(07-01-2012 06:22 AM)zonk Wrote: Hi Steve, welcome to the forum - If the clinician is not a doc than may suggest to find a sleep medicine doc. Your leak at 12 L/min is quite good but do you find yourself adjusting the mask during the night and not sleeping right through or mouth breathing?
This is right on the money. Clinicians are NOT doctors nor do they have a fiduciary duty to 'the patient' to provide educated, professional care and advice. They may or may not be licensed and may or may not have knowledge of your particular situation. Best of all, from my personal experience, they may be driven by the almighty buck and intent on getting you fit and out the door asap so they can move along to the next 'patient'. With all due respect to the clinicians out there who are the opposite! I have stories I could tell you that would raise the hair on the back of your neck!
The advise is good. I would most definitely seek the advice of an MD specializing in sleep disorders and perhaps even a respirologist to eliminate any other issues that may be in play here.
For example, I have allergies in play and my respirologist, although she know I had lung damage from my bout with bacterial pneumonia in 2009 (summer), has been most attentive and interested. I have had three CT scans since that time and the last was clean as a whistle. I had allergy testing done and I am allergic to everything under the sun including our family dog. No wonder my nose has a tendancy to plug up during the night and a nosebag may or may not work on any given night.... I have gone to a Quattro Full Face Mask and that problem is eliminated. I also discovered during sleep study No. 2 that during REM sleep (which I have not seen in 25 years) my breathing becomes shallow as it does for most folks. Except in my case I have compromised lungs (65% capacity at best when upright and moving about). I needed supplement oxygen in my airline to get and stay above 90% SpO2 and in the 95% range. Ultimately I got tired of the tests and waiting and went in and said "I NEED OXYGEN AT NIGHT TO STAY IN REM SLEEP!" She took my Rx from the file and added +++O2 on it. I bought a oxygen concentrator online (Everflo Q 5L - quietest available $650) and titrated myself to 4L/M of infused O2. Done deal. My SpO2 was at 95% and stayed there pretty much all night never dropping below 90% and I slept like a log.
This apnea thing is no simple matter. I urge you to visit all of the boards, gather all of the information and studies and listen to what folks have to say, educate yourself, contemplate, advocate for yourself and while I do not recommend self medication, I do say that you should not be afraid to make minor changes in things like pressure, mask type and size, etc. Gather data for your respirologist. The S9 Auto will provide a ton of data which you need to print and keep in a binder. A pulse oximeter like the Contec 50EW will record your blood oxygen levels all night long and you can print a time vs. SpO2 stripchart to put along with that S9 data. Set the time when recording so that you can marry up the data properly. When you see your respirologist or sleep doc you want them to see the data you have collected and answer the questions that you have. THEN they can talk. If the communications is not working? DROP THE DOC LIKE A HOT POTATO!!! He/she is not the doc for you and is more concerned about their own time or their own "God complex" than about any empirical data and thoughts or questions you might have. I did and never looked back.
My leak rate is generally what the mask leak rate is and rarely if ever shows anything greater (each mask will have a proscribed leak rate). My SpO2 remains at or above 95% even during REM sleep now and I sleep like a log excepting when I have to get up to use the washroom or when back pain insults me awake or when something is happening around the house (the kids are night owls). My AHI is always 0.00 and when it is not is always below 1.0 (rarely not zero). It does not guarantee that I am going to awake refreshed but all I can tell you is that I awaken when the sun comes up... and even if it takes me a half hour to shake the groginess out of my head (something that an early hot shower would certainly do immediately) I go all day and evening with loads of energy most of the time.
It did not happen overnight. I encourage you to be persistent in your search for the zenith. Educate yourself totally. Advocate for yourself totally. And contemplate what you are reading and hearing comparing same with what you have learned and have a gut feeling to be true.