Recently added to several section and added some sections – eventually most will come to have their own separate article.

Things that appear to help my CPAP work:

Pursuit of an active lifestyle:

I started my pursuit of an active lifestyle simply by using a pedometer to track how close to the “threshold” of 10,000 steps a day I was walking. I started being happy to make 2,000 steps per day.

Learning to eat well:

Dietitian for 3+ years and still read and continue to find new good fuel every week Learning to eat well should be a life long process.

Learning to move well:

The need for a personal trainer as well as yoga and other instructors. Sports someday I think

A bit of sunlight:

Vitamin D3 (good definitions at: ) appears to be helpful in staving off sleep apnea. Dr. Gominak reports that many of her patients are enabled to avoid CPAP simply by raising the D3 levels to between 60 and 80 (see: ).

The basic process of making your own vitamin D3 seems to be that you “shock” you skin with burning sunlight and then your skin (and body) respond by drastically increasing the levels of your natural repair capabilities. As part of that process vitamin D3 is produced.

I like the idea of using sunlight to make my own vitamin D because I believe that other things are produced by the process that also help with repairs and all. I note with interest that those who expose “a little at a time” yet have high exposure levels due to where and when they work do not appear to have high skin cancer levels. Perhaps it is true that if you gradually get used to sunlight and have an active lifestyle (and perhaps eat well as well) then sun exposure does not result in skin cancer.

For myself I try to see that I do limit exposure (not more than a UV index of 8 for longer than 20 minutes – a level I have very gradually worked up to with skin that tans well). I have used a tanning booth for two minutes at a time every other day in the winter but hope to construct a better lighting system for winter by this winter.

It is not just the skin that is helped by sunlight. The brain appears to be stimulated when the light hits the eyes and also by the stimulation of glands in the brain.

Job stress AHI was helped by a bit of cold medicine at night:

Monitoring CPAP flow data:

I believe that to use CPAP effectively long term you must us feedback. You must check your nightly CPAP data and respond to any problems showing up in the air flow data.

While I think the commercial software has likely improved the “still in beta” SleepyHead (see: ) allows me to quickly see what I need to see. Learning to use it well is a process interactive.

Eucapnic breathing:

Of PTS, ventilatory control, raised ventilatory gain, CO2 maintenance and the brain.

EERS if necessary:

Talk with your doctors about [1,2].

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008

Learning to self titrate:

I would recommend that you work with your doctor to guide the following process.

I was “pushed” into doing this. In my new city good doctors to deal with sleep issues seemed to be lacking. As well I had come to understand that doing a titration in a laboratory would in my case tend to be driven way off base by my Post Traumatic Stress issues. As well, one night to me seems simply a bad approach to titration. I knew from observing my nightly CPAP data that I do not sleep the same any nights.

I had moved to a much quieter city with a much much lower crime rate (likely less stress means better ventilatory stability even while using CPAP and so better quality sleep for me). However the last several years I had lost and was continuing to loose weight. Perhaps it was this “lessening of resistance (to my breathing efforts)” added to my effective ventilatory gain a bit. When things got hot in the summer time, when my body was stressed by that heat ventilatory instability raised it’s ugly head yet again.

Moved 1 cm/H2O per ten days from 15 cm/H20 – saw ventilatory instability disappear at 12 cm/H2O – but – obstructive events occurred at 7 cm/H2O so began using 8 cm/H20 – the process taking over sixty days.

If you think about it this allows my body some time to adapt to each new pressure and truly try it out and show what it can really do in my own home in my own bed over several days not a “snapshot” of a few hours at a new pressure. Actual data rather than a “snapshot” taken in a “pressure cooker”.

I have made a few changes up and down since then and now run at 7.5 cm/H2O which is half of the highest set by the doctor. I believe that titration should be a very very slow but ongoing process. Part of the ongoing “feedback” where the nightly CPAP data results in changes first to lifestyle but then to such things a pressure as necessary.