Advice on Dad’s centrals, Cheyne Stokes, and overall worsening sleep

My Dad really wanted to try EPR so we gave it a go last night. He's in town for a bit so he wanted to try it out while he can get my help with it. He wanted to go for broke and start out at 3. To my untrained eye looking at Oscar I don't see a noticeable difference with it on.
https://imgur.com/vfpdJhX
He felt having EPR on made sleep more comfortable. He normally has to get up to urinate one time during the night and didn't have to last night, but with only one night hard to know if that can be attributed to EPR.

Reread this part:

Rubicon wrote: ↑

Thu Sep 29, 2022 4:31 am

A problem is a problem only if it's a problem.

The first question to ask is:

Does he need a more restful night's sleep? How's his function during the day?

I mean, if he's a short-sleeping ASPS (and I am an expert on that) targeting 7.5 hours sleep per night might be asking too much. Add the pain in and at 0200 he's ready to start the day.

Don't force 7.8 hours of sleep on him if he doesn't need or want it.

That said, Sonata, perhaps Ambien. See:

https://www.aafp.org/pubs/afp/issues/2017/0701/p29.html

cause a lot of stuff happens, some not so desirable.

I mean, if there was one drug that solved the insomnia problem, there' only be one drug.

Rubicon wrote: ↑

Thu Sep 29, 2022 3:19 pm

How's his function during the day?

And I think this is a critical point in that from what you're describing I see a man basically chair-ridden, who could easily be taking multiple naps per day. While the company line is that you need 7.8 hours per sleep per day, it doesn't matter how you get it. If he's napping on & off during the day for several hours it's not reasonable to expect him to sleep for a continuous 7.8 hours at night. Sleep consolidation should be considered if appropriate.

With all that depression no meds? Look of surprise. OK not really.

colomom wrote: ↑

Thu Sep 29, 2022 3:17 pm

He felt having EPR on made sleep more comfortable. He normally has to get up to urinate one time during the night and didn't have to last night, but with only one night hard to know if that can be attributed to EPR.

Don't underestimate the importance of his subjective feeling that he was more comfortable. Given that it's likely the CAs are SWJ, being comfortable in bed is important.

Given his seemingly intractable pain problems, being comfortable in bed is important.

I want to quote Rubicon:

Rubicon wrote: ↑

Thu Sep 29, 2022 4:13 pm

Rubicon wrote: ↑

Thu Sep 29, 2022 3:19 pm

How's his function during the day?

And I think this is a critical point in that from what you're describing I see a man basically chair-ridden, who could easily be taking multiple naps per day. While the company line is that you need 7.8 hours per sleep per day, it doesn't matter how you get it. If he's napping on & off during the day for several hours it's not reasonable to expect him to sleep for a continuous 7.8 hours at night. Sleep consolidation should be considered if appropriate.

With all that depression no meds? Look of surprise. OK not really.

How accurate is Rubicon's description? Does your father nap a lot during the day? If so, Rubicon is correct: Expecting him to sleep for a continuous 7.8 hours at night is not reasonable.

Sometimes giving up on the unreasonable goal is necessary: Perhaps your father should go to bed a bit later. Or get up earlier. Or at least get up when he wakes up and can't get back to sleep easily. Or even simply sit up in bed and do some reading or some other kind of entertainment when he can't get back to sleep until he feels sleepy enough to lie back down and turn the light out.

Of course, convincing your dad to do that is a whole different can of worms.

And if we remember the significant pain issues your dad is having, this question needs to be asked: Can he get himself out of bed unassisted? Or is he more or less forced to lie in bed trying to sleep until someone else wakes up and helps him get out of bed and start the day?

Rubicon wrote: ↑

Thu Sep 29, 2022 3:19 pm

How's his function during the day?
And I think this is a critical point in that from what you're describing I see a man basically chair-ridden, who could easily be taking multiple naps per day. While the company line is that you need 7.8 hours per sleep per day, it doesn't matter how you get it. If he's napping on & off during the day for several hours it's not reasonable to expect him to sleep for a continuous 7.8 hours at night. Sleep consolidation should be considered if appropriate.

With all that depression no meds? Look of surprise. OK not really.

My dad is a brilliant, persistent, stubborn, and tough man; even with all his health issues he’s far from chair ridden. The day I brought dad home from the hospital after he nearly died following heart surgeries and even though he couldn’t even stand from a chair without assistance I had to spend hours arguing with him to convince him allow me to do the yard work for him that he had put off until his heart was fixed.

My dad loves the outdoors and up until 2 years ago he hiked a minimum of 5 miles a day and his likely unrealistic goal is to get back there. No matter how bad his pain and weakness he gets outside and walks everyday. Before his heart surgery things were bad, incredible weakness, dizziness, breathlessness, syncope. Following surgery it took longer than he had hoped to rebuild some strength and stamina, but things from my perspective had greatly improved.

As to how he is doing right now, he had been making steady improvements until about 3 weeks ago but over the past 3 or so weeks some breathlessness, dizziness, and weakness have seemed to return and there has been a decrease in the amount of physical activity he can do.

If he’s had a really bad nights sleep he will take an afternoon nap, but he doesn’t sleep all day.
It’s good advice to not be married to 8 hours of sleep a night, but that is the standard my dad wants for himself and I’m unlikely to talk him out of.

As far as the depression, he has been given numerous meds for it over the years. During his last 2 major depressive episodes he would take himself on and off the meds he had most recently been prescribed and would sometimes decide to restart old psych meds he has stashed away that a previous doc had prescribed. I felt that his self treatment
made things quite a bit worse so for now I’ve backed off on trying to convince him to take the psych meds.
It’s a tough illness:(

robysue1 wrote: ↑

Thu Sep 29, 2022 5:43 pm

Don't underestimate the importance of his subjective feeling that he was more comfortable. Given that it's likely the CAs are SWJ, being comfortable in bed is important.

Given his seemingly intractable pain problems, being comfortable in bed is important.

How accurate is Rubicon's description? Does your father nap a lot during the day? If so, Rubicon is correct: Expecting him to sleep for a continuous 7.8 hours at night is not reasonable.

Sometimes giving up on the unreasonable goal is necessary: Perhaps your father should go to bed a bit later. Or get up earlier. Or at least get up when he wakes up and can't get back to sleep easily. Or even simply sit up in bed and do some reading or some other kind of entertainment when he can't get back to sleep until he feels sleepy enough to lie back down and turn the light out.

Of course, convincing your dad to do that is a whole different can of worms.

And if we remember the significant pain issues your dad is having, this question needs to be asked: Can he get himself out of bed unassisted? Or is he more or less forced to lie in bed trying to sleep until someone else wakes up and helps him get out of bed and start the day?

You have a great point, his comfort is the goal:)

I think you are both right, the goal of sleeping 8 hours likely isn’t realistic but that’s my dad’s goal for himself and I don’t think I can talk him out of it.
It’s likely a vicious cycle, I imagine the goal to sleep a certain amount when sleeping that long may not be attainable could add to stress and anxiety.

I haven’t done a good job of describing his current condition. He is able to get in and out of bed and chairs on his own. We have grab bars and walkers next to the bed and other areas. He often needs a cane or walker to steady himself while standing or walking, but he can walk and stand on his own. Today he and I went for a walk around 3
city blocks, it took about an hour to do that distance. 3 weeks ago he was able to walk around about 6 city blocks, before heart surgery i’ld have to walk behind him and catch him to keep him from falling after only walking a couple hundred of feet.