Fair is fair

[GoofyUT]

I recently posted here about my frustrations with my sleep-doc for ordering me a ResMed S8 AutoSet Vantage APAP when I was experiencingt early AM awakenings with my Fisher&Paykel HC608 CPAP, which I started xPAP treatment with. My beef was that he apparently lacks the ResMed ResScan software, so he is unable to view the detail data that my S8 provides. I was frustrated because I'm still having early AM awakenings and though my efficacy numbers are looking good, I'm still waking up at 4:00 AM and I don't know why. I was hoping that he could use the detail data of the S8 to figure this out for me, and I was outraged that he had the thoughtlessness to order me a machine that he couldn't read the data from.

Well, I saw him today, and the fella was EXACTLY on time for the appointment and spent more than 45 minutes with me chatting about all aspects of my sleep disorder and its treatment. He acknowledged that he has Encore Pro, because he normally used Respironics machines, but quickly stated that, now that he is having patients with ResMed machines, he would immediately get ResScan. So, I asked him why he ordered me a ResMed when he KNEW that he didn't have the software to fully query it. He looked at me for a second and then produced my script, which actually said "Auto-titrating CPAP 6-14cm". So, it was my DME that chose to give me a brand new S8 AutoSet Vantage AND the matching H3i heated humidifier, even though the script said nothing about heated humidification, or humidification at all, for that matter.

Now, its tough for me to be pissed at my DME for giving me a state-of-the-art, top-of-the-line ResMed S8 APAP when they could have just as easily given me a used Remstar Auto which I'm sure that they have TONS of since my sleeplab is part of the same organization as my DME, and they admittedly use Respironincs mostly.Especially now, since Remstar Autos will soon be replaced by the M series auto, thereby obsoleting their fleet of Remstars. But they gave me a ResMed APAP, which I wanted anyway after researching the ResMed algorithm. And I didn't even have to ask or argue. Not with my sleep-doc and not with my DME.

And, i can't be pissed at my sleepdoc. He ordered my an APAP, and didn't specify which one. My DME made the choice of the new ResMed, I would guess while they are waiting to get the M series auto in. I am a bit perplexed about my early AM awakening, as he was, since my compliance and my efficacy numbers are excellent (AHI=3.1;AI=0.1;HI=3.0 last night). He's speulating that I may have advanced circadian rhythm, where my sleep cycle is a little too fast with respect to the day/night cycle, and he's suggested OTC melatonin when I wake up early, to try to re-synchronize.

But, the guy spent close to an hour with me. He looked up articles on the internet regarding circadian rhythm, while he was with me. He and I came up with a plan together, and he's gonna monitor my progress in two weeks.

I mean, is this quality medical care from my sleep doc/DME or what???? I'm in the business, but these guys have earned my respect. BTW, I use InterMountain Health Care Sleep Lab (Dr. Shilling) in Salt Lake City,and IHC Homecare as my DME.

I thought that I had to post this extraordinarily GOOD experience here. Fair IS fair.

Chuck

P.S. Anyone have any experience with advanced sleep phase/circadian rhythm??

[Guest]

i don't know, chuck, if this will help at all but my problem has been delayed circadian rhythm, and karen moore's post a couple of weeks ago to me really helped a lot. essentially, i had been trying to push the clock back even though i didn't want to go there. karen's suggestion was to put the focus on good preparation for sleep rather than the sleep/wake times themselves. a little more complicated for me than for you, i suspect, because i've got some depression going on, but the main idea is to stop fighting the battle and just get the nicest preparation so there's not so much battle, if that makes sense. translated to your situation, maybe if you ignore it, it will go away, whereas putting the focus on it makes it stronger.

just a suggestion.

caroline

[chdurie2]

whoops... that was me.

caroline

[GoofyUT]

Thanks Caroline!

My thing appears to be somewhat of the opposite of what you're experiencing. I actually get pretty tired by mid-evening and retire to bed after a standard, but nice routine. I usually read or watch the news for a few minutes, and then I turn over and go to sleep within a few moments. But, then I awaken at four in the morning and I'm unable to fall back asleep.

I have few other clinical symptoms during the daytime, and my numbers look good.

So, I'm perplexed.

Chuck

[bbeck4x4]

I have experienced similar problems with early awakenings, my sleep doc(right before I fired him)for the 2nd time tried to convince me that it was depression, (it isn't) I belive that it was a form of insomnia, which I was able to rectify by staying awake until 2am the first night and then the second night I went to sleep at 1am, increasing the nights sleep by 1 hour each night until my sleep rhythm was back to normal, I feel that the insomnia was due to the fact that before xpap I was really only getting 4-5 hours of sleep a night and that was all that I was used to. I now am sleeping 7 to 8 hours a night, before I tried this I used sleep meds to get some rest, not a quality rest, but I wanted off of the sleep meds. No meds now,

One other thing is to make sure that you are getting enough water each day, 8-10 glasses a day, WATER, not any liquid. Try it what have you got to loose, it's free.

[woozle]

Hey there! That is good advice regarding going to bed later. I am having the same problem - I have the same machine s8 auto set vantage - working well and my numers are very close to AHI of 3.1. I keep trying to go to be later - latest I can stay up is about 10:30 and I ROUTINELY wake up at 4 am and can't get back to sleep at all - I have been on cpap since 4/06 so not too long and wonder if I have the same problem with the circadiam rythm. I try to stay up later but it is really hard as I too, get real tired in the evening and try to make it to 10 so I can sleep longer, but it doesn't work. I guess I could go to be earlier but am afraid I will wake up even earlier and be more tired, with this cycyling to the point of I'm sleeping in the day and up all night, which I don't want. I think I will try the melatonin as noted - thanks for posting this as you aren't the only one!
Monica

[GoofyUT]

Thanks Monica and BBeck!!!! Its so reassuring to know that I'm not the only one!!! I was pretty sure that I was having some strange problem that others here managed to skip, judging by the posts I've read.

Monica, I also started CPAP in the beginning of April '06, and I'm having the exact same experience as you are. My sleep doc suggested that I try 0.3 mg (300 mcg) of over-the-counter melatonin, and I will.

BBeck, your explanation makes SO MUCH sense to me! MAybe its ebcause I'm in total getting more sleep than I'm used to for the past many years, and my body is waking up after 6 hours because its saying "Hold on!!! You used to get five hours, so what's up with this six hours crap????" Man, that makes so much sense, cause my day-time and evening drowsiness has virtually disappeared. I'm going to try re-synchroinizing the way that you suggested, this weekend, and we'll see what happens.

THANK YOU BOTH!!!!

Chuck

[woozle]

This forum is so nice, I don't feel so 'alone' with this site - anyway, thanks for the information and when are you supposed to take the melatonin?

[chdurie2]

chuck--

according to this sleep i.q. test on a different thread, going to bed at a regular time, then awakening in the middle of the nite and not being able to go back to sleep, is a form of insomnia. how you treat that, i don't know. but one of the best anti-insomnia tricks i've learned is to lie in bed, and instead of thinking how much you want to be able to go back to sleep, you think of how much you want to get up--but you do not get up. think about what you would do if you did get up. it's a reverse psychology thing developed by some dr at stanford back in the 50s. you may have heard about it in your training. that and a cup of warm milk i've found most effective for insomnia (use both together sometimes.

your thread makes me think of something different, which is how about if we all posted the names or locations of sleep docs we LIKED. I also like my sleep doc a lot. instead of foisting a bunch of pills on me for my non-apnea sleep disorders, i thought, when it worked, that it was brilliant of him to hypothosize that my mild apnea may be the root problem -- solving that might alleviate all the other problems. i was so grateful when he looked at me and said, "you probably don't want to take pills, do you?" (they hadn't worked before.) that sounds pretty basic, not to suggest pills if they hadn't worked before, but i've had docs push pills in frustration. i thought the willingness to use cpap to treat other disorders, when apnea barely could be justified to the insurance company, showed a real openness.

so does anyone need the name of a good sleep doc in NJ? If so, PM me.

Caroline

[GoofyUT]

Great point, as usual Caroline! We spend so much time talking about our anger and outrage about sub-standard performance from the medical community. And in far too many cases , its more than well justified. But, I also wonder this flavor lends itself to a mindset of contempt and distrust for our clinicians, that may not serve us well.

Rastaman posted the suggestion here that we start some sort of user rating system for our equipment, and with the appropriate cautions, I believe that that might be useful, though I worry about the potential for abuse, and for misguiding some. Your idea is also really interesting. I was awfully impressed with Dr. Shilling today, and I would want others in Salt LAke City to know of my very positive experience with him. Perhaps others with similar experiences might decide to share that with each other here, so that maybe someone reading this can get a tip about a clinician that someone else has benefitted from. (BTW, I have absolutely NO affiliation with Dr. Shilling other than as his patient). However, above all else, I still believe in CAVEAT EMPTOR, and for us all to demand nothing less than we deserve with regard to our care.

Monica, my sleep doc recommended taking the melatonin on awakening at 4:00 AM to try to coax the pineal gland back to sleep signals, and ultimately foster resynchronization.

Cheers!

Chuck

[GoofyUT]

Caroline-
I forgot to comment. You're absolutely right. I've found for myself that one of the best ways to get myself to fall asleep (and what I've successfully advised others to attempt) was to try to keep myself awake for as along as I could. Simply by focusing on staying awake, I'd soon get frustrated and exhausted from my efforts, and drift back off to sleep. I think that I learned this trick from the film "Saving Private Ryan" and its worked like a dream since!

Thanks!

Chuck

[birdshell]

So Chuck:

Will you be starting a bed and breakfast for all of us hoseheads who want to come and see your Dr. Shilling? Sounds like a good plan, as a good doc is hard to find.

Also, maybe we should start making location-based plans to fly charter planes in to SLC. Then the good doctor could have patients all day on Mondays from the East, Tuesdays from the Southeast, Wednesdays from the Midwest, Thursdays from the Southwest, and Fridays from the West. Especially if the doctor is prompt and spends a lot of time when a patient needs it, PLUS does my favorite thing for doctors--research more about my conditions!

Just kidding, but it would be nice....

[GoofyUT]

Wouldn't that be cool??????? Think of the possibilities. How's about a travel agency serving hoseheads exclusively??? Books special trips to visit good sleepdocs/DMEs around the world!! Appointment and a script for an APAP of your chociue, guaranteed or your money back.

Kewl!

Chuck

[brasshopper]

When I first got out of high school, I felt like my natural clock was about 26-28 hours. I used to work from home, programming and would just naturally stay up- 2-4 hours later every night and do these all night deals every few days.

It didn't bother me until I changed jobs and had to go to a lot of meetings - and then I managed to get into a 24 hour cycle - with a vengance - to the point that if I came back from Japan I would have my clock flipped - when I had a 28 hour clock I would just let it precess after a trip - no big deal - but suddenly I was on a 24 hour clock and I would try to fix it with 5 days of sleep meds and as soon as I stopped taking them I would have rebound insomnia and "click" I'd fall asleep at midnight - Japan time. It would take me a month to get back to sleeping USW nights.

One of the things that happened at about the time I shifted from a long clock to a 24 hour clock was, well, I got my CPAP. I had never thought about that until just now.