onward (and upward?)

Perhaps I got a wee bit overconfident that my condition was improved enough that we didn't need to run back into Walgreen's to pick up my sleep meds. We decided, since the sleep doc wants to examine the memory chip in my old CPAP, to pick up the meds in the morning when we need to drop off the chip at the Budge Clinic. Well, check the time stamp on this post to see how good a decision that was!

Here are some reasons in my thinking. Yesterday afternoon, I had a wonderful nap. I slipped under real easily and stayed that way for 2 hours. I wasn't too worried about impacting last night's sleep since the sleep bank is very low. The night before, I tried a variety of things to help recondition the sleep environment. I used some bluetooth phones to pipe in a streamable Long Beach jazz station. One never quite knows how effective that is, if one hears quite a bit of music all night--which I did--but it has a calming effect and might help countercondition the O2 starvation reflex. (Or at least distract from it.) I moved among 3 related environments: my bedside recliner, my bed, hugely elevated, and the bedside recliner while listening to music and/or reading. I thought that this procedure produced slightly better sleep. At least I could continuously monitor where I was most comfortable and have a planned next move. Entering into sleep was marked by dropping the book in my lap. And it started well last night. I began in bed, couldn't get comfortable with the head raised so high, and gradually brought the bed to horizontal, where--surprise, surprise--I could get enough O2 on my side to lie there for maybe 30 min. In the recliner, I noticed much less music, and the book was repeatedly dropped in my lap. I made it through 5.5 hrs this way. And while that is not great shakes in the overall scheme of things, it is, given my recent history. While I am short in the last bout--and I can feel that in my head--with the nap yesterday afternoon, I am close to 8 hrs for the prior 24 hours. (And, I can nap this morning,)

The sleep doc made me a copy of my overnight oximetry report filling in important details, for example, I am less than 89% O2 saturation for over 60% of the night. He will be ordering supplemental O2 (I can see that my internist just wanted the sleep guy to deal with all of this and so didn't report details.) I had one period of near 15 min in O2 saturation of 88%. All of this makes me eligible for supplemental O2. So that should help sleep and make loss of neurons less likely. I had a fair number of desaturation events, defined as a 4% loss in saturation. I had 14 of these that were over 3 min duration and a total of 310! This appears to relate to the variability in my heart rate. As hr decreases O2 saturation also decreases. I think that supplemental O2 will decrease this variability.

Finally, the sleep doc taught me that there are 2 kinds of apneas: those caused by physical obstruction--the collapse of the soft palette while breathing and a CNS caused one. In the latter the brain continuously monitors/regulates blood PH. It sends out hormones (?) to do so. But if one hyperventilates in order to get O2 back to the status quo, it rapidly changes blood PH. It can make too big a change in the blood chemistry leading to another apnea owing to the hyperventilation. In other words an apnea caused by the CNS. Not a great explanation but it is indicative of the sleep deprivation I am under, Point: there are CPAP machines made to deal with both kinds of apnea. The machine I have now deals only with obstructive apnea, So there are more tools! That is satisfying.

Add to that that tonight we will go to bed tonight truly medicated--more on that in another post--and I end this one optimistically!