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

[SaltLakeJan]

SWS

Are you the culprit that sent this message to me? IF YOUR SLEEP ARCHITECTURE CONTINUES TO BE FUBAR

Pardon me, I'm ROFL, I guess your description fits my sleeping pattern, as well as any that I'v heard. But I have excuses - better excuses than you have ever heard.

My genes were configured before I was born to be an afternoon/evening/night person. My DH is a Lark. He needs gene therapy to discover a better way of life.

It is true I slept 'till noon and I am unrepentant. I had stressed out, & obsessed out over the doctor's appointment. I was so exhausted, I didn't sleep well 5-5-09 the day I met him. The next evening I got to bed about 11:00. got to bed close to midnight and couldn't sleep for a while. Then I fell in a sleep so deep and satisfying I slept till noon. I'll admit it screwed-up by next two night's bedtimes. My sleep problem is that I usually can't sleep.

I have sleep problems, I have had insomnia off and on since I was a child. I got comfort when the new sleep doctor said there is a type of insomnia that changes when CPAP is used. That seems to be what is happening to me. Usually, I sleep much sounder than I did pre CPAP. Sleep issued may be in my genes. My brother, son, and 4 year old grandaughter all have going to sleep/staying to sleep problems.

My December 2008 Sleep Study had some conclusions about my sleep.
CONCLUSIONS: #1 PATIENT'S SLEEP WAS FRAGMENTED ON THE CURRENT STUDY BY INTERMITTENT PERIODS OF WAKEFULNESS. THE MOST MARKED EPISODE OF SLEEP FRAGMENTATION OCCURRED BETWEEN 0030 HOURS AND APPROXIMATELY 0145 HRS. tHE PATIENT'S TOTAL SLEEP TIME MEASURED 5.59 HOURS AND THE SLEEP EFFICIENCY WAS 82%. NORMAL IS GREATER THAN OR EQUAL TO 90%.
SLEEP LATENCY WAS NORMAL AND MEASURED 23 MINUTES.

Comment by Jan: One reason I was wakeful is that the mattress was uncomfortable. It hurt my back within a short time.
Once I awakened and the two technicians were waking me asking me what was wrong. I was moaning in pain in my sleep,, because the mattress had sunken in the middle & my back was half in and half out, of the uneven place.

I have to post this in sections. My new computer drops the posts if they are long. Happened today. Jan

[SaltLakeJan]

post continued:

Sleep Study 12-2008
CONCLUSIONS:
THE PATIENT HAD INCREASED AMOUNTS OF STAGE 111/1V SLOW WAVE OR DEEP RESTORATIVE SLEEP. THIS SUGGESTS THE PATIENT MAY BE SUFFERING FROM CHRONIC SLEEP DEPRIVATION AND SLEPT BETTER ON THE SLEEP STUDY THJAN SHE DOES AT HOME.''

jAN'S CONCLUSION: a major reason why I slept better was because in my 9-2001 sleep study, I was bothered by the noisy circumstances. When Sleep Study was proposed, I asked if would be quiet. They said it would. It was very quiet in the room. No light or noise from outside penetrated the room.

FURTHER CONCLUSION FROM JAN: The sleep room was in contract to our home area - which is noisy. My nest door neighbor has 5 dogs. She lets them out in her yard for the night, & they bark at every sound. There are several teen age girls, who go on dates and I can hear their good by's. Another neighbor has parties and neighbors in. NBD, but I can hear his guests call out when they leave.
Another person gets home around 2 AM, He makes a lot of noise bringing in garbage cans closing car door. There is nothing wrong with any of our neighbors, It is just the fact they it has always been a noisy neighborhood.

Conclusion #4 Sleep Study 12-2008.
The patient has moderate sleep-disordered breathing. Her lowest oxygen level was 81%. She had 16 apneas resulting in an AHI of

[SaltLakeJan]

Hello everyone - my two week old computer is having a breakdown if I make a large post. I couln't even finshsih the last statement.

I'll begin at CONCLUSION 12-2008 SLEEP SUDY:
#4. The patient has moderate sleep-disordered breathing. . Her lowest level is oxygen level was 81%. She had 16 apneas & 97 hypopneas resulting in an AHI of 18.9 per hour. Her sleep apnea was worse on her back. The AHI was 32 per hour on her back, and 11.2 on her right side. She only slept on her back and right side, and not on her left side. The majority of hypoopneas, as noted, with a mean duration of 24 seconds.

jAN, COMMENTS TO #4 aFTEER A SHORT TIME IN THAT BED, I TRIED TO STAY IN THE SAME PLACE BECAUSE IT FELT LIKE IT SAGGED. I AM USED TO A FIRM SUPPORITIVE MATTRESS. wHILE i WAS AWAKE, THE UNCOMFORTABLE BED WAS THE REASON I DIDN'T MOVE.

#5, There is no evidence of periodic leg movement syndrone. Of note is the patient does take Mirapex but often uses it during the day, and hasnumerous family members with periodic leg movement syndrome.

Janet comments to #4. I take 1.2 mg of Mirapex to stop leg movements. It works. (IS THAT WHY THERE WAS NO PERIODIC LEG MOVEMENT) . THE COMMENT PAGE WON'T ROLL DOWN, THE ENTIRE SCREEN WILL.I'VE GOT TO POST. jAN

[Muffy]

Sag would be the genial host.

SAG does not want to host genials. That's disgusting.

Let me know how you decide who gets what card. (I think that was a comedy routine)

Right. See, when Muffy goes to the store, since she has Multiple Personality Disorder, she has to cart along the other 8 people. When anything that involves making a decision comes up, an argument usually ensues...

Oh, NM.

I used humidification January through the end of March. earlier I said it is a winner, it works when it wants to. It was inconsistent in heating. I took it to DME twice, and of course the heating element warmed within seconds. I am going to turn it back on tonight.I'll wonder if it will heat this time.

Make sure your outlet isn't the problem. If the humidifier is still under warranty, just exchange it. It's not a good idea to use faulty electrical heating devices of any nature in your home (unless you rent). Other than that, since you're such a light sleeper, the noise of the crackling fire will wake you up in time.

I never cared to smoke. My father's cigarette cough convinced me that smoking wasn't much fun.

See what the PFT shows. If it looks like emphysema, check the alpha1-antitrypsin level.

My new computer drops the posts if they are long.

Compose your posts in Word, Wordpad, Notepad, etc. Then copy then to the forum.

There is no evidence of periodic leg movement syndrone. Of note is the patient does take Mirapex but often uses it during the day, and hasnumerous family members with periodic leg movement syndrome.

How were those PLMs in the other family members diagnosed? I would say that if you take Mirapex during the day, the effect is gone by the time the PLMs should show up. Also, they tend not to disappear totally, but rather become less severe. I'd make sure that the movements weren't simply caused by respiratory events, in which case they aren't PLMs.

Where's my (your) graphs?

It is unlikely that the humidity in Utah is EVER sufficient enough to be able to not use the humidifier. Even if all the parts to your nose were still there.

I got comfort when the new sleep doctor said there is a type of insomnia that changes when CPAP is used.

From what to what?

II guess your description (FUBAR) fits my sleeping pattern, as well as any that I'v heard. But I have excuses - better excuses than you have ever heard.

My genes were configured before I was born to be an afternoon/evening/night person.

My sleep problem is that I usually can't sleep.

I have sleep problems, I have had insomnia off and on since I was a child. I got comfort when the new sleep doctor said there is a type of insomnia that changes when CPAP is used. That seems to be what is happening to me. Usually, I sleep much sounder than I did pre CPAP. Sleep issued may be in my genes. My brother, son, and 4 year old grandaughter all have going to sleep/staying to sleep problems.

THE PATIENT HAD INCREASED AMOUNTS OF STAGE 111/1V SLOW WAVE OR DEEP RESTORATIVE SLEEP. THIS SUGGESTS THE PATIENT MAY BE SUFFERING FROM CHRONIC SLEEP DEPRIVATION AND SLEPT BETTER ON THE SLEEP STUDY THJAN SHE DOES AT HOME.

My nest door neighbor has 5 dogs. She lets them out in her yard for the night, & they bark at every sound.

There are several teen age girls, who go on dates and I can hear their good by's.

Another neighbor has parties and neighbors in. NBD, but I can hear his guests call out when they leave.

Another person gets home around 2 AM, He makes a lot of noise bringing in garbage cans closing car door.

it has always been a noisy neighborhood.

If I were you, instead of a "data-capable machine", I'd get an XM-214:



and spend just one more noisy night in the neighborhood.

Muffy

[-SWS]

My nest door neighbor has 5 dogs. She lets them out in her yard for the night, & they bark at every sound.
There are several teen age girls, who go on dates and I can hear their good by's.
Another neighbor has parties and neighbors in. NBD, but I can hear his guests call out when they leave.
Another person gets home around 2 AM, He makes a lot of noise bringing in garbage cans closing car door.
it has always been a noisy neighborhood.

If I were you, instead of a "data-capable machine", I'd get an XM-214:



and spend just one more noisy night in the neighborhood.

Muffy

I think cpap.com should consider starting a product-section page called "CPAP Compliance Tools". Admittedly... coming up with a Medicare billing code that works may take some creativity...

SWS

Are you the culprit that sent this message to me? IF YOUR SLEEP ARCHITECTURE CONTINUES TO BE FUBAR

Pardon me, I'm ROFL, I guess your description fits my sleeping pattern, as well as any that I'v heard.

Uh, no ma'am... As you can tell from the picture above, SAG/Muffy heads up the Irreverent Humor Department (I.H.D.). I'm just an entry-level clerk in the Department of Redundancy Department (D.R.D.).

Anyway, may you festively celebrate a most maternal Mother's Day today, Sunday, May 10th!

Sincerely,
Me, Myself, and I---and the rest of the D.R.D. staff (all sets)

[Muffy]

Admittedly... coming up with a Medicare billing code that works may take some creativity...

And at $25,000, I'm sure they'd insist that the Certificate of Medical Necessity (CMN) was in order.

However, you have to admit that it certainly is stylish:



Muffy

[jnk]

. . . I'd get an XM-214: . . .

Are you sure that is really the right machine for the job, Muffy? What about weight, battery, and efficacy issues? I tend to think that machine may have been overpromoted by the manufacturer. Wouldn't any machine from the common M60 family, for example, be better able to address the neighborhood-sleep-architecture issues?

[jnk]

Admittedly... coming up with a Medicare billing code that works may take some creativity...

And at $25,000, I'm sure they'd insist that the Certificate of Medical Necessity (CMN) was in order.

However, you have to admit that it certainly is stylish:



Muffy

Based on the barrel clamps, I believe that stylish fashion accessory may actually be a misidentified M134: http://www.montysminiguns.com/Xm214page.htm

[SaltLakeJan]

who the heck do I address this to.'
Genial repells Sag. Muffy can't be around, she certainly doesn't drive a compact. You can't get 8 people in a politically correct vehicle. Anyway, Thanks for the Mother's Day Laugh. JTLYK the humidifier worked. I can almost breathe thru my nose this morning..LCD data was better than the previous days.
L/0.18---AHI 7.6-----AI 0.1----HI----7.5 ----Hrs Used 6.22

As soon as I get back from eliminating all my neighbors with my sweet M.D. gift. And I am positive no one is left alive - I guess the dogs have to go too. I can't even finiish I'm LOL, so loud the neighbors willl hear me coming. Funny, Clever, Funny.
Jan

[Muffy]

Genial repells Sag.

Oh, GENIAL!

I thought that was another spelling error.

In that case, NM.

Muffy

[SaltLakeJan]

Muffy,

What do you mean spelling errors? The transcript was perfect when I gave it to the Clerk. HE came from a temp agency. HIS C.V. was handwritten. Could that have been a warning sign? HE claimed to have been CEO at AIG. No current telephone listing for AIG, unable to verify his claim. Was AIG a valid business? I hired him as an exception, MALE former executives never make it in a clerical position - THEIR ego exceeds THEIR ability.

I take personal responibility for the errors - In HIS case ESO

Jan

[SaltLakeJan]

Muffy,
What's it like to have a different personality for different occasions. Never boring, There are times when I seem like a different person, around here it looks like, happy, cranky, bubbling, etc. A variety of moods, one person, occasionally boring.

Edward is my new data clerk - blame all errors on him.

STAGING SUMMARY INFORMATION, SLEEP STUDY 12-08
Recording Start Time------------------22:05:25----------------Recording End Time----------05:34:16
Lights Off Time--------------------------22:36:55----------------Lights on Time----------------05:30:24
Total Recording Time (hrs/min---------7:28:8-----------------Total Sleep Time---------------5:59:0
Wake After Sleep Onset (min)---------54.5---------------------Sleep Efficiency %---------------82.2
Sleep Onset Latency (min)-------------23.0---------------------Stage REM Latency-----------233.5

SLEEP STAGING
Sleep Stage------------Duration (min)-------------% Sleep Time
Wake-------------------54.5
Stage REM-------------19.5----------------------------5.4
Stage 1 Sleep----------26.5---------------------------7.4
Stage 2 Sleep---------213.0-------------------------59.3
State 3 Sleep---------100.00------------------------27.9
Stage 4 Sleep------------0.0--------------------------0.0

SPo2 SUMMARY
SPO2 Wake Average %-------------89
Spo2 Sleep Average%---------------91
Lowest Spo2% Sleep Time----------81
Average Spo2 Desat % S.T.--------6
Av. Low Spo2 % S.T.----------------90

Sp02 TABLE
-------------
-----Desaturation Statistics----------Saturation Statistics
----------Desat. %----# of Events--------Sat. Levels----------Hrs/mm/ss
---------->=2-----------208-----------------Time Bet 90-100%--4:26:54.0
---------->=3-----------148-----------------Time @ 89% & belo-1:31-4:0
---------->=4-----------108-----------------Time Bet. 80-89%---1:31:40
Time At 79% & Below 80%----------------------------------------0.00:0.0

OXIMETRY BY SLEEP AND POSITION.
----------------REM sup---REM no-sup--NREM sup----EM no-sup----Sleep time
Low Sp02%----87---------90--------------81-------------82------------81
Mean low Sp02 %---------89--------------91-------------90------------90
Average minimum

[-SWS]

However, you have to admit that it certainly is stylish:



Muffy

Indeed! And how adorable is that bold and sassy fashion statement!

Girlz in da hood!

Wouldn't any machine from the common M60 family, for example, be better able to address the neighborhood-sleep-architecture issues?

Notwithstanding that part about sleep... I'm thinking it ought'a take care of architectural problems in general throughout the neighborhood.

[SaltLakeJan]

Yikes Muffy,
Now I find more.
RESPIRATORY EVENTS SUMMARY (Sleep Time)
The Mixed & Centrals are all 0. have not included them.
--------------Parame---Obstructi.----Total Apnea------Hypopnea
Number-----------------16---------------16----------------97
AHI----------------------2.7---------------2.7--------------16.2
Av. Duration (sec)---20.3-------------20.3-------------24.3
Longest Dur. (sec)---------------------34.4-------------56.0
# NREM----------------16----------------16----------------91
# in REM---------------0------------------0-----------------6

RESPIRATORY EVENTS - REM/NREM (sleep time)
------------------Parameter-----REM------Non-REM-----Sleep
Apneas---------------------------0------------16------------16
Hypopneas----------------------6-------------91-----------97
Apnea+Hypopneas-------------6------------107---------113
Duration in Apnea (min)-----0.0-----------5.4-----------5.4
Duration in Hypop (min)-----3.2-----------36.1--------39.3
Duration in Ap-Hypo (min)--3.2------------41.5--------44.7
AHI (hr)-----------------------18.5-----------18.9---------18.9
Respiratory Arousal Inde---3.1------------25.5---------23.9

RESPIRATORY EVENTS INDEX (hr)) by Position (sleep time)
Mixed & central all 0.0. have not included in chart
-----------Obstructive----Hypopnea---All
Back-----6.0---------------26.5----------32.6
Left-----0.0----------------0.0------------0.0
Right----0.8---------------10.4-----------11.2
Front----0.0---------------0.0------------0.0
Total----2.7----------------16.2----------18.89

HEART RATE SUMMARY
Average Heart Rate--------52
Low Heart Rate-------------16
High Heart Rate------------150
no Bradycardic periods
no Tachycardic periods

Note From Jan: I showed heart rates to Dr when I had annual Treadmill Stress Test---He said, "They had just grabbed some numbers)
inaccurate on heart rates

AROUSAL SUMMARY
Number of-----------REM------non-REM-Sleep
Respiratory---------1-----------142-------143
PML (all O)
Spontaneous (all O)
0 0 0
Total per Hour------------------------------
143
Respiratory--------3.1------------25.1----23.9
PLM & Spontaneous all O
Total Arousals------------------------------23.9

PERIODIC LEG MOVEMENTS SUMMARY
----------------------------------REM---------NREM----Total
Total # Limb Movements
Exclud, PLM's during sleep.---1----------19--------20
PLM during sleep---------------------------10--------10
PLM per hour during sleep---0.0--------1.8------1.7
# Limb Movem. Assoc. Arrous. 0--------0---------0
PLM Arousal Index-------------0.0--------0.0------0.0

HISTORY:

Electrophysiologic Parameters: Total recording time was 448.8 min. with a total sleep time of 359.0 minutes & a slelep efficiency of 82.2%. The patient's sleep latency was 23.0. There was a total of 5.4 REM sleep with a REM latency of 233.5 min. There was 7.4% of Stage 1 sleep, 59.3% Stage 2, 27.9% Stage 3, and 0.0 Stage 4 sleep. PLM's were noted with PLM index of 1.7 and PLM arousal index of 0.0. Total arousal index was 23.9 and the respiratory arousal index was 23.9

Respiratory Parameters: Respiratory Analysis demo. 16 obstructive apneas and 0 mixed apneas with total of 16 apneas and an apnea index of 2.7. There were 97 Hypopneas, with a RESPIRATORY DISTURBANCE INDEX (ahi) OF 18.9. tHE PATIENT SPENT 35.9% of the total sleep time in the supine position, with a supine AHI of 32.6, versus a non-supine AHI 11.2. The REM AHI was 18.5 versus a non-REM AHI of 18.9. The lowest oxygen desaturatiion was 81, with 91.1 minutes of desaturations between 80% and 90%.

Technologist Comments: Pt a baseline study, no alpha intrusion of CSB seen during the night. Pt exhibited moderate sleep apnea due to the amount of hypopneas seen during the study. The night Technician noted that there was moderate snoring seen and this was confirmed via the record. Pt was not split due to the amount of (night technician perceived) events seen throughout the night. This pt might have slept better here at the lab than at her house, due to what she wrote in her pt questionnaire. ** Sinus arrhythmia was seen throughout the night (see print out) and there were no PV'C's. *The ECG lead had a poor connection so it was difficult to access the HR. Pt slept mostly on her right side moving to her back near the end of the night.

I noticed a comment under recommendations that is no longer applicable. "Pt does use Ritalin during the day"
I went to new internist about March 2007 again, with complaint of fatigue. He referred to previous diagnosis of Fibromyalgia & Chronic Fatigue. I explain IMHO doubted I ever had CFS, only symptom I had was fatigue. (This is the Dr who told me the changes in my lung were due to exercise) I left without accepting his prescription of 20 mg Ritalin. Fatigue continue, went back about June 2007, he again prescribe 20 mg Ritalin. I still doubted diagnosis of Chronic Fatigue. During the 13 year period I had Fibro/CFS Educational Group, the women I observed had multiple symptoms, many were disabled. He advise FYI that's what you have.. Took Ritalin Prescription. Continued with it through 12-08 Sleep Study. I disliked the effect of Ritalin, energy soared in A.M. by early afternoon, energy crashed. During Dec 08, disliked it so much I only took about 3/4's the time. December 26th began withdrawal.
By mid Feb, I was through. Never missed it.

**Conclusion #6. Single lead EKG revealed normal sinus rhythm with no significant arrhythmias.
* Sleep Dr. 12-2008 cover letter somewhere. Tech noted lead "off" or "poor connection, can't remember which. Jan

[SaltLakeJan]

SWS/SAG/Muffy and all 8 Associates

Thank you, thank you, the posts with the detailed and charming photos made a great addition to my Mother's Day celebration. I was ever so intrigued with the possibilities they suggest. And, you mentioned the VM 214 only weighs 50 pounds. A bit heavy to carry down the street. However, my garden cart has ball-bearing wheels, I can visualize Jan's little helper carefully tucked in the cart. Not that subterfuge is really necessary, but I thought a baby blue chiffon scarf draped attractively over VM 214 would appear to be a summer accessory. And, as I stroll down the street on a summer evening, casually pushing the cart . . . who known what might accidentally happen. EG

On second though, does the stylish model come with the VM 214?

I'v spent the day ROTFL , has been much fun.
Jan - AKA The Destroyer