Can you recommend a doctor at Stanford's sleep center?

[Semyon]

Can you recommend a doctor at Stanford's sleep medicine center?

I use the CPAP machine but I don’t feel it makes a difference. On nights when AHI is small (less than one), I feel less rested.

My sleep doctor was not very helpful: “If CPAP doesn’t work for you, we can try meds or a surgery”. I don’t want surgery and I try to stay away from meds. I really want to succeed with the CPAP solution.

As I am close to Stanford's sleep medicine clinic and they are covered by my insurance, I want to visit them. Does anyone here happen to have an experience and can recommend a specific doctor there? ( If you are not comfortable posting the doctor's name, please feel free to PM me.)

Thank you very much!

[PoolQ]

I can't help you with a recommendation, someone here should be able to.
I have looked at your posts and I don't see anything about sleepyhead and posting the results in this forum. Now that you have a data capable machine, while you are pursuing a referral, you might want to also collect some sleepyhead data and post it here for the pro's to look at. Their advice has been invaluable for me and others.
My sleep study, not Stanford but here is silicon valley, just said I had apnea and what pressure range to set the machine at.
The DME set it to that level and left everything else at the default.
My real results have come from this forum, without which I would have tossed the machine out the window by now.

[yaconsult]

Welcome. I had mine done at PAMF sleep center so I have no experience with Stanford's.

But please remember that a sleep study really only has two goals: to confirm sleep apnea and to get an idea of a starting treatment pressure. It's really not going to help with the treatment. We can do that here. The sleepstudy only shows what happened on that one night. Every night is different. We have better nights and worse nights.

If you want to get the best results, YOU need to take charge of your therapy. Luckily, you've got a good data-capable machine there. Your best option is to install sleepyhead, post some graphs and got some feedback from forum members. Theck the thread at the very top of the forum for Pugsy's tip on sleepyhead.

We can help. The doctors are experts in what they do, but they don't use cpap equipment every night. Most of us do. No matter what your issues, someone here has gone through it.

[Semyon]

I can't help you with a recommendation, someone here should be able to.
I have looked at your posts and I don't see anything about sleepyhead and posting the results in this forum. Now that you have a data capable machine, while you are pursuing a referral, you might want to also collect some sleepyhead data and post it here for the pro's to look at. Their advice has been invaluable for me and others.
My sleep study, not Stanford but here is silicon valley, just said I had apnea and what pressure range to set the machine at.
The DME set it to that level and left everything else at the default.
My real results have come from this forum, without which I would have tossed the machine out the window by now.

Hi PoolQ,

I resumed using the CPAP machine several weeks ago. I changed the mask to the Swift FX and it decreased the leaks. On several days I've got AHI at 0.2 and 0.32 but I had the headaches and I was really sleepy. On days when my AHI is above one I feel better. . When I sleep without CPAP machine, I feel myself 10-20% worse. My CPAP pressure 10-15 cmH2O was suggested by the sleep doctor after the study.

Here are my SleepyHead results:

This Night: http://imgur.com/9L3wn6h
Summary: http://imgur.com/3AJjWNd
How I felt: http://imgur.com/eJVAIc6

[Semyon]

Welcome. I had mine done at PAMF sleep center so I have no experience with Stanford's.

But please remember that a sleep study really only has two goals: to confirm sleep apnea and to get an idea of a starting treatment pressure. It's really not going to help with the treatment. We can do that here. The sleepstudy only shows what happened on that one night. Every night is different. We have better nights and worse nights.

If you want to get the best results, YOU need to take charge of your therapy. Luckily, you've got a good data-capable machine there. Your best option is to install sleepyhead, post some graphs and got some feedback from forum members. The the thread at the very top of the forum for Pugsy's tip on sleepyhead.

We can help. The doctors are experts in what they do, but they don't use cpap equipment every night. Most of us do. No matter what your issues, someone here has gone through it.

Hi yaconsult,
I was reading the postings and educating myself. It helped me alot. Most of the discussions are around decreasing the AHI. My problem is that there is a negative correlation between AHI and how I feel in the morning. My best "AHI" dates were my worse "How I feel" days. http://imgur.com/eJVAIc6 .

During my second sleep study, a sleep doctor casually said that I might have a restless leg syndrome. My wife confirmed it. I was prescribed a medicine and it made things better but it didn't solve the problem.
Maybe my problem is not with the respiratory system but something else? That's why I am thinking about Stanford.

[ChicagoGranny]

IMO, this goes with the CPAP program:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel well, make sure you have regular wellness visits to confirm there are no other medical problems.

Looks like you are working on the last item and you show a good AHI. How about the other items?

[Pugsy]

Long term usage is less than 6 hours a night. Why?
Is that all the sleep you are getting or do you wake up and turn the machine off and go back to sleep without the mask/machine?
Do you take any meds for any reason (even OTC) if so, what?
What is primary complaint? Fatigue? Need to nap during the day due to excessive sleepiness? They aren't the same thing.

[Sticky Fingers]

I use the CPAP machine but I don’t feel it makes a difference.

Is it correct that since you were originally diagnosed, you went nine years without using CPAP?

If so, it may take some time to partially heal all that damage and get you to feeling better.

[yaconsult]

Welcome. I had mine done at PAMF sleep center so I have no experience with Stanford's.

But please remember that a sleep study really only has two goals: to confirm sleep apnea and to get an idea of a starting treatment pressure. It's really not going to help with the treatment. We can do that here. The sleepstudy only shows what happened on that one night. Every night is different. We have better nights and worse nights.

If you want to get the best results, YOU need to take charge of your therapy. Luckily, you've got a good data-capable machine there. Your best option is to install sleepyhead, post some graphs and got some feedback from forum members. The the thread at the very top of the forum for Pugsy's tip on sleepyhead.

We can help. The doctors are experts in what they do, but they don't use cpap equipment every night. Most of us do. No matter what your issues, someone here has gone through it.

Hi yaconsult,
I was reading the postings and educating myself. It helped me alot. Most of the discussions are around decreasing the AHI. My problem is that there is a negative correlation between AHI and how I feel in the morning. My best "AHI" dates were my worse "How I feel" days. http://imgur.com/eJVAIc6 .

During my second sleep study, a sleep doctor casually said that I might have a restless leg syndrome. My wife confirmed it. I was prescribed a medicine and it made things better but it didn't solve the problem.
Maybe my problem is not with the respiratory system but something else? That's why I am thinking about Stanford.

All sleep studies that I know of put sensors on the legs and will record and note RLS.

Your first step should be to request full written copies of both sleep studies. They are your medical records and you are entitled to them.

Second, you need to install the wonderful, free sleepyhead software. The AHI is just one data point and in some cases can be wildly off, for example, if there is too much leaking. By posting screenshots, we can all see how your therapy is going, what events you are having, and how they are being responded to.

Another thing you might consider is setting up a video camera or a phone to record yourself sleeping. This would let you see if the RLS is likely what is disturbing your sleep.

We know that you have sleep apnea - it's been confirmed twice. Let's look at the data and see if you are being effectively treated. If you are, then we can look at other things like the RLS. But if your cpap treatment is not effective, as can be caused by many issues, we can help with that.

[Semyon]

Long term usage is less than 6 hours a night. Why?
Is that all the sleep you are getting or do you wake up and turn the machine off and go back to sleep without the mask/machine?
Do you take any meds for any reason (even OTC) if so, what?
What is primary complaint? Fatigue? Need to nap during the day due to excessive sleepiness? They aren't the same thing.

Hi Pugsy ( The Saint of all people with sleep apnea ),

"Long term usage is less than 6 hours a night. Why?
Is that all the sleep you are getting or do you wake up and turn the machine off and go back to sleep without the mask/machine?"

In general, once I woke up after 5:30 am, I can't go back to sleep. Sometimes when I wake up around 4:30-5pm, I might take the mask off and can sleep another hour or less.

"Do you take any meds for any reason (even OTC) if so, what?"
I take only Gabapentin which was prescribed to address Restless Leg syndrome.

"What is primary complaint? Fatigue? Need to nap during the day due to excessive sleepiness?"

When I wake up I feel:
1. Very, very tired. Can't think very straight. Try to perform automatic tasks because it does not require active thinking.
2. Very irritable.
3. Excessive sleepiness is less of a problem because it's not an option during the workday .

[Pugsy]

What have you tried to increase the hours of sleep?
Less than 6 hours of sleep simply is not enough...and I don't need to tell you that sleeping for another hour without the machine is a really bad thing to be doing. I know it's tempting but you aren't doing yourself any favors....you have less hours on the machine and end up with an untreated hour without the machine and your body gets a double bad whammy.

I do understand that it is not so easy to just go from 5 hours to 7 hours of sleep just because you know you need it. To have any chance of feeling much better you are going to need more hours of sleep.

[Semyon]

IMO, this goes with the CPAP program:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel well, make sure you have regular wellness visits to confirm there are no other medical problems.

Looks like you are working on the last item and you show a good AHI. How about the other items?

Thank you ChicagoGranny,
Yes, after reading the board, I made modification to my lifestyle:
Eat a good diet - My last meal is by 6pm and I try to make it light
Have a regular, moderate exercise program - volleyball/table tennis three times per week plus walking with the dog the rest of the week
Practice total abstinence of caffeine including sources like chocolate - last cup of not very strong coffee at 10am
If you still don't feel well, make sure you have regular wellness visits to confirm there are no other medical problems - just passed the annual checkup. No issues.

[Sticky Fingers]

I take only Gabapentin which was prescribed to address Restless Leg syndrome.

What dosage(s) and what time(s) do you take it? How long have you been at this dosage?

In general, once I woke up after 5:30 am, I can't go back to sleep. Sometimes when I wake up around 4:30-5pm, I might take the mask off and can sleep another hour or less.

Pugsy is correct. Sleeping without the machine can ruin what you did the rest of the night. If you just can't sleep with the machine, it is better to get up. This may actually help you sleep better the next night (with the machine).

[Semyon]

What have you tried to increase the hours of sleep?
Less than 6 hours of sleep simply is not enough...and I don't need to tell you that sleeping for another hour without the machine is a really bad thing to be doing. I know it's tempting but you aren't doing yourself any favors....you have less hours on the machine and end up with an untreated hour without the machine and your body gets a double bad whammy.

I do understand that it is not so easy to just go from 5 hours to 7 hours of sleep just because you know you need it. To have any chance of feeling much better you are going to need more hours of sleep.

Hi Pugsy,
I can see several separate problems:

1. Not sleeping enough hours with mask. I will try not to take the mask off and see if I can get back to sleep.

2. Not sleeping enough hours( with mask + without mask). It's still a challenge.

3. Total hours do not always correlate with overall feel. I am lost here

I noticed that most of my awakenings are in the second part of the night when we are supposed to have REM phase. If awakenings prevent me from getting into the REM sleep then it might
explain why a low AHI does not result in feeling rested in the morning. Does it make sense or is it based on misunderstanding of the process?

[PoolQ]

You are well on your way to getting good advice from the pro's around here!
A note from my personal experience: There are two issues with CPAP 1. getting apnea's under control (I will leave this to others) 2. getting yourself comfortable with using the machine so you can sleep!

What machine are you using? You should edit your profile and put the machine info in there so they can refer to it when reading your posts

There are many settings for modern machines and they can and do effect how you sleep.
Humidity, reduction in exhale pressure, delayed start up, hose temperature-I have made changes to all of these