British Snoring & Sleep Apnoea Association

good to see you are still doing ok mac, ye weight issue with nhs, and cpap, are very confusing, I like you think my ideal weight would be 13 stone and compared to last nights weight check still going down, I have now lost a total of 20lbs since last October when first diagnosed. I also noted I had no change for the first 2 months.

I believe one of the main reasons of the nhs increased pressure on indavidual weights, is it will be a target to achieve, ie more that shows positive results to medical advice, another brownie point, we also need to be aware many clinicians in private practice makes there revenue by quantity of well people clinics, weight, bp, well womens clinics, diabetous, copd, are all part of that revenue building practice as were brownie points to introduce appointment systems, although we now have to wait longer for appointments.

I know for a fact that many of my older GP colleagues left the system and became locums, for that reason. With a belief that it was a backward step, and promoted a system on greed, but of course the government had another agenda with a belief we were too dependant on our local friendly GP's. and as such trying to encourage an increase of private practices to develop.

The nhs system is plagaued by too much power over approaches by central government, that stifles many constructive and positive approaches localy to better health.

I was reading these short verses about diets yesterday, and found amusing Arnold Schwarzenegger, Brad Pitt are both classed as clinically obese and bordering on the morbid side, and Dame Kelly Holmes is considered as clinicaly over weight. Unfortunatly the BMI scale that is being used as a measuremnt tool, does not take into consideration of muscle weight, that is very is very rich in blood, and weighs approximatly 30% more than fat. of same volume.

Many years ago in the late 70's I was was involved with some research gathering on schizophrenia as at that time there was a belief it was due to too much white adipose fat cells around the shoulder blades, needless to say it was piffle, ironic though 90% of these people were all classed as an ideal weight. I also think we need to remind ourselves the food diet industry is worth a very large amount of money to our government, and knowing more and more of the chemical industry is moving away from the uk shoreline, they will be worried where else can public revenue come from? After all from a psychological perspective the whole diet industry is focused at suggesting and making people believe they are not happy with or in themselves.

So from an old psychie nurse have faith in yourself, and your health, no matter of the many minor blips that take place in life. We have 2 certainties in life we are born and we die, what is in between is open for all to do, and make what ever they can, so get on with it, but no one knows how long that term will be, only our Lord, and he is not prepaired yet to tell you.

Sorry if there is any confusion re GP's they actualy make money out of people, but more about how they are paid if they have their own practice,, which is very confusing but something like this,
per 1000 of patients that figure can vary dependant on eldrly, children, or working age adults, the latter they get the least for, so gp's in Easbourne have a better time than say your area. Tey also get paid per well persons clinic, so more they do and more that attend the more they will recieve, but out of that figure, they also will have to pay their staff, but not neccessarily nurses, unles employed directly by them as they may well be employed by the local community trust, they then will be supported by insurance jobs like medicals, or reports, and private certificates, although they cannot make money from dss ones. On average they are paid approx 75k, until recently was not liked due to the amount of hours it included, although since working time directive orders came into force they are now quite well off.

Although on one occassion I met a medic professional and he was paying 3k per month for medical liability insurance, hate to think what his rocords was like. In most government based jobs the state have a complicated target structure setup. Prior to me retiring, I had one by quantity of people I saw per day, yet nothing was set up to prevent hospital admissions, although I had to quantify why each one had been admitted, and prove I could not have prevented it. We also were pressurised to get people out of hospital so to free the bed for others, yet again whould have to quantify each care plan if complicated to reduce risk of injury to self or others.

I wonder why I am cynical of the system. It seems you are doing well mac, keep it up, ironic though weight loss and cpap, will be of some beneficial, but my loval clinicians think it is more to do with size of neck, and as such either muscle toning in that area, or lot of reduction, as I gather Pavarote although obese and had abcg neck, also did loads of throat exercises, and as such did not have osa. Also remember the osa syndrom as such also affects young babies and screened for it, due to cot death syndrom, whch as all been termed due to osa.

So the links between obesity and osa, are not very clean cut, and as such put the fats boys syndrom out to pasture, as my old friendly midwife explained, but you also know what the media is like!

Several months back I trawled through loads of research on this subject, ironic most of it was of a very socialogical structure, very little had any scientific evidence to support findings, when I say scientific, I was looking at biological and ore set of precise physical readings, not just what people felt at that moment of time, as when working we were told that was too subjective to too many variations. Ironic some of the best reserach on oxygen starvation and affects it has on the body, was done in the Himalayas, on climbers, looking at abilities our bodies can tolerate altitude and lack of oxygen in the air.

It was there that most of the stuff about humidifiers become evident to playing such a large part to compliance to therapy.

Hi mac, I suggested to nuneatonman, that his asthma may show improvement due to the cpap encouraging all the lungs to work more efficiently, several years ago I know the Russians was doing some work with regards teaching people to use all their lungs, so as to prevent overuse of inhalers. In psychiatry we often had to teach people who suffer full blown panic attacks how to breath so as to manage hyperventilation.

I don't think local Gp's if they have their own practice, will have to cut costs same as nhs ones where they will have to manage a reducing budget of upto 3% per year, although that budget will increase by population size. the cost of drugs are often used by them as cannot afford expensive drugs, or infact any therapy budget does not come directly come from the same direct source, and will be provided by the area health authority budget, but often will be told they will have to cut certain services due to another overspend in another budget.

With regards to distilled water, I just use ordinary tap water but my water supply is not very hard, a cheaper solution could include the use of a water filter, it will filter most chalk and other substances, I use one it here removes all the flouride and other chemicals from it's original taste, and all of our water is from reservoirs, not river or running water.

Ye I empty the chamber every morning, and rince it out allowing it time to dry before the following nights use, I have a schedule of weekly goingthrough the machine's filter, mask, and tube. But wash the container out in the disshwasher every month, or when the build up of chalky deposits start to show. I must admit our water localy, is not too bad so don't have the need to use anything other than filtered water, although when away, I soon noticed the build up even just after 2 to 3 days use.

Originaly I use to use diluted vinegar to wash it out with, but the smell put me off and after a chat with nuneatonman came back with the dishwasher route. It to day looks like it did last October when I got it, but if you do not have a dishwasher, Milton may well suffice, although dilute it.

mac
From your second to last paragraph my imagination gives me a picture of your cpap asking you permission to have a jimmy riddle.

Seriously though if I was to look closer at your wording, it is evident you are well and truly attached and can now pass yourself off as an accomplised "hose head" WELL DONE, only thing now is to wait for the medals to be given out by the way psychologists call this attachment theory term as "Proximity Maintenance".

I looked at your link about cpap and Bath Hospital, when I worked I use to be involved in writing those sort of policies, in Psychiatry.

mac
lossing weight, will be good for osa along with other health issues, but with regards to comming off cpap I have my doubts.

My next door neighbours brother in Canada came off it about 6 years ago due to weight loss, but his weight loss was extreme, as originaly he was 25 stone, and had surgery to he originaly was diagnosed with osa in 1998.

From a professional perspective, I would also question if all with OSA, have the same reason for going on cpap, although weight is a big link to it, but it is not the only one, my sleep centre says we have to seriously look at sizes ofour necks, and try to inprove muscle tone in that area. Also in France they have come across a gentic link with OSA running in families and from a neurologic perspective to be caused by myoline sheet damage of the nervous system. Probably why it is still classed as a syndrom, not a precise diganosis, knowing this same term is used with babaies to prevent cot death.

From a psychological perspective and feeling I can cope with the whole issue of noisy machine aside of me all night, and tubing and mask everynight needing to be rearranged, I have destined it as been a necessary evil in my life, so if and when I don't, it's a blessing, although on a positive side I have seen a need for pressure to be reduced, and have already done that myself, as I was experiencing a lot of ear ache when waking, it was very similar to taking off and landing on flights.

Yes as you say motivation and enegy levels are up, and start to feel you are alive again.

I am a big believer of the developmental theory, we did not become ill over night, it took time for it to develop, so our body will need time for it to adjust back to where it was or to move up from. Only too often people would come into our clinics and expect instant cures, and as an old medic once said, yes you can buy a pizza over the phone and have it delieverd in minutes to cure your hunger, but you cannot expect good health to be delivered by a phone call to cure your ailments, if and when you know it. Yes unfortunately probably not all facets of OSA are known and as such we are still learning about it. heck we have been told before it's a syndrom of symptoms, that affect all ages, some big some small, unfortunately research tends to focus on one type and forgets the others.

If we look closer at those theories of develoment we can see linear, or circular or even multi circular ones, I tend to like the circular and multi circular ones, we never knew at which stage of that circle you became ill, so may need to continue to round several times to reach that same stage again, just to move into the next stage of development.

Unfortunatly we never know what our next chapter in life will hold for us, but do we want to? so we just get on with lifes intricate patterns we weave.

For me osa was a challenge and will remain to be, I still hate plugging myself into the mains each night, but if it needs that to manitain my batteries charged, so what, a minor inconvenient!.

Must go got a full day with a minibus full of dissabled folks in wheelchairs to Southampton and return, I have learnt to expect the unexpected, and be prepair for the expected, knowing each day is different so it will just be another challenge to life. Being they all suffer from MS, they are thankful just to get out, or even see countryside, even if they are incontinent, or choke on every bit of food and drink they consume.

I must admit they also make our problems quite insignivicant to theirs, but for the grace of good there goes I!.

Be strong

Thankyou mac, but life is a challenge at times, so probably this is just an added part of it, I have my sleep clinic appointment this afternoon, but don't expect anything from it, just the usual compliance issue to keep dvla happy. Unless I wish to manipulate part of it for my own benefit, which I think I will stimulate some discussion regarding machine reliability and such items like filters pipes etc.

Yes I also still get bad days, so nothing new, other than continue and treat each day as a new one.

ye 1 year next call back, also discussed issues re spares and machine,
machine is mine until it is not needed again. all spares we think is necessary are available foc. we also discussed weight issue, they were not interested, because as she said general weight has little to do with osa, and it is all todo with size of neck, and very unlikely it would reduce below 16 inches, even if my weight reduced to below 11 stones.

You are doing well mac in your strive with weight loss, if you read meetcrunchers about his weight loss, down to 12 stone and sill on cpap. as the technician mentioned at the clinic yesterday unless my neck size reduses, there are fewer reasons to say I can go without. but turning the pressure down it welcoming I must say.

I have tried to discuss that issue with the persoanal instructers at the gymn, and it does seem rather futile, as although muscle strengh and tone can be built up there, it often coincides with an increase of neck size and shoulders, and as such can have a negative affect.

Yes the heat does have it's drawbacks, and probably more with us now due to the humidifiers, so necessary for 9 months per year, yet during these few hot summary weeks, when we have warm humid nights, the hot air blown into our faces can be vey frustrating.

Thanks for your kind comment, Mac...I found that programme interesting but still believe that it's carbs not calories that you need to watch. There is a programme on tonight on ITV with four celebs doing different diets from around the world. I still think that the one who loses most will be the one who has cut the carbs, but all these documentaries have different angles. It's like the "10 things programme" had a handy hint about soup. I shall certainly practice soup for lunch this winter. I love home-made bacon and lentil soup and if it makes me feel full from 1 pm to 6 p.m. then that's a thing worth knowing! I try to restrict my bread to one slice a day. I take it out of the freezer at breakfast time and straight into the toaster. The toaster is set for short sessions, the first one defrosts it and the second time toast it, it also has a reheat facility. More often than not, I have cheesey scrambled eggs, with two eggs, butter mature cheddar, crème fraîche S&P. Perhaps though, there's no "one size fits all" approach to weight loss. Keep up the good work
All the best Ken

I am sorry for you mac, because I know how difficuilt it has been for you to get attached, but as I suggested with my note on the sleep clinic was just a legality issue of seeing if I can continue to drive, and compliance my technician just looked at times I had machine on, as they averaged 8 hours no problem, I looked at the computer read out, and could not notice anything about if mask was on my face, or if pressure was maintained.

I also know the heat we have had these past few days have not helped me, but continued to push on, unfortunatly in your case with copd, and cpap, I would question amount of knowledge she has on the former, nor how much affect it will have on your ability to keep attached.

On the other hand I doubt the dvla will give any leeway, as they will focus upon your level of droswiness, and will not be able to take into consideration other overall issues. Do you have any appointments with a doctor, not other associated staff, as that can make a differnce as it will rest on your doctors word, not a sleep technician/nurse, who will only have the responsibility to report back and support. From my experience the latter word at times is not there when needed, or has a different mening to it than we the patient has.

At least you have next 2 months to show better figures.

Mac regarding dvla.

Only your consulatant has the final responsibility to stop you from driving, the technician/nurse will take readings and inform the specialist. Your GP can advice you not to drive due to certain health problems, but again that will depend upon who has the final word with regards that health problem

The medical conditions and driving, is complex, quite a few conditions are not even mentioned. When I worked we had to make legal decisions regarding a persons capacity to drive, in the end it often came down to intent to and not being aware of capacity. In mental health if they were psychotic and showed a delusional content to harm people with a method, then we often would be more cautious than just managing there delusions. Yes like you said by being cautious and thinking before of what you are capable of will all most surely be in your favour.

Recently with my MS duties, we had a bus driver often ramming into other cars even parked ones, and had reports of him going through red lights, or crossinf raliway lines when lights flashed. He also had a medical condition of spondulosis of the spine, that prevented him from turning his neck. Medics had no ability to stop him from driving, as it is not reportable, so due to advice from insurance companies, he went through another pcv assessment, ironic the instruced had no legal ability nto remove his licence, but had the ability to advice, his responce, was for him to drive with a passenger attendant, and for him to be more aware when in confined spaces.

We all still have anxieties, but yet have limited ways to stop him, other than ask him not to drive, but being short of volunteers, that at time is rather difficuilt to bite. GP's dvla, driving standards agency don't want to know, unless he has actualy commited a crime.

some people are born with brains, some have to live to find them! where they find them is at times hard to face, or just too stupid to go their in the first place. In the past you have called her a nurse, our senior technician here admitted she did 18 months as a nursing asistant in psyciatry, got shoved about, and quikly left and did a Btech certificate in allied health practices. I can assure you it will only include a basic level of theory, and introduction into managing it, unfortunatly it is very new to health care although it has been known about for 15 years or more only as recent as 2 years ago did it become part of the nhs. so education of it's complexities are not often seen. On the other hand medics and most registered nurses, may not know much about it personaly, they will have the added advanced theories to breathing and it's complexities, some will soon add 1 ans 1 and come back with more of a devinitive answer.

The bilogical process of how we breath is probably one of the most confusing, knowing our brain cannot measure amount of o2 we carry in our blood stream, so relies upon co2, hence probably why it is difficuilt to diagnose.

I take my words back, but still think she needs to go back to school, or her skills were probably not people minded ones.