Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

SaltLakeJan wrote: Mornin' jnk

Mornin'. Oops. Afternoon here now.

SaltLakeJan wrote:I'm glad you hung with me, . . .

I'm glad I hung with you too, but I'm also glad the other posters have managed to change my mind on just about every word I posted in this thread. Oh well, that's how I learn too!

SaltLakeJan wrote: . . . it takes several readings, of SWS's posts, for me to get the "ah haw" moment. Sometimes, I think I will have to ask you to translate. His intellect is in the stratosphere. i'm glad he is deciphering my complex subjects. I had no idea my body was hiding them. I thought I was (to use Pres. Obama's word) transparent.

-SWS's post are always worth the reread. I have gone back and reread some of his posts from a few years ago over 20 times. I learn something new every time! (I am not the gifted translator, though, rested gal is.) I agree with you about his intellect, but I appreciate his cordial manner and giving spirit just as much as I do his intellect. Personally, I am glad he uses the words he uses. He uses them for a reason. They seem to be the most precise way of giving accurate information concisely. I think he sometimes considers his own way of wording things to be a drawback, or something. But I'm glad he posts exactly the way he does.

SaltLakeJan wrote:I agree with your analgy of Ozji's posts. She has the ability to make things simple/direct/clear. It certainly helps to have different points of view - & watch them being resolved.

Ozij is gifted in many ways. Logic and wisdom come from many posters here, but her wise eyes have a way of often seeing right to the heart of the matter and nailing it. When she posts, she generally has something to say that very much needs to be said, from what I've seen.

SaltLakeJan wrote:I'm still resolving my thoughts about my new doctor. At first glance, he has a proffessorial air about him and presents a genial disposition. But, I have decided, he actually is a firm man with definite objectives. He just has the ability to put his thoughts into a "nice package" for delivery. I'd like to know what his thoughts are 'bout my future.

A good doctor is hard to find. But if what this guy is doing sounds logical to the experienced posters on this board, that is about as good of a sign as you are going to find, I think.

Part of the discussion here on approaches may fall into the category of kicking around ideas and figuring out important things for you to get educated on and eventually decide to ask your doctor about--not as something you read on an internet forum, but as something you were 'wondering about based on your own personal research.' However, for now, if a doctor has taken the kind of interest in you that this doctor has, it may be worth it to play the game his way as much as possible as long as he doesn't make any obviously bad move that might affect your long-term success. You don't want to tie his hands, so you might want to give him a grace period for now and cut him a lot of slack so that he can get comfortable knowing he has the leeway to give full attention to your particular situation his way. It's OK to ask where you're going. But you may want to let him drive for a while.

Threads like this one educate the entire board, so thanks for starting it, Jan. I know I'm learning a lot. We don't pay these people posting here enough. In fact we don't pay them at all. So maybe we should get up a fund for them so they don't have to keep eating at McDonald's!

jeff

-SWS wrote:a recap of my own take of the humidifier issue:
1) The external F&P HC150 humidifier can interface with any straight-pressure CPAP machine on the market.
2) The S8 Elite II CPAP machine is very compatible with that HC150 external humidifier.
3) The HC150 external humidifier has ambient tracking (the far more important feature IMHO), but not a heated-tube feature called Thermosmart.
4) The Aussie heated hose can nicely substitute for that Thermosmart feature IMHO

Excellent summation.

Personally, I'd want to continue using the S8 Elite II -- with a Fisher & Paykel HC 150 heated humidifier attached to it (the humidifier comes with a short connection hose.)

I would also go ahead and order the Sleepzone heated hose (affectionately called the "Aussie heated hose" here on the message board.) I wouldn't wait to see if I experienced rainout. I'd go on and order the heated hose immediately. The reason I wouldn't wait about getting the Aussie heated hose is this: the doctor put great emphasis on your need for very good humidification.

Rainout is not only annoying (can even cause an unpleasant WAKEUP!!) but rainout also means that some degree of humidification is being lost en route. You want all the humidified air that starts out from the humidifer to actually reach you. Not be lost in droplets condensing out along the 6 foot journey to your snout. So...I'd get the Sleepzone hose (Aussie heated hose) at the same time I got the F&P HC 150 heated humidifier.

"Sleepzone heated cpap tube" is at www.sleepzone.com.au

Also carried by a U.S. online dealer:
http://www.cpapusa.com/item.php?productcode=SZ4IA-AU

But that's just me. I don't have to worry about getting along with any doctor. I haven't been through your particular set of problems, or had to search for a good doctor. I can understand ozij's great advice about why you might want to cooperate fully with this new doctor.

The doctor is probably not familiar at all with the Aussie heated hose. He's on the right track, thinking "heated hose", but he probably thinks the only way to get that is by using a Fisher & Paykel machine. I think his goal of getting you effective humidification would be met just as well by the F&P HC 150 humidifier along with the Aussie heated hose. I wouldn't be surprised if that combo provided even better humidification than an F&P machine with "thermosmart" and a proprietary heated hose.

-SWS wrote:But again, I'd take extra care not to alienate such a well-meaning and sharp sleep doctor. I think a competent sleep doctor for a likely CompSAS/CSDB candidate with yet other health issues is far more important than data read-outs. But those data read-outs are especially important for any patient with great potential for night-to-night variability IMHO as well. A complex issue.

Agreed. You definitely don't want to alienate this doctor. But I'd sure not swap the Elite II with its data recording capabilites for any F&P machine. Again though, "that's just me."

R.G.
Today was an exceptional day for me. I've received counsel from the the Luminaries of the Apnea World . In order of appearance Muffy SWS, in tandem, Ozji then you. When you all team-up there isn't much you can't accomplish in your field. Combined you gave me the help & guidance I needed. I feel I had had the best advice that could be given to me. When a group was working with Bleeping Beauty last month, I marveled at the brain power gathered to aid her. I didn't dream that a short time later, I would be the beneficiary.

My R. T. was not in the DME's office today. So, I couldn't discover the Doctor has ordered the stand-alone humidifier. - I hope it is. My R.T. is a young guy, he said the F&P couldn't be used by ResMed. I've had verification from all of you that it can. He might have been talking about a CPAP combined with Humidifier. I sent an e-mail to CPAP asking for price and full equipment of the F&P stand alone humidifier in the event I have to buy the unit.

All of your buddies gave me similar suggestions. Keep the Elite, buy/trade for the stand-alone. My ResMed Hi4 Humidifier isn't a winner, it humidifies when it decides to. I think I will see if the DME will take the Res Med Humidifier and give me the F&P Hum. Since the DME owner intervened, his R.T's and Staff greet the customers with a smile and a what-can-I-do-for-you-attitude.

I feel grateful & appreciative for the wise guidance I have received.
Jan

Don't forget the heated hose - it makes a world of a difference!

O.

ozji

Woops.
Jan

SaltLakeJan wrote:If you are planning to run past Olympus H.S. this morning

No, it'll be a bit before there's another run in the shadow of the Wasatch(es).

Muffy wrote:This theory could also explain the improvement in the NPSG. If the obstructive component was located in the lower airway, UP3 wouldn't have made a difference in disease severity.

SaltLakeJan wrote:are you referring to my UPPP surgery before the 2000 sleep study & titration...

No, the difference between 2000 and 2008.

I'd like to try to reconstruct the prior history from what you have posted so far, add some info and make corrections where necessary. Accurate data is critical, as a fr'instance, there's a big difference if the leak is 54 (as originally posted for the 2/22/09 data, which means a different machine) or 0.54. Or the 9/2001 study, where the "oxygen saturation is good", which makes Muffy go "Hah?" There's 2 surgery dates, were the turbinates done during the first surgery (cause that's not really "sleep apnea surgery", that's "compliance" surgery)? Would've like to see a titration after that. One wonders if nasal patency alone was the initial compliance obstacle.

What's really up with that oxygen? Do you have COPD, is there an altitude effect, an artifact effect or what? Do you have a PFT?

There was indeed another study around 9/2001? Was it a split study (half without CPAP, half with)? Was that the "summer study" when you were awakened in the dark (I think summer ends Labor Day, hence my confusion)? What time did they wake you up (if it was a split, then that was a lot for a short night)? You should try to get that complete report. BTW, what medications were you on for that one? Looking at REM in all studies would be helpful in differentiating CompSAS from unadulterated obstructive component.

If 2001 titration was effective, then one would really wonder what the present AHIs are telling you. If your overall sleep architecture continues to be FUBAR (I don't think waking up at noon would be a sign of good sleep hygiene), how much of your sleep is really wake.

I think you have to carefully look at the PLMs (are they present when respiratory events are under control?) The assessment of PLMs in 3/00 where "most were associated with respiratory arousals" cannot be made, if there are respiratory arousals, then they can't be PLMs. Or put differently, if all the PLMs disappear with effective titration, then they weren't PLMs in the first place.

Full face mask has been mentioned several times, have you ever tried it?

The Muffmeister also has confusion about these two lines:

SaltLakeJan wrote:My ResMed Hi4 Humidifier isn't a winner, it humidifies when it decides to.

SaltLakeJan wrote:I thought of telling the doctor that I have not used the humidifier (this is 100% true) because it is summer, and I didn't think I needed it.

Summer where? Does Utah ever have a season other than summer (although I heard there was snow a couple of Julys ago, THAT can certainly make things confusing)? Are you saying you've NEVER used the (a) humidifier?

"IMO", I think anybody in SLC needs a humidifier all year long.

Anyway:

SaltLakeJan wrote:NPSG 3/3/00:
OXYGEN SATURATIONS: Nearly continuous cyclical fluctions in saturation present. Oxygen saturation as low as 77%.
RESPIRATORY EVENTS: Severe Obstructive Sleep Apnea with 99 apnea & hypopneas per hour, most of which were obstructive apneas. Obstructive breathing was much worse while supine (125 events per hr) Snoring was noted frequently
LEG MOVEMENTS: Patient was noted to have 62 leg movements per hr of sleep. Most were associated with respiratory arousals.

TITRATION 4/25/00:
RESPIRATORY EVENTS & OXGENATION:
Patient oxygen saturation above 90% majority of time. The most striking finding is the difference in nature of apneas (central apneas or hypopneas) up to 84 events per hour with occasional obstructive apneas up to 16 per hr. Respiratory distress 81 events per hr)
SLEEP ARCHITECTURE: 419 min of recorded sleep. Sleep Latency 67.5 min. Sleep period 346 min. No Rem Sleep during study.
INTERVENTIONS: Nasal CPAP applied & titrated up to 13 cm H2O. Significiant reduction in obst. apneas, but overwhelming apneas being central, there was little change in condition.
SUMMARY: In previous study, patient demonstrated severe obstructive sleep apnea with hypoxemia. During CPAP trial, slight improvement in hypoxemia, but no significant improvement in sleep architecture. Further, frequent central apneas were noted during CPAP trial.

9/2001
Consider UPPP surgery. Doctor wants another sleep study. The new sleep doctor said previous sleep study and titration were not done according to established protocol. His diagnosis, severe Obstructive Sleep Apnea 84 events per hr. Oxygen saturation good. 65 leg movements per hr. Titration 4 cm to 8 cm satisfactory. Dr said previous study & titration were so dissimilar they could have been different patients.

sleep apnea surgery in 2002
UPPP surgery 2003

12/17/08. Total arousal index was 23.0, respiratory arousal index 23.9. Respiratory Parameters: 16 obstructive apneas & mixed apneas, with total of 18 apneas & apnea index of 2.7. 97 hyponeas. RESPIRATORY DISTURBANCE INDEX (AHI of 18.9. Lowest oxygen desaturation 81 with 91.1 min of desat between 80 & 90%.

Doctor prescribed ResMes 8 Elite ll, Hi3, Resmed Mirage Swift ll nasal pillows. Average heart rate 52, low heart rate 16, high heart rate 150. Respiratroy arousals 143.

CONCLUSIONS: Patients sleep fragmented between 0030 & 0145 hrs. Total Sleep time 5.59 hrs. Sleep efficency 82% - Normal is equal to 90%. Patient has moderate sleep-disorded breathing. Low oxy 81%, AHI of 18.9 per hr. Patient moderate sleep apnea.+ Patient may suffering from chronic sleep deprivation. Leads came off during study.

I didn't take that much (sleeping meds) but on one study, I finally got to sleep about an hour before they came in and woke me up. It was in the summer, and it was still dark outside - I asked the sleep doctor if they didn't send the patients home a tad early. He said, how do you think they get their sleep?

I only did therapy in 2000 for a few months. I couldn't get a mask that did not leak into my eyes. Developed conjunctivitis. Started sleep apnea therapy in January 2009

This time we can share COPD stories

2/22/09 This about my sixth week of cpap therapy. I was sleep deprived for a couple of weeks, but the last few nights (OK). I slept for seven and a half hours of sleep last night, I thought it was a good night until I checked the LCD. Leak rate had climbed from 0.38 to 0.54. AHI 18.0, AI 4.8, HI 13.2. Pressure is 6.6. It was temporarily reduced for sore nares, & will continue to climb.

2/24/09 Leak 0.10 AHI 5.4 AI .03 HI 5.4

4/28/09 Leak 0.14 AHI 11.1 AI 1.2 HI 11.1
4/29/09 Leak 0.26 AHI 19.1 AI 2.8 HI 16.5
4/30/09 Leak 0.30 AHI 15.1 AI 1.5 HI 13.6

Muffy

Well Muffy,
Just how many over-nighters did it take for the complicated complication that greeted eyes this morning. Five, perhaaps using the old computer at the U of Utah. The one that occupies the entire lower level of the Computer Science building.

Before I can begin to think about it, I have an unexpected event that I have to reluctantly tend to this a.m.. A routine dental appointment yesterday morphed into the dentist discovering a cavety under a crown. His assistant did prep for removal of crown. Her hands were so powerful, the paramedics could use them, rather than the Jaws of Life in opening crushed vehicles. After the dentist drilled perilously close to the supposedly deaded nerve, he decided I needed a root canal. A temporary crown was slapped on the tooth. DH led a woman he presumed to be his wife to their car. She resembled Jan from the neck down. She appeared to be shell shocked - When she spoke, she mumbled, don't let that woman near me again. Take me home.

I am leaving in seconds for a root canal. If the dental assistant has transferred to this office, I don't know if I will survive. Jan

SaltLakeJan wrote:I'm interested that the 2000 technician was awake & on the job that morning - seems so long ago.

All of your sleep studies should have kept the technicians really hopping, Jan. My hunch is that missing lead may not have been replaced if an inexperienced or overwhelmed tech felt they were up to their neck in PSG alligators so to speak. They may have initially not wanted to disturb you after that lead fell off, waiting and hoping for you to achieve stable sleep "any time now". I agree with SAG/Muffy that the correct call would have been to walk in and place the lead back on shortly after it fell off.

Jan, this is the very fortunate point in this thread where SAG/Muffy questions and comments about your sleep studies. Rather than have the thread going off in multiple potentially confusing directions, I think I'll just sit tight for a while and follow along.

SaltLakeJan wrote:I am leaving in seconds for a root canal.

Good luck with that. Please don't feel obligated to play good hostess in this thread if/when you should really be resting and recovering. This thread will be going strong after we finally get the results of your upcoming sleep study. So please remember to take breaks and rest up as appropriate, Jan.



____________________________________________________________________________________________________________________________________

On that note, I would like to place a personal bookmark for me to resurrect this facet of our discussion during one of the upcoming conversational lulls:

Muffy wrote:

-SWS wrote:The best argument I can think of for not having a data-capable machine available, would be if anxiety associated with tracking that nightly data was observed or predicted by the doctor as potentially being psychologically counterproductive.

Regardless of the health problem(s) at hand, my understanding is that some patients may obsess and become anxiety ridden to the point of hindering health or recovery. That's a valid consideration for any sleep doctor IMHO. But blindly running with unacceptably high AHI can be very counterproductive as well---a far more common scenario I would guess based on countless anecdotes here.

Jan also c/o insomnia, PLMs and RLS. It is not clear to me if that AHI is heavily tainted with wake, wake/stage 1 transition problems and/or a breathing pattern generated by PLMs.

In light of the observations above, and the CFS diagnosis that Jan received, I have some interesting supporting links and pathophysiologic conjecture about hyperactive cognition-based arousals possibly having some degree of interrelatedness in neurology between overlapping CFS pathology and that of CompSAS/CSDB. Also a comment about a possible neurological stimulus/response mechanism that just may exist as an interrelated cohort for this particular hypothetical patient phenotype in neurology.

I apologize in advance to those people reading this thread who don't care for highly technical/theoretical discussions of that nature. I would only intend that conjecture as idle-curiosity type discussion during a pause in this thread.

_________________________________________________________________________________________________________________________________




Again, I'll simply sit tight for a while. I'd encourage Jan to take just as many days to rest and recover from root canal as she would like... and then to come back and resume discussing past sleep-study information with SAG/Muffy.

-SWS wrote: . . . the very fortunate point in this thread where SAG/Muffy questions and comments about your sleep studies . . .

-SWS wrote: . . . I have some interesting supporting links and pathophysiologic conjecture about hyperactive cognition-based arousals possibly having some degree of interrelatedness in neurology between overlapping CFS pathology and that of CompSAS/CSDB. Also a comment about a possible neurological stimulus/response mechanism that just may exist as an interrelated cohort for this particular hypothetical patient phenotype in neurology. . . .

Perfect teaser!

I look forward to both.

jeff

G'day Mates,
I did survive the root canal, but I didn't think I was going to be intact after Camille, the dental assistant from Hell. Wasn't there a hurricane named Camille - If so, that describes her. Camille, must weigh about 275, and has hands the size of hams.. She opened my jaw so powerfully, I wondered if the jaw hinge had been pulverized. I tried to protest, but the numbing had turned my tongue to mush, the dentist couldn't understand my glub/hop remarks. He interrupted me shaking my head to mean I was worried about the pain, & assured me, he had given me an extra shot.

Anyway, I met another dental ass't today. She was perfect, had probably stored her angel wings in the cloak closet. Told her jaw hinge muscles in spasm. She'll try massage she learned in Dental School. It worked.

Now, I search for answers to Muffy's questions.............

Jan

Hi SWS,
In reading your posts here, there & everywhere, it is apparent your HEART is equal size to your INTELLECT. Your knowledge doesn't make the complete caring person that you are. I am touched by the analysis and personal suggestions you have given me. I have been pleased you linked my post to Mar's. In addition to connecting the information base for all who will study it in the future, I have personally enjoyed, and learned from Mar.

Number one issue. Leak rate 2-22-09. Checked my original copy, 0.54 with a pressure of 6.6 cm.

March 5, 2001 My husband had emergency open heart surgery. Repeat hospitalizations through 2004. Then entered Cardiac Rehabilation Program. Health improved. No further hospitalizations. I mislaid some of my records during this time.

Re: 9-2001 " In Clinical Summary, "Previous attempt to use nasal CPAP were unsuccessfull & therefore has been using only nasal Oxygen.
Morning Questionnaire, Sleep Latency: 3 hrs . .Total SleepTime: 5 hours... # Of Awakenings: Ten plus . . Quality of Sleep. Much worse than usual: patient indicated that humidifier was making a knocking sound all night"
Respiratory Measurements: Arterial blood gas measurements not performed. Intermediate nasal CPAP (7-8 cm HJ20 )stablized ventilation (RDI 3-5/hr sleep) & maintained SP02 at approximately 92%,
Re: the statement "oxygen saturation is good" It isn't on the sleep study. Possibilities, 5-5-2009 Sleep Dr. mentioned it.
I copied from different study. (was that the one that I stated was hard to read?
to further confuse the issue. a Certificate of Medical Necessity for nasal.CPAP oxygen Prescription form dated 9-10-01, was in the papers I received 5-5-2009. It was "called in 9-14-01" wiith low SpO2 of 84. . . . . I have no record or payments for oxygen. I believe this was a part of the treatment that was never enabled.

You asked what was up with Oxygen. My internist ordered oximiter testing beginning 1998. He prescribe supplemental oxygen tank in late winter of 1998. Following repeat bronchitis. earlier pneumonia. Oxygen levels improved . Used night oxygen till late 1999.
Sleep Study Findings. 3-3-00 Oxygen saturations: Nearly continues cyclical fluctions in saturation were present. Oxygen saturations fell to as low as 77%
Impressions 1. Severe Obstructive Sleep Apnea Syndrome; she had 99 apneas and hypopneas per hour of sleep accompanied by moderate to severe oxygen desaturations.

Titration 4-25-00. Respiratory events & Oxygenation. During this study, the patient's oxygen saturation was above 90% for majority of time. The most strikikng finding in this study compared to her previous, is the difference in the nature of the apneas. During the previous study, she had a predominance of obstructive apneas, but in this study, she had central apneas predominately, including central apneas or hypoponeas up to 84 events per hour. There were occasional obstructive apneas up to 16 per hours. The respiratory distress index calculates out to 81 events per hour.
Total RDI . . 80.8 . . . /Sao2 awake average ,. . .94%/ . . .Average SaO2 desaturation . . .3%/Mean Apnea/Hypopnea duration 15.5 sec.
Ave SaO2 report time 91%/ . . .Ave SaO2 awake 94%/ . . . Ave SaO2 Sleep time 92%/ . . .Number of desaturations .=3%in sleep time 419 events/ . . .Arousal per hour or sleep 29.4/ . . .Sleep Efficienecy 74.5%

For some reason my internist ordered oximiter 5-25-00. Just 1 month after titration.
Highest Sp02 96%m. . . Lowest Spo2 80%. . . Mean Spo2 91.2. Average mean low was 87.8% . . the mean high was 92.9%. He was an Assistant Prof at U School of Med. rated an excellent diagnostician . In September 2001, he ordered sleep study (this is the test that I did not get the results until sleep doctor 5-5-2009 had been able to get a copy.) Did not use the sleep labs that did tests March 2000, and April 2000.

There was an unusual circumstance with 9-2001 study. It was actually done end of August. I had appointment with Sleep Doctor to discuss it 9-11-01. The 2nd Day of Infamy. We discussed 9-11-01 and I don't know if we got to the test results. He had someone in NY, he was concerned about. The next day my car engine burned up, I was on a Bangerter Highway, (very busy) didn't have cell phone then. The truck that picked up my car, took me home, where I discovered my 2 year old grandaughter had hit her head, and was taken unresponsive to the Hospital. A few days later, My internist sent letter he was limiting his practice to severe Fibromyalgia and Chronic Fatigue. It took me 10 days 2 weeks to select a new car. Shortly after that, my husband was hospitalized. The sleep study didn't cross my mind for months. The medical bills would have been paid, but I don't recall any of those details. I never got a copy until . . I had given the date of the study to the new doctor (with forms returned to him, prior to appointment) I knew where I had taken the study. He traced it and got a copy. I have quoted from parts of it here.


Total RDI. . . 80.8 . . .SA 02 awake average 94%. Average Sa02 desaturation 3%. Mean Apnea/hyponea duration 15.5 sec




Sinus Surgery: My first was in the '70. No records. I had 3 additional sinus surgeries.
I have Clinical notes dated 8-14-2002. Pre Op & Post Op diagnosis same. Extensive nasal & sinus polyposis. First 3 paragraphs were describing procedure and removal of polyps from nasal cavity, nasopharynx, lateral nasal wall & posterior septum.
The 30 degree scope used to visualize sinuses & middle meatal polyps rmoved. Entry into ethmoid sinus was done & disection was carried into middle ethmoid and posterior ethmoid by traversing the remnant of basal lamelle of middle turbinate . Forceps were used to preform retrograde dissecction into middle & anterior ethmoids. These were all removed.

Disection was then carried into maxillary sinus. All procedures were done on both sides. Maxillary ostium enlarged on both sides. upbiting forceps were used. The abnormal mucosa was removed from within maxillary sinus & was removed. He did the same on posterior ethmoid cells.
So far, aan't locate clinical notes for 2004 surgery. Basically the sam e as 2002 surgery, that included UPPP surgery. I was too ill following the surgery to file notes. On follow-up he told me he had cleaned out turbinates - they wouldn't trouble me again.

Muffy,
Are your thoughts still with me? As long as you have questions, I am more than willing, I am anxious to answer anything you ask. I did a computer and filing cabinet/IRS records purge last year. Today, I regretted that I had been so thorough. Some of my medical files, that I specifically recall, now reside in the County Dump.
Part B.
Question: Do you have COPD? Answer: I believed I did, now I don't know. I volunteer at a Extended Care Facility In March of 2008, ( when flu vaccine didn't cover a strain) I didn't get the warning that there were flu cases at the facility. I went, gave part of lesson, felt ill, & cut the lesson short. I felt very ill by the time I reached home. My DH was away for several days. I had the flu, coughing, felt like I had a temperature, was too sick to care. I was very ill, & in bed for 2 months. Dragged for another month. At 1 mo. went to instcare, had an x-ray. It worked its way thru the system to one of my Drs. who told me because of all your bronchitis and pneumonia, I believe the x-ray is accurate. It wasn't his field, so I didn't push tests.
The X-ray findings : Baseline long hyperaeration and diaphragm flattening of COPD are demonstrated. Upper lobe lucency of emphysema also noted. I went to my internist. (despite not having the best health, I have been a regular exerciser 5 days a week ) He said, he thought the chest x-ray findings were connected to the changes exercise brings. I asked, should I have another x-ray. NO. After I while, I got the name of a pulumonogist (he was the sleep doctor in the 12-2008 sleep study) I gave him the hard copy, asking do I have emphysema/copd. He did some tests, asked me to vigorously walk up down hall 10 times. I never got an answer from him. He immediately wanted to do a sleep study. I also gave it to the new sleep doctor. He said it was an example of unsubstantiated conclusion. The 12-08 sleep doctor did some tests, I don't know if one is a PFT.
Question: is there an altitude effect: No one has mentioned altitude effect. In my exercise I did not do altitude effect training. I exercised for health reasons. I was born in Utah.
Question: Artifact effect. I have not seen that test mentioned in sleep studies.

Question: Sleep Study 9-2001. I referred to getting a copy 5-5-2009 from new doctor in first part of the Q&A. After the trauma of 9-11 was over I recalled it because I was so irritated about the conditions of the study. I have the study before me and I can confirm the time I was awakened 5:07 a.m. Under the quality of sleep on the first page. The answer was: much worse than usual; the patient indicated that the humidifier was making a "knocking sound all night" The humidifier did make a knocking sound all night, that was annoying. The reason my sleep was poor is that the bed was close to technicians desk. Two youngish women were the technicians. That night, they had the company of a young good-looking man trainee. The two women spent the night being enthralled by him. I heard womanish peals of laughter following each comment he made. It seemed I would get to sleep & be awakened by loud voices. I called to them twice, told them I couldn't stay asleep because of their loud voices. Bathroom break at 0210 hrs.
The only specific I remember of my 9-11-01 appointment with the Dr. was my complaints about the technicians. That wasn't noted in the study. When I made arrangements for 12-08 sleep study, I asked if the technicians would be quiet. The Dr. said they would, I also told the tech. that I was a light sleeper, & noise bothered me. It was quiet.
Results from Sleep Study 9-2001
Total sleep time . .293 min. 4.9 hrs)/ Wake before sleep. .68 min../Wake during sleep 74.0/ wake after sleep 1.0 min./
Total wake time 143 min (2.4 hrs)/ REM Time 49.5 min/ NREM 244.0 (4.1 Hrs/

Recording Start . 9:31 PM/ Light out . 9:45PM/ Sleep onset 10:54 PM/ Lights on 5:07 am/ Recording end 5:11 A.m./
Recording time . 460.3 min (7.7 hrs)/ Time in Bed 436.5 min (7.3 hrs./ Sleep onset 69.5 min/ REM latency 192.o min (3.2 hrs)
Sleep efficiency , 67% There were no leg Movements during any period.

ELECTROPHYSIOLOGIC MEASUREMENTS OF SLEEP: Sleep structure was very disrupted and onset to consolidated sleep was postponed. However, sufficient sleep data was present over last four hours of study for adequate analysis. The total sleep time (TST) measured 4.9 hrs with a sleep efficiency of 67% (normal 90%) Cycling of NREM and REM sleep was observed. Analysis off sleep stage distribution revealed mild reduction of REM sleep which measured 49.5 min or 17% TEST (normal 20-25) Otherwise analysis of stage sleep distribution was within normal limits. However, due to the marked reduction in TST, the analysis of sleep stage distribution may not meaningful. There was no evidence of sleep disruption steming from periodic limb movement.

RESPIRATORY MEASUREMENTS: Arterial blood gas measurements were not performed. Intermediate nasal CPAP (7-8cm H20) stabilized ventilation (RDI 3-5/hr sleep) & maintained the SP02 at approximate 92%. CPAP was discontinued and BiPap attempted, however respiratory abnormalities were not as well controlled with IPAP 8-9 and EPAP 4 cm H20.

CLINICAL OBSERVATIONS: The Patient had difficulty falling asleep and some limb jerks were noted. She had nocturia one time at 0210 hrs.

CONCLUSIONS: 1. In spite of technical concerns and disruption related to humidifier, the data is sufficient to indicate the effectiveness of intermediate level nasal CPAP. The majority of respiratory disturbances were eliminated with nasal CPAP of 8 cm H20
(RDI 3-5 hrsleep, average sp02 92%.
2. Although sleep was very disrupted, it is anticipated that she could adapt to this therapy which should become more acceptable him the home environment.

RECOMMENDATIONS. 1. Continue therapy with nasal CPAP therapy using a pressure of 8 cm H20
2. A heated in-line humidifier should be used to reduce nasal dryness/congestion.

Question. What Prescriptions were you taking in September 2001. Answer, A bunch.
Daily Prescriptions: Aciphex 20mg, Glucophage 850 mg, Lipitor 40 mg, Neurontin 100 mg, Ambien 10 mg, Triamterene/HZTZ (BP)
Nitroquick 0.3 mg. (For esophageal spasms) Rhinocort nasal spray. Antiobiotics Zithromax 250 mg Zpak, Cleocin, (A later prescription of Cleocin, put me in the hospital for 10 days with pseudomembranous colitis. Occasional use: Claritin

SWS. I had forgotten what a stressful period this was for us. With the exception of a very cranky back, my health is much better. IThe only time I have been sick in the last two years was the 2008 flu. A doctor recently told me that because of the years of first running & cycling, then reduced to walking 5 miles per day 5 days a week. that my bones would be grateful to me for the rest of my life.

Good night to all. "See" you tomorrow Jan

I'm sure SAG or Muffy will be back in this thread to scrutinize your sleep-study summaries, Jan.

And if SAG is the same family man we've always known, then he'll be very busy with family this weekend---- celebrating Mother's Day.

But the situation is now far, faaaaaaar more complicated than that..... Now that he's Muffy, his good-humored family just may feel compelled to double up on Mothers Day celebrations this year.

-SWS wrote:Now that he's Muffy, his good-humored family just may feel compelled to double up on Mothers Day celebrations this year.

Actually, there never was a SAG. He was just another product of Muffy's Multiple Personality Disorder.

Speaking of which, it was tough down at the Hallmark Store today. We couldn't decide on a card, so now we've got a half a dozen of 'em. I just hope everybody shows up to fill them out. But I don't know how the heck we're going to hand them out tomorrow. You know, it's like, "Here's your card." "Where'd you go?"

SaltLakeJan wrote:The X-ray findings : Baseline long hyperaeration and diaphragm flattening of COPD are demonstrated. Upper lobe lucency of emphysema also noted. I went to my internist. (despite not having the best health, I have been a regular exerciser 5 days a week ) He said, he thought the chest x-ray findings were connected to the changes exercise brings.

That's the most bizarre thing I've heard in a long time.

Regardless, the diagnosis of COPD cannot be made without a PFT.

I think looking at the oximetry graphs, arterial blood gas results and pulmonary function test results would be quite important in understanding your specific SDB processes and determining your treatment plan. Having a COPD component in addition to the obstructive and CompSAS components would put you into a different category ("Overlap Syndrome"), and perhaps a somewhat different approach. Given that supplemental oxygen was used ~1999, I think the whole oxygen issue needs very close scrutiny. Do you have graphs?

Whoa, lotta nasal surgeries there, but I see you ran into a thread about "ENS" already. Never hurts to toss in a plug every now and then, tho:

Empty Nose Syndrome

Repeatamente of preguntas

How many days have you used humidification in your therapy since all this started?

Have you tried full face mask?

BTW, which lab did you have the 9/2001 study in? I think we should give them a plug, too. A 5:00 AM wake time is ridiculous, but especially so in your case cause you're sounding like a "Delayed Sleep Phase" kind of person.

Not a capital crime, unless you smoke.

Do you/did you smoke?

Muffy

SWS
Pleased to hear from you, and I agree Sag should celebrate Mother's Day with his family. He and Muffy could take turns. Muffy could open the gifts, and Sag would be the genial host. Sounds like an absolutely lovely day. (said with a southern drawl.

Let me know how you decide who gets what card. (I think that was a comedy routine) That could be the beginning of a family tradition.

I plan to have a chat with my new sleep doctor re the COPD. I feel like it is a ball in a sack, tossed from one doctor to another & no one wants to bother to open the sack.

Skinner had an earlier post on ENS. I spend half a day chasing links. Never heard of it before that.

Here's the answer to the questions posted around 6pm today.

I used humidification January through the end of March. earlier I said it is a winner, it works when it wants to. It was inconsistent in heating. I took it to DME twice, and of course the heating element warmed within seconds. I am going to turn it back on tonight.I'll wonder if it will heat this time.

I tried on a Res Med FF at the DME, the proportions were wrong for my face. It was the only one they had at the time. I plan to check with them early next week. I have a prescription "for the mask of my choice" if they don't have one, I can try them on at Proxaire.

The sleep Lab is no longer there. The doctor who signed the study isn't in the phone book.

Muffy, I never cared to smoke. My father's cigarette cough convinced me that smoking wasn't much fun. . I lived in a smoking household until I married. I worked in offices where smoking was permitted for years.It wasn't till about 1996 that Utah finally passed an Clean Air Law. Have a nice day tomorrow TTFN
Jan