mid-March of 2021, we had been riveted to the TV while listening to yet another researcher reporting the latest findings about covid-19 long-haulers syndrome, something for which we had, and still have, a deep dread, and stopped in our tracks. The researcher stated that some of these covid patients had developed dysautonomia, a dysfunction in the autonomic nervous system, and that some of them were improving with the use of specific, structured breathing exercises.

Bill, who knew a little bit about dysautonomia, was blown away, and immediately began searching online medical literature for more details. I have a string of health oddities that seemed like should have a common cause and, in his mind, this diagnosis could tie them all together.

I didn’t have the defining symptom: light headedness upon arising, but I did have a long list of other issues that fit. Those symptoms included a weird, recurring, transient eye condition (ocular migraine equivalent); hypertension; GI issues; sleep problems; and extreme hot flashes. Dysautonomia didn’t mean a thing to me but the fact that it resonated for Bill did get my attention, as did the researchers success in treating the patients with breathing exercises. I was stunned that such a safe, simple intervention could reset their nervous systems and hoped it could do the same for mine.

The Backstory
I had a mild concussion back in 2000. A month after my concussion, my blood pressure (BP) was 130/90, largely remained elevated, and then climbed higher, over the years; the only pre-concussion reading I had in my notes was 98/60 and I knew that it had been typical. I’d always been puzzled about why my BP permanently rose after that event, though it never sparked any curiosity in my doctors.

After the concussion and my almost 2-year recovery from it, I never returned to my intense yoga practice. I was always very clear that two things dropped out of my life with my head injury: my very robust yoga practice and the equally intense pranayama (breathing practices). My exuberant teacher always included about 10 minutes of pranayama at the beginning of each class and at one time, had an hour-long pranayama class each week. I attended her rigorous classes 6 days a week for years.

Since yoga is recommended for treating HBP, I always assumed that it was the abrupt discontinuation of my formal practice that had contributed to developing hypertension. But, with the new research findings in covid long-haul patients, I wondered if instead of it being the loss of my yoga practice, it was the discontinuation of my pranayama practice that had such a potent effect on my BP. Perhaps dysautonomia had been brewing for years and the pranayama had kept a lid on it.

This new dysautonomia research was fantastically exciting for us both. Its bizarre, possible insights into my health issues from the struggles of covid long-haulers was incredible. The theory behind it was obscure, but the profound effect that the breathing practices could have on the nervous system was riveting—good news for the long haulers and perhaps, me. Yogis of course have long touted the benefits of yoga and pranayama for HBP and other health problems, but few details had been documented in the medical literature. This remote chance of a kinder, gentler way to control my hypertension without the intolerable side effects of prescription drugs, triggered me to launch a 20-minute pranayama practice the very day we heard the brief, one-time, televised story about dysautonomia.

For days, Bill furiously searched online for hours to see if his hypothesis really fit, with some success; I searched online for more specifics about breathing exercises for manipulating the nervous system with little success. The pranayama articles were full of contradictions: “definitely do bhastrika for hypertension” when another author said to never do it. I assumed that if pranayama improved my hypertension that it would take months to see effects and I didn’t want testing the nearly infinite combination of breathing forms and durations to slow me down.

A few nights later, after more research by both of us and when mulling my lack of guidance on breathing exercises from the online resources, I revisited one study indicating modest improvement in hypertension with 18 minutes of only breathing in and out through the left nostril. This was a stripped-down version of a more elaborate breathing practice I’d just resumed (alternate nostril breath) but it was the clearest recommendation. The simplicity of it was a little off-putting—I had already been reviving grander practices.

I pondered occluding my right nostril for 18 minutes a day, or more, while doing my usual activities, not just when seated in the formal breathing practice. Being prone to believing that “more is better until proven otherwise,” I concluded that using the treatment all night would surely be more effective than doing it for 18 minutes, if it didn’t kill me.

I wasn’t sure I could tolerate the right nostril obstruction for even a few minutes when sleeping, but there was no reason not to try. As a bit of hyperbole, I thought the lack of air movement in the right nostril could eventually cause mushrooms to grow out of my nose, or at least trigger a flora imbalance, or it could also disrupt my body’s energy balance as described by Eastern systems. No stranger to leaps of faith and setting up experiments, on March 16th, I gave it a try. Some people bungee jump, I take risks by putting ear plugs in my nostrils.

Amazingly, the single nostril occlusion was easy to tolerate. The super-low humidity of the desert air kept my typically runny nose dry, so there was no hit of mushrooms. The first night the plug fell out twice, but after that, I had no difficulty with comfortably seating the plug or tolerating it—I could hardly tell it was in place.

Bill spontaneously and enthusiastically commented the next morning that I had almost none of my typical gasping/awakening ruckus that causes him to insert his ear plugs in his ears to sleep. Stunningly, he did not know of my experiment. I too had noticed that my breathing was calmer through the night and that the calmness persisted the next day on the trail. We were both ecstatic.

I’d struggled with nocturnal breathing difficulties my entire adult life and my associated sleep fragmentation invalidated sleep studies intended to diagnose potential apnea. We both believed that I had longstanding sleep apnea even though my symptom pattern didn’t fit the criteria for the formal diagnosis. It was hard to believe that the recorded 18 events of sleep disruption per hour on the last study didn’t constitute a problem in the eyes of the sleep specialist, but they certainly made my life miserable. In addition, my snoring made me a menace in dormitories to the point of me passing out ear plugs to the other sleepers, like at Phantom Ranch in the Grand Canyon.

After my uncharacteristically quiet night, Bill read more about the medical side of breathing and hypertension. We were delighted that a credible story was coming together as to why my impromptu “ear plug in the nose” treatment might work for subduing my high blood pressure. Of course, just quieting my sleep was huge for both of us. The evolving hypothesis was that my breathing disruptions while sleeping activated my sympathetic nervous system and since it and the parasympathetic must be in balance, the parasympathetic also became overly activated, causing dysautonomic symptoms.

We didn’t know if there were any downsides to what Bill termed my “mini-CPAP device” (because both the CPAP machines and the ear-plug-in-the-nostril increased resistance when exhaling). It would have been nice to be reassured that there were no risks incurred with my approach from an ENT, but that would never happen because of course, they won’t know. Why would they?? And the stunning improvement in my breathing, day and night was worth taking some risk.

For further reassurance, I consulted an energy practitioner who knew me and my body for his cautions from the Eastern perspective. He wasn’t overly enthusiastic nor overly concerned, so I decided to proceed with the comfort of having his neutral opinions in mind.

Sleeping with my right nostril occluded immediately improved my breathing and my sleep (and Bill’s sleep because of the welcome quiet). After the second night, my gut that had been constantly in chaos from antihypertensives (up to 7 Imodium/day to calm it), was fine. After Night #3, I don’t even recognize the calm, quiet gut as mine. I’d only had 3 ‘treatment’ nights, but presumably other improvements would be slower to manifest, perhaps measured in months.

On the recommendation of my energy practitioner, I tried a brief excursion into right side breathing one night, which appeared to be agitating—expressed as dancing feet in bed. That agitation proved to be transient, and I was soon testing occluding each nostril at bedtime, choosing to keep open the nostril that gave me sustainable airflow.

My autonomic nervous system dysfunctions that we hoped would disappear with the treatment of my sleep apnea were:
..Ocular migraine equivalent
..High heart rate
..GI distress
..Sleep fragmentation & presumed apnea
..Vascular instability (hot flashes)
..Raynaud-like events in my fingers in the cold on 2 occasions
..Noise & light sensitivity
..Brain fog

And watching for improvement in:
.. Tinnitus
..GERD/chronic esophagitis
After a week of non-stop excitement over our unlikely discovery of a powerful remedy for my sleep and GI issues, we were reconciled to waiting, waiting for potential healing to occur in other body systems and to a sufficient degree to notice. I had my list of issues in need of cures or remedies, so we would wait. The biggest prize would of course be significant improvement in my uncontrolled high blood pressure, but all upgrades were welcome. It was a serendipitous convergence of Eastern and Western theory that still made us gasp and giggle for weeks afterwards.

Validating Strategies
Two commercially available, passive products to treat sleep apnea based on the same theory as my silicon ear plug are Provent and Bongos with the following links: There are others.

The Provent is a discontinued product I tried hard to make work for me years ago. It’s an adhesive strip with partially covered air holes that are placed over both nostrils. I did backflips to get a prescription that my internist wouldn’t authorize without a 3rd sleep study and modified them when they didn’t work. They were too restrictive: I couldn’t get enough air to breathe. Additionally, their tape was injurious to my skin. The “Bongos” design is more similar to my ear plug method.

I wouldn’t be trying the Bongos. In part, because I was too pleased with my “cowboy” approach using the ear plugs to accomplish the same thing. But the other reason was that for me, it was easier to deal with only constricting a single nostril, unlike the Bongos, which always partially occlude both. If I can’t breathe well with my ear plug in the right nostril, I switch it to the left, and I may switch again in the middle of the night.

With the Bongos, you fiddle with their different sizes in their sample kit, then always reorder that size. But what if you are a bit congested? It’s “all or nothing” and I liked being able to choose the side and switch through the night if need be. I also can vary the degree of obstruction if I already have some occlusion by making the ear plug narrower. Oh, and the silicon ear plugs are dirt cheap. At Walmart, it’s like $3 for 12 child-sized plugs and I reuse one for a week or so. We buy the orange-colored ones because they are easier to find in the dark.

The benefit to me of these 2 products was to validate that my approach had precedent. I’d totally forgotten about the Provent until months into my ear plug trial and only learned about the Bongos afterwards. But they were comforting to me; they reinforced that a CPAP machine isn’t the only way to partially restrict airflow to increase expiratory pressure to improve sleep apnea or nocturnal breathing problems.

A Year Later
A year after beginning my ‘increased expiratory pressure’ therapy with an ear plug in one nostril when I slept, and 9 months after discontinuing antihypertensives, my systolic reading ran in the mid-140’s or low 150’s and the diastolic in the high 80’s or low 90’s. Those are alarming numbers by today’s standards but, not many years ago, they would not have triggered prescribing medication at my age. When I began antihypertensives, my systolic BP would pop up into the 160’s and perhaps hit 170; the diastolic would run in the mid to high 90’s. If I was riled, both would readily go higher. I had hoped for more improvement with my nose plug therapy, and still hope for better without the use of medications, but I am content to remain off medication for a vastly superior quality of life.

I was shocked, horrified, and thrilled however, even 9 months out from discontinuing the prescription medications, my cognitive decline from the antihypertensives continued to improve. The dizziness, headaches, and malaise continued to recede. I was delighted and relieved to continue to feel healthier and more whole off the drugs. I boldly began to learn more about making little adjustments to my electronics instead of deferring to Bill.

I was certain that the medical professionals would have attributed my improved executive functioning to some other, unidentified cause than the release from the drug side effects because many didn’t believe I was having medication-induced side-effects at all, or that they were psychosomatic. It was hard for me to explain the dramatic transformation besides the discontinuance of the medications or the improvement in my sleep apnea.

I had been on 10 different medications, some of them twice, and sometimes 2 or 3 at a time. The sensations when the latest drug ‘hit’ were all too familiar, sometimes within a day of starting it. The side-effects could begin within hours of beginning a medication and increase over months until they were intolerable but would linger for months after stopping a drug. Feeling well, being able to think clearly, to plan, to undertake complicated tasks, to remember, were too precious to surrender again.

At times on my drug-free program, my BP and HR would drift high enough to challenge my resolve to risk a stroke over the deadening medication side effects; other times, I was content with the readings which were undesirably high but didn’t always put me at significant risk for a stroke.

It was sad, but not hard, for me to select between risking permanent disability from a stroke at some distant time or to continue living a marginalized life being chronically ill and depressed from drug side effects. I bluntly summarized it as a choice between being warehoused at some future time from a severe stroke but first, having had a few more good years, or being permanently warehoused because of being barely functioning on medication doses so small that they poorly controlled my BP. Neither was a great option, but I easily choose quality of life over quantity.

Making an active decision to accept the increased stroke risk was sad but made us both more pleased with having decided 22 years ago to retire early and play hard. We were already in a select group to have played and traveled many more years than most people have in retirement, years that often don’t include good health. We knew when we retired at age 50, that it was a gamble financially, but we also knew people who didn’t live to be 65 or couldn’t pursue their retirement dreams. We had gambled and won and this sobering juncture in my life underscored that point for both of us

Our pursuit of the dysautonomia diagnosis didn’t deliver the results we’d hoped for, which was the relief from a laundry-list of health issues and normalizing my BP, but it did directly trigger the bizarre experiment of occluding a single nostril while sleeping, which dramatically reduced my sleep-apnea-like symptoms, improving both my sleep and that of Bill’s. That in and of itself, was huge, likely literally, lifesaving result.

Supporting Strategies
Though the exciting prospect of cracking the code on my laundry list of health annoyances with a diagnosis and treatment of dysautonomia fizzled, I was left with a spectacular DIY treatment for my sleep-apnea-like, nocturnal sleep disturbances that was cheap, easy, effective, and seemingly without side-effects.

Sleep apnea is known to cause HP and my treatment of it seemingly was putting a welcome, downward pressure on mine. Since the damage done by sleep apnea is deep and far reaching, we could hope in another year that I would have even more recovery from the decades-old condition and perhaps further, concurrent improvement in my BP.

I’d also experimented with nutritional supplements in hopes of lowering my BP but lacked perceivable changes from months-long courses of CoQ10 and grape seed extract. In May of 2022, I began 4-month courses of whole cranberry powder and aged garlic extract, both of which showed promise of statistically significant cardiac and BP benefits. Just after beginning those products, I read that the use of probiotics might be helpful in preventing strokes or reducing their severity. Those were very early conclusions from new research but was comforting because I’d been taking probiotics daily for years, hauling piles of them with me on overseas adventures.

The fallback plan for deciding to live with an unknown amount of risk for a stroke from shunning HBP medications, was to move to a better apartment in September of 2021. We hadn’t had a ‘proper’ home since we began being nearly full-time travelers in 2001. The savings from having a marginal home base for all those years when we resided in it for only 1-3 months a year was compelling, but the drain on our sense of wellbeing was palpable. And our sense of mortality had been on the rise since I started antihypertensives in 2018. The need to “control what we could control” resulted in us moving into a more comfortable and pleasing apartment so if I did become an invalid, or if I should die, our home would be a supportive environment.
By the time we made the move to a better apartment in September 2021, we were more hopeful that I could live many years with my HBP, which had moderated a little bit without the use of antihypertensives. We tweaked our vision, hoping for a win-win: a nice place to live and a long, high-quality life for both of us.

September 2022 Update
The ear-plug-in-the-nose continued to be a wildly successful treatment for my sleep apnea. In the late spring of 2022, I drifted away from using the simple therapy because my chronic runny nose from allergies returned, partially occluding both nostrils. The occlusion was mild enough that I didn’t resort to mouth breathing, but significant enough that it gave me just enough occlusion to regulate my breathing. As hoped, it seemed that I had adopted a new way to breath, a new pattern of exhales and inhales from using the nostril occlusion, that was durable and dampened my apnea. Still imperfect, but it was good enough for our needs.

Sadly, the 4-month experiment with whole cranberry powder and separately, with fermented garlic extract, didn’t appear to dent my hypertension. My hypertension was still disturbingly uncontrolled, but I was delighted that my sense of well-being continued to improve; that would have to be good enough for now.