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$45 Tip to Sleep Doc.
12-09-2014, 04:31 PM
Went to my last appointment with Doc before ins company releases my apap to me officially. Waited about 20 min out front, 15 min in the back cell. He came in, sat down; said he had to ask one question, for insurance purposes. Did the apap cause me to vomit, or did my legs hurt? I told him no. He said his computer had been acting up, and was afraid to mess with it. I told him I was at 96.5 compliant, and showed him my SH results, He opened it, glanced at it, said "great", and handed back to me. Said we were through, and told me he would see me in a year. My average AHI over the last 3 months is 12-13. I am in the wrong business, for sure! Bye, bye, Doc. Just reset to auto, 9 min, 14 max, no ramp, from 14 fixed, no ramp. OA , and CA run about the same on my back, CA gets jacked when I wake up, but little OA, and purposefully go to my side. See how that fits. Any suggestions as to better handle this change?
12-09-2014, 05:05 PM
You have too many events and maybe they are CAs but the so-called sleep doc didn't bother to look at or consider a new machine or changing the current settings?
"AHI over the last 3 months is 12-13"
That's not good (enough).
"CA gets jacked when I wake up, but little OA"
You may have the wrong type of machine if you are getting a lot of CAs but OAs are minimal.
Post your actual results using SleepyHead and someone (very) knowledgeable about CAs will likely answer in more detail.
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)
"We can all breathe together or we will all suffocate alone."
12-09-2014, 07:18 PM
As I said, OA's pretty much go away when on my side, but CA remain. Honestly, current machine is what I have, with current doc attitude, machine to be billed out on 17th Dec; it is what it is. I am old enough to know you cannot make someone care. If sufficient groundwork is done, and I show no improvement, I can find another Doc, elsewhere, and lay out supportive data for Bipap, if indicated. No real experimentation has occurred, since I got machine, preset @ 4-20, since mid September. It was changed to straight cpap, about midstream, cause the Doc was trying to help me get some sleep; pressure changes were too drastic; not really having much sleep for weeks. I will have to read up on how to post data, then post it. Six week Doc appointments too long an interval to try much. Now is the time.
Agree that your sleep doc is a moron. 12-13 is not terrible, but its not good. Sleep medicine guidelines dictate that you are not considered "in remission" until your AHI is sustained below 5 on average. He should have discussed that with you.
12-09-2014, 07:46 PM
saltydawg2, You're right, you can't make anybody care and especially a sleep doc. Mine was giving me appointments three months in the future when I first started on CPAP. I say WAS since I dumped him when I found this forum.
You'd be well advised to install the free SH software and post some graphs here to get the kind of help you should be getting from that doc.
You can do much better here than almost any sleep doctor or DME clinician. They usually just want to set you up with a unit and put you on your own for a few months.
I don't think they realize that sleep deprivation is a very serious condition that can cause death due to any number of medical reasons but also including auto accident and suicide. It also takes a terrible toll on your relationships with friends and family and can cause a person to lose their job. An appointment for months in the future can be like a death sentence for some people.
You're right, it's time for you to make the move and install the software so you can be the best steward of your health. Get about it and you'll be glad you did.
12-09-2014, 07:49 PM
Well, I do have software; both SH, and Rescan, per profile. Am now attempting to upload; hold that thought!
Here are screenshots(hope). Might be a duplicate in there, can't tell yet. Dailies are pretty random, but typical. No large air leaks; very few small; not enough to consider. Largest AHI shown is on weekend, when I about collapsed.(11 hours) I typically get about 6 hours sleep. You can see the attempts to sleep on side, cause of no OA to speak of.
From the one graph, it's pretty obvious that 14 cm H2o didn't work, as you have said. I don't know what position you were sleeping in when that was generated. The change to auto mode was a good move but you may consider changing your setting depending on what sleep position you choose to use. If you can sleep on your side exclusively, you can lower the minimum and possibly reduce the CAs. You may even be able to do that anyway, even when back sleeping. If you're still at 9min & 14 max, consider trying 8 min & 14 max for a while. The 14 may be more than needed, especially if you can manage to stay off your back, but will obviously be needed if you intend to sleep on your back, possibly even higher will be needed.
I'd not be too concerned about the CAs just yet, wait until you get the OAs under control before working on those. I suspect most of them can be caused while you're awake and don't really count. You present AHI probably wouldn't be all that bad if you pitched out the first and last batch of CAs which were likely while awake.
Stick around for more opinions. I'm no doctor nor am I an expert on these boxes so I may not be seeing the obvious.
12-09-2014, 09:14 PM
I will add that if/when you post the results of any changes made it is best to arrange the graphs so that the four most important ones are shown. Those are- Events - Flow Limitations - Pressure - Leaks. Viewing those four and their relationship will give good insight into any possible problem.
12-10-2014, 12:59 AM
Click on the events tab, then click on individual events. See how long and how severe the individual apneas are. They're a lot more worrisome if they're long and ugly than if they're only 11 seconds or so.