..back to sleep (apnea)

 I have just had my second sleep study, about which, more below. 

I have known that I have had sleep apnea for at least 5+ years, since I now qualify for a new CPAP machine and Medicare only supports you for one of these every 5 years. But I am on my second machine which suggests that I was diagnosed for this condition more than 10 years ago.

The original speculation was by my primary doc who noticed I had a large neck. Larger in that area means a higher likelihood of a collapse of the soft pallet--larger necks weigh more-- because of gravity's effect when sleeping on one's back.  Such apnea is known as obstructive apnea. There is also central apnea which is controlled by the brain, I think. The mixture of the two is called complex sleep apnea. I believe my diagnosis is the latter.

The condition is now more important to health than formerly thought. Its extreme, that is, narcolepsy, is the uncontrolled falling into sleep during the day, not good if one is driving, for example. It is now known that people who have apnea and are untreated are twice as likely to die. It is strongly correlated with heart failure, for which, as all of you know, I also have a diagnosis. It is also associated with high blood pressure and headaches upon arising. There's more, but enough.

So, I have worn a CPAP (Constant Positive Air Pressure) machine now for 10+ years whenever and wherever I sleep. It changed my life when I first started to wear one because I was immediately less fatigued during the day. Prior to that I fought sleep and fatigue during the day. The machine is positively addicting because it makes one feel better, that is, rested. But some cannot get used to having their noses and/or mouths covered. (There a variety of fixes for this, of some effect.) Suffice to say that a fair percentage of wearers discontinue use. When I was diagnosed with heart failure circa 2015, oxygen was added and I have used that since. The oxygen is safely made by a machine that strips nitrogen from air leaving an enriched output.

A variation of the CPAP machine is a BIPAP for BI-Level Air Pressure. This forces air in at one pressure and makes breathing out more difficult without extra exertion, similar to SCUBA wherein one must force air out. My machine is set at 20 psi in and 16 psi out. The BIPAP is for complex apnea. And it is this machine which is 5+ years old.

But there is a new kid on the block called an AVS for Adaptive-Servo Ventilation. This machine senses when your breathing changes and adapts by altering the pressures in and out to keep breathing regular. It was this machine and subsequent therapy by it that was the central feature of my sleep study.

A sleep study requires a night in the sleep lab, in this case, our hospital. There they put sensors on your body from your knees to your scalp. I went in this week. The technician monitors you all night. The room was comfortable but sleeping was not since I am unused to clothing (TMI!) as well as the breathing straps, etc while sleeping. But I got through it and felt fairly good upon arising. The doc's office called to say that things looked good. And I don't qualify for AVS. This appears to mean that my apnea is more obstructive than central. But I am going to get a new BIPAP machine because I am not sure how well my current one is operating and because I can.

The highlight of the results at this point was that my pulse/O2 was at or above 90% all night. In fact the medical assistant said I no longer qualified for O2 under Medicare guidelines, but since I own my oxygen concentrators I am unaffected by this outcome. She was unconcerned by continued use. Good!  Continued under-90% O2 is associated with dementia. Don't want to go there. I'm already forgetting what TV series we watched last week.

Onward....

I DON'T KNOW WHAT THE HELL HAPPENED HERE, BUT THIS WAS NEVER PUBLISHED. I MUST HAVE BEEN DISTRACTED OR HAD AT LEAST A SENIOR MOMENT. ANYWAY I AM PUBLISHING THIS BELATEDLY BECAUSE THE SAGE CONTINUES IN MY NEXT POST...