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In anticipation of my BIPAP Re: New Thread
RE: In anticipation of my BIPAP Re: New Thread
Maybe it's my eyes or my monitor settings.  
The distinction for me is so subtle that it doesn't register in my brain... and if it doesn't register in my brain... it's psychologically not hi-lighted.  
The good news is I'm not red-green color blind.  A lot of UI designers fail to take that into account when they design color schemes.  Traffic signals included. :-)

Traffic: https://www.change.org/p/us-department-o...ind-people


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RE: In anticipation of my BIPAP Re: New Thread
(01-29-2020, 11:30 AM)ApneaQuestions Wrote: My hat also goes off to you for transitioning from "I'm seriously about to give up" to a totally different mindset.
Are you secretly doing a bit of CBT distortion-spotting at the same time?  It really can work when done properly.
Lolabove 

AQ, I'm sorry,  I'm not practicing CBT at the moment, at least consciously.  The quick turn-a-rounds mind set wise, the very long posts, the sheer number of posts, etc. are just a few of the symptoms of bipolar disorder.  Believe me when I tell you, you will probably notice quite a difference in me when I start back on my medications.  Tomorrow is my appointment with the new shrink, and hopefully we will have a very beneficial meeting.  (And I promise to bring up your interest in my partaking of CBT).

Regarding Dr. Krakow, it was very nice of him to call me back.  I had left a message and thought I would hear from one of his staff members.  I told him I was surprised to hear from him and he said I had said it was urgent so that is why he called me.

He will only be practicing in his clinic in Arizona for 2 more weeks.  He said I was more than welcome to make an appointment during these 2 weeks to see him personally.  However, he has brought on 2 new doctors that he is training to take over the practice.  Dr. Krakow will be moving to GA.  If I don't go during the next two weeks I'd see one of the new docs, but with Dr.Krakow involved in some way.  Afterwards, I'd take advantage of telemedics.  It would be all out of pocket.  I'll see how things go the next few weeks.  I think once my meds are taken care of, sleep hygiene improved at least a bit, make sure the dang mask stays set correctly, tweaks by you, we MAY be able to avoid ASV (or whatever), and avoid a trip to AZ.

I can't figuring out exactly what you guys are talking about with the colored traffic lights at the moment, (I am at work), but I hope it has to do with the fact that the list on the left regarding the actual numbers of events does NOT match the visual event indicator in the main graph.  (No gray bars vs. gray bars, unless the events were so close together you can't differentiate them visually).

Speak to ya later!
Plmn
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
I'm going through all the medical records I can find for my visit with the shrink tomorrow.

Amazing to me what I have found.  I actually found my oldest sleep apnea records.  Quite a wake-up call to me.  Apparently I started this journey 17 years ago, not 7 or 8 like I thought.  Oh-jeez

The earliest record I found is dated July 2003 and makes very little sense to me.  It is a letter from my sleep doctor to my primary doctor.  The letter states "I saw ____ in the office today.  She is utilizing nasal CPAP therapy.  She occasionally takes it off at night.  She has lost 60 pounds but continues to snore.  Nasal CPAP titration was undertaken, and this reveals evidence of obstructive sleep apnea of very mild degree which does not require nasal CPAP therapy at present.  However, the patient is tired during the daytime and does continue to snore, as above."

Ummm, how can I be utilizing nasal CPAP and at the same time be told I don't require nasal CPAP????

The letter goes on to state the doctor's impression: 1) OSA of mild degree. 2) Question upper airway resistance syndrome.
Patient to proceed with a dental evaluation for an oral appliance.  (I didn't proceed with this).

7 years LATER....(Same doctor)...I found a sleep study dated 12/2010.  Yada, yada, yada....conclusion: Obstructive sleep apnea of significant degree.  Associated hypoxemia.  Associated sleep fragmentation.  Reduced REM sleep.  Reduced delta sleep.  Positive response to CPAP therapy.

In 5/2011, letter to primary:  Difficulty using machine.  Underwent auto-pap titration.  CPAP pressure needs to be adjusted upwards.  Impression: OSA on CPAP therapy - difficulty tolerating it well.  Bipolar disorder.  Sleep maintenance insomnia.

This may have been when I stopped trying apnea therapy, probably due to the ups and downs of the results.

He adjusted my CPAP pressure up to 12cm of water.

In 6/2011, letter to primary:  I apparently told the doctor I was doing better and feeling rested in the morning.  Sleep maintenance insomnia, on p.r.n conazepam.  Bipolar disorder.

I can not find my surgery records.  I don't remember when I had my surgeries. I swear I can remember that I did have another titration study done after the surgeries.  I was told my sleep apnea was negligibly better. 

Oy, vey.
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
(01-29-2020, 10:43 PM)Plmnb Wrote: ...Ummm, how can I be utilizing nasal CPAP and at the same time be told I don't require nasal CPAP????...
If you started CPAP when you were 60 pounds heavier and then subsequently lost 60 pounds... could the weight loss have moved you across a threshold?

From google search:
https://www.google.com/search?client=fir...+and+apnea

In adults, excess weight is the strongest risk factor associated with obstructive sleep apnea. Each unit increase in BMI is associated with a 14% increased risk of developing sleep apnea, and a 10% weight gain increases the odds of developing moderate or severe obstructive sleep apnea by six times.

Presumably, losing weight has the opposite effect of gaining weight.  At least it's a reasonable starting hypothesis.

EDIT: Weight loss improves sleep and apnea: https://www.verywellhealth.com/how-weigh...ep-3015194


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RE: In anticipation of my BIPAP Re: New Thread
lots-o-coffee Hi all, especially sleeprider. (And AQ if you have any input as well).  (Not frantic or anything, just curious).

A little help with the following conundrums please?  (Things-data is/are confused by the fact that I DID actually use a hybrid full face/nasal mask on some days, I just don't remember which days.  When I have said my mask was on the wrong setting it might be confusion on my part due to the fact that it was a hybrid mask and I mistakenly thought the machine should be set to nasal).

1)  This was the worst night for being gassy.  Actual pain.  I have not mentioned any issues with this before because it was never anything that unduly bothered me.  However, last night and this morning has been very uncomfortable.  Isn't excessive gassiness from taking in too much air? Could this be because now that my mask type is set properly and I am not having issues with large leaks I'm getting too much air?

2)  The machine reports 5.07 hours of sleep.  However, I was unable to fall asleep for portions of the night.  I can't recall a worse night for having the mask on, machine running, laying down for sleep, (not watching tv etc.) and not being able to fall asleep right away.  Maybe I just had too much on my mind last night and my insomnia got the best of me, more so than on other nights?

3)  Obstructive events question: Last night I had more obstructive events since 1/4/20.  On this date I had on a full face mask also, my settings were 7/20 PS 5.6, last night my settings have been what they have been for a while, 14/25 PS 6.8.  Actually all my January data report obstructive events, nasal setting and full face setting, EXCEPT for 1/8 & 1/9 when I was trying VPAP-S 12/18 PS 6.  On these two days I DID have many hypopnea and unclassified events though.  Why am I having an increase in obstructive events now, especially since my mask type is on the correct settings? 

4)  I am STILL trying to figure out why the night of 1/12/20 resulted in my feeling so fabulous.  (AND my report shows I only had 2.41 hours of sleep! 14/25 PS 6.4, showing nasal mask type...not sure if I was using my hybrid or my regular ff.

If you guys want OSCAR charts, overviews and/or zooms let me know.

I would really appreciate any help you might be able to provide?

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
Hey AQ.  In response to your reply about the weight loss/gain.

It doesn't really matter in the scheme of things about this report I suppose.  It was so long ago, and things are what they are now.  60 pounds less, 60 pounds more...either way I FELT like I slept like crap and the snoring either way bothered the heck out of my husband at the time.  I was just surprised I found these copies of my records in my office. 

The letter confuses me because I can't figure out what he is saying, I think he messed up his chronology or something. First he states I AM using CPAP then he states he states nasal CPAP titration was undertaken showing mild sleep apnea and says I don't need CPAP, try dental device.  I wonder if I was on CPAP when I was 60 pounds heavier, then lost 60 pounds and he felt I didn't need CPAP because of the weight loss?  I don't know, so confusing the way he wrote the letter.

I'm not going to waste any more of our valuable time on this, appreciate as always your thoughts on this though.

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
4 questions (actually #4 isn't a question)

1) google aerophagia and CPAP for some ideas
https://www.google.com/search?client=fir...a+and+cpap

2) Yes maybe you did have a lot to think about

3) If you provide a copy of your overview data similar to the one I attached, I might be able to see if there is a true increase in OA or not over time.

4) You may be trying to answer the unanswerable.


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RE: In anticipation of my BIPAP Re: New Thread
I think a hybrid mask uses a full face setting. Aerophagia is not unforeseeable with the high pressures you have been using to fight flow limitation. Aerophagia occurs when pressure exceeds the ability of the lower esophageal sphincter (LES) barrier to airway pressure, and in your case it has happened from time to time in the past. The best way I know of to deal with it is simply to reduce maximum pressure. This can also help to set the maximum EPAP pressure. For example at 6.8 PS, a maximum pressure of 21.8 results in EPAP max of 15. It could help, or it might allow through a few more OA events. I have emphasized for a long time that your therapy turns more on comfort than the numbers. If you stick to that thought, it really takes away a lot of emphasis on analyzing OSCAR, and puts more focus on what matters.

This leads into whether weight loss or gain is that significant of a factor in changing an existing, treated case of OSA. Over the years I have been on therapy, my pressure needs have not changed very much in spite of a pretty significant weight gain and age gain over the past 15 years. I moved from CPAP to bilevel mostly for comfort, but have used a starting pressure of 9.0 for a long time. I don't really think losing as much as 50 lbs would change that a bit. We have had members that lost significant weight on their own or with bariatric surgery, and the anecdotal evidence is that weight loss may reduce need for CPAP pressure in younger individuals, but not so much as we age over 50.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: In anticipation of my BIPAP Re: New Thread
I tend to favor data and evidence and meta-analysis whenever I have a question I'd like to answer.

Here is a (small) meta-analysis focused on the relationship between lifestyle interventions and OSA with some emphasis on weight-loss

Title:Weight loss from lifestyle interventions and severity of sleep apnoea: a systematic review and meta-analysis.
https://www.ncbi.nlm.nih.gov/pubmed/25192671

CONCLUSIONS:
Intensive lifestyle interventions are effective in the treatment of OSA, resulting in significant weight loss and a reduction in sleep apnoea severity. Weight loss via intensive lifestyle interventions could be encouraged as a treatment for mild to moderate OSA.

To get clarity on what is meant by "intensive lifestyle interventions" we'd need to dig a little deeper than the conclusions.
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RE: In anticipation of my BIPAP Re: New Thread
Whom among has "mild or moderate obstructive sleep apnea"? I'm pretty sure Phoebe and certainly myself are severe to very severe ahead of treatment. I have seen similar statements with regards to CPAP alternative therapies from the Alexo Stent to INSPIRE, and in every case, these alternatives fall far short of our therapy expectations, even for moderate apnea. I could reach ideal weigh and still need CPAP, but I'd feel better.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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