Sleep doc recommends stopping cpap. Use for 10-days

[Wonka]

Take 5mg ambient for 5-days, and 2-1/2 mg ambien for 5 days all without using cpap and call with results to determine if machine is causing insomnia.

A short time ago I posted that I was disqualified as a candidate for an implantable device trial. Their sleep study indicated I had too mild of apnea. When I visited my sleep doc he said their sleep study was most likely biased. That didn't make much sense to me since mild apnea would have an easier threshold for positive results and the desired clinical trial outcome.

Now, a month or so later he's suggested at first that I may no longer need a cpap, then suggested I consider provent. I asked him I could try a sample, he indicated another sleep study would be needed first. I've had 3 in the last year. Then, he indicated that he did no suggest I may no longer need a cpap. Go figure...

Anyone try provent?

[cflame1]

appears that he wants to make $$ off you... 3 studies and then another one? Don't you have a data capable machine (no I haven't looked at what you actually have)?

Are you trying to get off the machine? Is that why the wanting the implantable? He may be trying to give you an option to get what you think you want... whether it'll work or not is another matter.

[Goofproof]

I smell aRAT, I'd suggest making friends with a data recording XPAP and making the treatment work. Quick fixes are quick, but they aren't fixes. Jim

[moresleep]

I don't understand your problem. Are you saying the doctor wants you to stay off of the Cpap and try Ambien beause you have insomnia? Or, are you asking if the Provent device might work in place of the Cpap?

[Wonka]

I'm sorry my post wasn't clear. It was simply a statement more than a question. If there is a question, it's probably do I need a different Sleep Doc based on the limited information I've provided?

Am I trying to get off of CPAP? Yes, I that would be great if if my Apnea can be effectively treated with another method that isn't as life-changing. If not, I'll continue to use the machine.

As such, I fully support research for other method to alleviate the problem. I volunteered as a participant in the clinical trial for the implantable device, but was declined. The screening process includes a sleep study as the last step for candidacy. Selected participants will be required to have extensive study physician contacts and frequent sleep studies and can discontinue participation at any time and have the device removed, so the risk is minimized.

The results of the sleep study for participation in the clinical trial indicated my Apnea was too mild to become a participant. I had two earlier sleep studies earlier in the year conducted by my Sleep Doctor and the conclusion was that my Apnea was much more severe.

Like many others on the forum, I never get a full nights sleep using a CPAP. I'm a side-sleeper and use pillows. When I turn, they seem to dislodge all the time. I've tried many masks with no improvement and cannot tolerate full face or nose masks. I've also developed what appears to be insomnia and take Ambien on a regular basis. I'd like to discontinue the use of the drug and determine if the Insomnia is CPAP related, or not.

My sleep Doc has prescribed Provent for many patients, but indicated he would not provide any samples unless I had another sleep study to see if they work. I was told the cost is about $60 month and not covered by insurance or medicare. The requirement for a sleep study bothers me because I know Provent offers a sample pack for $20, or so with a prescription. There's no way I'd want to have a sleep study before I try the darn things to see if I can tolerate them or not either. So, I'm concerned about my Sleep Docs motivation. Is it economic, or in my best interest.

This was the 2nd visit I had my Sleep Doc since I had the sleep study for participation in the trial. On the first visit, he seemed to discount the results and their motivation. During my last visit, my Sleep Doc briefly looked at the sleep study again and the first thing he said was "maybe you don't need a CPAP any longer". Later in the conversation that changed to Provent and his suggestion for 10-days of non-usage tapering off the Ambien. Using CPAP, my AHI is about 1.5.

There were a couple other situations that have created concerns about my Sleep Doctor. First, he was very upset that I changed my pressure from 9 to 8 (I have an S9 autoset) running on the CPAP mode (which he recommended). When I asked if lowering the pressure affected the ability of the S9 to treat the Apnea, he replied "No, it's a comfort question". Well...if it's a comfort question, why does he give a damn whether I change the pressure myself, or not?
Second, from what I've read on this board and elsewhere it doesn't seem like there's much question that both Ambien & CPAP use can actually increase insomnia problems (I was surprised to read that about Ambien...I thought it was for sleeping).

[cflame1]

I'd go with the different doc... and the keeping using the machine. You don't need to get more than 1 study every few years. Especially as you've got a datacapable machine.

Have you read the data that your machine provides? If not, why not? If yes what did it say?

[Slartybartfast]

I smell a rat, too. Something's wrong. My advice is to seek another opinion.

However, the fact that neither insurance nor MediScare cover Provent is troubling. Typically that indicates that there is a more cost-effective therapy available, or that the product simply doesn't live up to its claims. For example, BOTOX was first approved to treat movement disorders related to the eyes because injecting a drug into the affected muscles was far cheaper and had a better outcome than surgery. If Provent is all it's cracked up to be (i.e. if it really works), it should be covered.

[avi123]

I also don't understand your posts as "moresleep" indicated.

You posted: "I'd like to discontinue the use of the drug and determine if the Insomnia is CPAP related, or not."

How would stopping the Ambien indicate that the Insomnia is CPAP related?

Also, when you say "My Sleep Doc" what do you mean? "Sleep Docs" come in dozens of specialties and fashions including spine crushers.

Check this blog: http://adventures-in-hosehead-land.blog ... er_19.html by Roby Sue

[Wonka]

I also don't understand your posts as "moresleep" indicated.

You posted: "I'd like to discontinue the use of the drug and determine if the Insomnia is CPAP related, or not."

How would stopping the Ambien indicate that the Insomnia is CPAP related?

Also, when you say "My Sleep Doc" what do you mean? "Sleep Docs" come in dozens of specialties and fashions including spine crushers.

Check this blog: http://adventures-in-hosehead-land.blog ... er_19.html by Roby Sue

First, thanks for the responses. My typed sentences seem to be far too long and rambling, I'll have to work on my writing skills again.

I'm not the Doc. But I would assume the Doc believes if the Insomnia lessens or disappears/lessens in the10-day period and I'm able to both fall asleep and stay asleep, it's indicative that either the CPAP or Ambien is contributing to the Insomnia and he would have me eliminate the variables one at a time, then suggest another sleep study...UGH!! However, according to what I've read it seems that both can contribute to Insomnia.

As to the other poster's suggestion, that's probably correct. I'm having a very difficult time with compliance so the Doc may be just reacting to my apparent needs and looking for alternatives. I'm still working. Since starting CPAP, I haven't really had a good nights sleep the entire year. I've developed Insomnia, memory problems, and I'm tired...always. My Sleep Doc is a Pulmonologist specializing in Sleep Medicine.

My journey with Pulmonologists (3 of them) started with a severe respiratory problem. Each indicated I had developed severe Asthma, the last suggested Apnea. Nothing helped the Asthma. Next, I was diagnosed with Diabetes II. I immediately started a diet and excercise program and lost 50# in 3 months. The respiratory problem disappeared, and I've had no Asthma indications. My Apnea diagnoses was a by-product of the respiratory solution.

I don't want to sound like a "whiner" here. I've seen the negative reaction. I'll keep trying. But, I do want to keep a close watch on other possible alternatives. I don't like being "tethered" to a machine both mentally and physically. I also don't want to be a cash-cow of a Doc that might be more concerned about his pocketbook than my best interest. It's hard to tell. I could be all wrong about this guy.

In response to another poster, yes, I do read my data (as best I can). I look at compliance and AHI...that's about it. I've only been able to see the summary S9 data (usage, pressure, AHI, leaks) since starting usage.

[cflame1]

If you post something about wanting to see the detail and you can't on Resscan... I'm sure one of the Resmed users would help.

[BrandonB]

You may want to consider switching your machine into APAP mode and test out to see what your typically pressure is set to. With the changes in your physical condition, I'd imagine it's possible you need different settings now. I concur with the rest that you should seek a new doc though.

[rested gal]

I changed my pressure from 9 to 8 (I have an S9 autoset) running on the CPAP mode (which he recommended). When I asked if lowering the pressure affected the ability of the S9 to treat the Apnea, he replied "No, it's a comfort question".

In my opinion that was a terribly ignorant thing for a "sleep doctor" to say about the single pressure setting of a machine being operated in CPAP mode.

[kteague]

Just a few thoughts...

Using a hose management system that gives you freedom of movement may make your experience less bothersome. A tugging hose is notorious for dislodging nasal pillows and causing leaks. Also, of the several nasal pillows style masks I've used, I've yet to find one that didn't benefit from adding an extra strap for improved stabilization. If you do that, just be sure it can't slide and block the exhale vents on your mask. Sometimes just reducing minor aggravations can be such a relief that the treatment might feel more tolerable.

I'm have no delusion that this alone will turn your treatment around to the degree you need - just a piece of the puzzle. I concur with the need to assess your data for clues and determine if your pressure settings are optimal. Also, if you have copies of each of your reports and do an item by item comparison between reports, you may pick out some information that is meaningful. I know that in theory your doctor should have done that, but I can attest to the value of seeing with your own eyes. Nobody cares about the minutia of your life like you do.

Oh, I was not an early achiever on cpap. A few months in I even quit for a while. Never considered surgery as I have 3 friends whose sleep apnea was not cured by surgery, and one had some real problems afterward. I am not opposed to trying others means if they are proven over time. I just know there was a time when I never would have believed I'd ever be as well adjusted to cpap as I am. Even if that's not your experience, I hope your treatment becomes at least tolerable until you have clarity on other options. I'm not impressed with what you've said thusfar about your doctor, but I wouldn't consult another one until you are sure within yourself you've done all you can to help yourself. Best wishes.

[Wonka]

Just a few thoughts...

Using a hose management system that gives you freedom of movement may make your experience less bothersome. A tugging hose is notorious for dislodging nasal pillows and causing leaks. Also, of the several nasal pillows style masks I've used, I've yet to find one that didn't benefit from adding an extra strap for improved stabilization. If you do that, just be sure it can't slide and block the exhale vents on your mask. Sometimes just reducing minor aggravations can be such a relief that the treatment might feel more tolerable.

I use a Cozy Hose Mgt System, you're correct...trying to sleep with the hose on a nightstand is much worse. You must be reading my mind. I've been thinking about adding an additional strap of some kind but haven't figured out how to do that so it helps the pillows stay in place. I ordered a chin strap, but after looking at it decided it wouldn't be much help.

As an update, I slept the whole night (with only one bathroom wakeup)using 5mg Ambien without the CPAP. I went to bed about 10:45 waking up at 5:30 (my usual hour). I know that doesn't mean anything as far as the Apnea goes, but I'm trying to follow the Dr.'s advice for the 10-days. I'm interested in seeing how tired I am later today.

[chunkyfrog]

Just thinking out loud, but we had a doctor who was getting forgetful.
Once, maybe no biggie; but several times indicated a pattern.
He left DH on a med that was causing heart problems.
We changed doctors.