Totally getting rid of my apnea

[BlackSpinner]

Yet the testimonies exist.

Anecdotal data is not used in scientific studies except as a guide to develop them. According to anecdotal data gurus fly, UFO's kidnap people and big foot runs around not far from here.

What happens if you try them all at once?

Nothing much with respect to OSA say formerly skinny shiatsu, acupressure and yoga practitioner who ate macrobiotic vegetarian for many many years before and during the onset of OSA.

[Todzo]

Yet the testimonies exist.

Anecdotal data is not used in scientific studies except as a guide to develop them. According to anecdotal data gurus fly, UFO's kidnap people and big foot runs around not far from here.

What happens if you try them all at once?

Nothing much with respect to OSA say formerly skinny shiatsu, acupressure and yoga practitioner who ate macrobiotic vegetarian for many many years before and during the onset of OSA.

D3 levels between 60-80? Accupuncture (most often reported)? Eucapnic breathing? Resistance and Aerobic Training? Worked with dietitian for years? Fat to lean rates good?

What I know is that as I employ these things I am getting better!

[robysue]

SuddenlyWornOut45,

I really want to wish you luck in your goal.

You write

Its simple math:

Before tonsillectomy: 95th percentile was consistently in the 14s to 15s

After tonsillectomy full recovery: 95th percentile dropped into the low to mid 11s

If I go off all klonopin (a potent depressant and sedative), my experience has been a point drop for each mg of klonopin. Im on four mg klonopin, therefore I should expect a drop of three to four points, which would bring me down to low 8s or the 7s. Lets be conservative and say, the low 8s after discontinuing ALL klonopin.

Then lose forty pounds and get down to 200 lbs again. Im down to the low 7s now.

Then have deviated nasal septum corrective surgery and sinus surgery to reduce NAR. I figure another drop of a point. Down to low 6s

Then I have bariatric surgery and lose the remaining fat and get down to 165, my ideal weight. That drops my pressure needs down to under 4.

and

Well, Im saying I believe I can get rid of my apnea completely or very close to it based upon 1) the major pressure drop I experienced after my tonsil removal, 2) past experience with going down just one mg of klonopin, much less 4 mg and 3) past experience with losing forty to forty five pounds. I am a skeptic by nature, but its simple math, really.

I don't want to burst your bubble of optimism, but I have to address your misuse of "simple mathematics".

Pugsy tried to point this out to you earlier. What your data definitively shows is that with less tissue and less weight and fewer drugs, it requires less air pressure to keep your airway from collapsing. In other words, it's now easier to prevent your airway from collapsing. That does not imply your airway will no longer collapse when there is NO extra air pressure to splint it open.

To put it bluntly: A reduction in the pressure to keep your airway open does NOT mean that your untreated OSA has gotten any better. It may have gotten better. Or it may be about the same. Or it may actually have gotten worse. We just don't know, and the kind of pressure data is not enough to draw any legitimate conclusion about what's going on with your untreated OSA.

The only way to tell whether your untreated OSA has actually changed at all is to undergo another sleep study without a CPAP. It could be that even though it is easier to prop the airway open now, in its natural (CPAP-less) state, your airway is still prone to collapsing just as often as it did before you started CPAP. Or it could very be that with less tonsil and throat tissue and with less drugs in your system, you airway actually does collapse less often during the night in its natural (CPAP-less) state.

So even if in the long run you succeed in getting your pressure needs all the way down to the 4--6cm range, the real question will be: How often does your airway collapse when there is NO CPAP pressure? And if you are lucky and you succeed in all your plans, the real question will still be: Can you get the number of airway collapses down to less than 5 per hour when you are NOT using CPAP?

Having said all that, I want to add this: You plan on losing a significant amount of weight and intend to keep it off. You've had one surgical change in the structure of the upper airway and tentatively plan on some nose surgery that could (marginally) help the airway a bit more. You're tapering off of a medicine with some known potent side effects when it comes to night time breathing. Add all that up, and it's reasonable to think that once you've lost all the weight and you've tapered the klonopin as far as you intend to taper it, that it is very reasonable to request another diagnostic sleep study be done to find out just what the heck your upper airway actually does do when you're sleeping without a CPAP. And that would be true even if you didn't see any further reduction in the pressure needs between now and the time you finish your weight loss project and the klonopin tapering. In other words: If you get down to your goal of 165 lbs and manage to keep the weight there for several months, it's well worth requesting a new sleep study regardless of whether your pressure needs have continued to drop as you think they will or not.

And having said all that: There's the final usual caveat---if you do cure your OSA through substantial weight loss, the tonsellectomy and nose surgery, and the klonopin taper, you'll have to keep the weight off forever. Because if you gain the weight back, then chances are the OSA will come back, perhaps with a vengeance.

Best of luck

[robysue]

D3 levels between 60-80? Accupuncture (most often reported)? Eucapnic breathing? Resistance and Aerobic Training? Worked with dietitian for years? Fat to lean rates good?

What I know is that as I employ these things I am getting better!

Todzo,

As long as you continue to use your PAP machine, then that too is a part of why you are continuing to get better, even if you are skeptical about whether it is a positive or a negative with all your theories about how PAP leads to unstable breathing patterns. In spite of all your theories, you still seem to keep on PAPing.

So unless you undergo a sleep test that shows no OSA, no one around here is going to believe that you've "cured" or even "substantially improved" your OSA through these things and that the PAP is basically useless to maintaining your health. (Particularly since you do still seem to keep on PAPing.)

That said, keeping the D3 levels up, resistance and aerobic training, working with a dietitian, and keeping the fat to lean ratio good are all going to have major payoffs in multiple ways in the overall health of the individual and that will, in turn, have major payoffs in the "how well do I feel?" department.

In other words, nobody around here is going to argue that "Good Health" requires a good diet, some quality exercise, and a whole bunch of other things in addition to using the PAP machine to manage the OSA.

And "feeling better" really requires paying attention to all aspects of "good health" rather than just "treat the OSA."

[jnk]

If someone is on the lower edge of mild OSA, a lifestyle change or two may help him cross the line over into what docs consider non-OSA territory. It happens.

And if someone has a sudden onset of some major metabolic change, and that gets corrected before the brain gets hardwired in to OSA, the OSA may get corrected. For example, sudden weight gain and then sudden weight loss. Or fluid retention or swelling or some such thing.

But I believe that for the majority of OSA sufferers, especially those whose condition came on slowly or whose condition became moderate-to-severe, once the brain gets wired for OSA, there is not yet any known way to fix that wiring--no matter what vitamin you take, food you eat, or exercise you do.

Fortunately, simply using a little pressurized air to keep the airway open works very well as a solution for many.

Once a person is breathing and sleeping, he is in a better position to address other health concerns. But improving those other health concerns are not likely to rewire the brain in a way that fixes the OSA in a way that means PAP is no longer needed.

In my opinion.

Which rarely, if ever, agrees with Todzo's opinion on this particular subject.

Bless his heart.

[BlackSpinner]

D3 levels between 60-80? Accupuncture (most often reported)? Eucapnic breathing? Resistance and Aerobic Training? Worked with dietitian for years? Fat to lean rates good?

What I know is that as I employ these things I am getting better!

Yes Todzo - if you ever tried to do shiatsu you would know it consists of lots of lifting peoples bodies but I was also doing weight training and running and dancing and running after a toddler. I didn't need to work with a dietician because I was capable of reading a book and applying its logic and most dieticians were pushing low fat. D3 levels - nobody tested them back in the 90's. Yoga breathing long predates your silly stuff. My breathing abilities freaks out the medical staff as I can slow my heart beat in one deep breath. But I still had OSA.

[Janknitz]

Simply--I hope it's as simple as you think. Keep us posted along the way. Maybe you'll blaze a trail for others to follow.

[Todzo]

D3 levels between 60-80? Accupuncture (most often reported)? Eucapnic breathing? Resistance and Aerobic Training? Worked with dietitian for years? Fat to lean rates good?

What I know is that as I employ these things I am getting better!

Todzo,

As long as you continue to use your PAP machine, then that too is a part of why you are continuing to get better,

That is true.

even if you are skeptical about whether it is a positive or a negative with all your theories about how PAP leads to unstable breathing patterns. In spite of all your theories, you still seem to keep on PAPing.

That the pressure of CPAP tends one toward hypocapnic central apneas and unstable breathing in general is simply an established medical fact.

Yes I do use CPAP – with EERS[1]!!

So unless you undergo a sleep test that shows no OSA, no one around here is going to believe that you've "cured" or even "substantially improved" your OSA through these things and that the PAP is basically useless to maintaining your health. (Particularly since you do still seem to keep on PAPing.)

My use of CPAP is with EERS and with the use of several times a week examination of my CPAP data. It is carefully tuned for both a lack of obstructive events and a lack of unstable breathing.

That said, keeping the D3 levels up, resistance and aerobic training, working with a dietitian, and keeping the fat to lean ratio good are all going to have major payoffs in multiple ways in the overall health of the individual and that will, in turn, have major payoffs in the "how well do I feel?" department.

In other words, nobody around here is going to argue that "Good Health" requires a good diet, some quality exercise, and a whole bunch of other things in addition to using the PAP machine to manage the OSA.

And "feeling better" really requires paying attention to all aspects of "good health" rather than just "treat the OSA."

We agree!

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[SuddenlyWornOut45]

Well, I will just say this. Last March or February, when I first saw the ENT who told me "yep your tonsils ARE nasty and infected looking and I think I should cut them out," and "oh by the way, if we take out your tonsils I believe we should be able to drop your pressures some," I was HIGHLY SKEPTICAL. Very skeptical.

I did believe the tonsillectomy might reduce my pressure needs half a point maybe. A full point MAYBE. But I was VERY SKEPTICAL.

The procedure and three week recovery was hell and it was three weeks of being on narcotic painkillers, high dose Motrin, drinking ensure because I could not swallow real food for two to three weeks. And having to suck on ice pops and stuff like that.

But once the recovery was really over and the drugs cleared out of my system, WHOA what a change!!!!!!

Took me about two weeks after the recover to figure out I could no longer tolerate my old pressures. Things had radically changed. Then it took me at least a month on 4-20 and a download or two to realize, WOW my 95th percentile dropped A LOT.

So, trust me, Im a skeptical guy. Im generally a pessimist. But that surgery did work at reducing pressure needs. And I do know for past experiences of losing significant amounts of weight and past experiences of decreasing klonopin that both of those decrease my pressure needs and I already know about how much for each.

I think it would be a lot of hard work (but that does not scare me), but I think the combination of getting off klonopin completely along with a weight loss of 45 pounds would get me down pretty low pressure wise. To the very low 7s or to the 6s for 95th percentile.

I fully agree that I'd still need CPAP at a pressure of low 7 or 6, but thats OK. To me that would be ALMOST like no CPAP at all. And a further weight loss of thirty pounds I sincerely believe would drop me to 4 and under...negligible pressures.

Eric

[zoocrewphoto]

If someone is on the lower edge of mild OSA, a lifestyle change or two may help him cross the line over into what docs consider non-OSA territory. It happens.


Bless his heart.

But here is the problem. Mild does NOT mean low pressure.

Mild is a low untreated ahi with very little oxygen desaturation.

As Pugsy as said, and somebody else repeated, you can have mild sleep apnea and need a high pressure, and somebody with severe sleep apnea may do well with very low pressure.

Getting your pressure down to 4 or 5 does NOT mean that you would have fewer apnea events when not being treated. There is no correlation between pressure needed and severity of sleep apnea. And even severity is not just the frequency of events but also the length of events and how low the oxygen goes down. My mom used to have a *treated* ahi of less than 5, but her events were usually over 30 seconds, and some were over a minute long. That is still severe, despite being under the threshold of 5 events per hour. She needed more pressure to prevent those few (but severely long) events.

Without a sleep study, this whole idea is pretty unlikely.

Now, that said, it has great potential to result in lower pressure needed which is usually more comfortable. And that is a good goal.

[LSAT]

Well, I will just say this. Last March or February, when I first saw the ENT who told me "yep your tonsils ARE nasty and infected looking and I think I should cut them out," and "oh by the way, if we take out your tonsils I believe we should be able to drop your pressures some," I was HIGHLY SKEPTICAL. Very skeptical.

I did believe the tonsillectomy might reduce my pressure needs half a point maybe. A full point MAYBE. But I was VERY SKEPTICAL.

The procedure and three week recovery was hell and it was three weeks of being on narcotic painkillers, high dose Motrin, drinking ensure because I could not swallow real food for two to three weeks. And having to suck on ice pops and stuff like that.

But once the recovery was really over and the drugs cleared out of my system, WHOA what a change!!!!!!

Took me about two weeks after the recover to figure out I could no longer tolerate my old pressures. Things had radically changed. Then it took me at least a month on 4-20 and a download or two to realize, WOW my 95th percentile dropped A LOT.

So, trust me, Im a skeptical guy. Im generally a pessimist. But that surgery did work at reducing pressure needs. And I do know for past experiences of losing significant amounts of weight and past experiences of decreasing klonopin that both of those decrease my pressure needs and I already know about how much for each.

I think it would be a lot of hard work (but that does not scare me), but I think the combination of getting off klonopin completely along with a weight loss of 45 pounds would get me down pretty low pressure wise. To the very low 7s or to the 6s for 95th percentile.

I fully agree that I'd still need CPAP at a pressure of low 7 or 6, but thats OK. To me that would be ALMOST like no CPAP at all. And a further weight loss of thirty pounds I sincerely believe would drop me to 4 and under...negligible pressures.

Eric

Whether you are at a pressure of 15...12...10...8...6...you still need a CPAP for the rest of your life to eliminate your apneas. If you are making the life changes to make yourself healthier, that's great...you may live longer.

[jnk]

By "lower edge of mild OSA," I meant low AHI, not low pressure. I apologize if my statement seemed unclear to anyone. I have made no statements in this thread regarding levels of pressure.

[zoocrewphoto]

By "lower edge of mild OSA," I meant low AHI, not low pressure. I apologize if my statement seemed unclear to anyone. I have made no statements in this thread regarding levels of pressure.

But the OP has never stated what his ahi is or what it may be. He is ONLY talking about pressure, yet believes he will cure his sleep apnea. So, it is very important that we differentiate the two.

[SuddenlyWornOut45]

My AHI on my Resmed S9 Autoset is consistently under 4. Normally it is in the 2s. The 3s is kinda on the high side for my AHI. Its good. In my experiences, these newer APAPs give you good AHI's no matter how its set up or what you do. The only time I get a high AHI is when I have a chest cold or other serious respiratory problem.

Running my S9 Autoset APAP 4-20, AHI is consistently in the 2s. Although I dont go by AHI much on these post S8 machines Resmed has developed, I dont think AHI means all that much on modern Resmed machines to be honest.

Eric

By "lower edge of mild OSA," I meant low AHI, not low pressure. I apologize if my statement seemed unclear to anyone. I have made no statements in this thread regarding levels of pressure.

But the OP has never stated what his ahi is or what it may be. He is ONLY talking about pressure, yet believes he will cure his sleep apnea. So, it is very important that we differentiate the two.

[jnk]

My statements were broad concerning which patients may be "cured" of OSA. Some can. Obviously I have no idea whether the OP falls into one of those categories. I stated circumstances when OSA might be "cured" and circumstances when it was highly unlikely.

I do, however, appreciate your attempts to correct what I never said.

Thanks.