will the doc know if I changed pressure?

[PhiloHypnos]

Lol Rested Gal! that's one content cat!

And so am I!

I couldn't resist last night -- the time was ripe: I set my pressure to 14 cm. Up a full cm.

And man'o'man am I happy to have done that

UPDATE: DAY 8

slept 8 hours.

My brain Fog feels like an even fainter echo (almost completely gone)! No dryness in the Pharynx!

Now, the sleep quality was not as good as the two preceding nights. This is because I completely forgot to take my Gerd medicine, and with a full 1cm pressure increase, at such high pressure, I could definitely feel the air stretching my gullet open, causing minor aerophagia, and letting the acid out. But it was tolerable. Also, I didn't strap all my gear very properly so had some discomfort from that during the night and some mask side-leaks in the morning. So lots of arousals.

However, despite all that, I am feeling very refreshed mentally. This I put down to the fact that the pressure increase has probably almost eliminated my hypoapneas. I'm still not feeling perfect; still very faintly drowsy and even more faintly foggy; but I'd say I'm at a good 90-93% now! Definitely functional!

I have no doubt that with the gerd medicine and more careful strapping up, I will feel much better!



All the very best to All,
from a very chuffed arkein!


Edit: got a bit sleepy in the afternoon.

[PhiloHypnos]

Ok,

I'm just back home from seeing the specialist. I have mixed feelings about this meeting.

I wrote up a detailed explanation for the Doc, explaining absolutely everything, including the latest experimentation, for her to read.

She was very soft spoken and understanding in addressing my perhaps over-zealous and impatient experimentation. However, I could tell that she wasn't very pleased about my having changed the pressure myself, which is understandable. She also seemed to disapprove somewhat of my using this forum, saying it is simply not true that it can take up to two years for an XPAP therapy to be adjusted to optimal levels, which I said many forum users had reported...

I may be wrong, but this seems typical of Doctors' irritation with patients "who know too much" and "take matters in their own untrained hands". I was sort of expecting that reaction.

<edit> I think it is also a typical case of Doctors and Patients simply talking past each other. I think she meant it is just plain wrong that OSA takes so long to be resolved by XPAP therapy. What I think the forum users I was refering to meant was that it took so long for them to FEEL better. The OSA can be resolved, but other factors missed. The doctors are trained to look at 'objective' measures indicating OSA treatment, and once the oxymeter study shows normal oxygen saturation, case closed. <edit>

She said that she had her doubts as to whether my headaches, drowsiness, and brain-fog issues were due to the OSA, despite my having explained that I did notice a clear improvement after fixing the mouth leaks and increasing the pressure.

She suggested that part of the symptoms might be due to depression and anxiety, and that it was important to separate the two possible causes, and consider the latter.

I accept that as a very reasonable and entirely plausible suggestion. I have definitely been depressed and anxious over the past months, and I know from past experiences how depression can cause stark physical symptoms. However, I am still convinced that the adjustments that have been made recently to my CPAP therapy have improved my symptoms. This is another case of doctors looking at the problem "by the book" (i.e., based on my single-night oxymeter study) and not placing too much trust in their patients' subjective reports. Just because the obstructive apneas have been eliminated, it doesn't mean that other factors linked to OSA and XPAP have disapeared (mouth leaks, hypoapnea, snoring, mask comfort, etc.). But I felt I had already pushed my pro-activeness to the limits and didn't want to contradict her, so I kept my mouth shut.

She accepted that I do another sleep study, at 13cm pressure, to check the quality of my sleep and level of OSA etc. Then, if indicated, she said I should consider treating my depression with my GP.

All-in-all, I think it was entirely reasonable to consider the possibility that depression has been a significant contributing factor to the symptoms. I am entirely open to that possibility, and I have even considered it. However, she seemed to be suggesting that it was probably THE MAIN or even ONLY cause, thereby tacitly dismissing my conviction that the pressure and leaks were the main cause. I couldn't help feeling that this implicitly meant that I'm some sort of pushy hypochondriac who has just no idea how he REALLY feels or what he is doing. That's what gave me the mixed feelings.

This, again, in my experience, is typical of doctors here. The fact is, every single time I have self-diagnosed and pushed my doctors for tests to confirm my suspicions, I have been right. I was right about my hiatus hernia and GERD. And I was right about it for my Sleep Apnea. In each case, it was not the doctor who had concluded that I should get tested for these, it was I who had done the research beforehand, gone to see the doc, and asked for the tests.

Anyways, it's the results that count. I'm feeling better. I've got my 'official' pressure increase to 13.4 cm. I've got the sleep study I asked for. They even gave me a full face mask (I'm very happy about that, the chinstrap and poligrip-and-tape-sealed-lips were quite uncomfortable solutions).

So, in other words, my requests were reasonable enough to be met, but I had to be made to feel apologetic for possibly getting things right and being too pushy...

I dunno, maybe I'm being overly paranoid in my reading of the sub-script of the whole encounter, and perhaps too confident about my own conclusions. After all, I am not a doctor. But as I said, I got what I wanted and I'm feeling better!

She kindly asked me not to change the machine settings again, and I happily agreed. It is their equipment, and I don't want to push it too far.

Voila!

a mixed-feeling-ed arkein.

Edit: re-reading this, I may have been to harsh in my judgement of the doctor's reaction... It is reasonable, after-all to consider that depression might be a major contributing factor, and might even overshadow other causes. She did prescribe a sleep test to make sure the OSA is completely resolved. It is also reasonable for a specialist to be skeptical about a non-specialist patient's subjective appraisal of his condition.

[Wulfman]

She also seemed to disapprove somewhat of my using this forum, saying it is simply not true that it can take up to two years for an XPAP therapy to be adjusted to optimal levels, which I said many forum users had reported...

I'm not sure who you're thinking of......that it took that long.......but in my opinion, it would be ALL TOO TRUE if a patient was to put their therapy solely in the hands of the professional sleep doctors......and without the use of data-capable machines.
You gotta consider that the sleep doctors feel that knowledgeable patients are a threat to their incomes.

Den

[ozij]

Sleep apnea and depression:
Start you search here:

http://www.chestjournal.org/cgi/content/full/128/3/1304

Symptoms of Depression in Individuals With Obstructive Sleep Apnea May Be Amenable to Treatment With Continuous Positive Airway Pressure*
Daniel J. Schwartz, MD; William C. Kohler, MD and Gillian Karatinos, MD


O.

[PhiloHypnos]

Hi all, here's an update on my progress since getting the 'official' pressure increase to 13.4cm and a full face mask.

That mask has been a godsend! It is so much more comfortable sleeping with it than with the poligrip + tape + chinstrap mouth-seal (that was sticky, itchy, messy, complicated, and extremely claustrophobic!). I do get a bit of a dry-mouth in the morning, probably because of mouth breathing. My sleep quality feels tremendously improved by the mask. It has completely eliminated the mouth leak problem.

First night I went to bed early, woke up after 5 hours. Couldn't sleep so I got up, and then went back to bed two hours later, as I still felt sleepy. Then I slept another 6 hours! I got a pretty bad tension headache in the afternoon, probably because of oversleeping and not getting my coffee early enough. but this headache was different from the ones I had been complaining about previously: cognitively I felt fantastic, no brain fog, and the tension headache seems to have been from oversleeping with good quality sleep + skipping my morning coffee, like a typical "weekend headache", not at all like the foggy headaches I was getting from insufficient therapy pressure and mouth leaking. Unlike those headaches, this one responded very well to ibuprofen.

Second night: I also woke up after 5 hours and couldn't sleep again. I didn't have the option of sleeping later as I had to go for a blood test. I was only very moderately sleepy during the day, but not at all bad considering the small amount of sleep I got. Cognitively I felt very clear. A half modafinil tablet fixed the drowsiness for the afternoon.

This tendency to wake up after 5 hours and not be able to sleep for an hour is typical of when I get a pressure increase + new equipment + start sleeping earlier than usual. It happens each time. It usually resolves after a few days. There seems to be a number of reasons for it: 1) sleeping earlier disrupts my established sleep cycle; 2) adaptation to the higher pressure; 3) the effect of getting better quality sleep; 4) my circadian rythm -- it seems I go through an hour of very light sleep after 5 hours, but if I manage to fall asleep again, I then get another 2-3 hours of very deep sleep; I think my sleep hormones (melatonin) go through a brief slump after 5 hours of sleep, before going back up again for another 2 hours; 5) I'm generally woken up by discomfort from the new equipment; in this case over-tightened straps, dry mouth, and rain-out; due to the learning curve of finding the right strap-tightness and humidifier settings. I could try using the chinstrap to avoid the dry mouth, which would encourage me to nose breathe, while allowing mouth breathing if necessary... will try that tonight, but I'd rather not have to wear it.

Third night (today): I slept like a log, from 1 AM to 9 AM, with a brief arousal at 6 AM. 8 hours of sleep. I am feeling FANTASTIC! No headaches. No sore throat/pharynx. No brain fog. No drowsiness (except a very sligh slump in the afternoon). clear headed. sharp. focused. In a good mood. THIS IS BLISS!

During all three nights, I have had no episodes of sleep paralysis. I can't even remember dreaming. This is in clear contrast to my sleep prior to the changes, when I had vivid and distrubing dreams which would wake me up almost every night.

I would rate my level of refreshement at a good 96-98%. I could possibly use one more pressure increase to 14.4 cm.

I am back to work on my thesis. I've been going back to the Library to write. And I'm finally progressing again! YEY!

I think I can confidently say now that, contrary to what the specialist suggested, the main cause of my problems WERE mouth leaks and insufficient pressure, and not likely depression.

Also, based on further reading about Piracetam and Glutamate interactions, I am pretty sure that a main cause of the glutamate induced headaches were due to my supplementing with Piracetam for so long (5 months). Apparently, long term supplementation with Piracetam causes an increase not only in acetylcholine receptors, but also certain types of glutamate receptors in the brain, increasing sensitivity to glutamate, particularly in already glutamate-sensitive people. This can lead to increased tension headaches and brain fog when food containing lots of glutamate is consumed. This sensitivity can last for many months after piracetam supplementation is discontinued. Piracetam can also lead to increased demand for choline supplementation. Choline difficiency due to higher demand of acetylcholine can cause headaches. Choline supplementation should also be continued after piracetam supplementation has ceased. The low quality sleep, which also causes tension headaches, also made the problem even worse. Furthermore, most high-glutamate foods also contain high levels of tyramine, which also causes tension headaches and brain fog. According to the literature on Piracetam, the best antidote for these piracetam-induced choline-deficiency headaches and glutamate-sensititvity problems is supplementation with choline/lecithin (to keep up with the higher acetylcholine demand) and magnesium (which dampens the effects of excess glutamate).

I haven't taken piracetam in a while. But one thing is for sure: despite the increased headache proneness, I can definitely feel the significant improvements it has brought me in terms of cognition, memory and concentration. Piracetam has also been shown by many clinical studies to be extremely safe and to have very low toxicity.

Cheers to All, from a very very refreshed arkein.