Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SaltLakeJan
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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by SaltLakeJan » Sun May 03, 2009 5:42 am

Hi Mar,

It's 4 A.M.,(time has advanced itself to 5:40 A.M. as I have thought about SWS posts, your issues, and the finding the correct machine for both of us. I'm up at this awful hour because I awakened and go back to sleep. There are advantages to being up so "Early" no phone calls, no visitors/ I don't feel obliged to start housecleaning and it gives me the opportunity to really study your post. Your health issues seem very complex. You certainly feel the physical aspects of specific disease/s, but your doctors haven't been able to identify exactly what's going on with you. That has left you hanging in air. How do you treat mystery illnesses?

I have read SWS posts and keep going over them. There is so much there for me to consider and implement. One of his statements keep going round and round in my mind. SWS said
-SWS wrote:Jan, you and Mar have a couple similarities going in your threads: 1) postoperative UPPP difficulties (long term) regarding CPAP efficacy, and 2) outstanding hypopneas are predominate. However, you are running fixed pressure CPAP that leaves many hypopneas and some apneas under-addressed, and she is running APAP that cannot efficiently address her events. Another possible similarity is that hiking the pressure to address those outstanding residual events just may not be feasible, for a variety of unique reasons in physiology (presently undetermined IMO).


Your APAP and my CPAP are not addressing many of our hypopneas and apneas. How do we correct this - You have had success recently, but the entire problem may not be completely solved? In one of your early posts (I can't find it this morning) You mentioned wanting a prescription for another machine. My situation is equally vague, The ResMed Elite isn't designed to eliminate apneas and hypopneas above 10cm. My pressure is currently 9.8 cm.

It seemed to me that you had a specific machine in mind. Which one do you believe will bring you relief? Our situations are parallel, but not identical. I have been studying the different Bi-Level machines. Many people have said they can breathe better at the higher pressures BI-Levels can provide. Would one of these machines give us a better chance for sustained control of our "A. & H.'s"? And with this properly regulated, I believe both of us would find a new way of life ---relief from raging fatigue--just think of the opportunities that presents. Just writing this, gives me the feeling I should shout "Hurray", however it is still conjecture at this time.

SWS, What's your opinion on this? Is it realistic in any way?

SWS, also you mentioned our health issues, I know I have a long list of ailments. I'm not a doctor, but most of my conditions seem to be under control, (Diabetes, good AIC, Chronic Sinusitis, I still have a drippy nose, but because I am consistently using the Nasal Irrigitation, I haven't had an sinus infection. I do the best I can with my back. My BP is tamed by the use of Avalide. Nothing else is active at this time - I feel free to give what energy I have to tame my sleep apnea, asI think I have restrained my other medical issues.

Mar, I hope you feel well enough to give me your thoughts. I hope SWS will also. As for me, since I have no experience with the technical aspect of sleep apnea or the different machines, I also hope he, or one of the other "Heavy Lifters" on this forum, will share their experience.

If anything in this post doesn't make sense, it may be because while leaving a College Graduation yesterday, I slipped at the top of a set of rainy cement stairs, and banged my leg in a bunch of places. I concluded my fall down the slippery stairs by getting a large bump on the side of my head. You accurately say, say, I hurt from top to bottom. However, I didn't break anything and only left a few drops of blood on the stairs from my skinned leg.

Mar, you are in my thoughts, and I wish the very best continued for good results for you.
Jan

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by -SWS » Sun May 03, 2009 10:54 am

SaltLakeJan wrote:while leaving a College Graduation yesterday, I slipped at the top of a set of rainy cement stairs, and banged my leg in a bunch of places. I concluded my fall down the slippery stairs by getting a large bump on the side of my head. You accurately say, say, I hurt from top to bottom. However, I didn't break anything and only left a few drops of blood on the stairs from my skinned leg.
Ouch, Jan! So sorry to hear that. Hope those bumps and scrapes heal just as quickly as bumps and scrapes can.

We're getting ready to entertain at our house this afternoon and evening. So I'll be occupied today. But I can see that your thread is probably going to have several more pages of discussion. Honestly, there's a lot to put together and discuss here. And I think part of that discussion should entail considering the pros and cons of different PAP machine types. If you really have COPD, for instance, BiLevel can help with that additional facet of your sleep-related breathing--- by offloading some of the work of breathing (WOB) problems associated with COPD. However, there can be several unrelated drawbacks to BiLevel modality in physiology for some people as well.

So like I said, there's truly plenty here to discuss. More later...

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ozij
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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by ozij » Sun May 03, 2009 12:07 pm

Ouch! I hope you'll feel much better very soon.

Jan, the following is an utter misconception:
The ResMed Elite isn't designed to eliminate apneas and hypopneas above 10cm. My pressure is currently 9.8 cm.
The Resmed Elite (which is not an APAP) is designed to work at any pressure up to 20. And it is quit possilbe that you will find a pressure that will eliminate your apneas and hypopnea. If you've been following Mar's thread, you can see that her CPAP machine worked much better for her when it was set up - like an Elite - at fixed pressure. Mar's was 12.

Hobbling your machine at 9.8 is not necessary .


O.

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ozij
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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by ozij » Sun May 03, 2009 12:07 pm

Ouch! I hope you'll feel much better very soon.

Jan, the following is an utter misconception:
The ResMed Elite isn't designed to eliminate apneas and hypopneas above 10cm. My pressure is currently 9.8 cm.
The Resmed Elite (which is not an APAP) is designed to work at any pressure up to 20. And it is quit possilbe that you will find a pressure that will eliminate your apneas and hypopnea. If you've been following Mar's thread, you can see that her CPAP machine worked much better for her when it was set up - like an Elite - at fixed pressure. Mar's was 12.

Hobbling your machine at 9.8 is not necessary .


O.

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SaltLakeJan
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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by SaltLakeJan » Sun May 03, 2009 12:17 pm

Good Morning Ozij,
I appreciate and value your thought's about my pressure level. Your analogy to Mar's pressure, and ResMed Elite's capabilities helped me understand. I'd like to jump to 11cm tonight. Is that too much at one time?
Jan

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by robertmarilyn » Sun May 03, 2009 1:15 pm

Hi Jan,

My husband and I are getting ready to go for a hike from our house...lately (since the end of Feb), rather than riding my horses, I've been hiking with one of them at a time more often, because I have only so much energy and I want to get as much exercise out of what I do each day as I can...thus hiking instead of riding. I love hiking with my horses as much as I love riding them though, so all is good. Although I must say, my favorite thing to do with my horses is to ride them in 50 and up mile endurance rides...I won't be doing that for a while though...I'm devoting my time right now to seeing if the doctors can help me to find the right machine for me so I can feel better. But keeping my eye on getting back out on my horses and riding in endurance competitions is what keeps me working at this.

About machines. At this point I don't know what machine will be right for me. There could be several. (There is a possibility that no machine will help me because of problems specific to my body and it's past history and damage...I think very few folks have to worry about that so I don't want my problems to scare anyone else). I may have told you this before, but Rested gal has gathered links to a lot of very helpful info including descriptions of how various machines work and she has pointed me towards some machines that may help me more than others, depending on what my problems actually turn out to be. But at this stage we haven't pinned down exactly what is going on with me so I haven't zeroed in on what machine I might need...heck, I'm keeping an open mind that maybe, once the new doctor has run more tests on me, the machine I have will work...I just don't know yet.

ALL LINKS by rested gal:
viewtopic.php?t=17435,

I will say, I was feeling like things would not get better until I spoke to my new doctor and found she is willing to test me and really dig to see what is going on with me. I'll know more what machine might work best for me after the next set of tests and going over them with my new doctor...I do know that I like that this new doctor will be involved in helping me since there seem to be so many things going on with my body.

Every now and then I go back and watch this video...watching it helps to clear the fuzzies from my mind...I guess I like pictures of what could be going on
http://www.resmed.com/us/multimedia/und ... 40x380.swf

Maybe I will become an expert on machines and how they work on various sleep problems someday...thank goodness there are a lot of folks on this forum that can explain the machines...there are a lot of differing opinions also...I wish things could be more black and white but that isn't how life is...maybe someday I will know enough to feel like I can form opinions about machines...but I'm still way at the beginning of the learning curve so I read what the more experienced folks have to say and file the info in the back of my brain for times when I want to look it over more closely.

ALL LINKS by rested gal:
viewtopic.php?t=17435,

BTW,I just noticed something Rested gal said in another thread to a poster named Nazareth:
"P.S. I still get a chuckle thinking about your tongue-in-cheek humorous comment (in a different thread) -- "Why would cleaning the buttons change the pressure?"
I'm going to have to look that one up for the fun of it

Oh yikes, sorry about your fall...when you said you hit your leg, I thought...good thing it wasn't her head ...and then you say you hit your head ...aw hope all feels better soon.

Be back in a little while
mar

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by jnk » Sun May 03, 2009 8:00 pm

SLJ and RM,

If I had had UPPP and was having touble with CPAP, I would be SURE I wasn't sleeping on my back or anything close to that. The body can play tricks on someone where a person goes to sleep on his side or stomach and wakes up the same way, but he may still be ending up on his back or leaning slightly with his neck turned so that his face is aimed upward, allowing the tongue to fall back into the throat at some points in the night. So I would make SURE what I was doing was working. I might even go so far as to video myself sleeping for a night or two to make absolutely sure what I was doing was working as well as it needs to.

Next I would get a mandibular advancement device (MAD) to keep my jaw forward in an attempt to keep the back of my tongue as far away from the back of my throat as I could stand. That mouthpiece would help me keep my mouth closed during PAP, too.

Next, if I was using a ResMed to self-titrate, I would do what I had to do immediately to try to get AI consistently below one. Then I would raise pressures gradually to address what ResMeds consider HI. I would not worry overly much about the AHI and HI numbers, as long as my AI stayed below one. I would run EPR at 3 if I were using a ResMed with that feature, which would mean that my pressure might need to be 3 cm higher to make up for that drop in exhalation pressure. I would use the ramp (or settle) feature so that the events that occurred as I fell asleep weren't counted. And I would initiate ramp/settle by turning the machine off then back on any time I woke up in the night to start that ramp/settle feature again so that the events that occurred as I fell back asleep weren't counted against me in my numbers either.

If all that didn't work well enough, I would insist on getting an autobilevel so that I could get my pressures up to where they needed to be without being uncomfortable with them. I would use my earlier "failed UPPP surgery" as my excuse for demanding such a machine.

But that's just me, and my approach is likely not standard in many respects, since it is based on my own flawed understanding and personal experience. I did not have UPPP, but I had a close call -- that was what my PCP wanted me to get. I do use an MAD and an autobilevel, so those facts may have had an undue effect on my recommendations above.

My primary general advice, though, would be to listen to people like -SWS, ozij, and rested gal who have many years of experience reading other people's experiences in dealing with such problems.

There are plenty of things to try, though, so don't get discouraged. Try one thing at a time, methodically and scientifically. You both may surprise yourselves at just how effective your PAP therapies may eventually turn out to be.

jeff

(The experienced ones here know I don't mind being corrected, contradicted, clarified, commented on, etc. If nothing else, my words may give -SWS something to bounce his observations off of, once he is back from partying, oops, I mean, "entertaining." )

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Kiralynx
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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by Kiralynx » Sun May 03, 2009 8:16 pm

Jan,

Ouch! You make my body hurt just thinking about that fall! If you can find some, comfrey ointment is good for the scrapes, and homeopathic arnica should help the pain. (I used the arnica after my surgery, and they took me off the morphine drip within 24 hours because I was using so little of it.)

I can profoundly appreciate being desperate for some real rest.

I really don't have the knowledge that others do, but there's a part of me that's thinking a Bipap might be helpful, for reasons we discussed in that other thread. viewtopic.php?p=359079#p359079

For want of a Bipap, maybe what JNK is suggesting.

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by jnk » Sun May 03, 2009 8:34 pm

Kiralynx wrote:. . . a Bipap, maybe what JNK is suggesting. . . .
Yes, BiPAP, or maybe even an auto-BiPAP, but fully data-capable regardless. That's what I was getting at with:
jnk wrote:If all that didn't work well enough, I would insist on getting an autobilevel
I would probably run it in plain bilevel mode, even if it was auto, and find my pressures by self-titrating, before experimenting to see if it responded and gave me as good numbers in auto mode. (UPPP can keep an auto from doing its thing. But it's still worth a shot to see.) If it didn't respond well in auto mode, I would put it right back in plain bilevel (or, BiPAP) mode at the pressures that worked best for me. And ResMed autobilevels can run in straight CPAP, not just straight bilevel, if they have to.

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by Kiralynx » Sun May 03, 2009 8:54 pm

jnk wrote:
Kiralynx wrote:. . . a Bipap, maybe what JNK is suggesting. . . .
Yes, BiPAP, or maybe even an auto-BiPAP, but fully data-capable regardless. That's what I was getting at with:
jnk wrote:If all that didn't work well enough, I would insist on getting an autobilevel
I would probably run it in plain bilevel mode, even if it was auto, and find my pressures by self-titrating, before experimenting to see if it responded and gave me as good numbers in auto mode. (UPPP can keep an auto from doing its thing. But it's still worth a shot to see.) If it didn't respond well in auto mode, I would put it right back in plain bilevel (or, BiPAP) mode at the pressures that worked best for me. And ResMed autobilevels can run in straight CPAP, not just straight bilevel, if they have to.
Check. I'm amazed the thought that a CPAPTalker might suggest anything except a fully data capable machine would even cross your mind!

As I said... I don't have enough knowledge, nor am I a medical practitioner, but it seems reasonable to me that since UPPP left a great gaping hole in Jan's throat, then it might be necessary to use one pressure to hold her throat open, and another one to go after everything else.

Of course, persuading her medical practitioners of this logic could require patience, diligence, and maybe some downright subterfuge.

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by robertmarilyn » Sun May 03, 2009 9:13 pm

Hi jnk,

Right now I'm running my machine as a CPAP on a pressure of 12 with a epr of 2 and am having the best readings so far...boy, I have had some really really bad readings in the past. But I started seeing a new doctor this week and will be having another sleep test and a MLST (day test) on June 2...she will be testing me in different positions, she is esp concerned about my arousal readings...just a whole lot of things because I have a lot of problems...and really, most of them may not have anything to do with my UPPP. My thread, which explains a lot more is:

viewtopic/t41490/so-very-tired-and-it-i ... etter.html

I have been so aware of position when I sleep...even before I could get a doctor to listen to me that I thought I had sleep apnea more than 15 years ago, that this new doctor knows she may not have a chance to get readings with me sleeping on my back...I haven't been videoed while sleeping before but in my Feb sleep tests, I wasn't able to fall asleep on my back, but did fall asleep on my side, and from what the tech told me, even though I did change sides, I never slept on my back. Not only that, all these years it has seemed important to me to sleep with my head on the edge of a pillow so that my face is facing more down than even sideways. I think your suggestions to be sure that we aren't sleeping with our faces up or partially up or sleeping on our backs, is a very good one.

With this new doctor's help, I will get a different machine if I need one...thank goodness. It may even be a machine that treats central or complex apneas...don't know for sure yet. I have a lot of issues that need to be looked into and they probably all stem from being born with obstructive sleep apnea that went untreated for 38 years. When I had the UPPP the doctors made no promises and actually told me that with my long term untreated sleep apnea, that my brain might not regulate my breathing properly, even without obstructions.

Before my operation, I had constant dreams that I was very deep underwater and there was no way to get to air. I would not be breathing since I knew I couldn't breath water. But with no hope of getting to the surface, I would finally "breath water" and find that it was air and I could breath it! I would wake up immediately after taking a breath...I guess I could have had those dreams even more than I remember if I didn't wake up after them, which might cause me not to remember them. I think those dreams were my mind trying to get my body to breath...I stopped having those dreams after the UPPP and actually felt much better for at least 10 years.

I can't say enough about how much help and support I have gotten from Rested gal and -SWS...both privately and publicly. I haven't posted much with ozij until very recently but I have certainly followed her posts and read them in the archives. We are very lucky to have so many of you who have the knowledge, experience, and willingness to help and support us.

Oh and I plan to hang in here and I plan to give Jan as much support as I can...so many folks have helped me and I want to pass it on in ways that I can. I was feeling like I was butting heads with a boulder before I met this new doctor. But I am always willing to keep trying...the alternative doesn't appeal to me

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by SaltLakeJan » Sun May 03, 2009 9:40 pm

Hi jnk,

My husband has said, "There are times when you will not take advice." This isn't one of those times, I read, ponder & consider each piece of advice that is given to me - I appreciate the thought you put into my situation. It's scary to me. I answered Den, when he asked me if I slept on my back - a definite no. However, I have been bothered about my cpap treatment not working, and I have awakened several times in the night - and there I was sleeping on my back. I had an pillow and towel arrangement that I thought prevented back sleeping. I guess before bed tonight, I'll get an old t-shirt of my DH, sew another pocket in it, and put a tennis ball in each pocket. I might find a better method tomorrow, but you are right, each step is important. My health depends on it.

Is the MAD, a custom dental device, or an OTC type. I checked with my dentist on a custom type, he says my mouth is not a good candidate for that.

I have read your posts many times and for a Brooklyn guy you give pretty good advice.

I am considering everything you told me in your post - just exactly as you said, methodically and scientifically. Everything I get from the forum will help me with my doctor's appointment tuesday. I have been gathering information on both auto's and bilevels today. So I am glad to have more information from you on each. I am pleased SWS linked my post and Mar's. I believe we will both gain from added information.

Anything you think of that relates to my "wide open throat" and successful apnea treatment - send it out to this westerner & I'll give it a grateful reception. Thanks jnk.
Jan

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by robertmarilyn » Sun May 03, 2009 9:55 pm

SaltLakeJan wrote: Anything you think of that relates to my "wide open throat" and successful apnea treatment - send it out to this westerner & I'll give it a grateful reception. Thanks jnk.
Jan
You know Jan, even though we have very similar situations, some of our problems seem very different. Even with my UPPP, I still don't have much room...this new doctor looked over my ears, nose and throat and she suspects my esophagus may be very small too. I think the fact that my tongue fills up my mouth so well may be why I don't have more trouble with losing air through my mouth. Good luck with your doctor's appt!
mar

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by jnk » Mon May 04, 2009 6:31 am

I use a version of the snoreguard as an MAD. Not adjustable, just a one-off customized plastic molded piece.

One cheap but highly effective method I've heard of for preventing back-sleeping is using a child's bike helmet and running a soft belt through the slats and wearing the helmet high up on the back with the belt up underneath the armpits. I have heard that you only have to wear it for a few weeks to train your body not to sleep on its back and then you can just wear it for one night every few weeks to make sure your body still remembers to stay off its back. You pay a price in arousals doing that at first, but it pays off eventually for some once the body learns.

I didn't mean to leave Den off my mini-list of a few of the experienced posters earlier. My point was only to keep in mind how inexperienced I am in comparison to so many here.

jeff

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Re: Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

Post by jnk » Mon May 04, 2009 11:14 am

http://www.entoday.com/pt/re/entoday/pd ... -00003.pdf

I'm not sure how good that article is, but it seems generally relevant to the topic.