wallowing in self-pity :( UPDATE pg. 4 doing better today

NotMuffy · Post by **NotMuffy** » Sun Apr 10, 2011 8:52 am

BTW, do you have a Dillon? I think we're going to need one.

SleepingUgly · Post by **SleepingUgly** » Sun Apr 10, 2011 8:55 am

First of all, why do you have trouble swallowing pills?

Secondly, what is the depakote for?

A reputable sleep doc once told me that I have aerophagia because I have GERD (which I don't have, as far as I know). He told me to elevate my head by sleeping on a wedge. But also said that taking a PPI (a proton pump inhibitor) would help the aerophagia. An equally reputable gastroenterologist said that taking a PPI will not help aerophagia. I do sleep on a wedge since then, and I went on a PPI when I was taking prescription NSAIDS, and even though I went off the NSAIDS, I haven't gone off the PPI yet because I didn't want to introduce another possible variable on the unlikely chance that I have silent GERD causing arousals. At some point I will go off, once I'm at a baseline and will know whether I worsen off them. I take prescription Dexilant, and it is a small capsule that opens up, although I don't know if that's a recommended way of taking it. It's a once a day pill that doesn't have to be taken at any particular time. Prilosec works best if taken 30-60 minutes before meals.

If you want to learn about the relationship between UARS and functional somatic syndromes, look up research by Dr. Avram Gold, and you can listen to his recent presentation through the link here:

viewtopic.php?f=1&t=61702&p=579855&hili ... nk#p579740

Remind me why you had a sleep study if you were asymptomatic?

SleepingUgly · Post by **SleepingUgly** » Sun Apr 10, 2011 8:56 am

NotMuffy wrote: Hope you're feeling better today.

I'll pass along my support and well-wishes, as well as a muffin-hug:

~~~~~~~hugs~~~~~~~~

WOW! A hug from NotMuffy!

How do I get in on THAT?

NotMuffy · Post by **NotMuffy** » Sun Apr 10, 2011 8:59 am

Migraines.

And she didn't even move her lips.

NotMuffy · Post by **NotMuffy** » Sun Apr 10, 2011 9:14 am

Although one might argue that if the migraines are a part of the FSS constellation, why aren't they better with xPAP. Or are they?

robysue · Post by **robysue** » Sun Apr 10, 2011 9:26 am

NotMuffy,

The summary graphs are now scanned. I still have to edit out the personal info and post. I'll do that after we return from church.

Thanks for letting me know you were talking about apneas during REM. On four sleep tests, all of which have at least 15 minutes of REM, I have NEVER had an apnea scored during REM. Only "hypopneas with arousal"

And yet, the vast majority of the events scored by both the Resmed S9 AutoSet and the PR S1 BiLevel Auto are scored as "OAs". Another things that has puzzled me right from the start.

So when I post the summary graphs---you only want the diagnostic ones? Or the titration studies too?

I appreciate your taking the time to look at this.

Robysue

robysue · Post by **robysue** » Sun Apr 10, 2011 12:42 pm

The migraine seems to have abated while at church.

The stomach is better, though I do not know if it is the generic prilosec OTC I managed to choke down this morning or the fact that I've had two rather large bowel movements today. (sorry for the graphic details, but we are all family here)

And so while I'm extremely tired (3 1/2 hours of sleep wth an AHI of 2.8 will do that to you), I've decided to go outside on this overcast day and try to get the lettuces, some peas, and possibly some carrot seed planted in the pots I must use to grow my veggies because our small yard is so shaded.

To NotMuffy, I have the sleep study summary graphs and data scanned, but still need to edit out my personal idenitifying features. I'll most likely do that tonight and post them to a new thread rather than the end of this one.

Thanks again to all for the warm words of support and caring. Although this forum is not face to face and I crave that, I cannot express just how grateful I am to all of you cyber-family going through this misadventure with me.

avi123 · Post by **avi123** » Sun Apr 10, 2011 2:25 pm

Roby, all the issues besides the migraines seems to me to be just kvetching about. All those OVC Rx that you mentioned I take daily for years including two Prilosec and Vitamin D (50,000 units weekly) just to be healthy. Prilosec is a miracle drug which avoids getting the Barrett Syndrome and esophageal cancer which is deadly.

During the first month on CPAP, for those regular headaches I took two Tylenol Arthritis at a time. For that ingested air I took two Pepto Bismol at a time. All of it worked fine. Now, at the fourth month I no longer have them. During some days I also take an hourly nap with or without the CPAP. No problem. Now to the AHI. Even if you had AHIs between 10 and 15 as I do then since you're using a XPAP with FOT (I think) or without FOT, you should not be affected by the obstructive and hypos events. This is b/c the pressure, if set correctly, opens them up and you don't desaturate yourself by lack of Oxygen. So why are you so occupied by a few of those events?

I wonder if changing XPAP pressures, often, works like withdrawals from some Rxs, headache wise?

About the Insomnia, which I guess that you had also before CPAPing, imo, it's NOT the RT, or the Clinician, Sleep Doc, Neurologist, etc. to deal with it but a real Psychiatrist ala Ziggi. So what if again you take Benzo or non-Benzo for a year until you sort things out?

Regards.

rested gal · Post by **rested gal** » Sun Apr 10, 2011 2:26 pm

OutaSync wrote:
robysue wrote:And all I can say is that last fall when the ENT did the endoscope looking down thru the nose and the upper air way, he sure didn't mention anything about GERD. And yes, he knew I was on CPAP at the time. And not doing well on it.
My ENT said the endoscope did not go down as far as the esophogael spincter. I had to go to a gastrointestinal doctor for a lower scope. They had me do some swallowing tests where I swallowed some radioactive (I think that is what they called it) oatmeal and sat up until it went down to my stomach and then laid down and watched it on the screen come right backup. I didn't believe I had GERD until I saw that.

Very interesting, Bev. Thanks for explaining the difference in how far an ENT's endoscope goes, vs scoping by a gastrointestinal specialist.

robysue wrote:tonight I asked hubby to go buy some OTC Prilosec since I thought running through a course of the OTC stuff would be a good experiment for seeing if GERD really is part of my aerophagia problem. And imagine my great disappointment when I opened the bottle and discovered they are horse pills that cannot be crushed or bitten. Nor can the capsules be opened and sprinkled on food

OutaSync wrote:The namebrand Prilosec OTC pills are smallish (certainly not horse pills), easily swallowed pink pills.

Right. The Prilosec OTC I've bought comes in a box containing foil packets of small, pink coated, oval shaped tablets... not a bottle of capsules. Just now snapped one of the little pink pills in half with my fingers. Then cut a whole one repeatedly with a knife it to see if it could be chopped down into tiny particles. (yes)

BlackSpinner · Post by **BlackSpinner** » Sun Apr 10, 2011 2:55 pm

robysue wrote:The migraine seems to have abated while at church.

The stomach is better, though I do not know if it is the generic prilosec OTC I managed to choke down this morning or the fact that I've had two rather large bowel movements today. (sorry for the graphic details, but we are all family here)

One of the things migraine does is shut down ones digestive system, which is why one is told to take the nasty zombie making (to me) medication on the first hint of possibly getting one, (advice I usually ignored), in order to actually get the medication into your blood stream.

avi123 · Post by **avi123** » Sun Apr 10, 2011 3:08 pm

rested gal wrote:
OutaSync wrote:
robysue wrote:And all I can say is that last fall when the ENT did the endoscope looking down thru the nose and the upper air way, he sure didn't mention anything about GERD. And yes, he knew I was on CPAP at the time. And not doing well on it.
My ENT said the endoscope did not go down as far as the esophageal sphincter. I had to go to a gastrointestinal doctor for a lower scope. They had me do some swallowing tests where I swallowed some radioactive (I think that is what they called it) oatmeal and sat up until it went down to my stomach and then laid down and watched it on the screen come right backup. I didn't believe I had GERD until I saw that.
Very interesting, Bev. Thanks for explaining the difference in how far an ENT's endoscope goes, vs scoping by a gastrointestinal specialist.

OutaSync wrote:The namebrand Prilosec OTC pills are smallish (certainly not horse pills), easily swallowed pink pills.

Right. The Prilosec OTC I've bought comes in a box containing foil packets of small, pink coated, oval shaped tablets... not a bottle of capsules. Just now snapped one of the little pink pills in half with my fingers. Then cut a whole one repeatedly with a knife it to see if it could be chopped down into tiny particles. (yes)

I don't think that you're supposed to crash those Prilosec tablets but swallow whole. IMO, they are small compared to other tablets such as the anti anxiety Gabapentin 300 mg, which I got at one time but decided not take. BTW, I don't think that Roby should take Melatonin while taking the other stuff.

As to getting those Prilosec tablets out of the Al wrapping, I cut with regular paper scissors one side (tangential cut) of those pockets ca coons together with the plate in straight lines. I do it on all the three plates in a box. So I end up with about 30 strips each containing one row of tablets. Then I use one edge of the scissors to pry out each tablet and put it in a vial. Thanks G-d that Porcter& Gamble agreed to take over the purple pills and provide them OTC.

SleepingUgly · Post by **SleepingUgly** » Sun Apr 10, 2011 3:24 pm

NotMuffy wrote:Migraines.

And she didn't even move her lips.

Is this an answer to the question of why she had a sleep study if she was asymptomatic?

If so, have the migraines decreased at all on CPAP, even if they haven't remitted completely?

Finally, IF a person is completely asymptomatic (I don't know if RobySue fits that or not) without CPAP, AND they do not desaturate, what is the point of CPAP? It's not to address symptoms in an asymptomatic person, and it's not to prevent the known cardiovascular risks associated with desaturations, so what is the point? I am really asking, as I just don't know.

NotMuffy · Post by **NotMuffy** » Sun Apr 10, 2011 4:01 pm

rested gal wrote:The Prilosec OTC I've bought comes in a box containing foil packets of small, pink coated, oval shaped tablets... not a bottle of capsules. Just now snapped one of the little pink pills in half with my fingers. Then cut a whole one repeatedly with a knife it to see if it could be chopped down into tiny particles. (yes)

"TS", my recollection of Pharmacy 101 is that you don't want to take a "slow" or "timed" release drug and bust it up and swallow it, lest you'll get 24 hours worth of drug in about an hour.

-SWS · Post by **-SWS** » Sun Apr 10, 2011 4:04 pm

Robysue, I just went looking for your SDB details and found this earlier post of yours with a treasure trove of PSG details:
viewtopic.php?f=1&t=55636&p=520725&sid= ... 5f#p520725

I'll link to it so that other readers might become more familiar with your PSG details toward offering ideas in this or upcoming threads. I must also apologize that post went unanswered.

robysue wrote:I'm a newbie here. I apologize in advance for the length of my posting about my sleep studies.

I've now had two sleep studies done, one baseline and one with titration. After a brief tussle with my sleep doctor's office, I've now got copies of the reports, but not the full studies. Having been reading a lot about sleep apnea both here and elsewhere, I'm pretty sure I understand most of the things on the report, but I am confused by a few things under the Respiratory Analysis and Movement & Arousals sections of the summarized data.

So here's the brief version of the original study without CPAP:

EEG/EOG
Latency to sleep onset was slightly prolonged at 55.8 minutes.
Latency to REM sleep was prolonged at 159.0 minutes.
Overall sleep efficiency was 69.7%
# REM Periods: 1
#Stage Transistions: 41
#Awakenings: 13
Total sleep time in Stage1: 8.6%
Total sleep time in Stage2: 71.9%
Total sleep time in Stage3: 9.4%
Total sleep time in REM: 10.1%
Patient was observed in both supine and non-supine positions.
Frequent arousals were present and were commonly associate with respitory events.
All stages of sleep were identified.

Repiratory Parameters:
Baseline respiration rate was 12-14 breaths per minute in REM and 12-18 breaths per minute in NREM sleep.
Soft snoring noted by technician.
Overall respiratory disturbance index was 23.1 with a minimum oxyhemoglobin saturation of 91%.
Mean oxyhemoglobin saturation was 96%

EKG:
Baseline heart reate was 66 beats per minute in REM and 64 beats per minute in NREM sleep.
No significant EKG abnormalities were observed.
Mean Pulse (beats per minute) for total time in bed: 65.3
Min. Pulse (beats per minute) for total time in bed: 55.4
Max Pulse (beats per minute) for total time in bed: 97.3

EMG:
7.0 periodic limb movements per hour of sleep noted. They were rarely associated with arousals.

Interpretation:
These findings indicate the presence of moderate obstructive sleep apnea consisting mainly of apneas and hypopneas, with associated disruption in sleep architecture and minimal oxyhemoglobin desaturation. (RDI: 23.1 and minimum oxyhemoglobin desaturation: 91%).

Additional Data of Respiratory Analysis
There's a table that looks like this:
Code: Select all
Type                       NREM count     REM count     Total Count     Total Index
Central Apneas:               0               0             0              0.0
Obstructive Apneas:          14               0            14              3.5
Mixed Apneas:                 0               0             0              0.0
Hypopneas:                   71               7            78             19.6
Hypopneas w/ Desat:           0               0             0              0.0
Hypopneas w/ Arousal:        71               7            78             19.6
Apneas + Hypopneas:          14               0            14              3.5
Supine Events:                -               -             7             15.3
Nonsupine Events:            -                -            85             24.2

AHI = (OA + CA + MA + OH w/desat) per hour of sleep:
AHI NREM:  3.9
AHI REM:   0.0
AHI total: 3.5

RDI = (OA + CA + MA + OH w/arousal + OH w/desat) per hour of sleep:
RDI NREM:  23.8
RDI REM:   17.5
RDI total: 23.1
Additional Data on Movements & Arousals:
This is in a table that looks like this:
Code: Select all
type                      NREM count   NREM index     REM count     REM index    Total count    Total index
Total PLMs:                 28             7.8             0           0.0           28            7.0
PLM Arousals:                1             0.3             0           0.0            1            0.3
Respiratory Arousals:       71            19.9             7          17.5           78           19.6
Spontaneous Arousals:       11             3.1             3           7.5           14            3.5
Total Arousals:             83            23.2            10          25.0           93           23.4
So here are my questions:
1) I'm real confused about why the Hypopneas with arousal don't seem to be counted in the AHI. They're clearly counted in the RDI. Any ideas or comments on why they're not counted in my AHI?

2) What's a Spontaneous Arousal? Do they show up in the AHI? the RDI?

Sleep study done with CPAP titration results
On the sleep study with the CPAP titration, the sleep doctor's report indicates that once the pressure was set at 9cm of H20, "supine sleep was noted and the overall respiratory disturbace index (RDI) was reduced to 0 with a minimum oxyhemoglobin saturation of 95%" The chart showing sleep position also shows that this is the FIRST time that night that I'm asleep on my back. I don't like sleeping on my back because it makes my lower back hurt. Total time at 9cm was only 30 minutes and included no REM. Should I be concerned about this at all?

Also on the titration sleep study, the EEG/EOG notes say: "Latency to sleep onset was prolonged at 61.4 minutes. Latency to 1st REM sleep was within normal limits at 93.5 minutes. Overall sleep efficeincey was diminished at 73.7%. The patient was observed in boht the supine and non-supine position. Frequent spontaneous arousals were present." The sleep report also says:
# REM periods: 2
# Stage Transistions: 44
# Awakenings: 15
Total sleep time in Stage1: 5.5%
Total sleep time in Stage2: 76.1%
Total sleep time in Stage3: 0.0% [That's not a typo--it really says zero.]
Total sleep time in REM: 18.3%

All the numbers listed in the Respiratory Analysis section went down. Total PLMs and PLM arousals were 0. But the Spontaneous Arousals went way up:
Code: Select all
Total Arousals     without CPAP     with CPAP
NREM count:              11            20
NREM index:              3.1            5.8
REM count:               3             10
REM index:               7.5           12.9
Total count:             14            30
Total index:             3.5           7.1
So what does this mean? Is it unusual to have NO Stage 3 sleep during a sleep study? And why would my spontaneous arousals go up so much during the titration study? Could it simply be that the wires (and the mask) were bothering me more during the CPAP study? [Maybe because my breathing was bothering me less?] I do remember waking up several times that night with a super itchy nose and feeling like I needed to seriously rearrange the bedcovers too.

At any rate, I do have a second appointment with the sleep doctor scheduled in a couple of weeks. I'm hoping to have a CPAP at home by then, but I'm running into problems with my insurance/HMO/PPO not wanting to pay for a full data CPAP machine and I don't want to accept a basic level machine that only tracks compliance since I really think I need to be able to see that the CPAP machine is working on a regular basis in order to help me with compliance. At any rate, at that meeting with the sleep doctor, what kinds of things should I be insisting on having explained to me about either of the sleep studies?

Thanks in advance for any help you can give me.

rested gal · Post by **rested gal** » Sun Apr 10, 2011 4:35 pm

NotMuffy wrote:
rested gal wrote:The Prilosec OTC I've bought comes in a box containing foil packets of small, pink coated, oval shaped tablets... not a bottle of capsules. Just now snapped one of the little pink pills in half with my fingers. Then cut a whole one repeatedly with a knife it to see if it could be chopped down into tiny particles. (yes)
"TS", my recollection of Pharmacy 101 is that you don't want to take a "slow" or "timed" release drug and bust it up and swallow it, lest you'll get 24 hours worth of drug in about an hour.

Excellent point and good caution. I don't normally chop the already-small Prilosec tablets down into bits and pieces or even break them in half. I should have added "Don't try this at home!"

Was curious to see if those little pink pills could be broken at all, since back on page 2...

robysue wrote:I asked hubby to go buy some OTC Prilosec since I thought running through a course of the OTC stuff would be a good experiment for seeing if GERD really is part of my aerophagia problem. And imagine my great disappointment when I opened the bottle and discovered they are horse pills that cannot be crushed or bitten. Nor can the capsules be opened and sprinkled on food unlike my depakote capsules. Who the hell designs a pill the size of a small zepplin for a syndrome that includes difficulty swallowing as one of its primary symptoms anyway? I'm in tears again because I genuinely have no idea how the heck I'm going to choke these pills down the next fourteen days. Are the prescription ones any smaller?

Just wondered from robysue's description of what her husband brought back -- a "bottle" of "horse pills" -- if it was, indeed, the kind of Prilosec OTC I've seen and bought.

I suppose that just like "high pressure" is relative to how it feels to each person, "small pill" is relative to how it looks to each person. And, of course, how it goes down.

wallowing in self-pity :( UPDATE pg. 4 doing better today

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Re: wallowing in self-pity :( UPDATE pg. 3 doing better today

Re: wallowing in self-pity :( UPDATE pg. 3 doing better today

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Re: wallowing in self-pity :( UPDATE pg. 3 doing better today

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Re: wallowing in self-pity :( UPDATE pg. 3 doing better today

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