Soon to start CPAP - Question on dehydration

[picante]

A Dentist is allowed to treat sleep apnea, as long as he says to support the apnea should be no problem with the insurance.

Even when I am quiet I am following your progress closely.

Fred

Oh, that's very reassuring to me that you're still following! What do you mean "as long as he says to support the apnea"? Something came out wrong in that sentence, n'est-ce pas?

It's a c-c-c-cold night here, -6 F right now, time to go stoke the stove and burrow under the covers.

[Gideon]

A Doctor needs to state what condition is being treated for insurance purposes.

[Sleeprider]

DDMs widely prescribe mandibular advancement devices and even perform oral surgery to resolve sleep apnea. Nothing precludes them from using their medical expertise to treat apnea with positive air pressure or adaptive servo ventilation. Many dentists are licensed in anesthesia, oxygen and other tools of the trade, so you are indeed under the care of a medical doctor with a DDS license (Doctor of Dental Surgery).   Here is an article from Healthgrades:  All of the following types of doctors may play a role in diagnosing and treating your sleep disordered breathing.

1. Primary Care Doctors

Most likely, you already have a main doctor who handles your regular health complaints. This could be a family medicine physician, an internist, a general practitioner, or a geriatrician if you’re older.

See your primary care doctor first if you have questions about snoring, morning headaches, memory problems, or other signs of sleep apnea. Sometimes, he or she will take steps to diagnose and treat you. In other cases, you’ll get a referral to a specialist.

2. Sleep Specialists

Board-certified sleep medicine doctors have undergone special training and testing to ensure they can diagnose all sleep-related disorders, including sleep apnea. Often, sleep specialists begin with another type of specialty, such as otolaryngology (ear, nose and throat) or neurology. The best sleep specialist for you may depend on what’s causing your sleep apnea. Ask your primary care doctor for a referral or recommendation.

3. Ear, Nose and Throat Doctors

Also called otolaryngologists, these doctors specialize in diseases involving the structures inside your head and face. They can help if your airways are narrowed by the shape of a body part—for instance, if your tonsils or tongue are large compared with the opening to your windpipe, or if your airway is naturally small.

4. Neurologists

As you age, your brain may not signal your throat muscles to stay stiff while you sleep, narrowing your airways. Your tongue may also relax too much, affecting how much air you breathe in. Neurologists focus on this and other ways your brain and nerves contribute to sleep apnea.
5. Psychiatrists or Other Mental Health Professionals

Sometimes, behavior change alone can resolve—or help treat—sleep apnea. Losing weight, sleeping on your side, and quitting smoking may help keep your airways open. Behavioral health experts can help you create a plan to modify these factors and get a good night’s rest.

These professionals can also help you manage the effects of poor sleep on mental conditions, including depression, anxiety, and bipolar disorder.

6. Dentists

That’s right—these medical professionals do more than fill cavities. Some dentists have special training in treating sleep-related breathing disorders, including sleep apnea. They may help by fitting you with a special dental device that moves your jaw forward, making breathing easier. Usually, a dentist will work with a board-certified sleep specialist to manage your care. The doctor will oversee your treatment, while the dentist will make changes to your oral device as needed.

7. Surgeons

If your sleep apnea doesn’t respond to treatments like weight loss, breathing machines, or dental devices, you might need surgery. The type of surgery you have will depend on the cause of your apnea. In some cases, a surgeon can perform a simple procedure to shrink or stiffen the tissue in your mouth or throat that’s blocking your airways.

[Sleeprider]

Here is a short article on long-term oxygen therapy. You have sleep studies and lots of data that show the need for oxygen therapy as well as the benefits of using it. Your GP should be able to pick up the ball and run with it, but your DDS friend is equally capable.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170342/

[picante]

Just a quick reply: THANK you both for the info. The dentist fit me into somebody's cancellation slot tomorrow!
I will report in again after that.

[picante]

Hi guys, I'm sorry, it's been a rough couple of weeks with appointments. Briefly, the dentist said he is authorized only to make an oral appliance for apnea treatment, not to issue prescription changes -- they'll throw it out.

The ENT who just diagnosed me with a deviated septum left for Africa without answering my request for a prescription change. This week, the PCP at the state employees' health clinic issued the script to stop CPAP and continue oxygen on a cannula.

Along with that, last week my weight dropped so low, DH & I decided to take me to my ND and see if he thought IV nutrition  was a good idea. It's the first I've seen him since last July. He was shocked. He gave me a Meyers cocktail IV and I've been back twice more. I'm going twice a week. My weight stopped dropping.

Night before last (Thursday), I finally figured out that I've been swallowing air all along, even since stopping CPAP. You see, as a trial I raised from 2 to 2.5 LPM. And I woke up with air being pushed through the lower esophageal sphincter. I had had a terrible gut-ache in the evening, and the higher flow was doing it; I just didn't know, I thought it was from sitting in the recliner at the ND's office for the IV.

Now I've reduced the flow to 1.5 LPM and less air is going down to my stomach, so magically, my gut-aches are much less severe, and I'm able to eat 3-4 times what I was eating before Friday (yesterday).

No medical people have suggested that I might still be swallowing air. What a dunce I am for not thinking of this before, considering all the airway constrictions I have:
Vocal cord constriction from gastric juices in my airway + nasal passage inflammation
Chin-tucking positional apnea
Deviated septum

I am swallowing the air mostly when my mouth is shut, on the exhale, when the pressure in my mouth is highest.

The dentist had me call the sleep center in Bozeman, and I found that the woman who runs it understands this whole airway reflux / apnea feedback loop very well. She also understands the switch from OAs to CAs that happens on CPAP. She talks a lot with my dentist and thinks the world of him. She says I have complex apnea and echoed what you said, Sleeprider: that I would never tolerate the higher pressures of ASV.

I can go there and try every mask on the market through a free loaner program they have for tough cases like mine.

The dentist is recommending mandibular advancement surgery and the ENT is recommending septoplasty. Any surgery or travel has got to wait until I gain at least 15 pounds. And I've got to have rest from all these appointments in order to gain weight, because exertion aggravates all symptoms -- the Post-Exertional Neuro-Exhaustion I get.

Crazy, huh?

[Sleeprider]

Oxygen feed through a cannula is a dose, not a pressure. It cannot increase aerophagia at 2-L/min vs 1.5 L/min. If you need more oxygen, you are depriving yourself of it for no reason.

[picante]

Oxygen feed through a cannula is a dose, not a pressure. It cannot increase aerophagia at 2-L/min vs 1.5 L/min. If you need more oxygen, you are depriving yourself of it for no reason.

Thanks for the quick reply, Sleeprider. I believe you, which means that air is still being pushed down through my sphincters for other reasons, and there is no correlation with oxygen dose.

If I can get control of the air passage inflammation (the reflux, in other words), I may see huge improvements. All of that is creating quite a vacuum effect on my sphincters.

[Hydrangea]

The dentist is recommending mandibular advancement surgery and the ENT is recommending septoplasty. Any surgery or travel has got to wait until I gain at least 15 pounds. And I've got to have rest from all these appointments in order to gain weight, because exertion aggravates all symptoms -- the Post-Exertional Neuro-Exhaustion I get.

Crazy, huh?

First of all, you are not a dunce. Look at all of those *medical professionals* who didn't think of it either. 

Second of all, doctors will recommend what they know.  An OBGYN will recommend C-sections because their specialty is surgery (rather than midwifery).  So of course the dentist recommended that surgery, and the ENT recommended the other surgery.

I was experiencing constant clicking and popping in my ears due to CPAP.  I met an ENT at a social event, so I asked what he thought. He said since he's not my dr and isn't familiar with me, he couldn't give me advice... but if he were my dr, he'd look into surgery.  That motivated me to figure it out on my own; and what do you know, I just needed to eliminate the exhale support, and the clicking & popping have disappeared.  But I can't blame him for jumping to surgery... because it's what he's trained in, so it's what he's been taught to think of.

[picante]

Second of all, doctors will recommend what they know.  An OBGYN will recommend C-sections because their specialty is surgery (rather than midwifery).  So of course the dentist recommended that surgery, and the ENT recommended the other surgery.

I was experiencing constant clicking and popping in my ears due to CPAP.  I met an ENT at a social event, so I asked what he thought. He said since he's not my dr and isn't familiar with me, he couldn't give me advice... but if he were my dr, he'd look into surgery.  That motivated me to figure it out on my own; and what do you know, I just needed to eliminate the exhale support, and the clicking & popping have disappeared.  But I can't blame him for jumping to surgery... because it's what he's trained in, so it's what he's been taught to think of.

Thank you, Hydrangea. I know, I'm the only one who has drawn the whole picture. And it's such a job persuading doctors, in their compartmentalized world with no central brain, that my picture is relatively accurate.

I'm going to try nostril dilators next, which I ordered yesterday, to open up the left nasal passage (both of them actually). Whenever I hold it open from the bottom of my nostril, I get so much more air flow, it seems really promising. In my dreams, the dilators open it up enough that I no longer need surgery!