sleepydave,

Thanks so much providing so much information.  I can't begin to tell you how much I appreciate your efforts on my behalf.

I want to be certain that I understand what my plan of action should be, so please bear with me for my next set of questions   



1.  See if I can get my doctor (remember, that's the gp that I have not spoken to since after my 1st study) to order an autopap, one that identifies flow limitations?  What exactly does that mean?  What does "getting ready to kick up the flow limit" mean?

If no better, go to step 2.

2.Get checked for GERD? I assume that means seeing a gastroenterologist?  Do the 4:30 a.m. arousals indicate the possibility of GERD being a problem?  Do GERD problems usually occur during sleep? GERDY being something caused by GERD...got it!  

If no better, go to step 3.

3. Get treatment for PLMs.  Again, what type of doctor do I see?  

If no better, go to step 4.

4.  Through away antidepressant and anti-anxiety meds.  Something I hope I can do in time, once I'm all set with CPAP!

If no better, keep on bugging sleepydave.  


I truly am sorry to be such a pain, but I am lost as to how to go about finding out exactly what is going on, especially with the dr that I have.  You have at least given me some direction, and hope that there is an answer to be found.

sleepyjean

sleepydave,

Thanks so much providing so much information.  I can't begin to tell you how much I appreciate your efforts on my behalf.

I want to be certain that I understand what my plan of action should be, so please bear with me for my next set of questions   



1.  See if I can get my doctor (remember, that's the gp that I have not spoken to since after my 1st study) to order an autopap, one that identifies flow limitations?  What exactly does that mean?  What does "getting ready to kick up the flow limit" mean?

If no better, go to step 2.

2.Get checked for GERD? I assume that means seeing a gastroenterologist?  Do the 4:30 a.m. arousals indicate the possibility of GERD being a problem?  Do GERD problems usually occur during sleep? GERDY being something caused by GERD...got it!  

If no better, go to step 3.

3. Get treatment for PLMs.  Again, what type of doctor do I see?  

If no better, go to step 4.

4.  Through away antidepressant and anti-anxiety meds.  Something I hope I can do in time, once I'm all set with CPAP!

If no better, keep on bugging sleepydave.  


I truly am sorry to be such a pain, but I am lost as to how to go about finding out exactly what is going on, especially with the dr that I have.  You have at least given me some direction, and hope that there is an answer to be found.

sleepyjean

sleepyjean wrote:

1. order an autopap, one that identifies flow limitations?  What exactly does that mean?  What does "getting ready to kick up the flow limit" mean?
2.Get checked for GERD? I assume that means seeing a gastroenterologist?  Do the 4:30 a.m. arousals indicate the possibility of GERD being a problem?  Do GERD problems usually occur during sleep? GERDY being something caused by GERD...got it!  
3. Get treatment for PLMs.  Again, what type of doctor do I see?  
4.  Through away antidepressant and anti-anxiety meds.  Something I hope I can do in time, once I'm all set with CPAP!

Hey SJ:
In the summary of the CPAP titration, the MD had already noted about increasing the pressure or trying AutoCPAP, so that this titration is suboptimal is a real possibility.  You could for now ask to have your pressure kicked up a cm or two and see how you feel.  AutoCPAPs like the PB 418E have a "flow limitation" switch specifically designed for subtle events like RERAs.  Unfortunately, it doesn't work all the time.  But setting the low range at like 6 or 8 may insure that no RERAs slip by.  BTW, if you ever get rid of the AD meds, your REM will increase, and if it turns out that you have more severe supine REM OSA (got all that), we'll have to be ready with higher CPAP pressures.  Hence, the benefit of an AutoCPAP.

You might also be able to trial an AutoCPAP from your DME.

In re:  the GERD, any symptoms of distress in the daytime?  Although you can have asymptomatic GERD.  In the big SHHS, 25% of respondents reported symptoms, so GERD is a huge problem.  GERD symptoms were strongly associated with increased weight, carbonated soft drinks, snoring and EDS, insomnia, hypertension, asthma, and....benzodiazepines.

BTW, I got another study that shows GERD is worse when you're on your right side.  Overall. the incidence of GERD is such that you really have to keep it in the back of your mind if you've got a bunch of arousals you can't explain.

Any sleep doctor could make the recommendation for PLM treatment.  But again, that's the last option.  Those PLMs might be simply the result of the arousals, rather than their cause.  In that case, they're not really PLMs, and treating them probably won't help.

The antidepressants.  They can easily be the cause of the arousals, but again, untreated depression can put you in the same boat, so that's definitely an MD decision as to stopping or changing the regimen.
sleepydave

Hey SJ:
RG brings it to my attention that it's the 420E PB Model that we would need here, not 418, if you're looking for the PB version of the AutoCPAP.
The 418 was from the Jurassic Period.
sleepydave

Thanks, sleepydave.

So far this morning:  

1.  I have a call in to my gp, awaiting a call back.

2. Spoke with DME who said he has one APAP, available for one week's trial.  He also said that I haven't given the CPAP enough time...I should give it 3 months...sure, 3 more months of this I can take...not!


GP just called back.  He's going to order the APAP.  But, first he asked "what kind of machine is that?" He said he would recommend a sleep specialist to me, but what do I want, the AutoPAP or a recommendation to a sleep specialist?  When I asked if I could have both, he said no, one or the other, so I opted for the AutoPap for now.  What the @#&* is going on here????????

The only bright spot in this has been the terrific help of you, sd.

sleepyjean

Called my DME at 2:50 to see if dr had faxed him the info for the AutoPAP.  Nope, nothing had come through so I called my gp.  When I said "Hello, this is sj calling", she said "again?"  Biting my tongue, remainiing polite because I NEED them, I very nicely inquired as to when my DME might expect to receive the fax.  She says the doctor has left for the day so it certainly won't be today.  So much for my hope of picking up the machine on my way home from work so I could begin using it tonight.  

When I got off the phone, I just burst into tears. I am so frustrated from trying to get the dr to do something on my behalf.  Physically I'm feeling so awful and having to rely on someone so unprofessional is really taking a terrible toll on me.  

Once I stopped crying, however, I decided to take matters into my own hands.  Found another sleep lab connected with a renowned hospital.  I called there and explained what was going on and how I was feeling.  The woman to whom I spoke was wonderful.  (I think she heard the desperation in my voice. She set up an appointment for me to see a sleep specialist, however, the first opening they had was for Jan. 25.  She was very apologetic, saying she wished it could be sooner and if I could fax her the copies of my sleep tests, she would email the doctors to see if perhaps one of them could work me in at an earlier date.  I was so appreciative, not only of the fact that I will finally be seeing a specialist, but also of speaking with someone who seemed to understand and care aboout the hell that I have been going through and saying it really should not be that way (which of course I know, but it was nice to hear someone else say it).  Well, lo and behold, about an hour later she called me back saying that they had a cancellation for tomorrow morning at 9:00     She said she was so happy when that cancellation came in so she could offer the appointment to me.  So, after all this, it looks as though I will finally be seeing a health professional who  1. has knowledge of OSA and  2. might actually take it as the serious condition that it is and help me.  Please wish me luck.  When I am feeling better, I will try to get back to all of you who have encouraged me along this long and painful journey.

Thank you.

sleepyjean

SleepyJean,

I am so relieved that you got in to see a real sleep doc. Your gp needs a swift kick in the bum. Sounds like this new sleep lab is on the ball.

Good luck tomorrow!

Snoozehunter

Want to help me kick?  

Thank you so much for your good wishes.

sj

and then we can take care of mine next!    

jenny 33, do you have the same type of gp?  needs a good swift one too?  Isn't it awful?  Makes you wonder who they think they are.  I'll be happy to help with the kick for yours too

take care.

sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

SJ:

Yep, mine needs a kick. Haven't spoken to him since November when he gave me the referral for my sleep study. (I've left msgs)

He probably can't answer my questions anyway.

Sounds like things are going well for you!