Doctor says. "Machine is overreacting"!!

[pikov22]

Had my 3 month appointment and the doctor said that she's no longer concerned about my 10-14/hour AHI because my pulse ox on the CPAP is the same now as it was during the titration study. Since the lab uses a CPAP-type device that is not any more sophisticated than the one I use, she thinks that my CPAP is over-reporting apneas. Said that the lab report (4/hour) is based on 12 channels of data that the lab techs use to determine when an apnea occurs, rather than depend on just what the CPAP reports.

And, she said, my poor sleeping is probably behavioral, not respiratory-related. So I'm not to get into bed until lights-out time, am to get up at the same time every morning, use a bright light when I get up (anyone know any specifics on using a bright light?), try to skip naps and I do take one, make it short and get up before 2:30PM!

I expect to be a zombie for a while until this starts working.

[49er]

How long has this 10-14 AHI been occurring?

If it has been constantly, her point may have more merit if your AHI was slightly above 5 and you were feeling really good. But with it being that high, there no way she should be blowing you off.

Personally, I would get another doctor if this is not a one time occurrence.

49er

PS - Engaging in a behavior program with an AHI that high would be like my being given pain meds for a broken leg.

Had my 3 month appointment and the doctor said that she's no longer concerned about my 10-14/hour AHI because my pulse ox on the CPAP is the same now as it was during the titration study. Since the lab uses a CPAP-type device that is not any more sophisticated than the one I use, she thinks that my CPAP is over-reporting apneas. Said that the lab report (4/hour) is based on 12 channels of data that the lab techs use to determine when an apnea occurs, rather than depend on just what the CPAP reports.

And, she said, my poor sleeping is probably behavioral, not respiratory-related. So I'm not to get into bed until lights-out time, am to get up at the same time every morning, use a bright light when I get up (anyone know any specifics on using a bright light?), try to skip naps and I do take one, make it short and get up before 2:30PM!

I expect to be a zombie for a while until this starts working.

[Mary Z]

Very interesting. It took me awhile to learn that there are two facets to getting good sleep while using CPAP. Your doctor gave you good sleep hygiene advice. Though the CPAP does help you sleep better by stopping the awakenings due to apnea events, it's no substitute for good sleep hygiene. We have to get to the deep stages of sleep and REM sleep for the sleep to be restorative and the body healing itself. Glad you're here. Keep us posted on how you're doing.

[chunkyfrog]

My diagnostic PSG showed my AHI to be only 13, and my lowest O2 was barely below 90;
but I was in pure hell because frequent awakenings were preventing sufficient deep sleep,
and my awakenings were always very stressful--high BP, very fast heart rate, and significant disorientation.
In your shoes, I would seek a referral to an expert. Your current doctor needs a clue.

[Pugsy]

Well.....whatever floats your boat I suppose. Can you see me rolling my eyes over here?

10 plus apnea events per hour that cause arousals can and will sure mess with overall sleep quality no matter what the O2 levels are.
Unless your machine is scoring a lot of events while you are awake (and that is a real possibility) there's enough going on to very likely keep you feeling like a zombie no matter how much you clean up your sleep hygiene.

When I first started therapy my AHI was in the 8 to 10 range and I felt just as bad as I did without the machine. I was still peeing frequently during the night due to the stress hormone production from the stress on the heart.
It wasn't until I got the AHI below 4 that I saw any improvement at all.

It never hurts to clean up our sleep hygiene though.....so do work on it.

Frequent awakenings or even little mini arousals that you don't remember will totally mess up your sleep cycles and thus totally mess up how you feel...making us zombies because we don't get the right amount and normal progression of the sleep cycles.

[ChicagoGranny]

Had my 3 month appointment and the doctor said that she's no longer concerned about my 10-14/hour AHI because my pulse ox on the CPAP is the same now as it was during the titration study. Since the lab uses a CPAP-type device that is not any more sophisticated than the one I use, she thinks that my CPAP is over-reporting apneas. Said that the lab report (4/hour) is based on 12 channels of data that the lab techs use to determine when an apnea occurs, rather than depend on just what the CPAP reports.

What are your pressure settings and what was your diagnosed AHI?

And, she said, my poor sleeping is probably behavioral, not respiratory-related. So I'm not to get into bed until lights-out time, am to get up at the same time every morning, .... try to skip naps and I do take one, make it short and get up before 2:30PM!

She is talking about sleep hygiene. Lots of good sources about sleep hygiene on the internet. Learn the details and practice them. No caffeine!

use a bright light when I get up (anyone know any specifics on using a bright light?),

30 minutes first thing every morning, near your face but do not stare into the light, occasional glances into the light are not harmful - http://www.walmart.com/ip/13916976?wmls ... la&veh=sem

[kteague]

While desats are a major factor, fractured unrestful sleep deserves attention too. If you are still symptomatic, then that AHI should be assumed to be a problem rather than assumed to not be a problem. If she thinks this machine is over reporting events, then maybe she could order a trial for a week or two on another type of machine with a different algorithm for comparison. Have there been any changes in your pressure to see if the AHI can be lowered? I would be really ticked off if no efforts were made toward resolution. A "blame the patient" approach does not set well with me unless efforts have been made to prove all else is not to blame. (Been there, lived that nightmare.) At 3 months in I don't think a "wait and see" attitude has any validity - just my opinion. Nor do I think that AHI should be accepted or blown off without a documentable explanation.

[pikov22]

Had my 3 month appointment and the doctor said that she's no longer concerned about my 10-14/hour AHI because my pulse ox on the CPAP is the same now as it was during the titration study. Since the lab uses a CPAP-type device that is not any more sophisticated than the one I use, she thinks that my CPAP is over-reporting apneas. Said that the lab report (4/hour) is based on 12 channels of data that the lab techs use to determine when an apnea occurs, rather than depend on just what the CPAP reports.

What are your pressure settings and what was your diagnosed AHI?

And, she said, my poor sleeping is probably behavioral, not respiratory-related. So I'm not to get into bed until lights-out time, am to get up at the same time every morning, .... try to skip naps and I do take one, make it short and get up before 2:30PM!

She is talking about sleep hygiene. Lots of good sources about sleep hygiene on the internet. Learn the details and practice them. No caffeine!

use a bright light when I get up (anyone know any specifics on using a bright light?),

30 minutes first thing every morning, near your face but do not stare into the light, occasional glances into the light are not harmful - http://www.walmart.com/ip/13916976?wmls ... la&veh=sem

1. The last lab study said 4/hr. She increased the pressure from 11 to 12 and decided that it did not make any difference.

2. Caffeine and the like has no effect on me. I went through a case of "5-hour Energy" drinks before I decided that was true

3. Cheapest one I've ever seen. I guess I could put it on the breakfast table when I eat.

Thanks.

[pikov22]

How long has this 10-14 AHI been occurring?

Since I started using the CPAP.

[pikov22]

My diagnostic PSG showed my AHI to be only 13, and my lowest O2 was barely below 90;
but I was in pure hell because frequent awakenings were preventing sufficient deep sleep,
and my awakenings were always very stressful--high BP, very fast heart rate, and significant disorientation.
In your shoes, I would seek a referral to an expert. Your current doctor needs a clue.

She is an expert! My awakenings are not at all like yours. I wake up, go to the bathroom, decide I am too awake to go back to bed, read email, etc.

[pikov22]

Well.....whatever floats your boat I suppose. Can you see me rolling my eyes over here?

10 plus apnea events per hour that cause arousals can and will sure mess with overall sleep quality no matter what the O2 levels are.
Unless your machine is scoring a lot of events while you are awake (and that is a real possibility) there's enough going on to very likely keep you feeling like a zombie no matter how much you clean up your sleep hygiene.

I take it you are a technical expert on how CPAPs measure flow and determine apneas? What I didn't seem to get across is that my doctor feels that I am not having 10-14 apneas/hour.

[ChicagoGranny]

1. The last lab study said 4/hr. She increased the pressure from 11 to 12 and decided that it did not make any difference.

What was your untreated AHI?

2. Caffeine and the like has no effect on me. I went through a case of "5-hour Energy" drinks before I decided that was true

I've heard that before. In some recent studies college students who said caffeine had no effect on their sleep were put in sleep labs. In the first study they consumed a measured amout of caffeine in the morning only. In the second study they abstained from all caffeine (even chocolate) for one week before the study.

After both studies the students still said the caffeine had no effect on sleep. But their EEGs showed their sleep was much poorer on the "caffeine days".

[BlackSpinner]

She is an expert! My awakenings are not at all like yours. I wake up, go to the bathroom, decide I am too awake to go back to bed, read email, etc.

Nocturnia - the need to pee - cause by apneas.

[49er]

Well.....whatever floats your boat I suppose. Can you see me rolling my eyes over here?

10 plus apnea events per hour that cause arousals can and will sure mess with overall sleep quality no matter what the O2 levels are.
Unless your machine is scoring a lot of events while you are awake (and that is a real possibility) there's enough going on to very likely keep you feeling like a zombie no matter how much you clean up your sleep hygiene.

I take it you are a technical expert on how CPAPs measure flow and determine apneas? What I didn't seem to get across is that my doctor feels that I am not having 10-14 apneas/hour.

Pikov,

Doctors have been wrong many times including ones who are highly credentialed. Just saying.

By the way, many of us would agree that Pugsy is more knowledgeable than many doctors.

49er

[4betterO2]

30 minutes first thing every morning, near your face but do not stare into the light, occasional glances into the light are not harmful - http://www.walmart.com/ip/13916976?wmls ... la&veh=sem

what is the wattage of that light, and especially, what is the cost of replacement bulbs?
You can achieve the same effect with a 24" "under-cabinet light" (@ Walmart) that costs about $9
http://www.walmart.com/ip/Lights-of-Ame ... e/17163528
(You can pace it where you want, doesn't have to be placed under a cabinet! It's a fully enclosed light, just has 2 holes for screws in the back to attach to cabinet if you want)
It lights up the room too.
Wattage: 17W
Incandescent equivalent: 75W
The replacement bulbs, as you need to get the special GE full-spectrum 24" bulb for therapy effect, can run $8-10.
I get those at Lowes; sometimes Walmart carries this kind of bulb too, called something like "Sun light"