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Need Adjustments
#21
RE: Need Adjustments
Tom, I thought you might like my overall impression of this sleep study.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

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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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#22
RE: Need Adjustments
           
Thank you for your very prompt response. 
I will pursue the erroneous conclusion and recommendation with my DR. It appears that my Dr. correctly read the study data in that he reset the max pressure for 8 not 11 as the study recommended. 

I have attached the reordered charts you requested. Will provide Sleephead charts with collar & pressure @ 8, later. 
My Dr did discuss the dental appliance. I told him I had purchased one online and did the custom fit but that I had a hard time tolerating it. Is it worthwhile for me to work harder on making the dental appliance work? Dr. is also suggesting an appointment with a sleep psychologist. 

It sounds like all these recommendations by Dr are designed to provide data to justify a smarter machine to Medicare insurance. It that a correct observation? 
I know you can't see video, but I was told that my apneas were not necessarily related to my sleep position. Is there any insight on this from the sleep study results? 

Ed
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#23
RE: Need Adjustments
I mentioned in my review of the sleep study results your apnea is not dependent on body position and pointed to the absurd "impression" that you avoid supine sleep.

Your doctor is apparently drawing his own conclusions and may even be skeptical of the sleep study results. Your part in this process is to continue following his directions, showing the data you are collecting, and encouraging him to pursue a more effective solution (ASV). As far as going to a "sleep psychologist" that is a specialty I have never heard of. We have had a number of members with anxiety issues and very poor sleep hygiene that perhaps could have benefited from this. You should consider your own attitudes towards sleep and therapy and be open-minded whether that is an important aspect to be examined by a specialist. I don't think the physical apnea and flow limitations with sleep arousals documented by your machine and sleep studies, amount to a psychological problem or something that will be overcome by counseling. If you agree, then you should decline the referral. It never ceases to amaze me the lengths and expense that the profession is willing to go to avoid simply prescribing a $2500 ASV.
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#24
RE: Need Adjustments
(12-31-2018, 10:05 AM)Sleepless Night Wrote: I know you can't see video, but I was told that my apneas were not necessarily related to my sleep position. Is there any insight on this from the sleep study results? 
I know I can't see the video, but sleep labs rarely look at the chin tuck, they are concerned about seeing if your apnea varies by side or back sleeping.  The chin tuck we see they see as standard obstructive apnea and I think the labs fix for that was to estimate a pressure of 11 to resolve that.

It is important to note your symptoms, as they are what really say that your treatment is not working.  Keep a daily log and share that with your doctor, give him a copy and allow him to include it in your medical record.  How you feel is so very important to justifying an ASV machine.

I would ask him if he sees an ASV in your future, then ask him what he needs to justify it, what is the path WE, you and your doctor, are following to get there.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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#25
RE: Need Adjustments
           
After your recommendation to try a collar to see if things changed I have attached a couple of charts (2nd & 3rd) representing my use of the collar. By my inspection there appears to be no difference with or without the collar.
The first chart represents my use of a mouth piece I bought on line to prevent snoring. The AHI 6.21 number was remarkably low and at first I was elated, however my teeth and gums ached for > 10 hrs. On top of that I felt terrible the next day both sleepy and tired one of my worst nights. Now I am reluctant to try another night with the mouth piece when there are no benefits in how I feel.  
1.      Is there any reason the lower number of events w the mouth piece made me feel worse than other nights when I have had 2 – 3 times the events?
2.      Is it typical for a Dr to let 4 wks. go by when a therapy in not working. Why isn’t a week or two of data enough to prove the failure of the approach? When I contacted the dr after a week he told me to switch from a nasal to a full face mask and of course that changed nothing.
 
Thanks
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#26
RE: Need Adjustments
Sleepless, I think your EPR at 2 might be causing some of the problems. EPR can increase central events in some people, and since it results in a lower EPAP pressure, allows more obstructive events to occur. If you were titrated for 7.6 cm pressure, I think eliminating the EPR may help here. Give it a try anyway, and if there is not improvement, then we should look at some strategies to have your doctor take notice and do something. Most doctors are not in a rush to change or even reevaluate therapy. They expect problems early in treatment and their experience is that it will often self-resolve or the person will quit therapy and go away. A typical follow-up is after 30 days. Your AHI is high enough and appears complex in nature to try to move that up in priority.
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#27
RE: Need Adjustments
            Dr has change from continuous set of 8 to auto setting of 4-9.
That didn't do much, so now trying side sleep only with a .25 xanax before bed w some improvement. 
Last night problem w onset and took a xanax @ midnight, but the result was amazing.
Still have some body aches from the restricted sleep position in the am. 
Note the hypopneas about the same but no RERAs 

Dr thinks xanax is helping my brain cope with CPAP and is ignoring AHI results

Is this therapy cumulative? or is it the xanax?
Do you think I am on track or is this just an anomaly?

Attached three nights of side restriction charts w xanax

PS I really appreciate your comments. Made a $30 donation today

Ed
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#28
RE: Need Adjustments
It's the drugs. Turn off EPR.
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#29
RE: Need Adjustments
    Can anyone tell me what happened to my data last night? 
Machine report says 7.31 hrs sleep AHOI 3.1


For some reason that is not what is on the card. 

Can I try to delete the files from last night and re-import? 

Ed
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