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BrianinTN wrote:I am trying to do better on the hygiene piece, as you saw from my previous post, but I find that to be very hard. Previously, it was the nature of my job (I headed up both US operations and several projects working with teams around the globe for my old company, which meant a lot of wacky hours and deadlines). Right now, it's school, which will end in June but has been stressful and exhausting in its own right and has made any sort of rhythm hard. And, add to all of that the fact that I am a stresser and a worrier, which often makes it impossible for me to settle down at night lest I toss and turn for hours. So, rather than that, I generally try to wait to get into bed until I'm ready to sleep.

Consequently, we must keep in mind the aforementioned tenets:

YOU CAN'T FIX BAD SLEEP WITH SURGERY!!!

and

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

mollete wrote: "IMHO", you'd need to double utilization to get to "decent"....
In order to expect equilibration to occur, the body must see the same thing every night.

I'll push back on this just a bit (despite it largely being semantic) because clearly I shouldn't need 1,000 nights to reach equilibrium. Sure, I'll grant that the lack of consistent sleep patterns meant that NONE of those periods were me giving myself exactly the same thing every night, for an extended period of time (days? weeks? months?). But surely there were SOME of those periods in between where I was giving myself quasi-consistency for weeks on end. So, if the answer is with time and consistency, one would posit I might have started to feel some improvement during one of those periods, yes? But the reason I would give up was that despite me doing what I was doing, my schedule was nuts, and I was feeling worse. Even right now, trying my best, the notion of a consistent bedtime is impossible. I hit the sack at 2:00 a.m. last night, and took a nap yesterday. Both were unavoidable because I needed to be clear headed to get stuff done yesterday.

mollete wrote: Is the ASV file uploadable?

It's the old PR machine, so there are no waveforms and no SD card. That means that, as far as I know, there are no direct ways to retrieve the raw data. The best I can do is paste Encore reports, or upload a patient export from Encore. Some of the old ASV Encore reports I pasted in an old thread are here, with DWing notes in red at the top of the pages (yes, if the equilibrium theory is true, I was giving it no chance to work -- but at the time, I was under the assumption, just as you mentioned earlier in this thread, that an ASV can figure out what it needs to do in a minutes):
https://dl.dropbox.com/u/15497133/asv_nightly.pdf
In case you're able to take the export of the Encore patient profile, here it is:
https://dl.dropbox.com/u/15497133/asv_EncoreExport.exp

mollete wrote: Consequently, we must keep in mind the aforementioned tenets:

YOU CAN'T FIX BAD SLEEP WITH SURGERY!!!

and

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

I guess I'd be curious:
1) What would qualify as acceptable sleep. I've read the posts in several of the past threads on the sleep hygiene issue, and have taken the hygiene/quality test you linked years ago (scored a 62). Just how much variation in bedtime is acceptable (or rather, unacceptable)? I do a excellent job on the food/alcohol before bedtime. Life stress, not so much.
2) What can a stressed, neurotic, working professional can realistically do here. Many of the people I'm in class with came from jobs that were 80-100 hours a week. I obviously don't want to get back to that sort of pattern, but see above on my unwillingness to be a "bump on a log" too.

Thanks, as always, for weighing in. Much obliged.

Got Stanford to work me in. They suggested I go to 5-9 on my pressure settings for now. They weren't too optimistic on an ASV helping much. They did seem to think that WINX or an oral appliance might help -- mentioned a guy who had a high AHI, but who started feeling better when he combined that with xPAP, where xPAP wasn't getting the job done by itself.

Check out the Winx thread. It may be possible to get the machine as a trial, and maybe inexpensively or through insurance if it works. MAD is another option. I have a feeling Stanford meant that you could use xPAP and MAD together, not Winx and xPAP. That would be very... stimulating... air coming in the nose, suction of the palate and tongue...two machines pumping and sucking all at the same time...

Winx would be out-of-pocket as best I can tell, so I'll go the oral appliance route first. There's an in-network doc who does his own. My guess, however, is that insurance will balk at paying with my AHI. Other than getting doctor letters raving about its likelihood to work for me and having exhausted all other options, any other suggestions for getting HealthNet to pony up?

BrianinTN wrote:Some of the old ASV Encore reports I pasted in an old thread are here, with DWing notes in red at the top of the pages (yes, if the equilibrium theory is true, I was giving it no chance to work -- but at the time, I was under the assumption, just as you mentioned earlier in this thread, that an ASV can figure out what it needs to do in a minutes)

Which it did. Your OAI and CAI were both </=1.0 during the entire period, and the HI showed a favourable trend:



at least, until "consistency" went out the window.

However, a review of sleep hygiene during that period could basically be summed up as "not".

To which I must add to my list of tenets:

mollete should have wrote:YOU CAN'T FIX BAD SLEEP WITH AN ASV MACHINE!!!

BrianinTN wrote:What would qualify as acceptable sleep.

Take everything you're doing now and do the opposite.

BrianinTN wrote:What can a stressed, neurotic, working professional can realistically do here. Many of the people I'm in class with came from jobs that were 80-100 hours a week.

That one you'll have to decide.

However, I'm reminded of the old adage

No one on his deathbed ever said “Gee, I sure wish I’d spent more time at the office.”

mollete wrote: Take everything you're doing now and do the opposite.

The log I pasted the other day wasn't acceptable? I thought my tolerances in terms of +/ on lights out and wake up weren't bad on average.

Also, none of this still really explains for me why I feel totally f'ing wiped out on xPAP, but functional (albeit lethargic) when not. I get that the effects are cumulative. But still.....

BrianinTN wrote:

mollete wrote: Take everything you're doing now and do the opposite.

The log I pasted the other day wasn't acceptable?

Log? I saw no log.

BrianinTN wrote:Sleep logs thus far:
Lights-out times: 11:45, 12:00, 11:30, 12:30
Wake-up times: 4:15/8:30 (woke up in middle of night and couldn't get back to sleep); 6:45, 7:30, 7:45

All food has been consumed at least 90 minutes before going to sleep. The one 90 minute food was just a small snack; 2 hrs 15 mins is the next incremental time.

Alcohol consumption on 2 of four days; 2 beers on each day, always at least 5 hours before bedtime

Oh that. That's more like a "branch".

We need "military" sleep hygiene. Sleep is aided by a number of components:



Eventually, everything needs to be lined up.

mollete wrote: We need "military" sleep hygiene.

As in exact same time every night and morning? C'mon, other than people in the military, who does that? In today's world, who can? The vast majority of people don't, and they function just fine. My classmates are grooving along with far nuttier schedules than me. So did most of my old coworkers.

Here is the complete food and sleep log.

Sunday, January 20 9:30 PM Chipotle burrito (barbacoa)
11:45 PM Lights out
Monday, January 21 4:15 AM Wake up; can't get back to sleep
5:30 AM maybe back to sleep
8:30 AM wake up
10:45 AM Chorizo
12:00 Gym
1:30 Protein milkshake, Jolly ranchers
3:45 Start nap
5:30 End nap
5:45 Popsicle
8:00 Tom Kha soup, Roaste Chili Beef
10:30 last bit of roasted chili beef
12:00 Lights out
Tuesday, January 22 6:45 AM Wake up
8:00 AM Granola bar
12:30 PM Protein milkshake
5:00 PM Salmon
6:00 PM French onion soup; small cup of red curry
9:00 Popsicle
11:30 PM Lights out
Wednesday, January 23 7:30 AM Wake up
10:00 AM Red curry
7:00 PM 2 beers, Indian (pakoras, tikka masala, lamb rogan josh)
12:30 AM Lights out
Thursday, January 24 7:45 AM Wake up
12:00 PM Indian leftovers
6:00 PM 2 beers; Mozzarella sticks; mushrooms; 10 boneless wings
11:45 PM Lights out
Friday, January 25 7:45 AM Woke up; went back to sleep
9:45 AM 2nd wake uo
2:00 PM Kung Pao chicken; Beef in spicy garlic sauce
8:15 PM 3 margaritas; taquitos; chicken wings; beef quesadillas
12:00 AM Lights out
Saturday, January 26 8:45 AM Wake up
12:15 PM Tacos
7:45 PM Baja chipotle chicken, au gratin potatoes, corn & mushrooms; with 2 glasses wine
9:45 PM 1 Beer
2:15 AM Lights out
Sunday, January 27 8:45 AM Wake up
9:00 AM 1/2 pear
1:00 PM leftover kung pao, beef in garlic sauce
3:30 PM 2 hour nap
8:00 PM beef short ribs; chicken wins; mashed potatoes
2:00 AM Lights out
Monday, January 28 8:00 AM wake up
11:30 AM woke back up
12:15 PM kung pao leftovers
7:00 PM kung pao leftovers; tom kha soup; basil chicken
12:45 AM Lights out
Tuesday January 29 6:45 AM Wake up
7:30 AM Protein milkshake
5:30 PM Margaritas; empanadas, kra prao leftovers
1:30 AM Lights out
Wednesday January 30 8:45 AM Wake up
12:00 PM Chicken and honey sandwich, shrimp
3:00 PM Nap
4:30 PM Wake up from nap

I think I figured out your problem: too wide a variety of ethnic food! j/k

BrianinTN wrote:

mollete wrote:We need "military" sleep hygiene.

As in exact same time every night and morning? C'mon, other than people in the military, who does that?

Me.

Anyway, Tuesday the 22nd looked pretty good:

The waking up at the same time (or within, what, an hour of the same time?) daily is more important than the going to sleep at the same time, right?

It's either the naps+xPAP, or no xPAP. I physically cannot function on xPAP without the naps. Period. If you take the xPAP out of the equation, the sleep numbers will look more reliable. I wasn't taking them very often at all until I got back on this God-foresaken thing. Again, I emphasize it wipes me out, which is why I resorted to the extreme last resort of surgery after over two years of trying to make it work.

SleepingUgly wrote:The waking up at the same time (or within, what, an hour of the same time?) daily is more important than the going to sleep at the same time, right?

Well, certainly AS important.

If one is waking up naturally, then it should occur at the end of the final REM period, so if one has 5 sleep cycles (each one approximately 90 minutes), they should end up with 7.5 hours of sleep. So perhaps a plan could be, figure out what time your day must begin and back up 7.75 hours (don't forget the 15 minutes it takes to fall asleep!) to figure bedtime.

BrianinTN wrote:It's either the naps+xPAP, or no xPAP. I physically cannot function on xPAP without the naps. Period. If you take the xPAP out of the equation, the sleep numbers will look more reliable. I wasn't taking them very often at all until I got back on this God-foresaken thing. Again, I emphasize it wipes me out, which is why I resorted to the extreme last resort of surgery after over two years of trying to make it work.

With those desaturations you had on the last NPSG, I don't think you can get away with doing nothing.

Why not ask about Provent when you're down there. Typically, they'll only cut AHI in half, but if those centrals settle down, you might have a Proventable AHI.