Spoke with my Doctor

[BleepingBeauty]

<snipped>

Ha ha, I think there is an echo in here

Whoa! How'd that happen??? Mondo...

Ah so you understand about the pedometer. Nurses also tend to get a lot of miles in during their work. I will keep a running total of my calories and things like fiber or whatever I am trying to track, in a little notebook.

I keep mine on the pc. Made a nice little chart for myself, listing the day, each meal, how much exercise I did that day, etc. Then I just fill it in as I go. It's come in handy and helps to keep me on-track (with the eating, especially).

If I am wanting to blow things to bits healthy eating-wise, I have this huge desire not to write things down Always a good sign that I'm wanting to let good eating go to the uh...hogs (tie in to my thread)

I'm sure I'd feel the same, although I haven't given myself the opportunity yet. Maybe my birthday will be one of "those" days!

I have worn my pedometer when I have been hardly able to move around because I was so tired and I am embarrassed to say that there have been a few days when I didn't even go 300 steps.

I hear ya. I've had days like that, myself.

This is not the way a healthy and "normal" body should act and I do not want to feel so old so soon.

mar

No argument here. Some days, I feel WAY too old for my age.

[-SWS]

I called the sleep lab this morning and had them fax me the report. It's five pages long and can be found here

All input is, of course, welcome.

I asked her, "So, does this mean I don't have Complex Sleep Apnea?" and she said that I don't.

I agree that there are no signs of CompSAS/CSDB in that study summary, BB. BTW, when did your DX and RX occur for edema and for hypothyroidism----relative to that first sleep study with the 107 AHI?

Can we attribute any of that extreme 107 AHI, central apnea, and CSR to untreated hypothyroidism or even pulmonary edema?

So, if I'm following you correctly, -SWS, I may have CSAS, but it's only obvious at certain times and at other times is "masked" by other factors?

CompSAS doesn't necessarily present uniformly. It doesn't present like clockwork every night. And when it does happen to present, the symptomatic severity can vary significantly from one night to the next---or sometimes from one week or month to the next.

No one knows the exact underlying etiology or pathogenesis behind CompSAS. But it clearly has a neurological component. Think of other neurological disorders that manifest in episodes or flareups. Take my own trigeminal neuralgia, for instance. No flareups at the present. But the problem is not masked per say. It's still there, but it's simply not triggered at the moment. A neurologist who didn't take into account my past flareups would find it impossible to diagnose me with trigeminal neuralgia right now (diagnostic imaging is inconclusive in my case). There presently are no diagnostic procedures that can yield an accurate trigeminal neuralgia diagnosis for me other than looking at "the overall historical picture" as Muffy alluded to earlier.

Similarly, no doctor could or should be able to look at your one-night PSG summary alone and diagnose you with CompSAS. But I'm not so positive they should look at that one-night sleep sample and rule out CompSAS either. No more than any doctor should rule out trigeminal neuralgia based on my absence of symptoms this week. Any doctor who might diagnose me with trigeminal neuralgia based on this week's inadequate diagnostic input alone would be a poor diagnostician. Any doctor who ruled out trigeminal neuralgia based on this week's absence of symptoms would be remiss as well. Any doctor who looked at the overall historical picture would be a doctor with adequate scope to make the correct diagnosis. When I happen to be in the middle of a trigeminal neuralgia flareup, just about any neuro would be able to give me a correct diagnosis. The challenge lies in differentiating episodic conditions when symptoms do not happen to conveniently present.

So does your one night in the sleep lab mean that you do not have CompSAS? I think that one night of yours in the sleep lab is inconclusive all by itself. I suspect that if you purchased a data-capable CPAP machine and sat at your best pressure, that over the course of a year you will see several disruptive episodes. I could be wrong. And I hope I am.

Well, the message is being received, loud and clear. I'm going to force myself to get out and walk on a much more regular basis.

I hate to press BB, but there's still a touch of vagueness in that commitment. And IMHO pinning a cure-all hope for your excessive fatigue on any xPAP machine or modality is unrealistic. As much as I hate the "tough love" approach, I feel compelled to tell you that I think a very structured and aggressive turnaround in lifestyle is absolutely necessary.

Targeted heart rates for targeted durations on targeted days of the week are the specific kinds of psychologically-committed goals that I think are needed to turn your health and life around. Again, xPAP therapy alone will not suffice.

I'm having repeat bloodwork done on Monday.

Speaking of levothyroxine, that's synthetic T4 for hypothyroidism. Did you perchance see what JoyD. and riverdreamer mentioned about taking a "free T3" test? T3 deficiency may account for some of your residual fatigue, and perhaps even difficulty with weight. When it comes to fatigue problems, we're pretty much the sum total of all our contributing factors. Perhaps addressing a T3 deficiency may help disordered breathing, weight loss, and energy levels improve across the board. Any chance of getting Monday's blood panel altered for a look at free T3?

BB, I intensely hate dishing out tough love. And I rarely do it. On that note, let's finish with an extremely positive comment from a consummate sleep professional:

Overall, I think there's a lot of positive stuff here.

[Muffy]

However, a sleep efficiency of 82% is fair at best (really need at least 85%, 90% is desirable, 95% would be excellent) and 31 awakenings is poor (you should have like "2").

Is there something I can do to improve that? And if not, what does that mean for my future treatment needs?

If all of the known causes of sleep disruption are removed, corrected and optimized, then you might want to consider some sort of pharmacological aid. The one selected, however, should match the problem you're trying to fix. If we use your last sleep study as a guide, and plot the periods of wake:



you could see that getting to sleep and the first couple of hours are basically OK, so plain Ambien (rapid onset, short duration), for instance, may not help, and a longer duration medication may be more appropriate.

I've never had issues with insomnia <knock on wood>. No trouble getting to sleep, no trouble staying asleep or getting back to sleep when I have to make a bathroom trip in the middle of the night.

You have trouble staying asleep. Look at the red crayon marks. And early awakenings are also problematic.

So, all things considered, what would you advise as my xPAP treatment from here on? If the centrals seem to be resolving themselves and ASV no longer appears to be a necessity, my own plan would be to get myself an APAP with software and reader, set it at a narrow range (maybe 8-12?) to see how I fare at the lower pressures, and then tweak things from there. Is that reasonable, in your opinion? And if not, what do you suggest?

Here's the titration table from the study:



In other words, you're asking if the potential benefits of "permissive flow limitation" (improved sleep efficiency and reduced awakenings) exceed the risks (more arousals and long-term health risks).

There's a bunch of cliches that say something like "20% of your effort will fix 80% of your problem, but it will take 80% of your effort to fix the remaining 20%".

You AHI was 107 and now it's about 5 (when nobody's dial wingin'). That's phenomenal. While I suppose software may help to maintain intense focus on health and well-being, I think at this point you should devote the great majority of your energies to the other issues, especially strict sleep hygiene and consolidating your sleep. Get those naps back into the night's sleep. Bedtime is not 10:30 to 11:30, it's 10:30.

Speaking of which, it's 10:30.

Muffy

[BleepingBeauty]

I agree that there are no signs of CompSAS/CSDB in that study summary, BB. BTW, when did your DX and RX occur for edema and for hypothyroidism----relative to that first sleep study with the 107 AHI?

I'm not sure, -SWS. With my poor memory, I'm guessing I've been on these meds for about a year, but I'll check with the PCP when I have the bloodwork done on Monday.

Can we attribute any of that extreme 107 AHI, central apnea, and CSR to untreated hypothyroidism or even pulmonary edema?

That's a very good question.

So, if I'm following you correctly, -SWS, I may have CSAS, but it's only obvious at certain times and at other times is "masked" by other factors?

CompSAS doesn't necessarily present uniformly. It doesn't present like clockwork every night. And when it does happen to present, the symptomatic severity can vary significantly from one night to the next---or sometimes from one week or month to the next.

No one knows the exact underlying etiology or pathogenesis behind CompSAS. But it clearly has a neurological component. Think of other neurological disorders that manifest in episodes or flareups. Take my own trigeminal neuralgia, for instance. No flareups at the present. But the problem is not masked per say. It's still there, but it's simply not triggered at the moment. A neurologist who didn't take into account my past flareups would find it impossible to diagnose me with trigeminal neuralgia right now (diagnostic imaging is inconclusive in my case). There presently are no diagnostic procedures that can yield an accurate trigeminal neuralgia diagnosis for me other than looking at "the overall historical picture" as Muffy alluded to earlier.

Similarly, no doctor could or should be able to look at your one-night PSG summary alone and diagnose you with CompSAS. But I'm not so positive they should look at that one-night sleep sample and rule out CompSAS either.

Okay. That makes perfect sense to me. So now, I have to ask: If my new sleep doc is looking at all five of my sleep studies, how is it that she's reached the conclusion that I don't have CompSAS, considering how obvious it was early on?

So does your one night in the sleep lab mean that you do not have CompSAS? I think that one night of yours in the sleep lab is inconclusive all by itself. I suspect that if you purchased a data-capable CPAP machine and sat at your best pressure, that over the course of a year you will see several disruptive episodes. I could be wrong. And I hope I am.

My fear is that I'll choose the wrong machine and wind up in the same boat a year from now.

I have no plan to rely exclusively on any xPAP treatment to cure my issues. But having the right treatment in that department would certainly elevate my energy level so I could exercise more.

I'm having repeat bloodwork done on Monday.

Speaking of levothyroxine, that's synthetic T4 for hypothyroidism. Did you perchance see what JoyD. and riverdreamer mentioned about taking a "free T3" test? T3 deficiency may account for some of your residual fatigue, and perhaps even difficulty with weight. When it comes to fatigue problems, we're pretty much the sum total of all our contributing factors. Perhaps addressing a T3 deficiency may help disordered breathing, weight loss, and energy levels improve across the board. Any chance of getting Monday's blood panel altered for a look at free T3?

Yes, I've been following mar's thread. Admittedly, I skimmed those hypothyroidism posts because I didn't realize that could be a factor in my own case. I'll go back and re-read, and I'll mention this to my PCP on Monday.

BB, I intensely hate dishing out tough love. And I rarely do it. On that note, let's finish with an extremely positive comment from a consummate sleep professional:

Overall, I think there's a lot of positive stuff here.

Thanks, -SWS. I liked Muffy's comment, too.

[jojo2785]

how long do you have to upgrade a machine. Ive had mine for 3 weeks.

[BleepingBeauty]

However, a sleep efficiency of 82% is fair at best (really need at least 85%, 90% is desirable, 95% would be excellent) and 31 awakenings is poor (you should have like "2").

Is there something I can do to improve that? And if not, what does that mean for my future treatment needs?

If all of the known causes of sleep disruption are removed, corrected and optimized, then you might want to consider some sort of pharmacological aid. The one selected, however, should match the problem you're trying to fix. If we use your last sleep study as a guide, and plot the periods of wake:



you could see that getting to sleep and the first couple of hours are basically OK, so plain Ambien (rapid onset, short duration), for instance, may not help, and a longer duration medication may be more appropriate.

I'll be getting therapy at 12cm for the next month, but I still won't know if that corrects and optimizes my sleep disruption unless I feel a whole lot better. Aside from a pharmacological solution (which I will consider, if necessary) and going to bed earlier and on a regular basis, what can I do to improve this situation?

I've never had issues with insomnia <knock on wood>. No trouble getting to sleep, no trouble staying asleep or getting back to sleep when I have to make a bathroom trip in the middle of the night.

You have trouble staying asleep. Look at the red crayon marks. And early awakenings are also problematic.

Okay, I guess I should have said, "To my knowedge, I don't have issues with insomnia. I think of insomnia as something a person is aware of, and that doesn't fit my own perception of my sleep. I didn't think waking up too early was a form of insomnia, but I guess it is.

So, all things considered, what would you advise as my xPAP treatment from here on? If the centrals seem to be resolving themselves and ASV no longer appears to be a necessity, my own plan would be to get myself an APAP with software and reader, set it at a narrow range (maybe 8-12?) to see how I fare at the lower pressures, and then tweak things from there. Is that reasonable, in your opinion? And if not, what do you suggest?

Here's the titration table from the study:



In other words, you're asking if the potential benefits of "permissive flow limitation" (improved sleep efficiency and reduced awakenings) exceed the risks (more arousals and long-term health risks).

There's a bunch of cliches that say something like "20% of your effort will fix 80% of your problem, but it will take 80% of your effort to fix the remaining 20%".

You AHI was 107 and now it's about 5 (when nobody's dial wingin'). That's phenomenal.

Agreed, it's a huge improvement, although I still don't feel that during the day. It's better, for sure, but it's not good yet. But this is making me scratch my head: Why does my new "CPAP Prescription" say that my AHI is 15.4? Where did that number come from?

While I suppose software may help to maintain intense focus on health and well-being, I think at this point you should devote the great majority of your energies to the other issues, especially strict sleep hygiene and consolidating your sleep. Get those naps back into the night's sleep. Bedtime is not 10:30 to 11:30, it's 10:30.

Speaking of which, it's 10:30.

Muffy

Yes, sir! I'll start going to bed earlier from now on, with hopes that that doesn't translate into waking up even earlier...

Hope you're sleeping peacefully right now, Muffintop. (And it's only 9:45 here, so don't yell at me for still being on the 'puter at this hour!)

[-SWS]

If my new sleep doc is looking at all five of my sleep studies, how is it that she's reached the conclusion that I don't have CompSAS, considering how obvious it was early on?

I'll wager a guess that she just may posit that your CompSAS gradually disappeared as a matter of biological adaptation: http://www.springerlink.com/content/a3v0682130648405/ . Others would contend that outstanding cyclic alternating pattern (CAP) and sleep architecture problems may still be remaining issues for those CompSAS patients with promising AHI <5 biological adaptation patterns---perhaps accounting for your excessive fatigue.

Generally CompSAS is much more consistent and much less episodic than the trigeminal neuralgia parallel I cited. That parallel was only meant to drive the point home about triggers and episodes being entirely possible. But I have also personally seen those on-again/off-again AHI fits and spurts on various charts.

My fear is that I'll choose the wrong machine and wind up in the same boat a year from now.

I'm guessing that if you use CPAP modality, you'll see far fewer elevated-AHI episodes. And that if you use any APAP modality, you'll see more elevated-AHI episodes. I personally doubt your physiology can handle the ups and downs of APAP pressure adjustments very well. So be sure to ask your doctor just how slowly they implemented your pressure changes during your recent sleep study---and why they did it that way. I'm sure she'll tell you that they made it a point to go very slowly with those pressure increases in your case especially---to avoid introducing disturbances in you central breathing that can happen via pressure increases and pressure increases alone.

I think your two best modalities will be either CPAP or ASV. However, CompSAS patients who are episodic "moving targets" seem to be the tough ones to get squared away on an ASV machine. So CPAP may be your best bet, although perhaps not a perfect modality. I don't see a reason to go to ASV right now, if there are no centrally-dysregulated breathing volumes for ASV to average out and normalize.

I'd pick up any data-capable machine and run it in CPAP mode while collecting data. If it revealed too many episodes, then I'd use that data as basis for an ASV trial. If the CPAP fixed-pressure data looked acceptable, then I'd focus on all those other factors that can help---including a look at T3, sleep hygiene, and healthy autonomic patterning via cardiovascular workouts. Cardiovascular workouts alone can improve sleep drive, architecture, and even circadian rhythms.

I'd definitely take an extended look at 8 cm fixed pressure and compare that with an initial and extended run at 12 cm fixed pressure---to see which made me feel better and which yielded acceptable AHI scores over the long run. The 8 cm scenario would be a "permissive flow limitation"' strategy, because it offers that lower pressure at the expense of permitting plenty of snore. I just don't think APAP modality is the right modality in this case. BiLevel can be either a bit better or significantly worse--- regarding how it makes you feel by day, and whether central dysregulation is exacerbated in your case compared to fixed pressure CPAP: http://www.chestjournal.org/content/128/4/2141.abstract .

Admittedly, I skimmed those hypothyroidism posts because I didn't realize that could be a factor in my own case. I'll go back and re-read, and I'll mention this to my PCP on Monday.

Reading JoyD. and riverdreamer's posts, I get the impression many PCP's will be clueless about T3 tests, let alone free T3 versus bound T3 tests. But T3 may turn out to be extremely important for you and that residual fatigue. Perhaps even relevant to your episodic AHI fits and spurts as well. Be sure to read Dr. Lowe's article.


Cool that you saved a hummingbird! And I happen to like Pink Floyd too! You fit in perfectly...

[Muffy]

Aside from a pharmacological solution (which I will consider, if necessary) and going to bed earlier and on a regular basis, what can I do to improve this situation?

Pick out a "sleep hygiene" handout (Google, they're all over the place) and follow it to the letter. There is no wiggle room, no "bargaining", because your sleep architecture is marginal and you have symptoms (that's a very key point-- like naps are OK, but only if they don't disrupt your sleep).

Get an absolutely fixed bedtime and awakening time, use it 7 days a week, do not drift. Sleep is a heap of biorhythms that must be set and/or taken advantage of.

At this point, no naps. Naps count towards total sleep time. Napping in the late afternoon might be a good idea for those people who need it and it doesn't affect their sleep, but if you're napping in the morning, that's not napping. That's part of a messed up night of sleep. In your case, I think all of your sleep needs to be consolidated during the night.

No alcohol, caffeine, chocolate, smoking.

Maybe a light snack before bed, no sugar. Stick to carbohydrates or dairy products.

Exercise program.

Cut BMI in half.

Evaluate bedding for comfort. Cool room temperature. No noise (especially TV).

Relaxation techniques before bed. Yoga, deep breathing, Herb Benson. Clear mind. No computer before bed (the screen eats up the melatonin). No bright lights during the sleeping period.

Establish pre-sleep ritual.

Being female has associated sleep maintainance issues. Morph into Roger.

Bright light therapy-- as soon as you get up in the morning, go outside and get 15-30 minutes of face-sun.

A lavender sachet (lavender helps sleep).

Address any pain issues.

Optimize medications-- are you on anything else other than what's listed? (Baseline heart rate looks OK, could take a look at the graph of that, but chances are they don't generate it)(as in the levothyroxine creating issues).

If I were to guess, I would say consolidating your sleep would do the most for improving architecture, followed closely by rigid sleep times to set the biorhythms (think of sleep as matching up a pile of undulating chemicals. If you're in the wrong place during a "peak" (or a "trough", depending on the chemical) you're trying to swim upstream.

But this is making me scratch my head: Why does my new "CPAP Prescription" say that my AHI is 15.4? Where did that number come from?

Insurance coverage number, the AHI on ambient pressure. She probably made it up.

My fear is that I'll choose the wrong machine and wind up in the same boat a year from now.

IMO, you could use a Shop-Vac with one end stuck in 12 cmH2O of "H2O" (just set it to "blow" instead of "suck") and "Warcraft" for software and be fine (fiddling with lowest effective pressure is your choice, but look what happens in every piece of data that has aggressive "fiddling"). Right now, your problem is not "sleep-disordered breathing", it's "sleep".

Muffy

[Muffy]

And they aren't using 2008 AASM Criteria either!

How many laboratories are using the new criteria? One?

Muffy

[rosiefrosie]

Just want to put my 2 cents in about an exercise program. Someone mentioned sparkpeople and it is a great site. I have lost 40 pounds in the past year and did it with the help of sparkpeople and increasing my daily walks from 2 to 5 miles a day. When I first started walking I had to force myself, now it's in my blood and I can't stop. How sick is that? Still have sleep apnea though, but have to say I feel allot better and so does my dog. Who, BTW, I think has OSA and I am thinking of hooking him up to my old machine. Good Luck.

Rosie

[robertmarilyn]

Just want to put my 2 cents in about an exercise program. Someone mentioned sparkpeople and it is a great site. I have lost 40 pounds in the past year and did it with the help of sparkpeople and increasing my daily walks from 2 to 5 miles a day. When I first started walking I had to force myself, now it's in my blood and I can't stop. How sick is that? Still have sleep apnea though, but have to say I feel allot better and so does my dog. Who, BTW, I think has OSA and I am thinking of hooking him up to my old machine. Good Luck.
Rosie

Rosie,

I'm the one who mentioned Sparkpeople...it is an amazing site!. I have been using Cathe Friedrich strength training tapes (very serious and comprehensive strength training with free weights...we are talking heavy barbells and dumb bells if you are willing to work up to them) for well over for over 15 years and I'm not sure you can fine better support for her workouts anywhere else than Sparkpeople other than Cathe's site itself. The 10,000 steps club on Sparkpeople will give you all the encouragement and advice you could need to work up to and past that goal when it comes to walking. The folks that use that site are everyday folks just like us who show what can be done if we really put our minds to it and have good help and support from others.

And the place is set up to be addictive in a good way. You learn to change your way of thinking so that you WANT to work out and take care of yourself...they will give you small steps to start with...they try not to overwhelm you but to encourage you to build on what is good for you. And they will point you to other sites that can help you with specific problems. In fact, through Sparkpeople, I learned a LOT more about hypothyroidism and links to follow, from Sparkpeople than I had learned anywhere else in the past. (I guess my biggest problem with that area of my life is that I have not found a doctor in El Paso that will even discuss anything past the TSH test results as a way of looking at a thyroid problem...I sure did allow myself to get sidetracked big time, off of the thyroid problem, when we started looking at the sleep apnea angle of fatigue...but getting sidetracked is easy when you are tired)

Congratulations on the loss of 40 lbs and increasing the distance of your walks. Owning a dog is a great way to have a partner who is always eager to walk with you...your dog is very cute BTW

mar

[rosiefrosie]

Thanks Mar, I think my dog is cute also. I also had hypothyroidism, it runs in my family, was treated with radioactive iodine at the Mayo and now am on meds. My last visit with my doctor found my level to be low. Which I think may be due to my weight loss. I still think my level is off, but go back to the doctor next week and will have my TSH level again. Fortunately I have a doctor that I trust and she gives me any information that I need or will point me in the right direction.

I also just started to do yoga, which is more strenuous than I thought it would be. I'll have to try the Kathe Friedrich strength training and will certainly check out her site. Thanks for the info.

[BleepingBeauty]

If my new sleep doc is looking at all five of my sleep studies, how is it that she's reached the conclusion that I don't have CompSAS, considering how obvious it was early on?

I'll wager a guess that she just may posit that your CompSAS gradually disappeared as a matter of biological adaptation: http://www.springerlink.com/content/a3v0682130648405/ . Others would contend that outstanding cyclic alternating pattern (CAP) and sleep architecture problems may still be remaining issues for those CompSAS patients with promising AHI <5 biological adaptation patterns---perhaps accounting for your excessive fatigue.

Okay. I'm going to question her about that when I see her. If I'm adjusting well to straight CPAP and the CompSAS seems to have stabilized, that's great; OTOH, if I am one of those with a cyclical problem, how will I know? Assuming I have a data-capable machine, will sudden changes in the numbers be the tip-off?

My fear is that I'll choose the wrong machine and wind up in the same boat a year from now.

I'm guessing that if you use CPAP modality, you'll see far fewer elevated-AHI episodes. And that if you use any APAP modality, you'll see more elevated-AHI episodes. I personally doubt your physiology can handle the ups and downs of APAP pressure adjustments very well. So be sure to ask your doctor just how slowly they implemented your pressure changes during your recent sleep study---and why they did it that way. I'm sure she'll tell you that they made it a point to go very slowly with those pressure increases in your case especially---to avoid introducing disturbances in you central breathing that can happen via pressure increases and pressure increases alone.

The slow progression of pressure seems to be apparent, from the graph in the study. Looks to me like I was at 12-14cm for almost the entire night, and there don't appear to be any sudden changes, except for one small blip in the middle where it dipped from 13 to 12 for a short time.

I think your two best modalities will be either CPAP or ASV. However, CompSAS patients who are episodic "moving targets" seem to be the tough ones to get squared away on an ASV machine. So CPAP may be your best bet, although perhaps not a perfect modality. I don't see a reason to go to ASV right now, if there are no centrally-dysregulated breathing volumes for ASV to average out and normalize.

I'd pick up any data-capable machine and run it in CPAP mode while collecting data. If it revealed too many episodes, then I'd use that data as basis for an ASV trial. If the CPAP fixed-pressure data looked acceptable, then I'd focus on all those other factors that can help---including a look at T3, sleep hygiene, and healthy autonomic patterning via cardiovascular workouts. Cardiovascular workouts alone can improve sleep drive, architecture, and even circadian rhythms.

Cool. I'm looking at regular CPAP w/data capability right now. I know from past experience that autopap doesn't suit me well, although I don't know if I'd tolerate it better with a very narrow pressure range. But no matter. As long as I have data so I can make informed and time-tested adjustments, I'll be happy.

I'd definitely take an extended look at 8 cm fixed pressure and compare that with an initial and extended run at 12 cm fixed pressure---to see which made me feel better and which yielded acceptable AHI scores over the long run.

I'm excited at the prospect of being able to compare my therapy numbers at different pressures. Is a week at any given pressure enough time, generally, to make a valid determination about how things are going?

Admittedly, I skimmed those hypothyroidism posts because I didn't realize that could be a factor in my own case. I'll go back and re-read, and I'll mention this to my PCP on Monday.

Reading JoyD. and riverdreamer's posts, I get the impression many PCP's will be clueless about T3 tests, let alone free T3 versus bound T3 tests. But T3 may turn out to be extremely important for you and that residual fatigue. Perhaps even relevant to your episodic AHI fits and spurts as well. Be sure to read Dr. Lowe's article.

I'm betting my PCP will fall into the same category (i.e., clueless about T3). If need be, I'll get a referral to someone who knows more about this subject. I'll be sure to check those posts again.

Cool that you saved a hummingbird! And I happen to like Pink Floyd too! You fit in perfectly...

Thanks! It gave me SUCH a feeling of accomplishment when that tiny little bird felt well enough to fly away. It was worth every ounce of effort on my part.

Floyd is a part of my music foundation (along with Yes, The Who, ELP, Traffic, and so many others). I've seen both Roger Waters and David Gilmour on solo tours and enjoyed each, although Waters is a bit of a wallflower on-stage and doesn't really engage the audience verbally. Gilmour is a different story in that regard, but they're both so talented, their concerts were equally enjoyable. Living where I am, I really miss going to shows. I easily have 200+ ticket stubs from concerts I've attended and have only added half a dozen or so to the collection in the six years I've been out here in no-man's-land.

[-SWS]

Cool. I'm looking at regular CPAP w/data capability right now. I know from past experience that autopap doesn't suit me well, although I don't know if I'd tolerate it better with a very narrow pressure range. But no matter. As long as I have data so I can make informed and time-tested adjustments, I'll be happy.

If you can't resist the urge to eventually try a narrow-range APAP, then get the 420e or Sandman Auto. That will at least give you the option of setting the machine up in a narrow range of snore response and various FL response patterns----while completely turning off the apnea pressure response if necessary. And much more importantly, you can run either of those machines in what will likely be far less-disruptive CPAP mode while collecting useful data. Possible caveat: no expiratory pressure relief on those two APAP models, if you happen to require it.

More later about your other comments. Also to say that I think Muffy's professional analysis and comments are nothing short of stellar.

[robertmarilyn]

Also to say that I think Muffy's professional analysis and comments are nothing short of stellar.

As I read what Muffy wrote, it makes me want to toe the line and clean up my act even more...Muffy is inspiring me and I am also learning a lot by reading her analysis and comments (plus she is funny too!)
mar