Written by Lori Ann Kostich M.S. CCC-SLP
Mandell Center for Multiple Sclerosis Treatment and Research
“I don’t cough when I eat… I cough when I sleep”
This occasionally happens to me. As you know (because you’ve already read the part of this website on swallowing), Speech Language Pathologists (SLPs) treat swallowing issues. So when a patient says “I cough…” for any reason, it usually means an automatic referral to the SLP. When a patient says to me “I cough, but only when I sleep”, I do a swallow evaluation just to make sure there is nothing obviously wrong inside that persons mouth, or when they swallow food. Then I ask if the patient has a breathing machine (CPAP, VPAP- one that you wear at night and usually has a mask). And about 75% of the time the patient who “chokes” in the night, will say to me “Yes, I have one of those, but it is too loud and it keeps my significant other awake, so I don’t use it”. Or they say, “The mask is uncomfortable, so I don’t use it”. Or they say, “It’s broken”.
At this point in my evaluation, I usually sigh.
Then I ask the following questions:
1. How long have you had the machine and do you remember which physician ordered it for you?
2. Why did the physician order it for you?
To that second question, I often get responses similar to “I wasn’t breathing during the night”, or “I stopped breathing too much during the night”, or straight up “I was diagnosed with sleep apnea”.
So let’s go back to the issue of fatigue. If you have a breathing machine and are not using it, it might not be fatigue you are feeling during the day. You might just be tired because you are not getting good rest during the night.
Here is a link that talks in more detail about sleep apnea.
In this situation then, what can be changed to make you feel better? Consider using that machine again. If you haven’t used it for a very long time, you might want to take it back to the physician to see if the last setting you were using it at is still correct. If it’s broken, definitely take it back to the physician. When you are at the physician’s, confess to the reason you stopped using it in the first place. If the mask was uncomfortable, there might be another option. If it was keeping your significant other awake, have a conversation with your significant other. If use of this machine is important to your ongoing health, then you need to use it. Even if it is keeping them awake, you still need to use it. And you need to have a conversation about some kind of compromise.
When I speak to significant others of patients who have breathing machines, however, usually they ae very supportive, saying the noise of the machine is a little like white noise, and easy to get used to. Sometime, they also say the noise of the machine is better than listening to the patient snore, stop breathing, choke, snore, etc. all night. So, every couple is different… have that conversation.
So, this is one more issue that needs to be thought through when a patient says they are “fatigued”
Is this something you can change?