Brief Answer:
Excessive head sweating.

Detailed Answer:
Good evening. I am a neurologist and have read your comments/questions.

Apparently, you sweat profusely when sleeping on your back as well as a numbness on the tip of the tongue. You've been told that you have sleep apnea. You don't think there is a relationship of what's going on to what's happening. There is no mention as to what the sweating pattern is like when sleeping in any other position.

You do not give any history about this problem in terms of how long you've had it or if has been improving or worsening over itme. Nor do you give other symptoms aside from the stated ones. You do say that you drink lots of fluids during the day which one could interpret as a condition of POLYDYPSIA. You say also that you need a lot of protein and sugar in your diet and that you cannot sleep for more than 1 hr. at a time. You give no details on what is going on that you cannot sleep properly either. Is it become the sweating? Is it because of difficulty breathing which then, triggers you to awaken due to low Oxygen tension levels in the bloodstream? Or is it due to the thirst?

Activation of the sweating mechanism ONLY to the head area while asleep occurs through the Trigeminal Nerve complex. I am not sure I can fully explain why this becomes charged and tripped from simply lying on your back. The fact you tell me that you have sleep apnea, drink lots of fluid during the day and take in a lot of protein and sugar makes me wonder if there could be any metabolic component in play such as diabetes or some form of kidney problem. Have you been checked for these things? Are you overweight or obese? Does lying on your back feel uncomfortable in other ways aside from the sweating. Something is being activated to trigger sweating through an autonomic system dynamic and this seems to be active only when sleeping on your back at night...or so it would seem.

Have you had a sleep study in the past? Is that how you've been told you had sleep apnea or is that diagnosis simply someone's hypothesis based upon other information or has someone actually witnessed your stopping the breathing?

One recommendation is that you obtain a sleep study if you've not had one recently since many things are monitored at night. For example, if one were to have some type of electrical hyperactivity going on in the brain which could be one reason that profuse sweating mechanisms could be activated then, that might be one reason for what's going on. That could happen during a seizure as an example. During a sleep study something like that would be picked up. And there would be other things measured during the period of time that you are sweating such as your breathing patterns and perhaps something with that could help explain your symptoms.

Also, I would recommend you be reviewed metabolically for why you say you need more protein and sugar than the average person. This is me sounds like some sort of protein/sugar wasting phenomenon which can occur when there are problems with the kidneys. Of course, sugar wasting can also be a sign of diabetes while protein in the urine could be a consequence of the diabetes or some other kidney problem which is going on from an injury or insult in the past or which is ongoing. You should get a 24 hr. urine assessed aside from a traditional urinalysis and some other blood work to see what your protein and albumin stores are like.

Therefore, it seems to me that you could use a good physical and metabolic evaluation to determine why some of these things are happening. You may also benefit from an autonomic function set of tests which usually involves getting what is known as a TILT TABLE TEST done as well as some tests for the heart and lungs as well as other tests to measure sweating potential and whether that entire system is working correctly.

I hope these answers and recommendations satisfactorily address your questions. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 46 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
Thank you for your clarifications

Detailed Answer:
I've read through your detailed clarifications of certain things that you wrote in your original question and so thank you for taking that time.

In trying to understand your major concerns from all of this I would say that there are essentially 3 things you are trying to understand. Please correct anything that is incorrect in my assumptions:

1. Reason and/or significance of profuse Head sweating in the lying (supine) position and only when asleep.
2. Inability to sleep for more than 1 hr. at a time
3. Reason and/or significance of drinking large volumes of water during the day.

Now, based upon some of the information you've clarified in your followup response and facts that you've presented which include:

A. You are a smoker
B. You weight about 275 lbs. and are 6 feet tall
C. You are diagnosed with sleep apnea but do not use any equipment or supplemental O2 at night due to inability to sleep with attachments to face.
D. You have sweat profusely in the head and neck region nearly all your life that you can recall although some of that activity seems to have decreased as of 3 years ago.


I will give you the following opinions:

1. If sweating profusely throughout your body is a "normal" thing for you to do but that it becomes very noticeable in the head and neck upon assuming the supine position then, one possible explanation that strikes me is that somehow by virtue of the position you take on your back you are stimulating your autonomic nervous system (specifically your SYMPATHETIC SYSTEM) to activate the sweating mechanism but only in the local area of your head. This is referred to as a FOCAL HYPERHIDROSIS and though you've had it all your life in general this is considered an abnormality in the sweating mechanism. There is an autonomic system dysfunction that is signaling excessive sweating to occur in the face and scalp region which is often brought on by emotional stress, excessive heat, or sometimes in the face of neither of those triggers. I would also suggest that in addition to the head sweating when you lie down your palms and feet may also sweat although to a less noticeable extent because of the way the system tends to be wired. It is said that abnormalities include either lesions in the nerve tracts that control the sweat glands in face and head resulting in a hyperactive response or nerve inflammation. The best way to characterize this problem any further would be to do AUTONOMIC FUNCTION TESTS and to specifically test the sweating mechanism. In your case, activation seems to occur when you assume the supine position AND WHEN YOU ARE ASLEEP. I do not have a ready explanation for that last detail but it is an interesting one to contemplate from a physiological point of view and something that could possibly have an answer turned up through autonomic function testing.

2. Inability to sleep for more than 1 hr. at a time. I know you have already stated that you disagree that the sleep apnea is a contributor to any of the problems you've mentioned. However, I must respectfully take a medical position against that statement since we know quite well from experience as well as studies that sleep apnea DOES CAUSE PEOPLE TO AWAKEN multiple times a night from sleep. It would appear that you've had at least 1 sleep study. I invite you to obtain the copy of the report. In that report you will find a number that indicates the number of times you awakened during the night from a sound sleep. In people with apnea this number can be very high. If you then, correlate when these awakenings actually occurred during the night to what the oxygenation levels were in your bloodstream at the time you will find that on average people will awaken at precisely the moments when oxygen saturation is running at some of the lowest levels during the night. Why this is the case is not fully understood but one simple explanation would be that the organism's protective mechanisms against oxygen starvation of the brain, kidneys, and muscles in general cause a stirring and arousal to occur so that additional breathing and oxygen can be taken in for the purpose of supplying the needed requirements to continue functioning. So the person arouses..sometimes they are unaware of the arousal and other times they are to the point of actually coming awake. This would be a significant event in terms of the low oxygen levels and this then, in my opinion is at least one reason why you have trouble sleeping for very long at a time. Add to that the fact you are a smoker which means you are further depleting your body's oxygen supply by blocking your red blood cells with carbon monoxide from cigarette smoke which takes about 8 hrs. to clear out of the system from just 1 cigarette. This will add to the oxygen DEBT that your body runs when you fall asleep further causing you to LOSE SLEEP since you need to keep that oxygen supply up constantly for your organs to function. And finally you're diagnosed with severe constrictive respiratory dysfunction which means that you are unable to take good deep or full breaths because of a CONSTRICTIVE FORCE which is usually considered to be external to the respiratory system apparatus. In this case, your condition of obesity is the likely cause. The weight of your chest (and especially if you lie either on your belly or back make respiratory excursions very taxing and with the muscles working in an environment of oxygen debt you further stress the system causing you to have to awaken even more during the night to accomplish this task.

3. Large volumes of water that are ingested. I'm not quite sure why this is except to say that if you have a disorder of sweating which involves not only your head and neck but your entire body and this is the way you've been then, it is not hard to imagine that when all your sweat glands are working at full capacity (for whatever the reason- excessive heat, emotions, oxygen debt, etc.) that you could be losing as much as 3 LITERS/HR. of fluid from your entire body....and in your case it may be more since that number I gave you is based upon the surface area of a man weighing 70 Kg. and standing at 1m 50 cm. You are considerably larger than those numbers and so your calculated hydration deficits through just your seating system alone could be considerably more. Of course, if you were running a marathon in the Sahara desert I would rightly believe that the rate of 4L/hr. or more of fluid loss were possible....obviously that's not what we're talking about. Nevertheless, given the abnormalities that we've alluded to in your possible condition of cranial focal hyperhidrosis I would say that it is altogether possible that your fluid losses both sensible as well as insensible total to an amount that is more than sufficient to explain your large amounts of fluid intake due to increased dehydration status as you put it.....now just an aside but one way to slow dehydration down would be to add protein to your system since this produces what we call an oncotic pressure within your blood vessels that tends to retain fluid...so long as your kidneys are in good shape and not passing the protein out. Ingesting large amounts of sugar could conceivably produce the same results but the down side to that way of increasing oncotic pressure is that while protein doesn't do much to add sheer weight to your body.....SUGAR on the other hand is your enemy when it comes to your weight. 50% of the sugar you ingest will be likely converted in fat stores and once that happens the likelihood that you will burn it off in any type of easy way is small. You really need to consider that fact and start limiting your sugar intake to get your body more adapted to much less need and hopefully, your weight can come under better control as a result.

---