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AHI 22.1 AND SO TIRED
#1
Hi there,

It was two years ago this month that I started cpap, and my AHI is higher now then it was when I started. I wasn't getting enough oxygen at night, so they started me on cpap. My apnea was light at AHI of 8, now it is at 22.1.

I cannot stay awake anymore and when I ask my doctor about it, he says the problem is probably caused by my machine. WHAT!!!

Kate
:Using cpap then vpap since Feb.2013,
Kate
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#2
Your profile shows a pressure of 8/4 which is remarkably low. As far as I know you have not ever published a chart of the events, flows, pressure, leaks that would help interpret what is going on. If your problem is central apnea, it seems unlikely machine pressure at that level is causing it.

Are you using sleepyhead? What is the composition of events. Is your pressure as shown in your profile accurate?

Post data.
______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
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#3
(02-17-2015, 09:05 PM)Kate Wrote: Hi there,

It was two years ago this month that I started cpap, and my AHI is higher now then it was when I started. I wasn't getting enough oxygen at night, so they started me on cpap. My apnea was light at AHI of 8, now it is at 22.1.

I cannot stay awake anymore and when I ask my doctor about it, he says the problem is probably caused by my machine. WHAT!!!

Kate
Sounds like you could use a new doctor!, he should be a little more concerned about you going the wrong direction , I agree your pressure sounds off. need more data to be of any help.
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#4
Thank you Sleepyrider. That was a bit of information that I didn't know. The fact that your pressure has to be high enough to cause centrals. All I have to do is convince the doctor that he knows it without my telling him. Doctors are so sensitive.

And to everyone I will try to figure out how to get my numbers online.

Kate
:Using cpap then vpap since Feb.2013,
Kate
Reply
#5
Kate, CPAPs can cause centrals, and sometime it can happen at low pressures, but I would want to look at your data to make any conclusion that that is a likely cause. Also, you may have central apnea which is basically a lack of respiratory effort, and the solution to that would be a machine that provides adaptive servo ventilation with a backup respiratory rate.

I don't want to throw this back in your doctor's face, but rather help you to understand it enough to go in with a pretty good idea of what is going on. To do that you need to download Sleepyhead, and post some typical charts.

Is that something you can do? I can give you links to the program and tutorials that describe how to post the data.
______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
Reply
#6
As much as I hate sleep studies, I would think that they need to do a titration study to see if they can find a pressure that works better for you, because if your treated AHI has tripled, something has changed. But I would not prompt the doc for one; I would let him come to that conclusion on his own, and if it never comes up, well, buh-bye, doc.
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#7
Im going to buck the tide here and say nothing has changed about YOU since your titration. Id say that the one night titration they are going by you had a very good night apnea wise compared to what in REALITY night to night your level of apnea actually is. And set your pressures to low. One night where you are sleeping in a strange place for a few hours and trying to figure out pressures is a shot in the dark at best.

About the best thing that comes of a sleep lab study is determining if you have central apnea or not.

I may get jumped on a bit for saying this but any Dr that sends anyone home with a machine set at 4 as the min pressure is suspect in my mind. Heck most folks cant even tolerate a pressure that low without suffocating.

The sooner you start running software and taking charge of your own therapy the better. JMO

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#8
Well, I'll jump on that Ghost, but only to say I agree that you just need to learn what is reality, and react to it.

When I got here, I did have my machine set at 4-20, and had no problem breathing at 4. However, my AHI was really high, only dropping to the mid-teens from my study at AHI of 27.

I have since changed to start at 6 because I wanted my AHI to decrease. And, it worked. (some) I dropped by AHI into the 4 thru 9 range still with fairly wide variability.

Now, 6 cmH2O has become the new normal, and I feel comfortable starting there.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#9
(02-19-2015, 09:46 PM)Ghost1958 Wrote: Im going to buck the tide here and say nothing has changed about YOU since your titration. Id say that the one night titration they are going by you had a very good night apnea wise compared to what in REALITY night to night your level of apnea actually is. And set your pressures to low. One night where you are sleeping in a strange place for a few hours and trying to figure out pressures is a shot in the dark at best.

About the best thing that comes of a sleep lab study is determining if you have central apnea or not.

I may get jumped on a bit for saying this but any Dr that sends anyone home with a machine set at 4 as the min pressure is suspect in my mind. Heck most folks cant even tolerate a pressure that low without suffocating.

The sooner you start running software and taking charge of your own therapy the better. JMO

I will not jump on you for your advice; I agree with much of what you say, but maybe I am confused and am reading this wrong. If the OP has a BiPAP at 8/4 does that not mean 8 for IPAP and 4 for EPAP? an 8 IPAP is not low, it is actually pretty common. And a spread of 4 (8-4) is also not that severe. An EPAP of 4 should not be contributing to a problem "getting air" since that refers to "getting rid of air", or what pressure you are breathing out against, and an EPAP of 4 is pretty common as well; when I was on APAP at 5-20 to start with with EPR set at 3, EPAP then for me was essentially only 2 cm when the IPAP pressure was at 5. My apologies for my confusion as I don't follow BiPAP much, since it does not apply to me.

If the IPAP were set to 4, that is the lowest most CPAP/APAP machines will even do. My understanding is that since mask tech has changed, some of them don't work unless you use a minimum of 5, which is why xPAPs capable of 4 to 20 are common, and a APAP setting of 5-20 as a starting point is typical. So I don't know what I am missing here, and unless I am misunderstanding this, it looks like the inhalation pressure is not "low", unless the patient's requirements dictate that, patient requirements that we do not even have any data on.

But it is also not clear what happened in the 2 years between being placed on xPAP and now, from a medical care standpoint. Did the OP see the doc every 2 or 3 months? Did the doc look at her data and change pressures accordingly? Is the OP using the same mask now for 2 years straight, when many masks need replacing after 3 months? There is a large hole in what we know simply from two brief posts.

I also see nothing in the OPs posts that indicate that she ever had a titration study, or that much has changed about HER. She might have had a home study with no xPAP, or no study at all. But if her AHI went from 8 to 22, then something definitely changed regarding THAT. So I also don't see how we can evaluate a study that is not even mentioned or posted here.

Maybe I am missing something, but it feels like the story is missing a lot that would be relevant to answering the questions posed.

We have no clue what the makeup of event types even is. What I think we know for sure is that it would be a good first step to look at the data, another thing we are missing.

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#10
(02-20-2015, 01:00 AM)TyroneShoes Wrote:
(02-19-2015, 09:46 PM)Ghost1958 Wrote: Im going to buck the tide here and say nothing has changed about YOU since your titration. Id say that the one night titration they are going by you had a very good night apnea wise compared to what in REALITY night to night your level of apnea actually is. And set your pressures to low. One night where you are sleeping in a strange place for a few hours and trying to figure out pressures is a shot in the dark at best.

About the best thing that comes of a sleep lab study is determining if you have central apnea or not.

I may get jumped on a bit for saying this but any Dr that sends anyone home with a machine set at 4 as the min pressure is suspect in my mind. Heck most folks cant even tolerate a pressure that low without suffocating.

The sooner you start running software and taking charge of your own therapy the better. JMO

I will not jump on you for your advice; I agree with much of what you say, but maybe I am confused and am reading this wrong. If the OP has a BiPAP at 8/4 does that not mean 8 for IPAP and 4 for EPAP? an 8 IPAP is not low, it is actually pretty common. And a spread of 4 (8-4) is also not that severe. An EPAP of 4 should not be contributing to a problem "getting air" since that refers to "getting rid of air", or what pressure you are breathing out against, and an EPAP of 4 is pretty common as well; when I was on APAP at 5-20 to start with with EPR set at 3, EPAP then for me was essentially only 2 cm when the IPAP pressure was at 5. My apologies for my confusion as I don't follow BiPAP much, since it does not apply to me.

If the IPAP were set to 4, that is the lowest most CPAP/APAP machines will even do. My understanding is that since mask tech has changed, some of them don't work unless you use a minimum of 5, which is why xPAPs capable of 4 to 20 are common, and a APAP setting of 5-20 as a starting point is typical. So I don't know what I am missing here, and unless I am misunderstanding this, it looks like the inhalation pressure is not "low", unless the patient's requirements dictate that, patient requirements that we do not even have any data on.

But it is also not clear what happened in the 2 years between being placed on xPAP and now, from a medical care standpoint. Did the OP see the doc every 2 or 3 months? Did the doc look at her data and change pressures accordingly? Is the OP using the same mask now for 2 years straight, when many masks need replacing after 3 months? There is a large hole in what we know simply from two brief posts.

I also see nothing in the OPs posts that indicate that she ever had a titration study, or that much has changed about HER. She might have had a home study with no xPAP, or no study at all. But if her AHI went from 8 to 22, then something definitely changed regarding THAT. So I also don't see how we can evaluate a study that is not even mentioned or posted here.

Maybe I am missing something, but it feels like the story is missing a lot that would be relevant to answering the questions posed.

We have no clue what the makeup of event types even is. What I think we know for sure is that it would be a good first step to look at the data, another thing we are missing.

Granted there is alot missing and I am assuming some stuff. One thing Im assuming is that to be on a Vpap which is an expensive machine there was probably a sleep study that got her from a cap to a vpap machine. But thats a guess on my part.

Also she lists a Fitlife mask as her mask. That is the mask i used for a good while. Its a total face mask and a Ipap pressure of only 8 would be the absolute min I could have tolerated in that mask.

It is also a mask that one will usually have to bump pressures up a bit to get results from simply because its got so much internal area inside the mask.

Whatever the reason an AHI that high for that long and her DR having done nothing but say its probably the machine causing it??? Thats just IMO inexcusable. Nor can I think of defense for the DR that has allowed her situation to go on this long. But thats just me.
Sounds more like the DR causing it by setting the machine up totally wrong for her to me.

But thats just one guys opinion too.Coffee

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