Auto SV,who is it for?

dsm wrote:... As said your posts are very well explained & informative plus indeed that link clearly explains using the bipap auto algorithm to adjust epap. ...

It's amazing what some good sleep can do! I'm not 100% yet. But I'm working my way back to "normal" ( Whatever that might be! ). I only get about five hours of sleep. But that's five completely, uninterrupted, apnea free hours of sleep!!! It's nice to be able to think clearly again.

I can't wait until I hit 8 hours! ( But then my wife has a honey-do list for me that should keep me busy for the next decade or two! )

Following on John's comments re weight & use of cpap. This is a very emotive issue for many doctors (& also for us xPAP users) because many doctors don't grasp that OSA/CA is a *major contributor* to losing the ability to manage food & thus weight. Diabetes easily follows. It is classic OSA/CA to lose the will to exercise & I would ask all those among us who have been on this slide who got their OSA/CA under control via cpap therapy THEN were able to get their exercise/weight *better* under control, to comment on their experience in this vicious OSA/CA => weight gain => GERD symptoms => depression => weight gain => loop back - etc: .

I know that ASV etc: xPAP might be seen by a few people as the answer to their weight problem, but there is a cart & horse situation here. I would argue that once OSA/CA gets control of any us, we will gain weight, likely develop GERD (but, the GERD may come 1st), go through the daytime drowsiness & depression put on more weight, get further depressed, etc: etc: etc:.

I am thinking that there might be a barrier between people who regard OSA/CA as a result of lack of personal control (diet, exercise etc: ) vs a well meaning & capable person being taken down by a medically little understood condition that is called OSA/CA. Maybe some OSA/CA patients are self inflicted but I doubt thosee would bother coming here to try to deal with their problem. We do see a lot of wonderfully dedicated spouses who can see their partners in decline & are so committed to doing what they can to arrest the decline in their loved partner who they know are in a situation beyond their own control.

Anyone who gets as angry as I know John B has said he has been (& myself when I feared my possible lack of employability) will prove they were not on a slide due to pure personal lifestyle choices. Some of us may have got angry at the lack of medical awareness of the real reasons for a decline but once we understood what was happening most of us fought back !!! - My weight is very good these days but I can not last more than 3 or so days without xPAP therapy before a decline starts. Anyone who has been through this fine balancing act knows what I mean.

Pls excuse what has become a bit of a rant -

DSM

John,I appreciate the empathy that you have shown me.I find it quite disturbing the heated discussion that I had with this young, flat bellied sleep doctor.I tried to reason with him that the high pressures,lack of sleep and lack of energy to do anything active was a hinderance to what he thinks is going to make change.I told him lets treat the apnea and then weight.I asked him if someones heart was failing would you tell him to go home and lose some weight or would you treat the problem.This seemed to irritate him worse,he seemed to dig his heels in even deeper.That was when I asked him to at least try renting an SV so as to prove me right or wrong.
Folks may wonder why my sleep study doesn't show my need,well who knows.I was titrated at a 12cm h2o(supposedly) but encore pro said differently.Over a 2 month period of careful self-titration I am finally at an Ipap/Epap of 25 and 18.How in the hell did they miss that?I couldn't get rid of the vibratory snores until 14cm h20.All my data points to centrals and osa,I even had a desat of 77 the other day while on bipap.I have had sleep apnea since I was a child and I was not overweight then so how is that supposed to change much if I could lose it.I do believe I would benefit from a health point but good grief what a stupid diagnosis from a supposedly trained sleep specialist.Basically he was telling me there is nothing more that can be done,now what?
Please forgive me if this sounds like I am on the pity pot because I am not.I will move on and try to find an answer to my medical condition.

grandpap wrote:John,I appreciate the empathy that you have shown me.I find it quite disturbing the heated discussion that I had with this young, flat bellied sleep doctor.I tried to reason with him that the high pressures,lack of sleep and lack of energy to do anything active was a hinderance to what he thinks is going to make change.I told him lets treat the apnea and then weight.I asked him if someones heart was failing would you tell him to go home and lose some weight or would you treat the problem.This seemed to irritate him worse,he seemed to dig his heels in even deeper.That was when I asked him to at least try renting an SV so as to prove me right or wrong.
Folks may wonder why my sleep study doesn't show my need,well who knows.I was titrated at a 12cm h2o(supposedly) but encore pro said differently.Over a 2 month period of careful self-titration I am finally at an Ipap/Epap of 25 and 18.How in the hell did they miss that?I couldn't get rid of the vibratory snores until 14cm h20.All my data points to centrals and osa,I even had a desat of 77 the other day while on bipap.I have had sleep apnea since I was a child and I was not overweight then so how is that supposed to change much if I could lose it.I do believe I would benefit from a health point but good grief what a stupid diagnosis from a supposedly trained sleep specialist.Basically he was telling me there is nothing more that can be done,now what?
Please forgive me if this sounds like I am on the pity pot because I am not.I will move on and try to find an answer to my medical condition.

Grandpap, Be aware that an Ipap as high as you have set it, may well be introducing the Centrals that you say are occuring. I can see you put a lot of effort into tuning the epap setting & that seems to have been very helpful.

Do you sleep on you back a lot ?

Cheers DSM

DSM and John, it makes me mad just reading what you've been through. I got some of the same myself and I think now, reading your posts, that perhaps I sabotaged my own apnea therapy because I felt such anger towards my doctor all those years ago. You're strong and you controlled your own therapy. Once my husband's all settled with the right machine, I'll talk to his doctor about my symptoms. Thank you. Maybe there are other spouses or browsing folks out there who will decide after reading your posts that they too will help themselves.

DSM,yes I do sleep on my back.I also sleep on my side and sometimes stomach.I know this from my having to hold my mask on my face all night.Plus my wifes observations have been fairly informative.In the evening I literally tie my mask down so I can sleep on face and stomach.
I agree the centrals could be from high Ipap but I am only able to get my OSAs below 15-20 AI by the high pressures.I think they(sleep study) missed the centrals and the doc may have blown the diagnosis. I am at a loss on where to go from here because my doc sure isn't offering anyother treatment ideas.The high pressures have finally taken there toll,tonight I am lowering pressures and taking a break.

grandpap wrote:DSM,yes I do sleep on my back.I also sleep on my side and sometimes stomach.I know this from my having to hold my mask on my face all night.Plus my wifes observations have been fairly informative.In the evening I literally tie my mask down so I can sleep on face and stomach.
I agree the centrals could be from high Ipap but I am only able to get my OSAs below 15-20 AI by the high pressures.I think they(sleep study) missed the centrals and the doc may have blown the diagnosis. I am at a loss on where to go from here because my doc sure isn't offering anyother treatment ideas.The high pressures have finally taken there toll,tonight I am lowering pressures and taking a break.

grandpap, Don't be disappointed if you find you do spend a lot of time in the supine (back) position. I struggle with this a lot due to having done a tumble, 3 months back, off my bike & having wrenched my shoulder. I used to find it easy to sleep on my left side until then. Am almost back to normal but am spending far too much sleep on my back & I have to say I sure can see one hell of a difference in the daily outcomes. Am on a fine line between just keeping everything balanced. Back sleeping exacerbates every aspect of OSA & some influences on CA.

Any alcohol at night is most likely always going to show a negative effect on breathing if we also sleep on our back after it.

GERD is also almost always going to produce worse side effects when we sleep on our back *and* if we throw in a little (by one's own measure ) alcohol.

GERD can and does contribute to sinus infections & throat soreness - By sleeping on our left side, we are keeping the stomach opening (where the LES is) on the upper side of our body & that greatly reduces the spill from the stomach that is more likely to occur on our back or right side. Being overweight (which most of us with GERD are or have been) adds to the pressure on the stomach & thus if we sleep in any position where the stomach opening is below the contents of the stomach - watch out


Here are some easy to read links (the 1st one says a lot !) ...

http://www.everydayhealth.com/gerd/mana ... -gerd.aspx

EXTRACT:
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Researchers have figured out several ways in which GERD-related acid reflux interferes with sleep:

* Most obviously, individuals may be awakened by the pain of heartburn, which occurs when stomach acid refluxes into the esophagus and eats away at the esophageal lining.
* If acid reflux reaches the back of the throat or larynx, it may prompt a coughing fit or choking.
* People might wake up when they experience regurgitation, in which a small amount of stomach acid comes up through their esophagus and into their mouth.
* GERD has been identified as a risk factor for sleep apnea, a disorder in which the person repeatedly stops breathing during the night. Researchers believe that refluxed stomach acid causes the voice box to spasm, which blocks the airways and prevents air from flowing into the lungs.

Unfortunately, many of the mechanisms of sleep make GERD more likely. For example, just the act of lying down increases the risk of acid reflux. When you are in a sitting or standing position, gravity helps keep gastric acid in the stomach. When you lie flat, however, it's much easier for stomach acid to backflow into your esophagus.
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MORE from the same link ...
>>
GERD and Sleep Position: Dos and Don'ts

If you are a GERD sufferer, you can do a lot to improve your quality of sleep by changing your sleeping position. Doctors recommend that you:

* Do elevate the head of your bed 6 to 8 inches, to assist gravity in keeping your stomach acid from refluxing.
* Don't sleep on your back, particularly if you are obese, because the pressure on your stomach could help drive acid into your esophagus.
* Don't sleep on your right side. For some reason, this seems to prompt relaxation of the lower esophageal sphincter — the tight ring of muscle connecting the stomach and esophagus that normally defends against reflux.
* Do sleep on your left side. This is the position that has been found to best reduce acid reflux.

You also can improve your chances of a good night's sleep by waiting for three to four hours after you eat before going to bed. That gives your stomach a chance to process your meal and move it through your digestive system. Your stomach will then be empty and less likely to promote reflux when you lie down. Eating a smaller and lighter dinner also is a good idea.

With a few lifestyle adjustments, you can save yourself a lot of the discomfort that comes from the dual problems of GERD and sleeplessness.
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ANOTHER ITEM (more generic in nature) ...


http://www.tipsinlife.com/acid-reflux-t ... estyle.htm

I had lathroscopic surgery for gerds years ago,the best thing I ever did.Sleep apnea and gerds is a very uncomfortable place to be and would suggest surgery to anyone that has it(reflux) bad enough.Not only is it sleep disruptive it can cause the esophageal skin cells to possibly become cancerous.I lived with gerds up until 15 years ago,now if someone could do something with high pressure and apneas

PS my other above post section that covers DOs and DONTs absolutely explains why xPAP users who have GERD - must be given the 'right' side of the bed (standing at it's foot and looking at the bed that is the right hand side (also called by common sense, the more logical side) ).

That way you get to sleep on your LEFT body side & the air from your mask is NOT blowing into your long suffering partner's face

BUT, if you damage your left shoulder, be prepared for months of anguish & less than ideal results

DSM

(when it comes to sleep apnea - there is soooooo much to learn - 1st there is the medical & symptomatic side, and then there is practical side -
just look at the extensive wisdom gathered here from xPAP regulars like RestedGal's how to get your mask under control with some really innovative use of wife's underwear (pantyhose) or what sleeping position you really need to think about based on your size - or how to clean your mask with baby shampoo - or how to clean your H/H with vinegar - or how to be even smarter & buy a distilled water generator & eliminate dirty H/H chambers altogether - etc: etc:

D

grandpap wrote:I had lathroscopic surgery for gerds years ago,the best thing I ever did.Sleep apnea and gerds is a very uncomfortable place to be and would suggest surgery to anyone that has it(reflux) bad enough.Not only is it sleep disruptive it can cause the esophageal skin cells to possibly become cancerous.I lived with gerds up until 15 years ago,now if someone could do something with high pressure and apneas

grandpap,

The surgeon I went to a few months back did an endoscopy on me & said - don't bother with the operation, you are doing very well on PARIET meds.

He made the case that GERD LES operations really only work for much younger people - for us older folk we might get 4 years before the same situation recurs. This link shows him doing a GERD repair op. http://www.sydneygastricbanding.com.au/ ... rgery.html

This is the doc who I went to & I really admired him for telling me I did not need the surgery (I had become used to medicos selling you anything that fattened their bank accounts). This DR - Oliver Florica - whatever I might have thought of his appearance / manner, treated me like an intelligent person, told me the risks, covered the costs, then after the endoscopy said - "don't bother you are already doing as well as I could do for you with surgery, perhaps better" !!!. That I was not expecting. He added that my LES was as good as many 20-30 YOs he inspects & thus Pariet medication had done me well.

Anyway, be aware that LES hernia surgery is not expected to last more than 7 years at the extreme.

DSM