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NotMuffy wrote:OK, time for a quiz:

My score was 12.

NotMuffy wrote:OK, time for a quiz:

The Epworth Sleepiness Scale

That was on my questionnaire for my first sleep study. Looking back, I scored a 16. I also rated myself 8 out of 10 for daytime sleepiness.

Life is short, and this article saved vlaubale time on this Earth.

Paper_Nanny wrote:

NotMuffy wrote:OK, time for a quiz:

My score was 12.

As a tool to try to differentiate "fatigue" from "sleepiness", "IMAYULOPHO", with this result I think it would be extremely difficult to put all of the blame on "how you feel" solely on "sleepiness".

Further, we only need a couple of points to get you into "normal", and these may easily come from some of the aforementioned suggestions.

There's a bunch of homework that still needs to be passed in, so let's see what that brings.

NotMuffy wrote:

Paper_Nanny wrote:

NotMuffy wrote:OK, time for a quiz:

My score was 12.

As a tool to try to differentiate "fatigue" from "sleepiness", "IMAYULOPHO", with this result I think it would be extremely difficult to put all of the blame on "how you feel" solely on "sleepiness".

Difficult yes, and downright silly to even try. I have never meant to convey as my belief that "how I feel" is solely because of sleepiness and not at all bcause of fatigue. I have meant to say that I am trying to fix the sleepy by taking care of problems related to breathing (or not) while sleeping, sleep architecture abnormalities, etc.

I have meant to convey as my belief that here is an underlying level of fatigue that cannot be addressed with better quality sleep. I believe that even if I had perfect sleep, I would still experience fatigue associated with ms. Sleep will not fix my damaged CNS.

I have also meant to convey as my belief that I can subjectively tell the difference between "sleepy" and "fatigue". People who have never experienced the fatigue associated with ms often don't understand that it feels different than being tired. People without ms will refer to being "fatigued" but the referent is different.

NotMuffy wrote:Further, we only need a couple of points to get you into "normal"

NotMuffy wrote:There's a bunch of homework that still needs to be passed in, so let's see what that brings.

I can only remember coming up with the list of questions for my appointment with My Sleep Doctor, the review of my drug list by a sharp pharmacist, and finding the other two "suggestions". What else is in the bunch?

Deborah

Paper_Nanny wrote:

NotMuffy wrote:There's a bunch of homework that still needs to be passed in, so let's see what that brings.

I can only remember coming up with the list of questions for my appointment with My Sleep Doctor, the review of my drug list by a sharp pharmacist, and finding the other two "suggestions". What else is in the bunch?

That should do it!

And I'm sure that within those answers there'll be enough to get you down to an "8"!

Good luck!

Guest wrote:What kind of trained professional is Muffy? . . .

A helpful one.

NotMuffy wrote: If time is infinite before us, and time is infinite after us, the liklihood of being alive at a point along the continuum such that you would be aware of your existence is absolutely impossible.

Science fiction goes on one shelf; theology, on another. It's a rule. Unless you work at the Adjustment Bureau.

jnk wrote:

Guest wrote:What kind of trained professional is Muffy? . . .

A helpful one. ...

Great answer! I would also add, a very knowledgeable professional, as well.

jnk wrote:

NotMuffy wrote: If time is infinite before us, and time is infinite after us, the liklihood of being alive at a point along the continuum such that you would be aware of your existence is absolutely impossible.

Science fiction goes on one shelf; theology, on another. It's a rule. Unless you work at the Adjustment Bureau.

What?! And all these years, I thought they were one in the same. Of course, reading "A Canticle for Liebowitz" in my teens may have given me an unusual start to my science fiction reading.

You don't increase EPAP min for hypopneas. EPAP min should only be increased for OA's. Due to your underlying medical hx, you probably need more help with pressure support, so I would try increasing your PSmin to 3. Keep the PSmax at 15. Decrease your EPAPmin to its original setting of 8 and increase the EPAPmax to 18. You should always keep the EPAP min/max range at 10, so if you increase the EPAPmin to eliminate OA's, then increase the EPAPmax by the same amount to keep that range at 10. As with any medical condition, always consult with your doctor prior to making changes to your ASV. Good luck and I hope this helps you to understand this process a little more.

NotMuffy wrote:

Paper_Nanny wrote:

NotMuffy wrote:There's a bunch of homework that still needs to be passed in, so let's see what that brings.

I can only remember coming up with the list of questions for my appointment with My Sleep Doctor, the review of my drug list by a sharp pharmacist, and finding the other two "suggestions". What else is in the bunch?

~~snip~~
Good luck!

I checked in with the pharmacist today. She said there is nothing in the data base she uses for drug information about the effects on REM sleep. Only sleep related thing should could find was that insomnia is a side effect of some of the medications I take. So... What to do?

I could look for information myself on the wide wide world of the internet.

I could make an appointment with my neurologist, who is the physician most responsible for medication management. Based on my last appointment with him, I do not think he knows much about the sleep related side effects of the drugs he has prescribed to me. But, he is an emplyee of the hospital and perhpas has access to pharmaeutical resources that I cannot directly access on my own, for example, the hospital pharmacist.

Suggestions on how to proceed, please!

Deborah

NotMuffy wrote:

Paper_Nanny wrote:

NotMuffy wrote:There's a bunch of homework that still needs to be passed in, so let's see what that brings.

I can only remember coming up with the list of questions for my appointment with My Sleep Doctor, the review of my drug list by a sharp pharmacist, and finding the other two "suggestions". What else is in the bunch?

That should do it!

And I'm sure that within those answers there'll be enough to get you down to an "8"!

Good luck!

I have been going through all of your posts in this thread in order to come up with my list of questions and to find the other two "suggestions". Also hoping that if I read the information over a few more times, I will understand more of it. In reading back over everything you have posted here, I have come across a few "miscellaneous bits of confusion."

This is one MBoC. On Thu Jul 14, 2011, in posts at 6:42 pm and 7:05 pm,

NotMuffy wrote:No, seriously, take a big, deep breath, exhale and hold that exhalation until you feel the urge to inhale again. Count the number of seconds from the end of that exhalation to the beginning of the needed inhalation. If that time span was 10 seconds or more, that was a central apnea (not really, you'd need to be asleep, but pretend).

MBoC: Why do people have to be sleeping for a central apnea event to occur? It seems like there could be cases in which someone were awake and having central apnea events. And, if it is only when someone is asleep, then what would it be when someone is awake and not breathing because of a irregularity in brainstem functioning? And is there a name (other than "normal") for when somoene is awake and experiences a pause in breathing, because of distraction, for example?

NotMuffy wrote:The response to the large breath was normal. The body needs to build up CO2 and then a regular breathing pattern resumes. This phenomenon occurs following an "arousal" - a sleep disturbance that causes a deep breath, or "sigh" followed by a compensatory pause.

Are there causes other than "arousals" for "sighing" while asleep? "Arousals" are identifiable by a change in EEG. Do you know if "sighing" while awake correlates with changes in EEG?

Enough confusion for one post. Thank you in advance for any clarifying information you see fit to bestow upon me.

Deborah

Paper_Nanny wrote: . . . the other two "suggestions". . . .

My interpretation of "suggestions": (1) Check your response to low-level CPAP; (2) explore possibilities of present drug influence on your sleep; (3) work on sleep-hygiene issues in order to "pass" Epworth's crazy quiz. But I could be wrong. I often am. But that's OK. It can still help move a discussion along.

Paper_Nanny wrote:

NotMuffy wrote: . . . If that time span was 10 seconds or more, that was a central apnea (not really, you'd need to be asleep, but pretend).

MBoC: Why do people have to be sleeping for a central apnea event to occur? . . .

(bolding mine)

I believe the "not really" statement was (1) partly in view of the 10-second rule, which is for sleep, not wake, and (2) partly in view of the fact that during wake when one chooses to behaviorally control breathing by choosing to sigh, one has mostly entered the realm of metaphoric comparison to sleep-breathing rather than the realm of a true demonstration of exactly what happens during sleep. I very much respect NotMuffy for always being that careful in his teaching about the matter. Good stuff. Perfect illustration. Especially when qualified like that.

An overview that I found enlightening, myself:

http://emedicine.medscape.com/article/3 ... view#a0104

I did a brief search but could not find a reference. I recall I read somewhere that sighing is built in to our sleep by design. Apparently in normal sleep its necessary to sigh periodically to preserve integrity of smallest airways during sleep. Anybody else remember reading that?

Paper_Nanny wrote:I have been going through all of your posts in this thread in order to come up with my list of questions and to find the other two "suggestions". Also hoping that if I read the information over a few more times, I will understand more of it. In reading back over everything you have posted here, I have come across a few "miscellaneous bits of confusion."

jnk wrote:(2) explore possibilities of present drug influence on your sleep;

From previous posts:

NotMuffy wrote:

rested gal wrote:I think this might count as a second "suggestion"...

That would be more like "treatment optimization", and it may be that nothing will be able to be done there.

jnk wrote:(3) work on sleep-hygiene issues in order to "pass" Epworth's crazy quiz.

That quiz is crazy. As am I. Quizes like that are difficult for me to figure out the answers. Two examples off of the Epworth Sleepiness Scale. "Lying down to rest in the afternoon when circumstances permit." For me, that is an obvious "3- high chance of dozing" because the only reason I lie down to rest in the afternoon is if I am very tired, wiped out, need to sleep.

If it were a regular day, I wasn't particularly tired, but for some reason I had to lie down to rest in the afternoon, the answer would be "0-- no chance of dozing." I scored that question a three, because it is the score for the circumstance most closely resembling My Real Life.

"As a passenger in a car for an hour without a break." I answered that question also for circumstances most closely resembling My Real Life. Taking into account where I live, the only reason I would be a passenger in a car for an hour is because I was going on or returning from a longer trip or I was going to or returning from the lake. Going, I would have gotten up early and would be tired from that. Returning, I'd be sleeping because of the unusually high activity level. So, I scored that one three also.

Am I reading too much into the questions? Maybe. That thought did cross my mind while taking the test, but I don't know how to make sense of the questions otherwise.

jnk wrote:I very much respect NotMuffy for always being that careful in his teaching about the matter. Good stuff. Perfect illustration. Especially when qualified like that.

Yes, that level of precision is but one of the many reasons I respect NotMuffy. My question is could an irregularity in brain stem functioning cause apnea while someone was awake. I gather that the answer is no, that wouldn't happen, because there would be behavioural override of that irregularity. Is that a more correct way to look at this?

Deborah