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New to board; please help me prepare for my appointment with sleep specialist
#61
RE: New to board; please help me prepare for my appointment with sleep specialist
(01-20-2020, 09:41 AM)Sleeprider Wrote: CPAP is a convenient scapegoat for your insomnia issue and unwillingness to accept the easiest, most affordable path forward to resolve a serious health issue related to your severe sleep apnea and insomnia.   If seeing a doctor is a financial hardship, then an invasive procedure like INSPIRE or upper airway surgery will be a revelation. Both of those avenues introduce new worlds of sleep disruption and relatively low chances of efficacy.  The samples of your sleep we have seen on CPAP are exemplary of good therapy, but rather than looking for ways to make it work, you're looking for excuses to quit.  There is nothing we can do about that, and it's clearly in your court. Different masks, may help, but your CPAP therapy works well. I think you need to treat your insomnia and psychological resistance to the therapy, or quit and live with the consequences.

Thank you for your blunt feedback.

I am going to see a sleep physician on Feb. 3. This will be my first appointment with a sleep specialist. I will ask him whether he knows of a good psychologist who specializes in CBT sleep therapy. I will also ask him to see if I am putting on the mask correctly. It feels really tight over my large nose. I will also ask him if I am breathing correctly (I've been using both my nose and my mouth I think). I will also ask him if he thinks I should use sleep medication for awhile.

I have ordered a new mask.

I hear what you are saying about surgery. I didn't know that surgery has low efficacy.

I doubled my time on the the CPAP mask last night (nearly two hours). I hear what everyone is saying and am trying my best.
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#62
RE: New to board; please help me prepare for my appointment with sleep specialist
A positive attitude and trying new solutions to improve your comfort are all moving in the right direction, and will lead you to success with this therapy. Sorry for the blunt approach with my last post, but I thought it best to point out the kinds of attitude that we have seen in past members that will lead to certain failure. It's worth being very familiar with INSPIRE and UPPP surgery, with an awareness that they promise to resolve between 50 and 70% of the problem. For your AHI that leaves you with somewhere between 15 and 27 AHI. Both procedures are very expensive and invasive, and especially UPPP has significant recovery pain and permanent complications including issues with air ingestion (aerophagia), gastric reflux (GERD) and potential swallowing issues in old age (aspiration). The good news is, if you can overcome your discomfort or anxiety with CPAP, you will sleep comfortably and preserve your health without undergoing anesthesia, surgery and permanent physiological changes and medical follow-up. It's an easy choice, however overcoming your insomnia and anxiety are going to be a bigger hurtle than most people have. For my part, I will try to be more respectful of how difficult that may be for you.
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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#63
RE: New to board; please help me prepare for my appointment with sleep specialist
I'm so glad to hear about all the ways you're working toward effective CPAP therapy for your apnea and insomnia. Please keep us posted.
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#64
RE: New to board; please help me prepare for my appointment with sleep specialist
https://fredflinstone.tinytake.com/tt/ND...MjM4MTQ1OQ
https://fredflinstone.tinytake.com/tt/ND...MjM4MTQ3OQ
https://fredflinstone.tinytake.com/tt/ND...MjM4MTUwOQ


my first stint with the new mask. Still unable to sleep very long. Looks like leaks were a problem. Should I go back to the old mask?
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#65
RE: New to board; please help me prepare for my appointment with sleep specialist
(01-28-2020, 06:40 AM)Aa438sj Wrote: my first stint with the new mask. Still unable to sleep very long. Looks like leaks were a problem. Should I go back to the old mask?

Call your equipment provider and tell them you need to try another mask. It's very common to have to try several before you find one that works. I would even alternate between masks trying to get to used to one or the other.

Are you still sleeping without the mask? If so, it will prolong the adaptation process. Have you tried wearing the mask with the machine on while awake and reading, watching TV, or listening to podcasts or music? That is a good way to get adapted.

When you sleep without the mask you're getting the kind of sleep that does you no good because you never fall into the deeper stages of sleep. Plus, you put a strain on your cardiovascular system. It can take only so much of that and usually by the time we get diagnosed and treated we've spent a few years or decades doing that.

My sleep doctor told me that CBT for sleep is difficult for most people because involves deliberate and systematic sleep deprivation. Things like waking up at the same time every day. No sleeping in!

Like you, I also do not like taking drugs to help me sleep. I've been taking trazodone for several years now, but only on nights when I need it. Most nights I don't need it so I don't take it. If you take it every night it will stop working and you will have increase the dose.
Sleepster

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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#66
RE: New to board; please help me prepare for my appointment with sleep specialist
Your results show a lot of flow limitation and RERA. We really want to open up your EPR and resolve that. What do you think of a minimum pressure range in Autoset mode of 9.0 to 14.0 and EPR at 3? I agree we need to resolve mask leaks, and it is just a matter of trying different brands, styles and sizes to get the right one. If you supplier has a private area for mask fitting, take your machine with you and try the masks laying down with pressure.
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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#67
RE: New to board; please help me prepare for my appointment with sleep specialist
Background:
For those who haven't read the entire thread, I was having terrible trouble with CPAP, waking up every 45 minutes. After seeing a sleep specialist (PA) yesterday, I slept continuously for 5.5 hours last night with an average AHI of 1.42 and no large leaks. My attitude has gone from pessimism/dread to optimism/delight.

Setup:
Respironics Dreamwear full face mask
Ambien 10 mg just before bed
CPAP in combination with oral appliance
Nasacort
Minor tweaks to settings by my sleep PA


https://fredflinstone.tinytake.com/tt/ND...MjQzNjUxMw
https://fredflinstone.tinytake.com/tt/ND...MjQzNjUxNw
https://fredflinstone.tinytake.com/tt/ND...MjQzNjUyMQ


I am grateful to my PA and I am even more grateful to everyone on this Board who urged me not to give up. Thank you so much!!

Looking at the OSCAR data, does anyone have any suggestions or concerns? Do all of you think it is OK to use Ambien every night for several weeks or months while I get used to this?
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#68
RE: New to board; please help me prepare for my appointment with sleep specialist
When I saw your first post, I saw someone destined to make CPAP therapy a failure. You had discontinued therapy and had were determined to find an alternative or nothing. What a rewarding and inspiring turn-around. Others that feel the same frustration can read your story and know that if you can do this, so can they. I really appreciated your PM this morning thanking me for moving you toward success. My posts you quoted above were the kind of "tough love" I rarely resort to, knowing someone in your position is likely to get mad and leave; but you stayed, and worked. Congratulations on one of the most impressive changes in attitude and grabbing the results and life you deserve. This goes down as a very special success story. Keep up the good effort to overcome the challenges to your sleep and well-being.

Tom
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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#69
RE: New to board; please help me prepare for my appointment with sleep specialist
5 Amazing

Something for me to shoot for!  Congratulations!
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#70
RE: New to board; please help me prepare for my appointment with sleep specialist
I'm still here and figured I'd check in. I am no longer using Ambien and am fairly comfortable with my mask now. Here are last night's results as documented by OSCAR:
https://fredflinstone.tinytake.com/tt/ND...MjU0MTkzOQ
https://fredflinstone.tinytake.com/tt/ND...MjU0MTk0NA
https://fredflinstone.tinytake.com/tt/ND...MjU0MTk0OQ

So 4 1/2 hours of continuous sleep with the CPAP on but without a sleeping pill. Not great, not bad.

I also have an oral appliance. I have been wearing it underneath the mask. I think the combination of the oral appliance plus the CPAP works well. However, when I wake up in the 
middle of the night, my mouth hurts a little and I usually remove both the CPAP mask and the oral appliance. 

I have the CPAP machine pressure set on a maximum of 10 cmH20. When I had my sleep study last month, the technician told me he got good results at 12 cmH20, but it looks to me like my apnea is well controlled at 10 cmH20.


I will be seeing my sleep doctor in a few weeks for a follow-up visit. In the meantime, please let me know if you all have any suggestions.

Thank you!
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