Doctor says. "Machine is overreacting"!!

[pikov22]

30 minutes first thing every morning, near your face but do not stare into the light, occasional glances into the light are not harmful - http://www.walmart.com/ip/13916976?wmls ... la&veh=sem

what is the wattage of that light, and especially, what is the cost of replacement bulbs?
You can achieve the same effect with a 24" "under-cabinet light" (@ Walmart) that costs about $9
http://www.walmart.com/ip/Lights-of-Ame ... e/17163528
(You can pace it where you want, doesn't have to be placed under a cabinet! It's a fully enclosed light, just has 2 holes for screws in the back to attach to cabinet if you want)
It lights up the room too.
Wattage: 17W
Incandescent equivalent: 75W
The replacement bulbs, as you need to get the special GE full-spectrum 24" bulb for therapy effect, can run $8-10.
I get those at Lowes; sometimes Walmart carries this kind of bulb too, called something like "Sun light"

I don't think any of the listed lights will be of much help. According to NIH you need 10,000 lux to be effective for the stated purpose. You are going to have to spend more money.

I'm not sure but I think that adjusting one's circadian rhythm may be different from treating Seasonal Affective Disorder.

Do you have an URL for the NIH thing you mentioned?

[pikov22]

Are you reviewing your data from the machine? Can you post your data from sleepyhead or Encore? Let us see the data please...

I would be happy to do that. Encore has three reports: summary, trend and details (the 12 page report). Which should I post?

[pikov22]

"Clear-cut obstructive apneas and hypopneas overall average 18 per hour of sleep, but are more prominent during brief recording supine, and most prominent in REM , where they average 35 per hour of sleep and result in recurrent oxygen desaturation to as low as 77%"

If you get the CPAP software you can look to see if your events are well distributed over the night or if they come in clusters. If they come in clusters you might suspect that the very credentialed doctor doesn't have the pressure (or pressure range) set high enough to effectively treat the REM sleep.

I don't drink any caffeinated beverages after about 11AM.I was graduated from college in 1957. I doubt that studies performed on people 50-odd years my junior are relevant. Besides, college students don't sleep.

In other words, you have no damn intention of experimenting caffeine-less and rather than say it you pooh-pooh advice and evidence.

What are her credentials?

If you are looking for credentials get out of here. These are people who are "on the ground running and getting it done". They are here because the people with credentials often don't get it done.

1) From the titration study: "Little overall change in respiratory irregularities or oxygen saturation levels was identified during the night with CPAP over the range of 4-11 cm water. " She set me initially at 11 and then increased it to 12.

2) I'm willing to experiment with reducing caffeine intake from my present 200 mg/day. However, because ingestion of an extra 160 mg of caffeine in the afternoon that would supposedly serve to keep me awake at the bridge table did nothing (over a period of about 3 weeks), and because nitrous oxide has no effect on me (nor did smoking weed in my youth . it seems reasonable to conclude that caffeine does not affect me. However I will go full decaf for a week and report back.

3) Credentials are not just paper. People who are "on the ground running and getting it done" are probably not lay people. They have training and experience. Before I put absolute trust in people who post without revealing their true identities -- or at least what their training and experience is --, I will trust my highly educated specialist with 20 years of experience in the field.

However, I will be sending her some of the suggestions made in this thread and gauging her reaction.

Don't get me wrong. I *do* appreciate all of the responses you've written. Sometimes, I'm just a grumpy old man.

[MyIdaho]

Are you reviewing your data from the machine? Can you post your data from sleepyhead or Encore? Let us see the data please...

I would be happy to do that. Encore has three reports: summary, trend and details (the 12 page report). Which should I post?

I have a resmed machine and thus am unfamiliar with the Encore program. The daily detailed charts would be most revealing, in particular the events chart. Thanks!

[pikov22]

I take it you are a technical expert on how CPAPs measure flow and determine apneas? What I didn't seem to get across is that my doctor feels that I am not having 10-14 apneas/hour.

For example, see: http://www.acsu.buffalo.edu/~grant/94.pdf
Additional data see: http://journal.publications.chestnet.or ... id=1087558

Cool! I'm going to send her the links and get her reaction. Thanks so much!

[pikov22]

Are you reviewing your data from the machine? Can you post your data from sleepyhead or Encore? Let us see the data please...

I would be happy to do that. Encore has three reports: summary, trend and details (the 12 page report). Which should I post?

I have a resmed machine and thus am unfamiliar with the Encore program. The daily detailed charts would be most revealing, in particular the events chart. Thanks!

Detailed report at https://www.dropbox.com/s/80bu5qsu6ohad ... etails.pdf

Thanks for looking.

[pikov22]

Then your first step is to bring the machine back to the DME and tell them the doctor said it was not working properly because it is reporting your AHI too high. You can insist that they test it and send a report yo your doctor. After all you don't want a broken machine, do you? Who knows what else might be wrong with it.......

Good point! I'll call them tomorrow.

[Madalot]

You might want to mention to your doctor that just because they got you down to 4/hr in the lab DOES NOT necessarily mean it will stay that way at home.

My first titration study -- they had me titrated on cpap at IPAP of 11, no desats. Looking good!

But things went to crap at home and if my doctor took the stance that yours has, I'd probably be dead now. I complained I was horribly tired, she checked my oxygen and found despite a great night in the lab, I WAS desatting at home. Increased the pressure and found I needed bipap. When I started having issues with the bipap and FINALLY got the DME to listen, we realized that I was failing on bipap as well. During the period where they were trying to figure out what I needed, I told my doctor what the AHI was doing at home (increasing nightly) and she LISTENED to me. Never once did she try to tell me that my home machine couldn't be right.

It IRKS me (being polite there) that a credentialed professional would give you a line that since it was great in the lab, your home machine must be wrong.

Irks me, then scares the crap out of me.

[DoriC]

I apologize if you feel that I was snarky. How can I find more about how cpaps measure flow and determine data?

Pugsy would have gladly answered that question and then some,and probably gotten you on the right track.

Then your first step is to bring the machine back to the DME and tell them the doctor said it was not working properly because it is reporting your AHI too high. You can insist that they test it and send a report yo your doctor. After all you don't want a broken machine, do you? Who knows what else might be wrong with it.......

Right, who knows??

[scbeaver]

Definition of expert, ex = has been, spert = drip under pressure. I am not an expert but an authority, as are most others on the forum.

Sleep well,

Steve

[pikov22]

You might want to mention to your doctor that just because they got you down to 4/hr in the lab DOES NOT necessarily mean it will stay that way at home.

I cannot believe that she doesn't know that.

I complained I was horribly tired, she checked my oxygen and found despite a great night in the lab, I WAS desatting at home. Increased the pressure and found I needed bipap.

I'm not sure what "desatting" is or how it is measured/reported. Thanks.

[pikov22]

Definition of expert, ex = has been, spert = drip under pressure. I am not an expert but an authority, as are most others on the forum.

Is it OK to ask what makes you an authority?

[scbeaver]

Thirty plus years of experience on several different fields, end of discussion.

Sleep well,

Steve

[49er]

Pikov22,

As one who has had near malpractice experiences with doctors who were supposedly the best in their field, I can tell you from personal experience that taking the position that your doctor can do no wrong because of her top credentials may greatly endanger your health or kill you. Because you refuse to believe that, I am not sure why you are even posting in this forum since you're not receiving the answers you want to hear.

I can't think of any top sleep medicine doctor who would think that a continuous AHI of 10-14 on machine reports would be ok.

49er

[Madalot]

You might want to mention to your doctor that just because they got you down to 4/hr in the lab DOES NOT necessarily mean it will stay that way at home.

I cannot believe that she doesn't know that.

I complained I was horribly tired, she checked my oxygen and found despite a great night in the lab, I WAS desatting at home. Increased the pressure and found I needed bipap.

I'm not sure what "desatting" is or how it is measured/reported. Thanks.

desatting = oxygen desaturations. My initial titration got me at a pressure setting of 11 with oxygen levels staying above 90%. At home, that pressure was allowing me to drop down into the mid 80's and my events per hour was rising. A pressure setting of 11 worked that ONE night, but was not right for me on a consistent basis.

If your doctor KNEW all this, she wouldn't be disregarding the information provided by your machine.