My doctor wrote an script for cpap@21

[GumbyCT]

I doubt he is "board certified" but if he is you could ask them how to proceed?

Old is no excuse, I'm sorry. I have a brain injury and know better. Where's my pad?

I saw this quote somewhere

"If this isn’t rocket science why are there so many spaceshots?"

[ozij]

Braincloud, Why don't you ask SWS about SWS? Sorry, I couldn't help it!

Well, that one is another "-SWS"....

O.

[cpapernewbie]

Brain-cloud
would you please take a photo of the prescription where your doctor prescribe you a pressure of 21 cm H2O?

This will be a very valueable record for CPAP history and for posterity

[jnk]

(4) The recommended maximum CPAP should be . . . 20 cm H2O . . . for patients ≥12 years.

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf

[DoriC]

Usually they are in the form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight." Stuff like that. Did I mention he is rather old?

NO, he did not really say that!!

Sorry, sorry, no that is just me joking around without making it clear. Everything was serious until I got to the word "sea". Then my mind works by association and almost no inhibition (my boss is always having to put out fires that I caused). And of course "sea" brings to mind old sea-farer's sayings, right? But then I wasn't able to actually bring it off with something that made sense.

That's it. No more trying to be funny. It always blows up in my face.

And while you're at it, no more jokes about "old people"!!

[KatieW]

(4) The recommended maximum CPAP should be . . . 20 cm H2O . . . for patients ≥12 years.

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf

I love collecting articles like this, jnk. Thanks.

[Mebake]

I recently had a (Board Certified Sleep MD) Write a prescription for CPAP of 24! Brought this to the DEM provider and once she stop laughing she said this is crazy nobody is on straight CPAP of 24. I am very thankful I have a great relationship with my Pulmonary Diseases MD (who also thought it was nuts). So the nurse set my machine for 20 as high as it would go. Let me say it was the worst night since I started on CPAP. Went back to the DME and we had a plan to try an APAP for 2 weeks. After 2 weeks my Avg pressure was 14.5 and I felt great. So my MD wrote a new script for and APAP set from 12 to 20.


PS I felt like my head was going to explode on 20


Best of luck

[brain_cloud]

Brain-cloud
would you please take a photo of the prescription where your doctor prescribe you a pressure of 21 cm H2O?

This will be a very valueable record for CPAP history and for posterity

[-SWS]

What are the debilitating daytime symptoms... are we talking narcolepsy ?? Good sleep doctors are hard to find in my particular area (maybe most areas)...

Right now I'm most interested in causes and restoring sleep architecture rather than chemical modification. Although I am currently experimenting with Melatonin moderately.

Thanks for your "lay" help...
Nord

Nord, I think SleepingUgly and jnk provided REALLY good answers.

Usually they are in the form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight." Stuff like that.

Well, I knew you were being humorous and not literal when I read that. Still funny stuff, though!

Sorry, sorry, no that is just me joking around without making it clear. Everything was serious until I got to the word "sea". Then my mind works by association and almost no inhibition (my boss is always having to put out fires that I caused). And of course "sea" brings to mind old sea-farer's sayings, right? But then I wasn't able to actually bring it off with something that made sense.

That's it. No more trying to be funny. It always blows up in my face.

DO NOT give up the humor thing... partake as you may!

1) Latest PSG, overall arousal index was 11.5 ( Apnea arousal 0.7, hypop arousal 3.0, LM arousal 3.7, respiratory 0.9, spontaneous 2.8, snore 0.4). In the first 3 hours, it was closer to 15 though. The LM arousal index was down from about 9 last time, probably due to the gabapentin I was on this time. Subjectively, I slept pretty good. (80.2% sleep efficiency). Not sure if that is a yes or a no. But it seems to me, the lower the arousal rate, the more puzzling would be the absence of SWS. And so if the answer was no, the higher the chance of some organic defect.

I also noticed no mention of SWS-disturbing alpha wave intrusions that go with certain pain disorders in your thread with PSG results...

2) Daytime symptoms are just stupidity, sleepiness, low-grade dull headache lots of the time. That doesn't sound outstanding.

If the headaches persist now that you have a pressure that controls apneas, then I think I'd ask for the MRI just to get peace of mind. If there are no longer residual headaches at your new pressure, then I think there's a chance you still have some sleep debt to pay thanks to your former suboptimal pressures.

[cpapernewbie]

brain-cloud

Thank you for the photo of the prescription.

A great record of the state of the art of sleep apnea in the year of 2010

[SleepingUgly]

Brain Cloud, how is it going on CPAP of 21??

[brain_cloud]

If the headaches persist now that you have a pressure that controls apneas, then I think I'd ask for the MRI just to get peace of mind. If there are no longer residual headaches at your new pressure, then there's a chance you still have some sleep debt to pay thanks to your former suboptimal pressures.

Oh, it's unlikely the new pressure really controls them in the sense of, say, bringing the AHI under 4 or so. What happens is that in the morning hours from about 3:30 on, my events tend to subside naturally on their own (even happened in the baseline PSG--I seem to be one of the small proportion that has fewer events in REM than when in NREM.) Anyway, it never fails--AHI drops down very low in the last hour or two of the sleep study, the sleep lab says "Eureka, we've found your pressure!") Last time I warned them (although I knew from the start it was useless). I said look, here's a typical night for me. See how the events happen mostly in hours 2-5 and that's when the pressure in auto mode tends to shoot the highest? So you need to act fast and find the therapuetic pressure within the first few hours. Might as well have saved my breath. They have procedures and one-size-fits-all.

I will see if I can get the MRI done. But most interesting of all to me is to come up with the experimental setup that would establish definitively that I just flat out cannot put out any SWS. Instead of chipping away at arousals, testing again, chip away some more, test again, etc. Seems like the thing to do is to undergo PSG after taking some substance that 1) raises the arousal threshold so high that nothing is going to trip it (not stray hypopneas, not leg movements, not a Grateful Dead concert), and 2) does not extinguish SWS as part of its own effects. Obviously while using CPAP too.

[Nord]

Thank you SleepingUgly, jnk and SWS...
I have more reading to do.

BTW SleepingUgly... I don't suffer from Narcolepsy...
just don't dream that I remember and there seems to be problems evident in sleep architecture that is connected.
Maybe caffeine could be a minor culprit... not alcohol in my case.

Thanks and sorry for the sidetrack Brain Cloud
Nord

[SleepingUgly]

Seems like the thing to do is to undergo PSG after taking some substance that 1) raises the arousal threshold so high that nothing is going to trip it (not stray hypopneas, not leg movements, not a Grateful Dead concert), and 2) does not extinguish SWS as part of its own effects. Obviously while using CPAP too.

Hmmm, that wouldn't be Ambien then. It would raise your arousal threshold, but it decreases SWS. I don't know if Gabitril would be sedating enough for you that it would raise the arousal threshold enough for your purposes. Possibly, but who knows.

[-SWS]

No hijack at all, Nord! I was also glad to read SleepUgly's and jnk's good answers.

Oh, it's unlikely the new pressure really controls them in the sense of, say, bringing the AHI under 4 or so. What happens is that in the morning hours from about 3:30 on, my events tend to subside naturally on their own (even happened in the baseline PSG--I seem to be one of the small proportion that has fewer events in REM than when in NREM.)

I just searched to see if you own an oximeter... Can you correlate the headaches to severity of SpO2 desaturations?

Anyway, it never fails--AHI drops down very low in the last hour or two of the sleep study, the sleep lab says "Eureka, we've found your pressure!") Last time I warned them (although I knew from the start it was useless). I said look, here's a typical night for me. See how the events happen mostly in hours 2-5 and that's when the pressure in auto mode tends to shoot the highest? So you need to act fast and find the therapuetic pressure within the first few hours. Might as well have saved my breath. They have procedures and one-size-fits-all.

I agree about PSG methodology: its biggest flaw is a gross inability to measure night-to-night variability.

Seems like the thing to do is to undergo PSG after taking some substance that 1) raises the arousal threshold so high that nothing is going to trip it (not stray hypopneas, not leg movements, not a Grateful Dead concert), and 2) does not extinguish SWS as part of its own effects. Obviously while using CPAP too.

Well, you don't have enough measured arousals, leg movements, alpha wave intrusions, etc. to explain completely missing SWS IMO. I'd ask the doctor for the MRI---looking for lesions, etc. Then I'd consider an experiment with an SWS-promoting pharmaceutical. I don't think completely missing SWS can be restored with the likes of lifestyle management, CBT, etc. But I could be wrong...