"You sleep in survival mode"

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
lucrezaborgia
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"You sleep in survival mode"

Post by lucrezaborgia » Thu May 21, 2015 12:21 am

Monday night I had a sleep study with Pes. As bothersome as the probe was I am glad it was ordered after talking to the doctor today. The sleep tech didn't feel the need to fit me with a mask immediately and I thought that was a good sign. Apparently the tech was wrong. The doctors first words after saying the usual pleasantries were "you sleep in survival mode." He felt my results minus the Pes measurement didn't warrant a CPAP. The Pes results tho really surprised him and I still don't understand it all. He said that when I'm sleeping that I make extreme efforts to breathe and that it was worse in REM sleep. He quantified it by comparing the pressure exerted from drinking a bottle of soda. I breathe in my sleep at that pressure x8! Does that make sense to you? He's not even bothering to do abother sleep study to see how well a CPAP will work or what kind I need.

I also have a history of ARDS, asthma, and allergies that involve my respiratory system.

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kaiasgram
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Re: "You sleep in survival mode"

Post by kaiasgram » Thu May 21, 2015 12:57 am

lucrezaborgia wrote:Monday night I had a sleep study with Pes. As bothersome as the probe was I am glad it was ordered after talking to the doctor today. The sleep tech didn't feel the need to fit me with a mask immediately and I thought that was a good sign. Apparently the tech was wrong. The doctors first words after saying the usual pleasantries were "you sleep in survival mode." He felt my results minus the Pes measurement didn't warrant a CPAP. The Pes results tho really surprised him and I still don't understand it all. He said that when I'm sleeping that I make extreme efforts to breathe and that it was worse in REM sleep. He quantified it by comparing the pressure exerted from drinking a bottle of soda. I breathe in my sleep at that pressure x8! Does that make sense to you? He's not even bothering to do abother sleep study to see how well a CPAP will work or what kind I need.

I also have a history of ARDS, asthma, and allergies that involve my respiratory system.
Welcome to the forum. Can you clarify -- what does your doctor say is the next step for you?

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Krelvin
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Re: "You sleep in survival mode"

Post by Krelvin » Thu May 21, 2015 3:24 am

Don't understand if what you say is true, that they didn't do titration the same night. Seems like a good way to waste the patient's time. Each of the two studies I've done were assumed to be split night from the outset. The second study was a foregone conclusion since I had been using cpap for so long. The first I was told before the test it would be a two part test.
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zoocrewphoto
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Re:

Post by zoocrewphoto » Thu May 21, 2015 3:29 am

Krelvin wrote:Don't understand if what you say is true, that they didn't do titration the same night. Seems like a good way to waste the patient's time. Each of the two studies I've done were assumed to be split night from the outset. The second study was a foregone conclusion since I had been using cpap for so long. The first I was told before the test it would be a two part test.

They have to meet certain criteria by a certain time. It could be that not enough sleep was achieved in time. Or maybe the events were more during REM ad occurred later in the night. The person has to be a certain level of severe with enough time left for the titration, or they have to wait.

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Pugsy
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Re: "You sleep in survival mode"

Post by Pugsy » Thu May 21, 2015 6:08 am

The Pes is an esophageal probe used to take measurements and help establish a UARS diagnosis.
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome
With most UARS only (no OSA involvement) the AHI is already low and the reason a split night study wasn't done with titration was because OSA criteria wasn't met.

CPAP is still the therapy of choice but the normal data available on the machines like AHI....not particularly useful because his/her AHI is already low.
This is one of the situations where if it were me I would be wanting a machine that flagged RERAs. I don't know how accurate or meaningful it might be but I would at least want the chance to have it just in case.

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lucrezaborgia
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Re: "You sleep in survival mode"

Post by lucrezaborgia » Thu May 21, 2015 10:02 am

kaiasgram wrote:He's not even bothering to do abother sleep study to see how well a CPAP will work or what kind I need.

Welcome to the forum. Can you clarify -- what does your doctor say is the next step for you?
He is ordering a fitting for a CPAP machine for me to use at home. I am waiting for their phone call to set up an appt.

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kteague
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Re: "You sleep in survival mode"

Post by kteague » Thu May 21, 2015 10:10 am

I would suggest you call and find out the exact machine they plan to provide, then come back here and ask if it is one most suitable to your situation. It can be a real battle to get a machine swapped out once you accept it. Do yourself a favor and be sure in advance, and double check upon delivery that the machine they bring is the one promised. Also, ask for a copy of your detailed report of the study. It's another real pain in the behind to have to wait for callbacks from the office every time a question comes up. And they most likely will come up. In fact, having the report before getting the machine wouldn't hurt.

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ChicagoGranny
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Re: "You sleep in survival mode"

Post by ChicagoGranny » Thu May 21, 2015 1:10 pm

This report,

... does not jive with,
lucrezaborgia wrote:He felt my results minus the Pes measurement didn't warrant a CPAP.
kteague wrote:I would suggest you call and find out the exact machine they plan to provide, then come back here and ask if it is one most suitable to your situation.
Very important!

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kaiasgram
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Re: "You sleep in survival mode"

Post by kaiasgram » Thu May 21, 2015 1:17 pm

Thanks for posting the report. According to the report your AHI was 19.6 and that does give you a diagnosis of moderate obstructive sleep apnea. Maybe the tech didn't get you started on a machine during your sleep study because you didn't reach REM early enough (report says most of your apnea events were in REM). This happens fairly often with sleep studies -- patient has clinically significant sleep apnea but doesn't demonstrate it until it's too late in the study to complete a titration. I know a number of people who came home from their sleep studies thinking "Whew! They didn't put the mask on me so I don't have sleep apnea," only to get a call advising them to come back in for titration.

Your RDI (Respiratory Disturbance Index) was 26.1 -- the RDI includes all the events included in the AHI plus RERAs (flow limited breathing ending in a respiratory effort related arousal).

Re that discrepancy Chicago Granny noted -- I wonder if your doc was trying to say that even if you had no obstructive apnea you would still have clinically significant upper airway resistance needing treatment. Just a WAG!

I agree with Pugsy that it could be very useful for you to have a machine that shows RERAs. Post back if you need help identifying which models do.

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lucrezaborgia
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Re: "You sleep in survival mode"

Post by lucrezaborgia » Thu May 21, 2015 1:32 pm

ChicagoGranny wrote:This report,

... does not jive with,
lucrezaborgia wrote:He felt my results minus the Pes measurement didn't warrant a CPAP.
I probably misremembered? That was my impression of our phone conversation. The part of the report that you can't see says my desaturations never went below low 80s and that was only during obstruction. Otherwise high 80s.

I'm on medicaid in Wisconsin and can't figure out which models are covered. Which ones typically measure RERA? It would probably be best to know before I get fitted. Things move fast where I live.

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Re: "You sleep in survival mode"

Post by Sleeprider » Thu May 21, 2015 2:05 pm

The doctor's recommendation and plan for you is to prescribe an Auto CPAP with a mask of your choosing and humidifier. The two major brands of APAP are the Philips Respironics 60 Series Auto (560P), or the Resmed Airsense 10 Autoset. The PRS1 Auto does measure RERA, and the Airsense 10 Autoset For Her also measures RERA. The Autoset without the For Her suffix does not.

Depending on what your supplier carries, you are most likely to end up with one of these machines, and if it is Resmed, you can push for the Autoset For Her, which is the same cost. Both brands have a form of heated hose that can also improve comfort and prevent moisture condensation.

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kteague
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Re: "You sleep in survival mode"

Post by kteague » Thu May 21, 2015 2:36 pm

lucrezaborgia wrote:... my desaturations never went below low 80s and that was only during obstruction. Otherwise high 80s.
What were your levels when not having breathing events? I'm thinking you're saying the high 80's were during hypopneas as opposed to apneas. Just trying to be sure you don't have other lung issues and run in the high 80's normally.

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lucrezaborgia
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Re: "You sleep in survival mode"

Post by lucrezaborgia » Thu May 21, 2015 3:29 pm

The report doesn't say what the saturation was between events.

lucrezaborgia
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Re: "You sleep in survival mode"

Post by lucrezaborgia » Mon Jun 08, 2015 5:08 pm

I still do not have my machine due to a mess up by my doctor's office. The equipment authorization was sent to a facility that does not take my insurance. This facility decided to be helpful and forwarded it to a company that does take my insurance but didn't inform me of the mistake. The company that it was forwarded to does not serve my area and could not fulfill my order. This company also neglected to call me and inform me about the delay.

In the meantime my breathing took on a sticky consistency. A few days later I had a bad thrush infection on my tongue to the point where I had sores and cracks. Does anyone here have any insight into throat and oral thrush that are not caused by a CPAP or that can cause and/or increase apnea and sleep arousal events? I'm currently being treated for thrush with a oral rinse that I swallow and I'm seeing an improvement in my breathing as well.