Frustrated with recommendations by doctor

[sheepless]

great point Cpapian. I know I need to cultivate a more positive less cynical attitude and your comment helps a lot. I talk the talk whenever I say I'd give practically anything to improve my situation but am clearly lacking the walk... thanks for setting me straight.

[Cpapian]

I realize that in addition to sleep apnea, I’m struggling with insomnia. It takes me AGES to fall asleep (sleep latency), esp. if I’m wearing the mask; sometimes it can be more than an hour before I drift off. Also, as I’ve mentioned before, I wake up several times (sleep maintainace) and have a terrible time getting back to sleep. This was happing before I started CPAP, but in many ways, the discomfort of CPAP has exacerbated it.

I picked up a workbook on CBT approaches to insomnia yesterday; while I have pretty good “sleep hygiene”, there are some things I’m definitely doing wrong.  Like going to bed early to allow “extra time” to fall asleep. Apparently this is very bad; it is supposedly far better to go to bed quite late (e.g. 1:30), when you’re REALLY sleepy, and to do this for several nights, eventually moving your bedtime a little earlier every night until you get to a normal bedtime. The theory is that your mind eventually associates getting into bed with falling asleep, so you eventually are able to do so more quickly.  

I too have insomnia.  Can you recommend your book on CBT-I.  Previously , I enquired about attending training session, but the cost was way too high.  $250 per hour with no mention of how many hours it would take.  Psychologist pricing.

[Cpapian]

great point Cpapian.  I know I need to cultivate a more positive less cynical attitude and your comment helps a lot.  I talk the talk whenever I say I'd give practically anything to improve my situation but am clearly lacking the walk...  thanks for setting me straight.

Somewhere in my training I learned that the subconscious cannot differentiate betwwen the truth and a lie.

If I tell myself I am not good at x, enough times, my subconscious will, apparently, believe it.   I don't know how true it is or how to scientifically prove or disprove this, but the thought comforts me.

[sheepless]

Cpapian, that's a fascinating thought that I'd love to follow up a little but it'll likely take us down an off-topic rabbit hole.  instead I want to at least acknowledge that contribution with thanks and return the thread to allenri.  

[Mark Sadler]

Good afternoon!
First of all, I'm glad to see your making your own adjustments. My Dr. gave me a PR ASV[dreamstation]. I never got the results I thought I should be able to attain with it, so about 3 weeks I went around the Dr. and purchased an Aircurve 10 ASV like your using. 
Anyway these ASV are titrating the whole time they are on. Hunting for the right preasure. Going high and then back down low. I set mine up with higher or lower  EPAP to get closer to where the machine wanted to go. I check the nights summary and see where the machine went. I always give 7 days in between changes and only one change at a time. Don't rush and remember ultimately You are in control of your therapy. 
On using ramp. I do use a 5 min. ramp on this machine. 
Good luck

[allanri]

Another way of looking at those mind games would be to consider that you already have (unconsciously) played mind games that have negatively affected your sleep, so the new mind games (conscious) purpose is to negate the impact of the earlier, destructive ones.  

Yes, of course. I was being facetious when I spoke of "mind games" ... I realize that my mind has "faked me out", as we used say when we were kids, creating an invisible barrier that's making it hard for me to sleep with the mask on.

Unfortunately, my problem is with the new ASV machine; I am having a hard time getting used to the kind of therapy it provides. I've gone back to straight CPAP for a while, and am hopeful I can switch over to ASV again when I am able to fall asleep easily again with the mask on.

I saw another doctor at the clinic I've been going to. We talked about all the challenges I've been having, and he said that I was "an interesting case". I'm hoping he means that it's intellectually/medically interesting to him, as opposed to I'm a royal pain in the rear for them. He said that there were quite probably other things he'd like to try, but until I can manage to sleep with the mask on again, there's not much point in him suggesting different approaches. Which sort of made sense. He's referred me to someone who practices CBT, I think, who is supposed to help me get over this hump of being assuming the mask is going to prevent me from sleeping (and then not sleeping as a result of that anxiety).

[allanri]

 Can you recommend your book on CBT-I.  

The Insomnia Workbook, by Stephanie A. Silberman. ISBN 978-1-57224-635-5

I haven't heard from the psychologist yet. I'm fairly certain that if she wants $250/hour, I will be working through the CBT exercises on my own.

[Cpapian]

Hey Allan,

Is it the mask that is causing the insomnia? Have you tried wearing the mask while watching TV or some other routine activity?  If you haven't, it's worth giving it a try.

You have a lot going on with a full face mask and a cervical collar.  Since you are using a FFM could you try a night without the cervical collar?  See if that makes you more comfortable?  I failed miserably with a cervical collar (one night only), but instead I  rolled up some of the blankets and tucked under my chin which lasted about half the night (I don't move during the first half of the night).

I borrowed the insomnia workbook from the library (ebook). Will take a look tomorrow. 

Your extended health will probably cover a portion of phychologist fees to an annual maximum.  If you are still working, you might find it worthwhile for the coaching and feedback.  I am retired, and my problem seems to be delayed sleep phase, I am not pressed to fix it quickly.

[allanri]

Hi all ... been a while since I’ve been online.  I hadn’t been making significant progress with my insomnia, chronic rhinitis, and CPAP/ASV therapy, so I figured I’d just relax a bit about it all, and not spend a lot of time thinking about it.

Anyway, one piece of good news is that my useless sleep doctor retired, and I’ve been reassigned to the head of the clinic, who apparently is the one of the leading sleep physicians in the country. Unfortunately, he’s very busy, so it takes some time to get in to see him. I did see him recently though. He said more than once that my case was “interesting”. Gulp.

I didn’t come clean about going rogue with the ASV; I figured I’d see what he had to say about my therapy.  He thought my results on fixed CPAP weren’t horrible, but he was uncertain why they weren’t better, and why different pressures didn’t seem to make any difference. Rather than fiddle with the machine, he thought I might try an oral device for alleviating my apenas. This at least would help with those nights when my rhinitis flares up and I can’t wear the mask.  So I’m going for a Matrix sleep study next week to see if an oral appliance would help.

I’m the meantime, I’ve gone back to the ASV, using the settings that Sleeprider coached me through months ago. My AHI is usually between 8 and 9. Oscar says I have 0 obstructive and 0 central apnea’s, but I have some “Unclassified” apneas (?) and a number of hypopneas. I’ll attach some reports shortly ... would welcome any thoughts anyone might have.

Cheers

[allanri]

Attached last night's report ... I'm curious what the numbers for "unclassified apneas" mean ... and wouldn't the machine have some effect on improving hypopneas?

[attachment=14559]