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Ques about weight loss and titration....

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Ques about weight loss and titration....

Postby iggygirl » Thu Mar 11, 2010 10:21 pm

After having my machine for about 10 mos I still cannot get compliant on it. I had a brief moment early last June when I got up to 4 hours a couple of times. Then, during summer, my asthma was just too bad and the chest pain was too much to deal with. My question is this, when I had my titration study in April of 09 my pressure was set at 11. (AHI of 52 for sleep study in Jan) I have probably lost about 30-35 pounds since the titration. Is it possible that such a small weight loss could affect my pressure? Since I tried to start back up on my cpap after allergy season I have been REALLY unsuccessful. Usually only about 1.5 hrs. The first time that I took 2 klonopin that I was prescribed recently I did get about 4 hours but after that one time... right back to about 1.5 - 2 hours. Of course this is if I wake up at all to look at the clock. Usually I just wake up with the damn thing next to me or on the floor. My insurance won't pay for another study unless I get compliant.... but if I lost enuf weight to affect my pressure before I could get compliant in the first place..... i'm sure ya see where this is going. Sorry, I guess this is turing into more of a rant than a question. I am going to my dme tomorrow to borrow a fully data capable machine for a couple weeks until my next visit with sleep doc. Should I try to quit losing any more weight? (i'm still far from svelte)My apnea has been present probably my whole life so weight didn't cause it, but the apnea did cause weight gain. I haven't been dieting on purpose,( just MAJOR life stress and really really busy) so I'm not sure really how to stop it. Anyone have any pearls of wisdom for me?
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Postby Mrs Rip Van Winkle » Thu Mar 11, 2010 11:21 pm

For many, a loss of 20 lbs can mean a reduced pressure (1 or 2cm's) ..but I know a few that lost more than that and even had their pressure increased! Rule of thumb..yes, weight loss includes pressure reduction. I would NOT stop trying to lose weight...you owe it to yourself and your health to do it. A fully data capable machine is a good idea.

Now, you mentioned asthma...and the chest pain (could it actually be aerophagia?) ...the asthma would qualify you for a BiLevel..and that also will help some with the aerophagia. From your post...I think what we need to do is to get you sleeping through the night with the machine. I see you have been with us for exactly 1 year now ...Happy anniversary ;-) . Have you searched and asked for tips to help you acclimate to the mask..and to keep it on? Also, have you communicated with other SA/Asthma sufferers to find out what equipment they have, how they cope, tricks/tweaks they have learned..and how their conditions are managed by their Dr's? I feel this is the place to start.

Probably not pearls of wisdom...just a few thoughts :-)

Tami
I'm only a sufferer, not a medical pro. What I post are my thoughts as a sufferer, not that of the ASAA. As a moderator on these forums I oversee the posting rules. This is the internet, always discuss what you read with your medical team.
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Postby BARBCCRN » Fri Mar 12, 2010 5:04 am

Do not quit losing weight. Lower weight; BMI can only help you medically long term. I had gastric bypass surgery 26 months ago...have lost 170 lbs and would LOVE to lose another 20. So 2 titration studies later(since my surgery) I've gone from a pressure of 15 to my current pressure of 8.
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Postby CrohnieToo » Fri Mar 12, 2010 9:46 am

How much assistance w/your CPAP therapy have you gotten from your local DME provider's RRT - and from your sleep doctor?

Have you contacted them and tried to work w/them regarding the problems you have had w/CPAP therapy? If YOU haven't contacted them and asked them for assistance, shame on you.

But - if more likely - they have not provided you w/encouragement, assistance, education and support - that's all to typical and I'd seriously consider going elsewhere for both DME provider AND sleep doctor and even sleep lab if you've contacted the sleep lab for assistance and not gotten any.

Have you read the mask fitting tips in the stickies in the forum? Have you tried wearing your mask w/your CPAP turned on during the day and early evening whilst you read a book or magazine, work a jigsaw or crossword or soduko puzzle, watch TV - ANYTHING that occupies your mind w/other than "I've got to get to sleep".

How actively have you pursued effective treatment of your asthma? What part do allergies play in your asthma problems? Is your sleep doctor a pulmonologist w/sleep as a sub-specialty? Have you been seen and thoroughly examined by an ENT?
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Postby iggygirl » Fri Mar 12, 2010 1:01 pm

To answer some of the questions.... my asthma is allergy related. I have alot of seasonal allergy issues but for the asthma the biggest trigger is mold, so it usually only kicks up in the fall and was controlled with a steroid inhaler. However in 2008 my city underwent MASSIVE flooding. A friend of mine involved w/the community health clinic sd they were told to expect an increase in respiritory complaints for 2-3 yrs post flood. Sure enough my asthma kicked in much earlier than usual, much worse than usual and took both a steroid inhaler and an albuterol inhaler. I'm hoping it will bit more mild this year. The chest pain was definitely related to the asthma and the c-pap really made it uncomfortable. (almost felt like pleuresy a few times). My sleep doc is a neurologist w/a sub specialty. There is only one other sleep lab in town and they don't take my insurance. So I have to use a doc that is attached to the sleep lab that is covered. He is supportive if he is having a good day and if he's having a bad day, acts like i just must not be trying. (my last visit he was supportive and that is when he sugg borrowing a data capable machine for a month). At any rate it always is an 8-12 week wait to see him. My insurance company does NOT cover mask replacement at all, so I don't really have the opportunity to try many on, and the only DME w/pymnts I could afford at the time is 20 miles away so I don't see them much. I have tried what feels like everything... drugs at night, aromatherapy (still won't do w/o that!), hose cover, velcro clips, humidifying, sinus irrigation, taping mouth and mask, etc, etc, etc. While awake, the pressure doesn't bother me much... I have laid awake for as long as 2 hours at full pressure and if I wake up sometimes i put my hand in front of the exhalation vent to make sure its still going cuz I don't really notice it. But SOMETHING keeps happening once I fall asleep!!!
A couple of nights ago, I had major panicky episode, ya know dreaming like i couldn't breathe and couldn't scream... kinda sleep paralysis thing...that hasn't happned in a while, but may have been the klonopin. I take 1 or 2 mg as needed at bedtime if I am using (or trying to use) mask. This was prescribed by family doc (i don't have RLS or Periodic Limb Movement Disorder, but he thought it would help me not pull off mask) but my sleep doc was 50/50 on it. Mostly because if you keep your mask on it can help alot but if it comes off... klonopin can cause increased apneas. (and I can tell when that happens.) Yikes sorry this is sooo long, but as you can tell I have ALOT of frustration built up. Damn near suicidal some days from the inability to ever get some REST! :-(
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Postby CrohnieToo » Fri Mar 12, 2010 2:33 pm

I'd be inclined to drop the Klonopin and find something else in its place. I'd be inclined to try something SPECIFICALLY FOR sleep. And I'd acclimate to my mask by wearing it w/xPAP turned on whilst occupying my mind w/something other than having to get to sleep - read, crossword or jigsaw puzzle, etc. during the day or early evening in the family or living room, not the bedroom.

You have asthma and can "do" aroma therapy???? Ugh! No way would I even ATTEMPT aroma therapy! Gads, those scented candles and even most potpourri give me a rip roaring headache, or take my breath away, or both. Perfumes and colognes? Ergh! Same thing. I dread getting in an elevator! People w/the colognes and aftershaves, ergh!
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Postby iggygirl » Fri Mar 12, 2010 3:36 pm

My family doc actually deliberately chose not to go with a drug specifically for sleeping for a variety of reasons, the primary being that I usually have little if any trouble GETTING to sleep and that's what most of them are geared for. I cannot STAY asleep for any serious length of time. With or without my mask. He also thought klonopin would have less of a hangover effect in the a.m. I already am on 60mgs of time release dexedrine just to be able to stay awake enough to (barely) do my job. I have been on that same dose for about 14 mos, so it just barely gets me through an 8 hour work day. I haven't asked for any increase though because it has some icky side effects AND i don't want to then need anything stronger to go to sleep. Told my hubby I will not be turning into Elvis!
As for the aromatherapy, I am very sensitive to odors, (weird for a smoker, i know) and I cannot tolerate the smell of the equipment. I would wake up and swear I tasted it! And yes, I know I should quit smoking, but i only smoke about 3-5 cigs a day. DH is a pack a day, but since we have to stop smoking in the house while this other cpap is on loan I am hoping I can convince him to keep it that way for good!
I've worn my mask while watching movies, doing crosswords etc, and feel pretty okay with the pressure, but the problem just seems to be something going on after I fall asleep.
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Postby CrohnieToo » Fri Mar 12, 2010 6:42 pm

I'm fresh outta ideas for you. You're really caught between a rock and a hard spot here. I certainly extend my best wishes for CPAP therapy success for you.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
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Year Diagnosed: 2006



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