CPAPtalk.com

Casie, just be sure to tell Doc #1 to tell the resmed rep that your husband is a VIP case, and that hundreds of people, perhaps thousands, will be pouring over the results when you pop the PSG Report up here.

Can your husband go to sleep ok, with hundreds of spectators?

Seriously, I'm very, very glad to hear that Doc #1 has gotten in gear and is putting in more time on your husband's case. The doctor is making up now for having dropped the ball earlier. Or, as ozij put it wayyyyy back on page 4 (seems like a year ago, doesn't it?

ozij wrote:No wonder she was so upset at the lab and tech. Though the question remains: Who analysed the PSG? Who Rx-ed the machine with that configuration?

I've always felt that many busy doctors just glance at the bottom line when going through a stack of PSG reports, signing off on whatever the tech said, and dictating a few fill in the blanks bits with the tech's findings into a canned "summary" report their secretary pulls up on the computer. Then scribbling a quick Rx and going to the next report in the stack. They're supposed to look at the raw data and analyze the PSG data, but I very much doubt many of them do all that.

Anyway, you've got the doctor's attention now, Casie. Good luck to your husband at the upcoming study. He (and you) have a lot of people pulling for him. We'll be watching!!!

ozij wrote:

But, a doctor saying an Adapt SV would not necessarily be good for people with OSA or shallow breathing sounds to me like an idiot. The thought of Casiesea's husband doing better on a bilevel Auto than the current Adapt SV would tell me that his ASV was not setup properly.

The makers of the Adapt SV state very clearly that it is not the treatment of choice for people with OSA or shallow breathing, since it speicifically , epecially programmed to create hypoventilation.

Being knowledeable means looking for informaion in many sources, and sifting through the information. Some people think they know everything always because they have a very high opinion of themselves, and a very low opinion of others. This is a special kind of idiocy, and its prevalence is not restricted to doctors.

Anyone who reads information on a forum has to educate themselves and learn to separate the chaff from the wheat. Fortunately, Resmed publishes infromation for those who want to learn about the Adapt SV:

http://www.resmed.com/en-us/dealers/med ... daptSV.pdf

A longer-term correction is effected by the trailing 3-minute
memory of minute ventilation and pattern of breathing. After
a 3-minute initial collection period, the Adapt SV then sets a
minute-ventilation target that is 90% of the previous minute
volume. Hence there is a weak downward force on total minuteventilation
that nudges the PCO2 upward 2 or 3 millimeters of
mercury, decreasing or eliminating the frequent CO2 dips below
the apnea threshold that drives the central events. Because of
this 90% target, the manufacturer cautions that the device
should not be used in patients who have a condition that might
result in hypoventilation (severe COPD, neuromuscular disorders,
etcetera). At least theoretically, the downward force on
minute ventilation could worsen hypercapnia [too much CO2] in this patient group and perhaps even precipitate respiratory failure. We
have not seen this potential complication, even though several
patients we have studied have had PaCO2 values at, or a little
above, the upper limit of normal.

http://www.vpapadaptsv.com/product.html

Support when it's needed
The adaptive-servo ventilation algorithm:

Adapts to the patient’s ventilatory needs on a breath-by-breath basis
Automatically calculates a target ventilation (90% of the patient's recent average ventilation)
Adjusts the pressure support to achieve it.


Clinical references
1. Young et al. Am J Respir Crit Care Med. 2002; 165: 1217–39
2. Teschler H et al. Am J Respir Crit Care Med. 2001; 164: 614–19
3. Philippe C. Heart. 2005; Published online Jun 20
4. Töpfer V et al. Pneumologie. 2004; 58(i): 28–32

Simply put, the aim of the Adapt SV it to make sure you have a liitle more CO2 in your blood than normal. That is not something one can recommend for every person who has OSA or shallow breathing. Shouldn't, recommend, I'd say.

Can one setup an Adapt SV to function as regular bi leve machine? Yes. Is hobbling the machine's special features the right way of using it? No.

All added emphasis and links are mine.
O.

Casiesea wrote:Zyrtec D (P-ephed hcl/Cetirizine hcl) 5/120 mg - and he took it once a day in the morning. He actually was taking Zyrtec D for both 1/22/08 and 2/25/08. He did not start Allegra (Fexofenadine HCL 180 mg) until March 13 (prescribed by sleep doc #2).

Pseudoephedrine is not what you'd call a "sleep-friendly" drug. However, the half-life of the extended release version is about 6 hours, so perhaps taking it in the AM is OK. The present version of Allegra is sans pseudoephedrine?

Casiesea wrote:I forgot to mention his nicotine gum addiction...

Nicotine ain't particularly "sleep-friendly" either. It can also create sleep disruption and increase periodic limb movements.

Casiesea wrote:...and Prozac 40mg(started in dec/jan).

There's where the REM went.

Does he take in caffeine (coffee, Mountain Dew, etc.)?

Casiesea wrote:provigil 200 mg

I think you need to have one of your docs use all these words in the same sentence:

Left atrium contracting more frequently than the other chambers, nicotine gum, Provigil, and pseudoephedrine.

Casiesea wrote:2/25/08 - The sleep tech's were waking him up when they came into the room to change the machine. They were turning the lights on and making noise. He did say it took an unusually long time for him to go back to sleep that night.

Make sure the ResMed rep brings in a ResControl II and the 100 ft. connecting wire.

Where are those AdaptSV downloads?

What are his "normal" sleeping hours?

SAG

The VPAP Adapt SV can only be run in ASV or CPAP mode.

Banned

Thank you, DSM and Banned for putting me right.

O.

Is there a way for me to download the info from the machine? They canceled the RT appt because the doctor didn't want to change pressure until they could monitor him.

His caffeine intake has significantly increased in the past couple months. I have been hounding him regularly. I would say he drinks approx 2 cups of coffee and 1 soda per day. Sometimes more, never less.

He went cold turkey on the nicotine gum about 3 weeks ago.

He is on fexofenidine only - 180 mg qd.

I had no idea anti-depressants could disturb rem! His FP put him on it to help with sleep! I called them this morning...left a message...they must see my number and put me directly to voice mail. I guess I'll start using my cell.

He goes to sleep around 11p-12a and wakes up about 6:30am. Lately he has been going back from 8a-10a and always falls asleep in his office around 3p.

After today's thread he has refused all medications and has repetedly told me that medical science is a conspiracy and I am one of their pawns.

RG -
Right now, he could probably go to sleep on the superbowl field during halftime. I doubt he will get preformance anxiety at this point. But just in case, I won't tell him everyone is watching till Thurs. morning.

I am sure his first couple psg's got piled and filed with the rest of them! I don't believe it will happen again (esp now that I have doc #1's cell ).

It does seem like he has her attention now. I think SWS may have hit the nail on the head with the "professional excellence" comment.

Casiesea wrote:RG -
Right now, he could probably go to sleep on the superbowl field during halftime. I doubt he will get preformance anxiety at this point. But just in case, I won't tell him everyone is watching till Thurs. morning.

I am sure his first couple psg's got piled and filed with the rest of them! I don't believe it will happen again (esp now that I have doc #1's cell ).

It does seem like he has her attention now. I think SWS may have hit the nail on the head with the "professional excellence" comment.

Casisea,

Sorry to see that things are still very much in hiatus - hope you & hubby get some progress soon.

As RG said, there are many people now following your story & many hoping it can be resolved in the best possible way.

Keep up your good efforts.

DSM

Casiesea wrote: Is there a way for me to download the info from the machine?

That should be easy. If you are PC based at home with Windows XP and he is using the Enhanced Adapt SV, tell your husband to request that Doc 1 script both a Reslink module and ResCan v.3.4 so he can collect data from the machine and forward her the information periodically for her analysis and review. My guess is she would do it as she seems pretty motivated.

Banned

Casiesea wrote:I had no idea anti-depressants could disturb rem! His FP put him on it to help with sleep!

Yeah. Among other things.

Prozac
Anxiety and Insomnia — In US placebo-controlled clinical trials for major depressive disorder, 12% to 16% of patients treated with Prozac and 7% to 9% of patients treated with placebo reported anxiety, nervousness, or insomnia.
In US placebo-controlled clinical trials for OCD, insomnia was reported in 28% of patients treated with Prozac and in 22% of patients treated with placebo. Anxiety was reported in 14% of patients treated with Prozac and in 7% of patients treated with placebo.
In US placebo-controlled clinical trials for bulimia nervosa, insomnia was reported in 33% of patients treated with Prozac 60 mg, and 13% of patients treated with placebo. Anxiety and nervousness were reported, respectively, in 15% and 11% of patients treated with Prozac 60 mg and in 9% and 5% of patients treated with placebo.

There are a number of excellent pharmacological sleep aids out there now, this is an area that your sleep physician should be consulted on.

Casiesea wrote:After today's thread he has refused all medications and has repetedly told me that medical science is a conspiracy...

Unfortunately, SAG is very "thin-skinned", takes this comment personally and will not post any more.

Have fun tonite. Don't occlude the proximal pressure line.

SAG

StillAnotherGuest wrote:

Casiesea wrote:

Casiesea wrote:After today's thread he has refused all medications and has repetedly told me that medical science is a conspiracy...

Unfortunately, SAG is very "thin-skinned", takes this comment personally and will not post any more.

<snip>

SAG

I always thought SAG was a medical magician... and that all those graphs were part of the sleigh of hand...


O.

StillAnotherGuest wrote: Unfortunately, SAG is very "thin-skinned", takes this comment personally and will not post any more.

He was only joking with me (I am a nurse), and it was more about doctors and pharmacuetical companies (specifically his doctor giving him a medicine for sleep...that messes up sleep....as a nurse, I am their pawn....giving that medicine out to unsuspecting patients).

I thought it was cute and wanted to share. I am sorry.

I didn't realize SAG had "thin-skin", I would never purposely offend SAG, or any of you. You have all helped us so much.

I am just really, really sorry!

Casiesea wrote:

StillAnotherGuest wrote: Unfortunately, SAG is very "thin-skinned", takes this comment personally and will not post any more.

I didn't realize SAG had "thin-skin", I would never purposely offend SAG

He doesn't. And you didn't! You're fine!

I must admit, I didn't realize your husband was joking with you. Glad to hear it was just a family joke!!

SAG was joking, too. Well, not about the serious sleep stuff. Just about the "thin-skinned" stuff.

I think I just got my first ulcer!

Casiesea wrote: I think I just got my first ulcer!

SAG confuses many of us with his humour - that is a complication of not seeing his face when he posts

DSM