Spoke with my Doctor

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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BleepingBeauty
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Re: Spoke with my Doctor

Post by BleepingBeauty » Sat Jun 13, 2009 9:58 am

ozij wrote::)
I can well imagine that impatient waiting, BB! You can add me to the nosy busybody list of people waiting to see your data.
Good. As I said above, all input is more than welcome - especially from such experienced and knowledgeable users as yourself.
Pugsy wrote: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.
I'd be interested in the results of that study, too. Maybe you should create a Poll Thread (hint-hint) and see what the answers are among the members here?
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

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-SWS
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Re: Spoke with my Doctor

Post by -SWS » Sat Jun 13, 2009 10:07 am

BB, since curiosity is abound in this thread, how was last night's AHI?

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Pugsy
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Re: Spoke with my Doctor

Post by Pugsy » Sat Jun 13, 2009 10:10 am

ozij wrote: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.
When I get some extra money, and a little better grip on my leak rate, I want to get a pulse ox that records all night. Then I will experiment a bit. I think that the one variable in all this that we can't see are the O2 levels. I think that in my case I probably desat significantly with my little clusters of apneas. Hence the crappy feeling I have at what is usually considered acceptable AHI levels. I may be all wet in my thinking but I think that I will see desats associated with my clusters. I don't know at what levels we expect to see residual symptoms in the morning but I do know that I had desats to 73% and events lasting 40 seconds at the initial sleep study. So... if I have 6-10 of those 40 second events (with treatment) within 30 - 45 minutes (my little clusters) then the AHI overall won't be so bad but I might be desaturating enough to give me residual symptoms when I wake up.

When I get more money, I will see just how far I am off in my reasoning. All I know for now is that I can have 4.2 AHI/hr and leak rate below or at acceptable levels (and mostly straight line) and I feel like total crap.
Drop it down to 3 AHI or below and the difference is like night and day with all other factors being pretty constant.

Brenda

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BleepingBeauty
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Re: Spoke with my Doctor

Post by BleepingBeauty » Sat Jun 13, 2009 10:13 am

-SWS wrote:BB, since curiosity is abound in this thread, how was last night's AHI?
13.1
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Re: Spoke with my Doctor

Post by -SWS » Sat Jun 13, 2009 10:30 am

BleepingBeauty wrote:
-SWS wrote:BB, since curiosity is abound in this thread, how was last night's AHI?
13.1
CompSAS: pathophysiologic triggers and episodes.

ozij
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Re: Spoke with my Doctor

Post by ozij » Sat Jun 13, 2009 10:31 am

-SWS wrote:
BleepingBeauty wrote:
-SWS wrote:BB, since curiosity is abound in this thread, how was last night's AHI?
13.1
CompSAS: pathophysiologic triggers and episodes.
That's a bit too cryptic for me.

O.

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-SWS
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Re: Spoke with my Doctor

Post by -SWS » Sat Jun 13, 2009 10:53 am

ozij wrote:
-SWS wrote:CompSAS: pathophysiologic triggers and episodes.
That's a bit too cryptic for me.
Sorry. That was me thinking out loud. Conjecture as usual.

BB went from severe CompSAS with that severe PSG presentation of CompSAS triggers (those aggressive CPAP pressure deltas), to being largely but not completely adapted to fixed-pressure CPAP therapy. There's an inherently chaotic underlying component to this pathophysiology IMO----perhaps manifested as most-often subtle and occasionally/episodically not-so-subtle autonomic instability during sleep.

Hence that highly variable or episodic nature of BB's elevated AHI. Some nights her AHI is close to zero but often her nights will episodically yield unacceptably high AHI scores. If CompSAS is inherently episodic, then one-night PSG studies are inherently flawed methodology IMHO.

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rogelah
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Re: Spoke with my Doctor

Post by rogelah » Sat Jun 13, 2009 11:55 am

-SWS wrote:Let's not forget that if I accidentally sit on an ice cream cone, I can usually tell you the flavor and the brand before getting up.

Now if that doesn't fit the definition of smart ass...
Depends on which end is pointing UP!
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Re: Spoke with my Doctor

Post by -SWS » Sat Jun 13, 2009 12:31 pm

rogelah wrote:
-SWS wrote:Let's not forget that if I accidentally sit on an ice cream cone, I can usually tell you the flavor and the brand before getting up.

Now if that doesn't fit the definition of smart ass...
Depends on which end is pointing UP!
No argument there.

Besides, I think a recent Posteriorology Today article mentioned something like 10 more smart-ass IQ points being necessary under cone-side-up circumstances.

SaltLakeJan
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Re: Spoke with my Doctor

Post by SaltLakeJan » Sat Jun 13, 2009 2:18 pm

Hi Beauty

I'm intrigued with the details that will come when you get your softwear. And I wondered - did you ever mention if you have a mouth leak? If so, do you tape, or use a headband? I have a substantial mouth leak, and it improved when I taped or wore the headband.

your curious friend, Jan

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Re: Spoke with my Doctor

Post by BleepingBeauty » Sat Jun 13, 2009 3:05 pm

SaltLakeJan wrote:Hi Beauty

I'm intrigued with the details that will come when you get your softwear. And I wondered - did you ever mention if you have a mouth leak? If so, do you tape, or use a headband? I have a substantial mouth leak, and it improved when I taped or wore the headband.

your curious friend, Jan
Hi, Jan. Re: mouth leaking, I didn't discover that I had a problem until my sleep study last November, when the tech woke me up and put a chinstrap on me. So I've been using a chinstrap since then. Of course, I haven't known how effective it's been for all this time, until the tech at my study in April told me that I was still experiencing mouth leaks. But when I got the basic report of the study from the doctor over the phone, she said the leaks were okay.

I really don't want to give up my Swift LT, so eliminating the mouth leaks is certainly a goal. I've tried taping a few times, but I don't like it much, and I don't think the Poligrip strips would be much of an improvement for me. I just don't like knowing that my mouth is closed by "artificial" means.

My leak numbers for the past couple of nights (since I've had the new machine) are okay, I guess. At 12cm, the leak rate for my mask is 33 L/min. My numbers so far have been 29.5 and 34.2, so I'm going to have to work on that. I really like the "freedom" I feel with the LT but, if I can't make it work for me with a good chinstrap, I'll do something else. I have a Mirage Liberty (similar to the Hybrid) as a back-up and, as FFM's go, it's a good choice for me with its mouth mask/nasal pillows combo. But I've had leak problems with it on the few occasions when I've tried to use it. (In fairness, I didn't put enough effort into trying to fix the leaks with the Liberty on those few occasions, so I might have to do that now.)

I'm due for a new chinstrap next week, so I'm going to try a different style and hope that it works better for me than the one I'm currently using. I've accumulated three different ones so far; hopefully, the next one will do the trick.

I wish all of this was easier...
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

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Re: Spoke with my Doctor

Post by SaltLakeJan » Tue Jun 16, 2009 10:16 pm

Hi B.B.

You signature line nailed your situation - "simple OSA would have been too easy." I've been working on my sleep issues. Somewhere in one of your posts, you said "Does it have to be so hard?" I don't find it any easier than it was a month ago. I'm pretty much sticking to the basics. Get to bed by 10:30, do some exercise most days. And I no longer watch Goodmorning Joe at 4 A.M. And if I awaken during the night, I do not turn on T.V. . DH is appreciative of that. He had said, I will be sleeping peacefully, suddendly I have the weirdest dreams. I awaken and you are watching a political T.V. station, no wonder I have bad dreams.

I have made a few compromises, I haven't totally eliminated caffeine, and I allow myself a half-hour of T.V. after I get in bed.

I thought it would get easier - perhaps after the first year, it will.

How are you doing - I have been following your thread, and I read 13.1 and your cryptic remark after it. What chin straps have you used, and what are you going to get? I bought a new one, unfortunately I used it the first time the night of my sleep study. I imagine it kept my mouth shut - not many leaks - The Tech said it came off near the end of the study and I had a few leaks then - but my face felt like it had been squeezed in a vice and couldn't relax for a couple of days. It seemed far easier to tape.
Jan

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Re: Spoke with my Doctor

Post by BleepingBeauty » Tue Jun 16, 2009 11:26 pm

SaltLakeJan wrote:Hi B.B.

You signature line nailed your situation - "simple OSA would have been too easy." I've been working on my sleep issues. Somewhere in one of your posts, you said "Does it have to be so hard?" I don't find it any easier than it was a month ago. I'm pretty much sticking to the basics. Get to bed by 10:30, do some exercise most days. And I no longer watch Goodmorning Joe at 4 A.M. And if I awaken during the night, I do not turn on T.V. . DH is appreciative of that. He had said, I will be sleeping peacefully, suddendly I have the weirdest dreams. I awaken and you are watching a political T.V. station, no wonder I have bad dreams.
Aww, poor hubby. It's a good thing that you're not turning on the tv in the middle of the night anymore. The last thing you want to do is stimulate your brain when you really want to be sleeping.
I have made a few compromises, I haven't totally eliminated caffeine, and I allow myself a half-hour of T.V. after I get in bed.
Change is hard, especially at this point in life. We didn't develop these habits yesterday, so don't be too hard on yourself. Small steps are okay. As long as you're moving in the right direction, it's all good.
I thought it would get easier - perhaps after the first year, it will.
It might not take that long, but if it does, so be it. As I said, as long as we're moving towards the goal, we're doing fine.
How are you doing - I have been following your thread, and I read 13.1 and your cryptic remark after it. What chin straps have you used, and what are you going to get? I bought a new one, unfortunately I used it the first time the night of my sleep study. I imagine it kept my mouth shut - not many leaks - The Tech said it came off near the end of the study and I had a few leaks then - but my face felt like it had been squeezed in a vice and couldn't relax for a couple of days. It seemed far easier to tape.
Jan
I'm doing okay, thanks. Still working on more regular exercise. I've just received one of the Yoga DVDs I ordered, and I'm planning on checking that out tomorrow. But the eating plan is going very well. I'm enjoying cooking again, and making myself good meals not only satisfies my taste buds, it's also rewarding.

I'm expecting Encore software to arrive soon so that I can really see what's happening during sleep. Having the info from the machine is better than not having anything, but the leak rate and AHI are just numbers at the moment, and I have no means to analyze them and make improvements based on what the software can tell me. I'm trying to be patient, but it's definitely not my strong suit!

Re: chinstraps - the first one I was given by the DME was ridiculous. I think it was called the Sullivan, and it was just a little chin-cup with one Velcro strap. When the DME handed it to me, I looked at it in the package and knew immediately that it would be useless. It wasn't anywhere near as substantial as the one I'd worn during my sleep study in November. I asked for something else and was told that this was all they had. It was totally unstable and moved all over my head that night. Needless to say, I was on the phone to them the very next day.

Next was the 4" wide white chinstrap from Respironics. This one was terribly uncomfortable, as it pinned both of my ears against my head. I didn't like that at all, nor did I like having my hearing muffled. I ended up turning it over on itself, lengthwise, and sewing it so that it was almost half the original width and would leave my ears free. I still didn't like it, though. As you described, I felt like my head was in a vice, and I woke up with tenderness on both sides of my jaw.

The next one I tried was the Topaz, which was a little better. It was certainly more comfortable to wear, but the material leaves much to be desired. It's neoprene, and it retains odors. It also started falling apart on me after just a couple of months; the stitching at the chin seam started to let go, and the material in other stress areas was splitting. I'd sewn it back together three or four times, and then I called the DME in frustration. They replaced it with another Topaz, which has held up better, and I've continued to use it.

I don't know which chinstrap the tech tried on me during my most recent sleep study. She woke me because my Topaz wasn't keeping my mouth closed, and she put this other one on me in the middle of the night. But either it wasn't the right size, wasn't tight enough, or wasn't strong enough, because it wasn't helping. She put my Topaz back on me before long.

The one I've just ordered is the Respironics Premium, and I hope it does a better job for me than all of these others have. (I'm familiar with the concept of trial-and-error, but this is ridiculous!)

Taping would be preferable to a chinstrap (the less "gear" on my head, the better), as long as the tape wasn't OVER my mouth. I like the look of the Chin-Up Strips, but I don't think my skin can handle taping every night. If this new chinstrap doesn't work well, I will consider taping on a regular basis and see how it goes. The only other option for me would be a FFM, which isn't appealing. But I do have the Liberty (mouth mask w/nasal pillows) and, if that turns out to be my best bet to stop the mouth leaks, I'll work harder with it to stop the leaks I've experienced with it in the past. I love my Swift LT because it doesn't feel like I'm wearing anything, so making it work well - whether in conjunction with a good chinstrap or taping - is my goal.

Bottom line, I'll do what I have to do to make my therapy as effective as possible.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.