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NotMuffy · Post by **NotMuffy** » Fri Jan 21, 2011 6:55 am

secret agent girl wrote:I'm getting this image of a shovel...

You got that right. Another 6 inches of snow this AM.

Gumbo! Grab your shovel and get your DA up here!

Oh well, into oblivion...

...again.

jnk · Post by **jnk** » Fri Jan 21, 2011 7:11 am

secret agent girl wrote:. . . pills. I take them at night . . . don’t know if I was taking [___________], but if I was, I took that at night. . . .

Dr. Park believes in "nothing but water within four hours of going to bed," whenever possible and practical for people with sleep troubles, in order to help stabilize sleep, if I understand him correctly.

secret agent girl · Post by **secret agent girl** » Sat Jan 22, 2011 1:09 pm

secret agent girl · Post by **secret agent girl** » Sat Jan 22, 2011 1:10 pm

secret agent girl · Post by **secret agent girl** » Sat Jan 22, 2011 1:13 pm

NotMuffy · Post by **NotMuffy** » Sun Jan 23, 2011 5:36 am

In re: the NPSG raw data, on the diagnostic portion of the NPSG there are only hypopneas. These may be obstructive or central (or even artifact). On the treatment portion of NPSG, there are mixed apneas (and tons of them). True MAs are quite rare. Plus, it's odd that obstructive hypopnea would advance to obstructive apnea (part of an MA needs to be an OA) in the face of PAP.

Also, ("IMHO") the sleep needs to be microanalyzed. Looking at the quality of sleep within each individual epoch.

Here's what I think the approach should be:

Post a month of current respiratory data including detailed graphs and summaries.
If respiratory events are controlled then CompSAS discussion is interesting but totally historical (sometimes it resolves on its own, and apparently you haven't had an issue with this for a year).
The summaries will be reviewed for Total Sleep Time (TST) opportunity. Just because you're using CPAP obviously doesn't mean you're sleeping, or sleeping well.
Start keeping a sleep log.
It may be very beneficial to consider the use of Actigraphy. This would measure long-term sleep/wake if enough information isn't revealed by sleep log
The medication decision should be held until it is decided what the goals of medication are-- getting asleep, staying asleep, what portion of the night needs addressing, how long the medication period should be, is the sleep-SDB interface the thing that needs to be treated, how will the NPSG data be interpreted if it is influenced by medication-- stuff like that.

ozij · Post by **ozij** » Sun Jan 23, 2011 6:14 am

secret agent girl wrote:Questions about suitability of ResMed machines for primarily hypopnea OSA:

ozij wrote: (from another thread) Hypopneas do not cause a rise in pressure on the ResMed algorithm -- only apneas , snores, and flow limitations do.
I thought that there are flow limitations with hypopneas...? I have an S8 and experienced primarily hypopneas during my sleep study. If the ResMed algorithm is keeping the S8 from responding to them, maybe that's not the best machine to be using and why I didn't experience improvement?

You did say, consistently, that your AHI on the S8 was great - that means the alrorithm's response to flow limitations managed to pre-empt hypopneas. The S8 tends to score hypopneas more generously for many (I even think most) people, but it did not do so in your case - so it doesn't look like residual hypopneas are your issue.

secret agent girl · Post by **secret agent girl** » Sun Jan 23, 2011 1:00 pm

Banned · Post by **Banned** » Sun Jan 23, 2011 2:17 pm

secret agent girl wrote:Care to say ("IYHO") what pressure cpap/apap might be a good starting point, based on the summary data I posted previously in this thread?

That's my girl, dial wingin' time!

HoseCrusher · Post by **HoseCrusher** » Sun Jan 23, 2011 3:35 pm

secret agent girl, some people consider the fitbit as kind of a "poor mans" actigraphy monitor. I am not familiar with either, but just thought I would throw it out. It has been discussed here before and you can find more information on it using the search function.

Both units operate on the same principle, so the major difference would be how the data is interpreted. I did notice on the fitbit web site that some people were reporting a correlation between sleep study and fitbit data.

NotMuffy · Post by **NotMuffy** » Mon Jan 24, 2011 6:54 am

secret agent girl wrote:...will dust off the machine and start using it again.

So I guess

secret agent girl wrote:...Started on December 16, 2009 and used for 7 weeks.

means you got nothing since last February?

secret agent girl wrote:...Care to say ("IYHO") what pressure cpap/apap might be a good starting point, based on the summary data I posted previously in this thread

Anything that gets the machine out of the closet and on your face.

secret agent girl wrote:...The Actigraphy is outside my budget. Should I ask my dr to "prescribe" this...

Yes, if the point about sleep quality cannot be made by the Sleep Log.

secret agent girl wrote:...ideas of other things I should request while I'm at it...?

A way to get your BMI to <25. Unless you address Total Health, all of this is a BFWOT.

secret agent girl wrote:...BTW, would you be willing to post or pm me with your opinion of Dr Krakow?

Good insomnia guy. Not particularly mechanical.

NotMuffy · Post by **NotMuffy** » Mon Jan 24, 2011 7:05 am

NotMuffy wrote:
secret agent girl wrote:...will dust off the machine and start using it again.
So I guess

secret agent girl wrote:...Started on December 16, 2009 and used for 7 weeks.
means you got nothing since last February?

That said (y'know, I never said "that said" before I saw -SWS saying it. Now it's like I can't stop.), I'm not digging up the horse.

Reminder:

NotMuffy wrote:
secret agent girl wrote:I've read about the increased risk of the many potential adverse health repercussions of not treating OSA. I hear 'em--loud and clear. Please resist repeating them to me; that horse is dead.
Not only will I not repeat them to you, I will take a somewhat opposing view.

It is not clear what the long term benefits of treating OSA with AHI < 20 (or for that matter even < 30) really are. I mean, the big Yaggi study showed the incidence of catastrophic events didn't appear until AHI >36! And that was with treatment!

What can be shown, however, is that mortality increases with inadequate sleep (or for that matter, too much sleep). Kripke:

So "IMHO" (saying "IMHO" is a kind of cop-out in case one says "the wrong answer") if you've gone from 7 hours of sleep before treatment to 5 hours of sleep with treatment, now you have added "potential adverse health repercussions".

(BTW, while you mention your AHI is 70, take a closer look to see if that's correct, and that's not the total number of events.)

secret agent girl · Post by **secret agent girl** » Mon Jan 24, 2011 7:21 am

secret agent girl · Post by **secret agent girl** » Mon Jan 24, 2011 7:27 am

jnk · Post by **jnk** » Mon Jan 24, 2011 7:31 am

I am learning from this discussion.

Thanks to you both.

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Re: Dr Krakow--Have you had appt/consult with him?

Re: Dr Krakow--Have you had appt/consult with him?

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Re: Dr Krakow--Have you had appt/consult with him?

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Re: Dr Krakow--Have you had appt/consult with him?

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Re: Dr Krakow--Have you had appt/consult with him?