My doctor wrote an script for cpap@21

Start looking for a new sleep Dr. now. If the DME tries to give you a CPAP with an increased altitude setting start looking for a new DME too.

What they SHOULD do is contact your physician on your behalf and explain to him the situation and get a properly written script.

Nord wrote:

-SWS wrote:

brain_cloud wrote: The outcome I fear is simply that I will have to go on the way I am now. Not partaking in it myself, I see SWS as the key to feeling rested, maybe unreasonably.

Two questions come to mind:
1) Did you present an arousal rate during PSG that might have architecturally precluded SWS?
2) Do you now have outstanding daytime symptoms that might be associated with missing SWS?

If the answer is no to both of those, then I think I would be inclined to leave well enough alone. If the answer is yes to either, then I think further investigation is warranted. And that might entail getting a new sleep doctor on board if yours is reluctant to pursue the issue.

Hi SWS...

Not a thread Hi-Jack... just along the same thoughts

Could you explain your two questions...
I am exploring this issue myself and need to do some reading about missing SWS and REM.
I did the reading on Google Scholar and Wiki but it is quite limited.

Thanks
Nord

The first question has to do with finding out if there are EEG-measured arousals preventing SWS---and if so, trying to find a source for those arousals.

The second question has to do with whether brain_cloud is asymptomatic of that missing SWS. If there are no measurable symptoms and no known pathology, then attempting to restore SWS might not make sense----especially in light of possible treatment side effects. If, on the other hand, debilitating daytime symptoms can be correlated with that missing SWS, then I would personally want to experiment with known clinical methods of restoring SWS.

I'm definitely no expert.... Those are only my layperson's thoughts about how I might approach that problem with a good sleep doctor at the helm.

-SWS wrote: Hi SWS...

Not a thread Hi-Jack... just along the same thoughts

Could you explain your two questions...
I am exploring this issue myself and need to do some reading about missing SWS and REM.
I did the reading on Google Scholar and Wiki but it is quite limited.

Thanks
Nord

The first question has to do with finding out if there are EEG-measured arousals preventing SWS---and if so, trying to find a source for those arousals.

The second question has to do with whether brain_cloud is asymptomatic of that missing SWS. If there are no measurable symptoms and no known pathology, then attempting to restore SWS might not make sense----especially in light of possible treatment side effects. If, on the other hand, debilitating daytime symptoms can be correlated with that missing SWS, then I would personally want to experiment with known clinical methods of restoring SWS.

I'm definitely no expert.... Those are only my layperson's thoughts about how I might approach that problem with a good sleep doctor at the helm.[/quote]

Are there particular EEG measured arousals that prevent SWS... or do all interfere with sleep architecture ???

What are the debilitating daytime symptoms... are we talking narcolepsy ?? Good sleep doctors are hard to find in my particular area (maybe most areas)...

Right now I'm most interested in causes and restoring sleep architecture rather than chemical modification. Although I am currently experimenting with Melatonin moderately.

Thanks for your "lay" help...
Nord

Nord wrote:Are there particular EEG measured arousals that prevent SWS... or do all interfere with sleep architecture ???

-SWS will have to answer what he meant, but I would assume what he meant is that a large number of arousals could prevent someone from entering slow wave sleep because they keep bringing them to a lighter stage of sleep.

What are the debilitating daytime symptoms... are we talking narcolepsy ??

Again, -SWS will answer what he meant, but I assume he meant continued excessive daytime sleepiness. If Brain Cloud is asymptomatic and feeling great during the daytime, then perhaps it's unimportant how much time he spends in SWS. I don't know how you're using the term "narcolepsy", but narcolepsy is a neurologic disorder with particular manifestations, which can include excessive daytime sleepiness, but are not limited to just that. Messed-up sleep architecture tends to be part of the picture, but I don't know about SWS in particular.

Are YOU concerned about narcolepsy?

-SWS wrote:

brain_cloud wrote: The outcome I fear is simply that I will have to go on the way I am now. Not partaking in it myself, I see SWS as the key to feeling rested, maybe unreasonably.

Two questions come to mind:
1) Did you present an arousal rate during PSG that might have architecturally precluded SWS?
2) Do you now have outstanding daytime symptoms that might be associated with missing SWS?

If the answer is no to both of those, then I think I would be inclined to leave well enough alone. If the answer is yes to either, then I think further investigation is warranted. And that might entail getting a new sleep doctor on board if yours is reluctant to pursue the issue.

1) Latest PSG, overall arousal index was 11.5 ( Apnea arousal 0.7, hypop arousal 3.0, LM arousal 3.7, respiratory 0.9, spontaneous 2.8, snore 0.4). In the first 3 hours, it was closer to 15 though. The LM arousal index was down from about 9 last time, probably due to the gabapentin I was on this time. Subjectively, I slept pretty good. (80.2% sleep efficiency). Not sure if that is a yes or a no. But it seems to me, the lower the arousal rate, the more puzzling would be the absence of SWS. And so if the answer was no, the higher the chance of some organic defect.
2) Daytime symptoms are just stupidity, sleepiness, low-grade dull headache lots of the time. That doesn't sound outstanding.

I guess I'll see if he'll go for that MRI thing.

Many different kinds of drugs can have an effect on SWS, including ones as common as caffeine and alcohol.

A titration with a lot of REM might mean little SWS showing up, but that's generally nothing to worry about, as I understand it. I think that sleep architecture doesn't start to calm down and balance out for some people until they are used to PAP therapy and sleeping a few weeks in their own beds. But I could be wrong.

Don't listen to me, though--I'm not sure I even qualify as a "layperson" yet.

jeff

ps- As for when the AASM feels it reasonable to try BPAP (bilevel), here are their statements:

(12) If the patient is uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP. If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP.

http://www.aasmnet.org/Resources/Clinic ... 040210.pdf

brain_cloud wrote:If anything amusing transpires (and how could it not?), I'll post it tomorrow.

Nothing amusing happened at all. Today it was a different RT on duty, and she seemed okay. I went in; she scrutinized the order with a puzzled look on her face for a bit like she wasn't sure what to do. Then she tried to recalibrate my S8 to put out 21cm (an idea Jules floated), but said she couldn't get it to go above 20. Then she thought of the altitude adjustment on an Escape or Respironic M Plus (I think), but said I would be giving up a lot to get that extra 1cm. Finally, she said she would jerry-rig one of those older machines and I could try it out for a couple of weeks as a loaner (but I keep my S8) and then get together with my doctor and decide where to go from there.

So I'll just use that for a day or two, call my doctor and say this is killing me, and maybe then he'll write the script for the bilevel.

Sorry for no droll hijinks and capers.

brain_cloud wrote:So I'll just use that for a day or two, call my doctor and say this is killing me, and maybe then he'll write the script for the bilevel.

Sorry for no droll hijinks and capers.

Is the doc just beatin you out of your co-pay?

I would have to find another doc but hey that's me. Oh and another DME, this one should have certainly called the doc to straighten this out, on the spot.

Just be grateful neither are doing medical emergencies.

GumbyCT wrote:

brain_cloud wrote:So I'll just use that for a day or two, call my doctor and say this is killing me, and maybe then he'll write the script for the bilevel.

Sorry for no droll hijinks and capers.

Is the doc just beatin you out of your co-pay?

I would have to find another doc but hey that's me. Oh and another DME, this one should have certainly called the doc to straighten this out, on the spot.

Just be grateful neither are doing medical emergencies.

Gumby, I gotta feelin' that if you had been in the room with that RT, there may very well have BEEN a medical emergency!

GumbyCT wrote:

brain_cloud wrote:So I'll just use that for a day or two, call my doctor and say this is killing me, and maybe then he'll write the script for the bilevel.

Sorry for no droll hijinks and capers.

Is the doc just beatin you out of your co-pay?

I would have to find another doc but hey that's me. Oh and another DME, this one should have certainly called the doc to straighten this out, on the spot.

Just be grateful neither are doing medical emergencies.

I think he is more of a neurologist and less of a sleep doctor, but I do plan to let him go. And when it comes to the nuts and bolts of machines and guidelines, he frankly admits to being at sea. Also, he doesn't look at data; he is more governed by general principles. Usually they are in the form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight." Stuff like that. Did I mention he is rather old?

brain_cloud wrote: Did I mention he is rather old?

Whoops, no offense to the old people on the forum. Some of my best friends are old people. Yes sirree, I loves me the oldsters.

brain_cloud wrote:Usually they are in the form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight." Stuff like that. Did I mention he is rather old?

NO, he did not really say that!! If so, that is hilarious! (BTW, I get the headache in the morn', but what does the headache at night part mean?)

OK, this totally has to go on that thread that someone was supposed to start with the ridiculous things DMEs and doctors have said. Who was supposed to start that thread again? OK, I'll start one. Please post to this thread:

viewtopic/t52312/Ridiculous-quotes-and- ... -DMEs.html

SleepingUgly wrote:

brain_cloud wrote:Usually they are in the form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight." Stuff like that. Did I mention he is rather old?

NO, he did not really say that!!

Sorry, sorry, no that is just me joking around without making it clear. Everything was serious until I got to the word "sea". Then my mind works by association and almost no inhibition (my boss is always having to put out fires that I caused). And of course "sea" brings to mind old sea-farer's sayings, right? But then I wasn't able to actually bring it off with something that made sense.

That's it. No more trying to be funny. It always blows up in my face.

SleepingUgly wrote:

brain_cloud wrote:...form of rhyming sayings, like "Headache in the morn', cpapper take warn', headache at night, cpappers delight."

NO, he did not really say that!! If so, that is hilarious! (BTW, I get the headache in the morn', but what does the headache at night part mean?)[\quote]
Sailer's adages about sky conditions predicting the weather.

OK, Cloud Brain, now I understand. But you could still post on that thread how your doctor wrote you an Rx for a pressure of 21.