Spoke with my Doctor

[Muffy]

You probably think my PCP is pretty useless, and I'd be better off anywhere else.

That's not what I think at all.

I think your PCP is unfamiliar with interpretive strategies of Pulmonary Function Testing, he naively assumes that his technical person is submitting accurate reports, they are generating spurious abnormal test results in virtually every patient tested, and there's no quota on the amount of help we should offer on any given day.

Muffy

[SaltLakeJan]

Hey Beauty,

We are in this horse race (sorry Mar) together, and I am not droppin' out just cuz the Cpap Study is over.
Actually, I was a lot less nervous than if I had been in that situation all alone - You stuck with me and and I do appreciate it.

And, I want to enter my two cents worth about your decision to "handle what you can do right now, and to say no to all other entreaties" I am been in a similar position several times, I had to make an unpopular decision - because it was the best one for me at that moment. I had to consider what part of my physical & emotional health I could spend fighting battles, that I could postpone until I was better equipped to do so.

This sounds like a strange question, but what color is your hair? As I was entering my reply, I could envision a good-lookin' blond saying, "I can go so far today, but not one step more". If it is NOMB, forget it. My hair has been a long series of colors of blond. Finally, my hairdresser says "You're a brunette now - stay that way" I plan to support you as you have supported me.

[BleepingBeauty]

You probably think my PCP is pretty useless, and I'd be better off anywhere else.

That's not what I think at all.

I think your PCP is unfamiliar with interpretive strategies of Pulmonary Function Testing, he naively assumes that his technical person is submitting accurate reports, they are generating spurious abnormal test results in virtually every patient tested, and there's no quota on the amount of help we should offer on any given day.

Muffy

Fair enough, Muffin. I like -SWS's approach to the issue, and I'm adopting it. I'll be sure to let you (and anyone else who's interested) know how it shakes out when the time comes.

FYI, you'll be happy to hear that I've finally acquired a data-capable machine! I got a helluva deal from a seller on CraigsList and am now the proud owner of a Remstar Auto M Series with A-Flex. This machine is basically brand new, and the price was incredible; it has only 11.3 blower hours on it. (And no, that's NOT a typo!)

Now, before you go off like a rocket (scientist), Muffintop, please understand that I know all too well that I have problems with the Respironics auto algorithm and intend to use this as a data-capable CPAP machine. My CPAP pressure is 12, and I'm going to set the machine to run in Auto mode at a min pressure of 12 and a max pressure of 12. I understand I'll still be getting straight CPAP pressure, but I'll have access to more data with these settings than if I ran it in CPAP mode.

I'll only have access to my data from the machine's display, for now. (I didn't want to spend the money on the additional data components until I was sure the machine was all that the seller had claimed in his advertisement. And I'm happy to report that it IS!)

As of tomorrow morning, I'll be updating my profile with my new machine. Better still, I'll be able to remove "still a 'shroom" from my profile comments!

[BleepingBeauty]

Hey Beauty,

I want to enter my two cents worth about your decision to "handle what you can do right now, and to say no to all other entreaties" I am been in a similar position several times, I had to make an unpopular decision - because it was the best one for me at that moment. I had to consider what part of my physical & emotional health I could spend fighting battles, that I could postpone until I was better equipped to do so.

Thanks, Jan. I'm sure there are many on the forum who can relate. Each of us is only human, and when we add sleep-deprivation to the mix of other existing (or potential) medical concerns, we find it difficult to handle anything. I really think that, once my sleep is under better control, I'll have more energy to devote to other medical matters.

This sounds like a strange question, but what color is your hair? As I was entering my reply, I could envision a good-lookin' blond saying, "I can go so far today, but not one step more". If it is NOMB, forget it. My hair has been a long series of colors of blond. Finally, my hairdresser says "You're a brunette now - stay that way" I plan to support you as you have supported me.

Hope this isn't disappointing, but no, I'm not a blonde. Never have been - even in my younger days, when experimenting with such things as hair color was popular. I've been a brunette all my life; well, until aging took its course and I started going gray. I've never colored my hair, in fact. I'm still a brunette, but now there's quite a bit of S&P mixed in, and I like it. (I also like your hairdresser!)

As Bartles & Jaymes used to say, "Thanks for your support." That's what we're all here for.

[riverdreamer]

BB, congrats on your new CPAP!!!

Sounds like you got a fantastic deal. I hope it makes a difference in your ability to feel rested. Hang in there, and don't let anybody push you around! Not even us.

[BleepingBeauty]

BB, congrats on your new CPAP!!!

Thanks! I feel like a bit of a dope, being so excited over something like this. Only my fellow forum members can understand how happy I am right now.

Sounds like you got a fantastic deal. I hope it makes a difference in your ability to feel rested. Hang in there, and don't let anybody push you around! Not even us.

I really did get a fantastic deal. Best money I've ever spent, and the best birthday gift I've ever given myself.

The machine arrived with the Apria labels still attached to it (one ID'ing the local office, and the other under the flip-up door on the top of the machine, indicating the original settings). It's no surprise that the previous owner tried in vain to use this machine for just a few nights and then gave up on therapy in complete frustration. It was set on Auto with a range of 5-20cm, ramp starting at 4cm. I find it completely unfortunate that so many DMEs are dispensing machines with wide-open settings like this, which more than likely doom a newbie to therapy failure from the get-go.

If I operated a DME, this forum would be required reading for employees. (Oh, if only I ran the world...)

[sagesteve]

AMAZING deal!! I too have the Rem M series. I use straight CPAP. Used the auto and didn't like it...too much up and down and it disturbed the rem sleep ( what little I had ). I've almost got my AHI down to zero. I'm betting that you'll wind up at CPAP once you have a good solid base pressure number. I'm sleeping more and more straight through the night...7 to 7 and a half hours, working on 7 exactly. Newest study shows people that slept 7 hours were living longer on average. I was the KING of sleep hours! I was sleeping 12+ hours and taking naps for years. I feel really GREAT lately with the 7 hour thing. Had a beautiful PURE rem sleep last night. Good luck with your new "steal" deal.

[BleepingBeauty]

AMAZING deal!! I too have the Rem M series. I use straight CPAP. Used the auto and didn't like it...too much up and down and it disturbed the rem sleep ( what little I had ). I've almost got my AHI down to zero. I'm betting that you'll wind up at CPAP once you have a good solid base pressure number. I'm sleeping more and more straight through the night...7 to 7 and a half hours, working on 7 exactly. Newest study shows people that slept 7 hours were living longer on average. I was the KING of sleep hours! I was sleeping 12+ hours and taking naps for years. I feel really GREAT lately with the 7 hour thing. Had a beautiful PURE rem sleep last night. Good luck with your new "steal" deal.

Thanks, Steve. It's nice to finally be among those who are able to monitor their therapy and make improvements.

I'm using the new machine in Auto mode, but with the same minimum and maximum pressure setting, so effectively, I'm on straight CPAP pressure, and there's no adjustment of pressure going on while I sleep.

I didn't sleep for very long last night, but that's not due to any therapy issues (for a change! ); one of my cats decided to get into a yowling match with a stray on the other side of the glass door. This cat of mine is very vocal, even when he's happy, and he can take the top of my head off when he's not. Needless to say, I experienced a very rude awakening in the middle of the night, and I wasn't able to drift back off to sleep afterwards. But I expect I'll be able to sleep really well tonight and make up for some of last night's deficit (provided the stray cat doesn't make another visit in the wee hours, that is).

Sounds like your therapy is going very well, so congrats!

[SaltLakeJan]

Congratulaltions B.B.

What a birthday present. That is one that keeps giving 365 days per year

I'm using the new machine in Auto mode, but with the same minimum and maximum pressure setting, so effectively, I'm on straight CPAP pressure, and there's no adjustment of pressure going on while I sleep

Do you 'pose that cat of yours could be jealous

one of my cats decided to get into a yowling match with a stray on the other side of the glass door. This cat of mine is very vocal, even when he's happy, and he can take the top of my head off when he's not.

of your new machine

I'm still working on sleep issues, kinda taking it easy. It feels good to have the test behind me. I don't have anything pressing at the moment. Are you working on anything, or concentrating on your therapy with your new machine? Were you at 12 pressure? Everyone who got to know you through your first thread and the current one - is happy that things worked out for you to get the auto. That is one fine machine.

Jan

[BleepingBeauty]

Congratulaltions B.B.

What a birthday present. That is one that keeps giving 365 days per year

Isn't that the truth? The component gifts (software and reader) are on their way, and I can't wait to get them and put it all together so I can better determine what's really going on with my sleep. The numbers from the LCD are helpful in a general way, but they leave me scratching my head as to why my AHI is still so high. (Last night, it was 13.1.) I don't feel any better, so seeing the number simply confirms that my therapy isn't anywhere near optimal yet. It's nice to have that confirmation in a verifiable number on the screen, though. In the past, I've only been able to go by how I feel, and the only way to determine why I was still so tired was to participate in yet another sleep study. What a costly and inconvenient process - and all for a one-night snapshot answer (which likely isn't very accurate re: our usual sleep patterns at home every night). The current system is terribly flawed.

Do you 'pose that cat of yours could be jealous

one of my cats decided to get into a yowling match with a stray on the other side of the glass door. This cat of mine is very vocal, even when he's happy, and he can take the top of my head off when he's not.

of your new machine

Nah, he's the one who actually likes to snuggle up to me when I'm masked up. He seems to enjoy the exhaust, for some reason. Silly cat.

I'm still working on sleep issues, kinda taking it easy. It feels good to have the test behind me. I don't have anything pressing at the moment. Are you working on anything, or concentrating on your therapy with your new machine? Were you at 12 pressure? Everyone who got to know you through your first thread and the current one - is happy that things worked out for you to get the auto. That is one fine machine.

Jan

I'm still working on it, too. Retraining myself out of the night-owl mentality that I was accustomed to for so long is proving to be a little harder than I thought it would be. But I know it's an important aspect of getting a good night's sleep, so I'm working on it. One of the other issues I'm experiencing is having to get up during the night for the bathroom. The warmer and drier it gets here in AZ (could it really be ANY drier here?), the harder it is for me to stop drinking water in the evening, and that results in having to get up during the night. I'm able to get right back to sleep afterward, but sleeping straight through the night would be much better.

I'm glad your sleep test is behind you, too. I know you were pretty anxious about it. Now you get to play the waiting game for the results and some answers, which I hope are helpful in your future therapy success. In my own case, each re-titration has simply resulted in a pressure change of a few cm's up or down (at 12cm for the first year, then reduced to 10, then upped to 14, now back at 12), which obviously wasn't getting to the root of my problem(s) - and still isn't. But finally, at 19 months into my therapy journey, I hope I'll be able to make some progress. I'm very pleased with my purchase.

Thanks, Jan.

[ozij]

BB, I live in a warm dry climate, and I used to think my getting up at night for the bathroom was a result of drinking enough water to keep hydrated.
Wrong.
It's a result of sleep apnea. Nocturia (of course medicine has a fancy name for it) is a result of the havoc wreaked in you body by apnea, and the struggle to breath. The struggle to breath changes the pressure in your chest cavity. A side effect of that changed pressure is more flowing into your heart, entering your right attrium. Your body is (naturally) primed to interpret this additional blood volume as "to much fluid, has to be excreted" and you heart releases a hormone that sets your kidney working overtime.
With sleep apnea propely treated, we stop getting up so much at night.

And your numbers do not indicate proper treatment (I know you know that...).

http://www.nocturiacures.com/

http://scholar.google.com/scholar?hl=iw ... cturia+osa

Progress in Cardiovascular Diseases

Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment
Mary P. FitzGerald, MDa, Molly Mulligan, MDa, Sairam Parthasarathy, MDb
Volume 194, Issue 5, Pages 1399-1403 (May 2006)
Received 23 June 2005; received in revised form 21 October 2005; accepted 13 January 2006. published online 05 April 2006.

Objective
The purpose of this study was to determine the relationship between nocturia and obstructive sleep apnea (OSA), and the effect of continuous positive airways pressure (CPAP) therapy on nocturic frequency.

Study design
This was a retrospective review of sleep studies including patients with and without evidence of OSA, before and during CPAP treatment (where relevant). Chi-squared tests compared nocturia prevalence according to sleep diagnosis, logistic regression determined predictors of nocturia, and regression analyses determined predictors of nocturic frequency.

Results
In 196 eligible studies, predictors of nocturia included increasing age and diabetes mellitus; nocturia was equally likely to occur in patients with and without OSA. In patients with OSA and nocturia, nocturic frequency was related to age, diabetes, and severity of OSA (P < .001). Patients with OSA and nocturia who were treated with CPAP demonstrated a significant decrease in nocturic frequency (P < .001).

Conclusion
OSA severity predicts nocturic frequency. The role of testing in the triage of patients with nocturia remains to be determined.

O,

[Pugsy]

With sleep apnea propely treated, we stop getting up so much at night.

Yep, I can confirm this statement.
Pre-CPAP treatment, got up to pee at least 3 times a night within a 5-6 hour period, despite limiting liquids of any kind prior to bed time. It wasn't a tiny amount either.

Last night 7 hours 21 minutes of therapy, big glass of water at bedtime, and did not get up once to pee. AHI last night 1.5 /hr and I feel great today.

Since starting treatment I have had a few nights where I have had to get up once. They seem to correlate with slightly higher (for me) AHI's around 5 or 6. I have already figured out that for me to feel good I need less than 3 AHI/hour. My HI's are rare, so mainly I have AI's.

Brenda

PS: I am so curious as to what your data graphs will so. I am such a nosy busybody.

[BleepingBeauty]

BB, I live in a warm dry climate, and I used to think my getting up at night for the bathroom was a result of drinking enough water to keep hydrated.
Wrong.
It's a result of sleep apnea. Nocturia (of course medicine has a fancy name for it) is a result of the havoc wreaked in you body by apnea, and the struggle to breath. The struggle to breath changes the pressure in your chest cavity. A side effect of that changed pressure is more flowing into your heart, entering your right attrium. Your body is (naturally) primed to interpret this additional blood volume as "to much fluid, has to be excreted" and you heart releases a hormone that sets your kidney working overtime.
With sleep apnea propely treated, we stop getting up so much at night.

And your numbers do not indicate proper treatment (I know you know that...).

O,

Thanks, ozij. I know my nocturia situation is much-improved from my pre-treatment days. I was getting up 3-4 times a night back then, and now it's once. (And I do know it's because of my poorly-treated OSA and not because I'm drinking so much water all the time; but when I'm tired and not thinking as clearly as I should be, my initial thought is that if there was less liquid in my system, I might be able to sleep through the night, like a normal person. That's the obvious conclusion I reach, but I know that's not the issue. So thank you for the reminder about what's really happening.)

Maybe I'll get lucky and my software and reader will arrive in the mail today, instead of Monday. (I'm so impatient right now that yesterday wouldn't have been soon enough.)

[BleepingBeauty]

Last night 7 hours 21 minutes of therapy, big glass of water at bedtime, and did not get up once to pee. AHI last night 1.5 /hr and I feel great today.

I'm really happy for you, Pugsy (and jealous as hell!).

I am so curious as to what your data graphs will so. I am such a nosy busybody.

Me, too! (And if that's nosiness on your part, then I'm happy to be the recipient of it - from you and everyone else around here. I'll be relying on all of you to help me figure out what I'm looking at when I actually do have charts to post, and how to adjust my therapy to make it better.)

[ozij]

I can well imagine that impatient waiting, BB! You can add me to the nosy busybody list of people waiting to see your data.

Since starting treatment I have had a few nights where I have had to get up once. They seem to correlate with slightly higher (for me) AHI's around 5 or 6. I have already figured out that for me to feel good I need less than 3 AHI/hour. My HI's are rare, so mainly I have AI's.

If there's a study I would really want to run, it's the one on the difference between an AHI of about 3, and one of about 5. Some of us feel such a distinct difference -- (I do too) others don't.

O.