Can i improve my therapy beyond this point?

[Madcat207]

So, it has been a while since I have posted, and I feel like I have come a long way.  At the very beginning of the year, I started my therapy (and basically had a mental breakdown between health anxiety and my divorce).  It has been a really, really tough year, with lots being thrown at me.  In the end, I found out I have had long standing hypertension, and am now dealing with mild LVH and grade 1 diastolic dysfunction (which my cardio says shouldn't worry me as long as I keep my pressure controlled, but sadly.. with my anxiety, I fear I am not long for this world.....

But anyway, I have made a lot of positive changes, including a new food lifestyle (no more bad foods, way more salad).  2 mile walks every day, and I have now lost over 30lb, though I still have a huge way to go. 

The only problem I still feel like I am having, is that my blood pressure seems to be resistant (to a degree, though I do have white coat syndrome), and I am worried I am needing to make more progress on my apnea treatment, which is why I am returning now. 

The good news is, I have got my full apneas and hyponeas really under control:
   

to the point I have been able to drop my needed pressure with no problems noted. 
   

The bad news (maybe), is that in reading, I fear I have too many flow limits still, and may be fighting something like UARS (though, that I has never come up from Dr before). I FEEL generally good, and my heart rate has really improved overall (it can get as low as 48 at night, and stays comfortably in the 50s with almost no interruptions, and resting in the chair it can dip below 60s (both which make my cardio happy).  But I am still afraid the flow limits are choking me and spiking my BP (though if the fear is unfounded, lemme know). 

I will say, the CA's I see are explained by me rolling/moving (I take a big breath then hold it which triggers the CA), so I am not worrying about them. 

As always, I welcome any input!

[Walla Walla]

You really don't have much flow limitations from what I see. You could try to increase your pressure support a tiny bit at a time and see if it helps. You want to keep an eye on those CA events though. If they start increasing than you'd want to back off.

[Madcat207]

You really don't have much flow limitations from what I see. You could try to increase your pressure support a tiny bit at a time and see if it helps. You want to keep an eye on those CA events though. If they start increasing than you'd want to back off.

So those aren't too bad?  I read a few articles on here, but I wasn't sure of any FL blips were bad, or if it was prolonged markings that are bad.

IN terms of my CA, a majority look like this:
   

I had pretty much confirmed before that its a movement/rollover event, but I still have so few of them, I don't sweat it too much either way.  But noted on looking out for more, I don't want to go the wrong way.

[ardenum]

Theres a link between diastolic dysfunction and anxiety, try to find the right anti-anxiety pill for you. At this point who cares about addiction to benzo's or any other medication? Before trying a anti-depressant, know that any and all antidepressants cause a rewiring of the brain in the first weeks of therapy. This means only happy thoughts and feelings during this period will make you a happy person. You have 3 tries, meaning: a serotonin, a norapinephrine and a dopamine reuptake will each cause a rewiring at the biggest scale.

[Madcat207]

Theres a link between diastolic dysfunction and anxiety, try to find the right anti-anxiety pill for you. At this point who cares about addiction to benzo's or any other medication? Before trying a anti-depressant, know that any and all antidepressants cause a rewiring of the brain in the first weeks of therapy. This means only happy thoughts and feelings during this period will make you a happy person. You have 3 tries, meaning: a serotonin, a norapinephrine and a dopamine reuptake will each cause a rewiring at the biggest scale.

I am currently on 25mg of Zoloft, but it hasn't done jack squat for me (other than make me worse in the 2-4th weeks...).

The other big irony, is that knowing I have dysfunction is massively anxiety inducing for me.  Even though my cardiologist said I can still live a full life, I cant stop fearing I will die from it in a few years (thanks to some nurse calling it heart failure, even though the cardio said it distinctly wasn't.. anyway...). I am working on the anxiety, but it is not going well otherwise. 

Last night was another good CPAP night however,
   

So, my flow limits seem like blips rather than longer periods, and I am just not sure if I should worry about them..

[OpalRose]

Madcat207,
Your therapy looks really good, and I don’t see anything in those graphs to worry over.

Concentrate on lowering your anxiety, and be sure your doctor is listening to your concerns. If your doctor has you on some type of anxiety medication, then take it, but be careful and read up on side effects.

Also remember that we’re here to help with sleep apnea, but cannot recommend specific medications.
That is for you and your doctor to decide.

Just because something works or doesn’t work for one person, doesn’t necessarily mean the same for you.

[Sleeprider]

I don't see a flow limitation issue. On the contrary, every respiratory parameter is nearly ideal.

[Madcat207]

Madcat207,
Your therapy looks really good, and I don’t see anything in those graphs to worry over.  

Concentrate on lowering your anxiety, and be sure your doctor is listening to your concerns.  If your doctor has you on some type of anxiety medication, then take it, but be careful and read up on side effects.  

Also remember that we’re here to help with sleep apnea, but cannot recommend specific medications.  
That is for you and your doctor to decide.  

Just because something works or doesn’t work for one person, doesn’t necessarily mean the same for you.

Sorry about the med talk - it wasn't a reason I was posting here, but it is part of my overall condition; I have noticed on anxious nights, my apneas increase by 1-2 AHI, and my respiration averages up by at least 1 bpm.

For my therapy, I just wanted to make sure the FL spikes I was seeing wasn't anything serious, or if there was anything else I was missing in my therapy (since my blood pressure is still higher, and I want to manage that in the most effective way.

I don't see a flow limitation issue. On the contrary, every respiratory parameter is nearly ideal.

So you are also feeling good about what you are seeing?  I appreciate it.

I will also ask - since the weight loss, I have been able to pull my pressure down by 1.2cm, but I am wondering if I can or should pull it down more.  I notice I do seem to has a lot of air at night trapped in me, so I am wondering if I still have more pressure than I need.

[PaulaO2]

I wish mine looked like that!

One thing to release from your anxiety: your sleep apnea is well treated. The low AHI, the weight loss, and the exercise are all good for the heart and blood pressure. The question to ask yourself, is how do you feel when you wake up? Are you well rested? The answer to that question is often more important than the AHI data.

You cannot look at the nightly data just by itself. You are looking for trends. Look at your data and determine where your normals are. Just like your blood pressure is rarely the same each time you see the doc (or take it yourself, which you should be doing) but typically is in the Something over Something range, you will see that your treatment pressure median and min are typically between W and X while your 95% and max are typically between Y and Z.

If it helps to control your anxiety, start a sleep and blood pressure journal. Write down how your day was. What you did. What you ate that was different or good or bad. Note how you feel just as you go to bed. Or earlier if it makes you re-run the day in your head instead of going to sleep. In the morning, note again how you feel. Did you dream. Do you remember them. For the blood pressure, invest in a good one that has a memory function. I have the Omron 10 and love it. Take your blood pressure periodically during the day. Again, look for trends. Don't get wrapped up in the numbers themselves. If your data is better than what happens at the doc's office, then print it out and take it in with you.

You can do this. You will be the better for it.

[Madcat207]

I wish mine looked like that!

One thing to release from your anxiety: your sleep apnea is well treated. The low AHI, the weight loss, and the exercise are all good for the heart and blood pressure. The question to ask yourself, is how do  you feel when you wake up? Are you well rested? The answer to that question is often more important than the AHI data.

You cannot look at the nightly data just by itself. You are looking for trends. Look at your data and determine where your normals are. Just like your blood pressure is rarely the same each time you see the doc (or take it yourself, which you should be doing) but typically is in the Something over Something range, you will see that your treatment pressure median and min are typically between W and X while your 95% and max are typically between Y and Z.

If it helps to control your anxiety, start a sleep and blood pressure journal. Write down how your day was. What you did. What you ate that was different or good or bad. Note how you feel just as you go to bed. Or earlier if it makes you re-run the day in your head instead of going to sleep. In the morning, note again how you feel. Did you dream. Do you remember them. For the blood pressure, invest in a good one that has a memory function. I have the Omron 10 and love it. Take your blood pressure periodically during the day. Again, look for trends. Don't get wrapped up in the numbers themselves. If your data is better than what happens at the doc's office, then print it out and take it in with you.

You can do this. You will be the better for it.

Paula,

I am grateful for the support. Right now, my anxiety problem goes pretty deep, made worse by my divorce at the start of the year. I know I am doing the right things (I aim to go 2.5 miles of dedicated walking), but even with that and what the doc says, I still can't shake the I am gonna die in a few months worry... But that is another problem for another board.. sigh..

I do monitor my pressure at home, with an Omron 7, but even that gets me anxious, and I will see my bp spike the first few readings. 

Your point for all the pressures is good though.. trends matter in the long run.. one night of high pressure won't kill me like one low pressure won't save me. 

I am glad to know my treatment is working well. I feel good when I wake up, though I need more sleep in general. Getting up at 4:45 is tiring no matter how much sleep I can get.. heh


As an aside, I am also sleeping a bit easier now, as I just bought a spare Aircurve 10, with 700 hours for $200... Gotta love Craigslist!