Had my followup apointment.

[Rustyolddude]

Not particularily thrilled with the outcome. Had my ~ 70 day follow up with the sleep doc. Basically all he was interested in was whether I was compliant & had good numbers with the CPAP based on the DME's report. I was %100 compliant, I did my part. I discussed the fact that I was still tired, still waking up. Discussed all the changes & efforts that I made in an attempt to eliminate the cause. I metioned I was seeing more events when I actually got some level of sleep, very few events when I slept poorly, told him I quit taking the Ambien due to the side effects which was fine with him since it was just intended to help adjust to the CPAP.

Basically he said that he was done, no need for a followup appointment. If I was having issues with insomnia, that needs to be addressed by another doc. as & gave me a number (not a referal) for a clinical psychologist that does CBT. Stated that in his opinion that all cases of insomnia are the result of some other underlying cause like stress etc. and that medication isn't a solution.

On one hand, I'm miffed that his only concern was the OSA issue and not the entire issue of sleep quality but then he is a pulmonary doctor. Being that he ordered both PSG's and reviewed them and commented on the fragmented sleep I expected him to address more than just the OSA/UARS because it's certainly a bigger issue than the respiratory part of it. On the other hand, I'm glad I didn't become a drug experiment.

I guess I'll talk to my PCP next since she refered me to the pulmonary doc for the OSA based in my initial symptoms.

Anyway, I'm on my own at this point. My RT did bump my pressure to 11 to see if I could detect any improvement but my AHI is in the control region, around 5 +/-. Until I find a solution for my insomnia & fragmented sleep, I don't see any need to play with pressures unless something major changes. Going to give it a few weeks and if I don't see my AHI or snores change, I'll go back to 10. I'm very comfortable with the CPAP, not having any therapy issues.

If I can, I'll try & find someone that can scan my PSG graphs. They are very similar to robertmarilyn's in this post viewtopic.php?f=1&t=41490&start=285 But I'm not on any medications other than HBP nor do I have any underlying medical conditions other than HBP.

Going to create another post looking for feedback on CBT.

[millich]

Thanks for keeping us updated, Rusty. If it were me, I'd go ahead and make that appointment with your PCP.

[Rustyolddude]

Thanks for keeping us updated, Rusty. If it were me, I'd go ahead and make that appointment with your PCP.

Going to do that, she started all this

[stanps]

Rustyolddude,

Your story sounds a lot like mine. Not quite at 70 days, my CPAP therapy is pretty successful in terms of numbers but I don't get enough hours of sleep for it to make much of a difference. My sleep doc is unwilling or unable to address my insomnia as a sperate issue, which it clearly is. I'm seeing my PCP tomorrow about another issue but I am going to talk to him about what direction to go with this. CBT or some kind of therapy seems like the next step.

[Gerald]

The main thing is.....you now fully realize that you are on your own......and no one cares more about your health than you do.

Take charge of your own therapy.......

[pitrow]

I just had my one month follow up half an hour ago and got completely separate results.

my doc had me bring in my machine and she downloaded the data and we went over it together. Talked about masks and leaks and what to do if I get sinus congestion bad enough not to be able to use my nasal pillows. She asked also about how I was feeling and didn't just go by the numbers (mine were pretty good, average AHI 4.8 and leak rate under 0.1 which she said was fine) and I told her that it kinda went up and down; that the first two weeks were great, last week I didn't feel like it was effective, but this week feeling better again. She said that's normal and I'm still getting used to it and if I still didn't feel like it was getting better in a couple weeks to call in.

Overall she said I was doing good, and if I had any problems or significant weight changes to make an appointment, otherwise come back in a year for another follow up. Of course I'm going to be monitoring my numbers myself in the mean time. But I was very happy with my treatment so far.

Sorry your treatment wasn't as good.

[elg5cats]

Not particularily thrilled with the outcome. Had my ~ 70 day follow up with the sleep doc. Basically all he was interested in was whether I was compliant & had good numbers with the CPAP based on the DME's report. mmBasically he said that he was done, no need for a followup appointment. If I was having issues with insomnia, that needs to be addressed by another doc. as & gave me a number (not a referal) for a clinical psychologist that does CBT. I'm miffed that his only concern was the OSA issue and not the entire issue of sleep quality. Anyway, I'm on my own at this point. Going to create another post looking for feedback on CBT.

Rusty, I'm sorry your doctor didn't choose to make your care his investment...that really irks me and gives me flashbacks. There's a tendency among doctors recommending psychological services when they disbelieve, not interested or don't know what to do to help a patient. It's an escape route. You know yourself, if there are life issues/coping skills you need to address by all means do see the psychologist..it may be helpful. In addition, why not consider goggling sleep centers in your state, or nearby states and see if you can find a doctor who will be invested in your sleep needs. My current sleep MD is amazing. He is a neurologist who has seen me every 3 months since our first visit. He provided a RX to machine brand he doesn't use in his lab nor has software to. At f/u's appt I take in my laptop and we review data, discuss how I'm doing, DME experiences and if there's pressure changes has me to do them w/o any hesitation. There is no indication this is not his standard of practice, he's comfortable and has NO appearance of OMG, it's this patient again!!!! I'm really looking forward to discussing my OSA/sleep disturbance post surgery at my next appointment. I found this doctor by an online search of sleep clinics within 100 miles of where I live. He's about 35 miles away but worth the travel. We all deserve a sleep doctor who invests in patient care and communication. AS you explore CBT, also explore Sleep doctor options.

elg5cats

[jweeks]

Rusty,

Are things getting any better at all? For me, I sort of had to learn how to sleep again after years of not being able to get proper sleep (and being too dumb to know I couldn't sleep). It took me about 5 months to ramp up from an average of just around 6 hours of sleep (after starting CPAP) to where I was over 7 hours on a consistent basis. In the last 45 days, my average has crept up to about 7.5 hours of sleep. It is possible that you are still adjusting to your new life 'on the hose'.

I am underwhelmed by your sleep doc giving up on you. I think you do need another follow-up just on general principals. This is complex machinery and a complex bodily function. After all, your prescription expires after a year, so if nothing else, you need a follow-up to get it renewed. Can you find a different clinic or sleep doctor to work with?

-john-

[Rustyolddude]

I wouldn't neccessarily say that I didn't get 'good' treatment, more along the lines of 'thorough' treatment. The pulmonary doc concerned himself with the respiratory aspects but ignored the whole picture with the alpha intrusion/sleep fragmentation issue, he noted it in his PSG commentary and it's plain as day in the charts but not his concern.

A neurologist specializing in sleep disorders would have been a better choice in my case and that may be where I end up next. It's pretty plain after my time learing here that I'm not the normal case of OSA, in fact the doc. commented that I'm more of a UARS case due to my small airway even having had my tonsils out.

I had to start somewhere and play the in-network doctor/insurance/referal game. Going to make an appointment with the PCP and see where we can go next. You have to start somewhere and establish a baseline and that's what this exercise has been about, CPAP has made things marginally better and I'm thankful for that small gain and I've adapted to it so readily, but it's not the whole picture in my case.