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I mentioned sinus problems as I was still trying to figure out humidity levels. I was surprised my sinuses didn't even get looked at.

As one who has seen alot of sleep doctors, for some reason, telling them you have sinus problems is like speaking a foreign language. They just seem to think it is totally irrelevant.
And even if they had been looked at, your doctor still might not have been that helpful.

49er

If the doctor wrote the prescription for the machine to be set up in a certain way and it came into his office set up differently, he has every right to be upset and has duty to find out why the machine was not set up as prescribed. Did the DME provider do their job correctly?

Yes, it is silly to imply that someone has committed some sort of crime by fiddling with the controls of their CPAP machine. But committing a crime and annoying your doctor are two different things.

That said, CPAP machines have a very low potential for causing harm. It makes sense for them to be regulated by the FDA so that they meet certain standards (like no oil) but there is no good reason for them to be prescription devices. If the numbers on undiagnosed OSA and the harm that it is doing are anywhere near corrrect, there is an urgent need to sell the machines OTC.

archangle wrote: Humidifiers might be overrated to some extent. I'm somewhat puzzled over why I get more dried out with CPAP and no humidity than I do with normal room air. However, unhumidified CPAP does seem to dry me out a lot more than normal breathing without CPAP..

I would hazard a guess that being awake and constantly aware, swallowing, drinking, eating, etc would be the reason...

palerider wrote:

chunkyfrog wrote:All my doctors are intelligent, confident, and secure enough that they respect my opinions.
Of course, I speak to them as an equal--it seems to work.
(Knock on wood).

frog doctors must be better on average than people doctors.... *envy*

This could be because they are all 10th grade biology students.

DeadlySleep wrote:

palerider wrote:

chunkyfrog wrote:All my doctors are intelligent, confident, and secure enough that they respect my opinions.
Of course, I speak to them as an equal--it seems to work.
(Knock on wood).

frog doctors must be better on average than people doctors.... *envy*

This could be because they are all 10th grade biology students.

Definitely more thorough...

Well, I am working on researching doc's comments about straight CPAP being more effective at reducing cardiovascular health and did find something that supports his position. (Will keep researching as well for additional studies) However, I'm interested to know how this study applies to my situation. In the test, they had people on APAP ranging from 4-15 and achieved average AHI of ~ 6. My settings are not that variable (10-12) and my AHI is generally less than one (generally less than .5). The authors indicate they aren't sure if the differences in cardiovascular changes were due to varying AHI, continued sleep fragmentation in the APAP group, or something to do with the APAP algorithm.

So - I need to figure out how this applies to me and if my cardiovascular symptoms are improving. I can fairly easily track my own blood pressure to see how it progresses (which isn't bad anyway) but I'm not sure if there is a way to track my insulin resistance to see if I'm improving in those areas or not. I'm much more concerned with insulin resistance improvements. Any ideas?

Obviously, I could go back to straight pressure if I'm worried, but my ears were bothering me and aren't bothering me as much on the 10-12 range, so would prefer to stay where I'm at IF I'm not risking my heart.


This is what I have found so far that supports his position: http://journal.publications.chestnet.or ... 8#Abstract

Background: A strong association between obstructive sleep apnea (OSA) and the risk for cardiovascular and cerebrovascular diseases has been reported. Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, able not only to reduce daytime sleepiness but also to improve cardiovascular and metabolic outcomes. Autoadjusting CPAP (APAP), an alternative treatment to CPAP, can reduce OSA symptoms while increasing long-term CPAP compliance without the high costs of CPAP titration. However, no data are available on the effects of APAP on cardiovascular risk factors

Methods: We performed standard full polysomnography; obtained plasma levels of glucose, insulin, and C-reactive protein (CRP); and measured systolic BP (SBP) and diastolic BP (DBP) in 31 patients with newly diagnosed, severe OSA. After standard CPAP titration, all subjects were randomized to CPAP or APAP treatment. Measurements were obtained at baseline and after 3 months of treatment.

Results: The two groups were similar in terms of age, sex, body mass index (BMI), and severity of OSA. SBP, DBP, heart rate (HR), homeostasis model assessment index (HOMA-IR), and CRP were similar in the two groups. After 3 months of treatment, BMI, HR, and compliance to therapy were also comparable. OSA indexes were significantly reduced in both groups. Significant reductions in SBP, DBP, and HOMA-IR were observed in the CPAP group but not in the APAP group, while CRP plasma levels were similarly reduced.

Conclusions: Our results suggest that CPAP and APAP, despite significant effects on OSA indexes and symptoms, do not improve cardiovascular risk factors in the same fashion.

Interesting, but the sample size is miniscule.

Yes...interesting but along with the small sample size is the date...it's a bit old and there's a big difference using 6 to 15 range and small tiny 2 cm range....Especially if with the 6 to 15 range the 6 wasn't optimal and the AHI 6 could have easily been reduced with a more optimal minimum. We aren't privy to what those people's pressure averages or 90% pressures were.

Back when that report was written there was a lot of "use APAP with a big range and let the machine sort it out" but now we know that we have to help the machine sort it out by giving it a better head start with a more optimal minimum.

Some docs are really stuck in the dark ages though and they don't want to get out.
They are up their own DeNile River and really don't want to get out of the boat.

archangle wrote: Humidifiers might be overrated to some extent. I'm somewhat puzzled over why I get more dried out with CPAP and no humidity than I do with normal room air. However, unhumidified CPAP does seem to dry me out a lot more than normal breathing without CPAP..

For the first 51-1/2 years of my life I woke up every morning with a dry, nasty mouth. And lots of middles-of-the-nights, too. I've now slept with and APAP with a humidifier for the last 19 nights. No more waking up with a nasty, dry mouth. Even the night I set the hose temp to 65 and didn't set the humidity down and woke up at 3am with a rainstorm in my mask it was better than pre-CPAP. A totally unexpected xPAP win!

I have only one data point for CPAP-with-no-humidity -- the first night I didn't think I needed a humidifier and so didn't fill it with water. I woke up in the morning and several times in the middle of the night with an uncomfortably dry mouth, but no more uncomfortable than the previous 51.5 years.

Drowsy Dancer wrote:Interesting, but the sample size is miniscule.

Yes, the sample size is small, but there is a much bigger problem. The APAPs were set at pressure 4 - 15 and most people will do better with a higher minimum setting as advocated by most regular members of this forum.

If I set my minimum at 4, I would still be having many apneas.

I disregard the study results.

What I do with problem doctors is I threaten them. I tell them I am going to 1) file a complaint against them with the state medical board and 2) sue them and refuse to settle out of court. That always shuts them the f up fast. I also used to trash doctors on RateMDs.com, but I see theyve changed that site and made it where you cant just post stuff that bad doctors have done to you.

There are lots of bad doctors out there. Doctors with bad attitudes, doctors with booze and drug problems who are still practicing, doctors with depression problems and they are not treating their depression adequately enough with meds to continue doing a good job at work, excessively greedy doctors whom love the money they make but cant stand their patients. There are also doctors out there who (I think) privately hate their job, wish they could quit but are addicted to the money part of it.

Eric

doctors with booze and drug problems who are still practicing, doctors with depression problems and they are not treating their depression adequately enough with meds to continue doing a good job at work, excessively greedy doctors whom love the money they make but cant stand their patients. There are also doctors out there who (I think) privately hate their job, wish they could quit but are addicted to the money part of it.

Eric

Yes, they have patients like you who drove them insane.

All the more reason to sue them in a court of law. The Judge and Jury will clearly see the fffed up doctor has drug/booze/mental problems, yet they are insisting on still working (addicted to the $$$$ of medicine). That leads to Judge ordered complaints to the state medical board and involuntary outpatient civil committments, where the doctor MUST participate in drug and alcohol assessment and treatments or mental health assessments and treatments.

This gets the bad doctors out of practice, unless they can get it together again. I could absolutely care less about them because I know most care nothing about me.

Eric

[/quote]

Yes, they have patients like you who drove them insane.[/quote]

There seem to be a lot of degenerates in North Carolina.

So - I need to figure out how this applies to me and if my cardiovascular symptoms are improving. I can fairly easily track my own blood pressure to see how it progresses (which isn't bad anyway) but I'm not sure if there is a way to track my insulin resistance to see if I'm improving in those areas or not. I'm much more concerned with insulin resistance improvements. Any ideas?

You have hit the nail on the head. The issue IS insulin resistance, which I think many doctors are beginning to understand is the underlying cause of most cardiovascular disease. Insulin resistance = inflammation=cardiovascular disease. I think where CPAP dovetails with that is that interrupted sleep and poor oxygenation at night have a DIRECT impact on your hormones, including leptin, ghrelin, thyroid, and INSULIN. So if your sleep is disrupted from a poorly optimized APAP setting it makes sense that carries a cardiovascular risk, as does a poorly optimized CPAP setting that's not handling your apneas well e.g. I need a lot more pressure in REM sleep than lighter stages of sleep, and the APAP responds to that need. In the days of wide open settings on APAP it makes sense that sleep was disrupted or not adequately treated, but a well-tested range can keep your AHI in check without disrupting your sleep. In my personal opinion (I'm not a doctor and don't play one on the internet) I doubt very much a properly set up APAP range can cause any increase in cardiovascular risk.

As far as seeing how your insulin issues are progressing, head to Walmart and purchase a Relion Blood Glucose meter and test strips. I only recommend this brand because they are the least expensive test strips. Blood glucose meters are like printers, the meters are low cost or free, the strips are outrageously expensive.

Then learn to check your blood glucose levels when first waking up, before meals, 1 hour after meals, and 2 hours after meals (you only have to do it this often until you see patterns emerge). If your blood glucose levels fluctuate a lot or go high after a meal (140 should be the limit, but even 120 will show that your body is slow to respond to insulin) or go very low after a meal making you feel shaky, angry, hungry (hypoglycemia), then your insulin resistance is an issue. You can learn to "eat to the meter" see http://www.phlaunt.com/diabetes/flyer.pdf from the Blood Sugar 101 website (great website, BTW).

Keep in mind the meter tests blood glucose, not insulin resistance. There is a good laboratory test to measure insulin resistance known as a C-Peptide test, but very few doctors know enough to run that test. They will want you to do a fasting blood glucose level and an oral glucose tolerance test, but those test GLUCOSE, not insulin and may not really help you track insulin resistance PARTICULARLY if you are limiting carbs to keep control of your insulin levels. Your own home testing can give you a very good idea about how your insulin is functioning and how well your cells are responding to the insulin. If your blood glucose levels are too high or too low, there are problems. A good range should be around 80 - 85 when fasting and between meals, less than 120 after a meal, and returning to your pre-meal baseline (pre-prandial) within 2 hours of a meal.

IMHO, APAP made it possible for me to treat my apneas so the quality of my sleep is better and that allows me to use dietary intervention to improve my insulin resistance. If you don't do one without the other, you are fighting your own body every step of the way. So congratulations for understanding that both are crucial and that there are things YOU can do.

The book Grain Brain by neurologist Dr. David Pulmutter tells you what lab values you should be shooting for if you can get your doctor to run them (HbAIC, hsCRP, fasting blood glucose, etc), and helps explain the role of blood sugar/insulin resistance in stroke, Alzheimers, etc. Another good book on the topic is Wheat Belly Total Health by cardiologist William Davis which talks in more detail about the cardiac issues and covers many other topics as well.