Update and more questions

[DoriC]

It's possible you're not able to get the same results at home because you took 2 Ativan for the study which may have skewed your sleep pattern.

[vancity]

It's possible you're not able to get the same results at home because you took 2 Ativan for the study which may have skewed your sleep pattern.

NO, I think if anything the Ativan allowed me to doze off and sleep throughout the night. It was the best and longest sleep ( about 7 hrs) I have had in the last 6 months probably. If anything, taking something like Atavin or sleepers should make the numbers worse. Trying to recreate the AHI of 1.8 at the sleep study seems to be impossible. Will have to printout some of my charts to take with me.

Maybe tonight I will go back to 9cm and see what happens....

[Pugsy]

You know archangle may have a point about the sleep lab maybe not scoring a reduction in flow as a hyponea unless it is also associated with a desat or drop in Oxygen levels or some other difference that the machine doesn't have access to additional data.
Different labs can have different scoring criteria.
It might also be interesting to see if you would still have the hyponeas if you were using one of the new PR S1 machines instead of the M series.

[Julie]

It seems to have come up over and over - that a fair number of MDs are quite conservative and prescribe unnecessarily low pressures, possibly being afraid of a lawsuit if patients actually get enough pressure to be treated (feeling cynical tonite, please excuse). A lot of us are at least at e.g. 10 (having been prescribed something less) and while much higher is not a good idea, setting your machine at e.g. 8 and 12 or 8-13 is highly unlikely to do any harm.

[vancity]

It might also be interesting to see if you would still have the hyponeas if you were using one of the new PR S1 machines instead of the M series.

Could be different on another machine...a better machine...but I am stuck with this old one for now and the foreseeable future.
Thing is that all these charts are coming from my machine and at 9 cm it's a lower AHI with somewhat more equal OAs and HAs, but go down to 8 cm and the HA skyrocket and OA almost vanish.

I know that it's against logic to lower the pressure, but I was trying to match the sleep labs result and pressure setting....which I am not doing very well
Guess when I get an explanation of my sleep study and show them my charts, only then I will understand whats goin on.

WHy oh why oh why???

[DoriC]

It's possible you're not able to get the same results at home because you took 2 Ativan for the study which may have skewed your sleep pattern.

NO, I think if anything the Ativan allowed me to doze off and sleep throughout the night. It was the best and longest sleep ( about 7 hrs) I have had in the last 6 months probably. If anything, taking something like Atavin or sleepers should make the numbers worse. Trying to recreate the AHI of 1.8 at the sleep study seems to be impossible. Will have to printout some of my charts to take with me.

Maybe tonight I will go back to 9cm and see what happens....

My husband also gets better results and lower AHI when he takes an Ambien but then he's groggy most of the day. I don't think Ativan or Ambien gives you a "natural" sleep?

[vancity]

My husband also gets better results and lower AHI when he takes an Ambien but then he's groggy most of the day. I don't think Ativan or Ambien gives you a "natural" sleep?

I wonder why when taking something to help sleep through the results are better?

[Pugsy]

I wonder why when taking something to help sleep through the results are better?

In theory some meds might affect the sleep stages...like less deep sleep or REM sleep and if someone had a lot of REM stage sleep related events normally....then with less REM then it would stand to reason that there would be less events in general.
This is theory though. Not all sleep aids mess with sleep stages horribly.

[DoriC]

I wonder why when taking something to help sleep through the results are better?

In theory some meds might affect the sleep stages...like less deep sleep or REM sleep and if someone had a lot of REM stage sleep related events normally....then with less REM then it would stand to reason that there would be less events in general.
This is theory though. Not all sleep aids mess with sleep stages horribly.

My husband also gets better results and lower AHI when he takes an Ambien but then he's groggy most of the day. I don't think Ativan or Ambien gives you a "natural" sleep?[/quote]

Isn't that what I just said!

[Pugsy]

My husband also gets better results and lower AHI when he takes an Ambien but then he's groggy most of the day. I don't think Ativan or Ambien gives you a "natural" sleep?

Isn't that what I just said! [/quote]

There's always the risk vs rewards with any medication we take.
Which is worse...maybe a not so quite "natural" sleep with meds and maybe having a groggy hangover the next day
or not taking anything and not getting much sleep or getting sleep that is so fractured there is little chance of a person getting much of the restorative benefits that sleep should offer?

I take something to help me sleep...yes, it sometimes leaves me with a bit of morning grogginess but fortunately it goes away fairly quickly. It's not an ideal situation I know. I would rather not take anything and not have that morning hangover but if I didn't take it I wake up 30 to 40 times a night from pain...every little movement in bed will cause pain and wake me up.
That's guaranteed to make me feel like I didn't sleep at all and feel like that bus ran over me forwards and backwards.
So I prefer the little morning hangover that goes away to feeling like total crap all day because I didn't get much sleep at all and certainly didn't get good restorative sleep.

Some meds are worse than others in terms of what it might do to sleep architecture.
But sometimes we just have to compromise and figure out which evil is less scarey.
I have always felt that this decision was something best left up to the patient and their doctor to discuss the risks vs rewards.
It's not my place to pass judgement one way or the other when it comes to sleep aids or not taking sleep aids. I try to just present the facts and encourage people to educate themselves on the risks vs rewards and discuss them with their doctor and then decide on the best plan of action.

I do know this....a person has to get some semblance of decent sleep for them to have any chance of feeling decent and if the only way that they can do that is with some sort of medication...well then so be it. Might not be ideal but when the choice is wake up 30 times a night (and we know the havoc that does to sleep architecture) or maybe taking a little pill that might mess with sleep architecture just a little...guess what I chose to do?

That's why I don't cast any stones one way or the other when someone either feels the need to take something or they prefer to not take anything and deal with the problem without medication. It's not my place to tell them what they should do or not do.

In the situation here with vancity in this thread. I doubt that the meds taken the night of the sleep study impacted the sleep study results all that much if any. It's tiny dose of a med that is not known to horribly wreck sleep architecture even in larger doses. If anything in larger doses it might tend to cause more relaxing of the airway tissues than suppress REM sleep I would think.
Though it wouldn't be impossible I suppose for maybe suppress REM sleep and if a person has more OSA in REM sleep...maybe then they didn't experience what they would experience without the added medication. It's a stretch and going way out on a limb with supposing this or supposing that.
Getting the results of the sleep study and seeing how much REM sleep was achieved would clear up that question though.

Finally..maybe vancity just had one of those nights where pressure needs weren't all that exciting during his last titration study.
You know what I mean...those nights where the pressure never varies much above the minimum pressure and the very next night all hell breaks loose...and then the next night nothing exciting happens. Maybe they caught him on a non exciting night.

[DoriC]

My husband also gets better results and lower AHI when he takes an Ambien but then he's groggy most of the day. I don't think Ativan or Ambien gives you a "natural" sleep?

There's always the risk vs rewards with any medication we take.
Which is worse...maybe a not so quite "natural" sleep with meds and maybe having a groggy hangover the next day
or not taking anything and not getting much sleep or getting sleep that is so fractured there is little chance of a person getting much of the restorative benefits that sleep should offer?

I agree, if Mike is still awake after 1hr, I give him a 5mg Ambien. I'd rather have him groggy in the morning than have him dead tired all day from lack of sleep. My only thought was that the sleep study data on meds may not be accurate and isn't telling the whole story so the AHI and pressure needs may be off.

[Pugsy]

My only thought was that the sleep study data on meds may not be accurate and isn't telling the whole story so the AHI and pressure needs may be off.

I hear you and it wouldn't be impossible since insomnia is a listed known side effect for Ativan and if the sleep cycles are reduced and REM stage sleep was reduced and if vancity has a strong predominance of REM related events...then it is possible that not much exciting happened to warrant higher pressures.
But he says he slept well so I would think that insomnia side effect was less likely to be a factor.
Will be interesting to see what the sleep study shows in regards to sleep stages.

[Jeannh]

After years of intermittent Ambien use (usually not to get to sleep but to stay asleep) I now wonder how to know if the issue all along has been insomnia or apnea. Both result in fatigue....trying to convince myself that air, no matter how it's delivered, is better than meds, even given the obvious convenience factor.

[vancity]

Hi again, I thought I would bump my pressure back to 9 cm ( past 3 nights). I know that 3 days is not a trend make, but the data is different from the 3 nights at 8 cm.
AHI is way down as are the HA's. Note the OA's are up. Strange isn't it?
Here are the charts:







Any comments?
As my Oct 7 appointment draws closer, I will try the recommended pressure of 7 once again for a few days. Until then, I will stick with 9 cm, as at least on my machine seem to give good results as far as AHI numbers are concerned. Now if I could only sleep through every night. I will probably be put on something to help with my PLMD ( poss. mirtzapine sp?) and would like to find something for depression, but I have a hard time tolerating anything anti-depressants so far for more than 1 week...but that's another story.
Thanks for all the help...

[SleepyCPAP]

Hi Vancity,

vancity wrote: Hi again, I thought I would bump my pressure back to 9 cm ( past 3 nights). I know that 3 days is not a trend make, but the data is different from the 3 nights at 8 cm.
AHI is way down as are the HA's. Note the OA's are up. Strange isn't it?

I've never used a data-capable M-series, just a brick, so I don't know the nuances of their scoring. Everyone has been focused on the hypopneas, but I'm wondering if M-Series is more likely to lump some CA's into the OA category? If so, then perhaps you could ask at your appointment if you are seeing CA's emerge with higher pressure?

-- SleepyCPAP