Out of the Frying Pan and Into the Fire! Then, Deep Sleep.

[Bob3000]

...

[JohnBFisher]

... So now I can sleep. After a decade of waking up tired, feeling that gnawing, deep-seated fatigue all day, I finally found a way to get REAL sleep. Stage 3/4, here I come! I believe this is a life-changing event. And just in time, I'm about to start the busiest time of my life - medical school clinical rotations. ...

Congratulations! Thank you for posting your story. It provides hope to many other folks who come here hunting for answers. It might be daunting (and even comforting) to realize that even a medical student must work through the same problems everyone faces trying to make xPAP therapy work.

For you, of course, there are two benefits. The most obvious is that you will be able to be more focused and alert during your clinical rotations. That of course will help you and help your patients. The second, not yet so obvious benefit, is that you will understand - in a way that most other doctors will not - just how tenacious we (doctors and patients alike) must be to implement some medical therapies.

This is ESPECIALLY true with a therapy that treats a chronic condition, such as Obstructive Sleep Apnea or Diabetes. In both instances it requires tweaking the therapy to make it be as effective as possible for the patient. In both instances the patient must take charge and try to make it work - using tools that provide some feedback. Diabetics test their blood glucose on a regular basis. Patients with OSA should check their machine numbers on a regular basis. It is the objective numbers that yield the power of monitoring a chronic condition. Through those numbers you can find what works and what does not work.

I fortunately have a good endocrinologist, who when I asked if he wanted to see my blood glucose numbers was very frank about it. He said "God, no! You are the one that needs to see them. You need the reminder to understand the correlation between what you eat and how you feel. You need to try to do the best job possible at maintaining them toward 'normal' values." That was when I funally understood that I had to be responsible for my own management of my diabetes (and my apnea).

So, thank you for sharing your experience. And congratulations on making it work. It can be a real challenge.

[Papillon2]

Wow, Bob! What a story! It's amazing that you could function in Med School at all with your sleep situation! And the last thing we all need is a sleep deprived doc making critical decisions for patients! And, I'm sure God did help you--He's good about that!
I'm experiencing some of the same things your are, but without the long struggle. I've only ben on CPAP 8 days, and can already begin to tell that the brain fog is starting to lift, and I wake up feeling better. It's almost a miracle, and I'm looking forward to feeling even better!
Blessings to you, and thanks for sharing!

[DreamOn]

Congratulations on your success, Bob3000! And thanks for posting your story. I'm sure that sharing your experience here will help many people to troubleshoot their own challenges with xPAP therapy.

From my own experimentation, I have found that there are some masks that just don't work for me. For example, in order to get good numbers with the Quattro full-face mask, I cannot sleep on my back. With the nasal and nasal pillows masks I don't have that problem. And, as you've discovered, finding the right pressure can take some time and experimentation. I'm glad you persevered!

Best wishes to you as you advance in your medical career!

~ DreamOn

[Slinky]

What a set of experiences!! I surely hope you NEVER forget any of them and will carry them w/you thru your years of medical practice.

You will most likely be one of the few doctors who will look for and recognize symptoms indicating the need for a sleep study and possible OSA.

And you most likely will be one of the more patient and understanding doctors when one of your patients w/sleep apnea has difficulties w/their CPAP therapy and wants to give up and quit.

Thank you for sharing. And GOOD LUCK thru medical training and in your years of medical practice!!!

[rosiefrosie]

Congratulations Bob!!! It all takes time to get it figured out but once you do what a difference it makes!

rosie

[Scarlet834]

I enjoyed reading every little detail of your story. Thank you so much for sharing! There are a few things in there I've tucked away for myself.

(Despite enjoying the read, I also give you style points for your choice of detailed essay followed by cliff notes.)

[plr66]

Like all those above, I appreciate and am glad that you have shared your experience here, Bob. Surely others will benefit in all the ways already mentioned, from your journey. However (OT), I'm having trouble reconciling your avatar to your being a medical student. Can you explain?

[Muse-Inc]

WOW! What a story Bob, thanks for posting! Keywords: patience & persistence, gotta have 'em in huge amts to get apnea therapy dialed in. Love the detailed version, then Cliff Notes Your future patients will sing your praises for understanding how challenging this particular little (HAHAHAHA) odyssey is.

[famousnick]

Hi Bob,
Thanks for posting your story. You're a great example of perserverence and I'm encouraged to continue on my journey toward successful treatment. I have similar mouth breathing issues so I can identify with where you've been.

I have a couple of questions:
1. What is the most effective taping technique that you've used?
2. Are you still using Ambien and do you use regular of the controlled release?

Thanks,
Nick

[grandmma]

Wow Bob, what a story. Thanks for being so detailed with your experiences, and for sharing.

I read every word (and then read it all again!). I've had similar experiences early on with both masks and mouth breathing, and yes, perseverance and a 'never say die' attitude (so to speak) are the keys.

[torontoCPAPguy]

I am not even going to read all of the responses before posting my experience. Similar to yours excepting that I went ahead and set my APAP to 9 - 14 arbitrarily, as my Rx was for 9 cm. With EPR at 2 that means that my actual pressure range was going to be 7 - 14 and I have been monitoring this for two weeks now only to find that my median pressure happens to come out to around 9 cm . anyway but it varies such that I have a comfy sleep more and more these days. As to the topic of masks I refuse to wear a full face mask as I had a friend die during a robbery with his mouth taped shut. He vomited and choked to death. I went through all sorts of nasal masks looking for a good fit and finaly came to the Mirage Activa LT in Large Wide (why large and wide? Well, I carry a concealed firearm at times and one of the 'givens' is that a holster that sides WIDE on your belt is going to be more stable than one that does not.) It avoids the creases next to my nose. It is a bellows type fit and as air fills the mask it molds to the shape of my face. It also has a forehead brace that is adjustable and no more blisters on the bridge of my nose. It is one of life's little miracles although I am sure there are others. The APAP blower gives me feedback although not complete. My APNEA events have been exactly ZERO in the past two weeks. I would really like to see what the effect of all of this has had on my blood oxygen saturation and blood pressure at night. When in the hospital and under tight supervision (in my coma) and on full life support my BP was as high as 250-280 over some small number. Enough to pop your Aorta and in fact it blew one of my three arterial taps right out of my arm at one point and I filled the bed with my blood (although I was in la-la land when all this happened). So it is not just the APNEA that one need be concerned with and it is NB to work with a reliable sleep lab and specialist MD on a regular basis. I am buying a recording SO2 meter to tape onto my finger with a USB port and I have an Accutor automatic blood pressure monitor with printout and am going to try and sleep with all of that duct taped to me at some point. As far as stomache and intestinal gas is concerned... it is a problem that I am prepared to deal with as best I can. As far as my lips opening and air exiting , well, same deal, I am working with it as best I can and so far so good.

Now for the real surprise. I am a chronic congested nose sufferer. With the humidifier cranked up as high as I can tolerate it I discovered that it kept my nose clear and comfy all night. No nasties in my nose in the morning, even with a bad cold this past week that gave us concern about returning to the hospital if I could not live with the APAP working properly! Wowee!

That is my story and I am sticking to it. It appears to me that the new S9 series coming out may only have one model... the top end APAP version and that bodes well for the future of us hoseheads. Now if we could only get an oximeter to interface with it at a reasonable price and perhaps figure out how to feed the data from the Accutor 4 BP monitor into the graphics I'd be very pleased.

It would be great if we could simplify these sleep studies to get all of the numbers put together (i.e. how deeply are you sleeping when all the numbers appear... to corelate them). I have multiple issues... not only APNEA, but when I fall asleep my breathing gets more shallow as my sleep gets deeper and hence my SO2 drops and my BP rises inversely sky high. Im told it will be another year or even two before my lungs regain their capacity for sucking in air while I sleep. In the meantime it is APAP for sure. Once I reach optimum air intake while deeply asleep then it is going to be the APNEA that I will be having examined and deal with. So for you new hoseheads out there, fear not, you will overcome at some point. But please realize that it is not simply a matter of dealing with your snoring that we are talking about here. There are a number of variables and conditions that need attention and it is only sleep studies with all the doodads attached that will give one the full picture. In other words, APAPs are great blowers but make no mistake that you are not getting the full picture that you need to be well informed.

Carry on.

[Judy R]

Thank you Bob, for posting such an honest and open story. Even though I've been on CPAP therapy for three years now, it even encourged me! I wish you all the best with your new found sleep.

[DoriC]

Great story Bob, I'm sure it will help many others as it did me. And how about a BIG THANK YOU to your Dr who figured it out so quickly. That's a surprise!

[BlackSpinner]

Bob - now that your pressure is lower you may want to revisit the Hybrid mask. It is a bitch to get fitting well but when you have adjusted properly it works well. I and many others have added an extra light weight strap across the nasal pillows to keep them in.