Jay Aitchsee wrote:Right on both counts! Ergo my home system and my ealier comments about having more the one problem. I feel I have the respiratory portion under control, althought it took me a number of years to do it. And I think you hit the nail on the head about not trusting the techs. It's not that they're incompetent. I think it's because they're working with only one data set. A person goes to the lab, gets titrated (which may be right for that night under those conditions) and is sent home with a CPAP and a pressure setting. I think a person is extremely lucky if that works for them. For me it didn't work, I didn't feel better, so I wasn't compliant. It took a couple years for me to learn I could get data from my CPAP. Once I did, I started self titrating and got my AHI down to around 6 or so. I found the software, bought an autoset out of pocket, became compliant and got my AHI down to around 3. I have learned an APAP works better for me, that my ideal pressures changes with time, and that even though I have the respiratory portion under control I still don't get restorative sleep. Now, I was diagnosed with moderate to severe apnea and severe PLMD so I knew I had more than one problem, but I feel earlier attempts to treat the PLMD failed because I was not compliant and the only measure of success was whether or not I felt better. Well, of course I didn't feel better, I wasn't compliant so the PLMD meds might have worked but my sleep was fragmented by the apnea so there was no way to know. Now my Dr and I are trying the meds again and just last week we ordered full blood work to help rule out the things you mentioned. This included a metabolic panel, kidney function, Vitamins D, B's, iron, thyroid, etc., I am waiting the results now. I am hopeful that I will eventually find the root cause of my non-restorative sleep (I didn't see statins in your list) or at least a med that will treat it, but I don't expect it to be easy.avi123 wrote:.... Also, if I could avoid doing PSG, often, why not find a In Home system which would indicate vital signs of wrong treatment and cost a lot cheaper?....
p.s. Jay, looking at your graphs I don't see anything wrong and your events are miniscule. IMO, your sleep fragmentation comes from some underying medical conditions which are not related to respiration or sleep architecture. How about Diabetes, Depression, hi Epworth sleepiness score, alcohol, smoking, •Neurologic syndromes, etc.?....
So, back to you, I'm not sure I understand your data, but it looks like your best pressure is around 7? Don't you have an autoset now? When I was doing my titration with a CPAP, the best advice I got from a sleep Dr was to start low. My prescibed pressure was 10 and I was working around that but not getting anywhere. One problem was leaks. I couldn't get them under control. So I went to 7 and stayed there untill I got the leaks under control. Then I increased my pressure by .5 and stayed there until I got my leaks under control or at least a week. I found it took some time for my AHI to stabilize after a change in pressure. I kept this up until I reached about 9.5, my AHI had dipped and I started back down. Anyway, I ended up about 8.5. When I got my autoset, I set it for 7-12 and its median pressure came back at about the same around 8.4, but because it could control some of the apneas that needed a higher pressure, my AHI dropped. So, my point is I think self titration is possible, but it's a slow process even with an APAP. It appears to me the body must be given time to adjust after each change and leaks must be controlled or titration won't be successful.
Avi, this is a long rambling post the point of which I'm not sure, but I think we agree about treatment; some type of self monitoring is probably necessary for success, sleep disturbances aren't necessarily limited to respiratory factors, and those that expect to feel better just because they get a cpap are likely to be dissapointed - it takes work.
(I didn't see statins in your list) or at least a med that will treat it
Reply: the list does not refer to my daily Rx.
I take statin daily:
Simvastatin 20 mg (generic Zocor) tab, anti Cholesterol
Meloxicam 7.5 mg (Mobicox) tab, NSAID for artrithis
Avalide 150/12.5 mg, anti hi blood pressure (stopped taking)
Amlopidine Besylate (Norvasc) 5 mg, anti hi blood pressure
Actos 30 mg tab, anti Diabetes
Xanax 0.5 mg, twice daily for antidepression and sleep
Flomax 0.4 mg, for reducing sleep frequent urination
Vitamins & other:
Prilosec, two tablets daily
Centrum A to Z
Vitamin B12- 1 mg
Vitamin D (50000) weekly
I-Caps
Aspirin 81 mg (every other day)
DSS 50 mg stool softener (two)
Acidophilus capsule- one, to counter the Dicloxacillin
Biotene mouthwash-for dry mouth
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As to my AHIs, firstly, I don't believe in them as the report in my signaure line attests. Secondly, I could not find a correlation (or a Trend) between the AHIs and the pressure that I been getting from my S9 Autoset data for the last six months. This also baffles my sleep MD and a reason to adding more At-Home Sleep Clinic's equipment for verifications. See here a sample of the randomness of pressure vs AHI in my ResScan summary graphs:
Jay, do you see a TREND in my data?