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AHI avg. 11, mostly CA's, comments?
#1
Cpap treatment for 4 years. Use Encore Viewer to monitor my results. My doctor has no suggestions, he's not a specialist. AHI almost never below 11. At my only sleep study 4 years ago, my average AHI was 24 in REM sleep. It is always the CA number that is high. Doc says these results could be inaccurate with just my machine data (Respironics Auto AFlex) If I just combine the OA and H indexes, I'm fine, way below 5. My doc thinks I need a new sleep study and possible a Bipap machine. I'm thinking that I had better get to a Sleep specialist at a major univ. hospital. Now that I'm beginning to understand all this and I'm paying more attention to my numbers, I'm wondering why the doc didn't put me on a machine to treat Central Apnea in the beginning. Rural central PA is not a good place to have apnea treatment.
Thankfully will appreciate any suggestions/comments.
deb
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#2
Sounds like a good idea to me. I switched to a GP who has a lot of experience w/ sleep apnea and has his own sleep clinic, and am pleased with going out of my way to see a good doc.
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#3
Hi deb,
WELCOME! to the forum.!
I wish you good luck in finding another doc and much success to you as you continue your CPAP therapy.
Hang in there for more responses to your post.
trish6hundred
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#4
(09-20-2015, 05:16 PM)deb Wrote: Cpap treatment for 4 years. Use Encore Viewer to monitor my results. My doctor has no suggestions, he's not a specialist. AHI almost never below 11. At my only sleep study 4 years ago, my average AHI was 24 in REM sleep. It is always the CA number that is high. Doc says these results could be inaccurate with just my machine data (Respironics Auto AFlex) If I just combine the OA and H indexes, I'm fine, way below 5. My doc thinks I need a new sleep study and possible a Bipap machine. I'm thinking that I had better get to a Sleep specialist at a major univ. hospital. Now that I'm beginning to understand all this and I'm paying more attention to my numbers, I'm wondering why the doc didn't put me on a machine to treat Central Apnea in the beginning. Rural central PA is not a good place to have apnea treatment.
Thankfully will appreciate any suggestions/comments.
deb

If within your insurance/budget a sleep specialist is a good idea -- especially when in doubt as to efficacy of therapy.

IMHO: Bilevel will not help with CA. Might even exacerbate it.

The ultimate machine for CSA is Adaptive Servo Ventilation (ASV.)
ASVs detect central apnea and work much in the way mouth-to-mouth inflates the lungs with puffs of air.

ASVs are relatively expensive; and not often the first prescribed machine. Working with a specialist is best.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#5
deb,
Definetly find another doctor. If your doctor is recommending a bilevel, I would find a specialist that understands and will be able to interpret a new sleep study, should you have one.

Agree with justMongo, a bilevel is not the correct machine if you suffer from CSA
OpalRose
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#6
Deb I think you are right. Your numbers and symptoms sound identical to mine. My Doc and physician gave me a resmed aircurve 10cs pacewave machine to trial. It nailed the centrals straight away. AHI now 1 or less . I have now purchased a machine ( quite expensive) The same machine is available in the usa but with a slightly different name.
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#7
There are some BiPAP machines that treat central apnea. They are far more sophisticated than simple bi-level machines. This is probably what the OP's doctor was referring to.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
(09-20-2015, 05:16 PM)deb Wrote: I'm thinking that I had better get to a Sleep specialist at a major univ. hospital. Now that I'm beginning to understand all this and I'm paying more attention to my numbers, I'm wondering why the doc didn't put me on a machine to treat Central Apnea in the beginning.

It could be that you weren't diagnosed with central sleep apnea because you only have it when you're using a CPAP machine. This is a well-known issue called CPAP-induced central sleep apnea.

Getting a good doctor who treats it is a good idea.

Meanwhile, I suggest you download SleepyHead so you can get a better view of what's happening. Look at how long your central apneas last. If they last for only 10 seconds that's not as much of an issue as if they last for 60 seconds. You could also get an oximeter to measure your oxygen level. Do you feel you're getting a good night's sleep on most nights or do you feel tired during the day?

I agree with your doctor's statement that this could be just an artifact of how the machine takes its measurements, but it needs to be checked to be sure.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
(09-20-2015, 05:16 PM)deb Wrote: Cpap treatment for 4 years. Use Encore Viewer to monitor my results. My doctor has no suggestions, he's not a specialist. AHI almost never below 11. At my only sleep study 4 years ago, my average AHI was 24 in REM sleep. It is always the CA number that is high. Doc says these results could be inaccurate with just my machine data (Respironics Auto AFlex)

Hi deb, welcome to Apnea Board.

In my view, a very excellent machine for treatment of combined obstructive and central sleep apnea is the Philips Respironics System One BiPAP autoSV Advanced. It is very versatile and can be adjusted to operate similarly to a fixed CPAP, an APAP, a fixed bilevel, and Auto Bilevel, an ST machine with backup respiration rate or an ASV machine with backup respiration rate. I think a new Respironics ASV model has come out or is coming out soon which will have similar features, and I would suggest getting the new model, if it becomes available in time for you.

I think the ResMed AirCurve 10 ASV is better for some ASV patients than the Respironics ASV model, and the A10 ASV is fine for most ASV patients, but the complete adjustability of the Respironics ASV unit can be really very important for a few patients. I think I will likely get the Respironics ASV when my current ASV machine wears out.

Regarding your doctor's statement that the CA events reported by the machine "could" be inaccurate, I think his attitude "could" be lackadaisical and lazy.

In my view he should have bothered to look. If one zooms in closely to look at the detailed data around the time of a reported CA event one can usually clearly see in the Flow waveform whether the CA was likely real or likely not real.

"Flow" is the estimated rate at which we are inhaling air or exhaling air. Upward, positive, is the rate of airflow into our lungs. Downward, negative, is the rate airflow out of our lungs.

The Tidal Volume is the estimated volume of air breathed in or out in one breath, averaged across a few breaths.

Occasionally, large quickly-varying Leak will cause a CA to be scored when no apnea occurred.

Occasionally CA can transition into OA during the same apnea, which can cause the machine to miss an obstructive apnea which started as a central apnea. Only the CA is scored.

But far more commonly, if the unintentional leak is steady and is not very large, the CA and OA events reported by the machines are pretty accurate, in my opinion.

Take care,
--- Vaughn
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#10
I want to thank everyone who replied to my original email. Your support and encouragement is so much appreciated. And I've learned a lot! I'm awaiting an appointment with a quality sleep specialist at the Univ. of PA medical center, 3 1/2 hours' drive away from me. If what I have is mostly Central Apnea, I now know what questions to ask my new doctor. I will not be shocked if I find out that I do need an ASV machine, but now I also have the information to help make the right decision for me. How many brain cells may have been lost over the past 4 years? I am so looking forward to some answers and hopefully some daytime energy!

I will surely update this when I have more information, so others can possibly learn from my experiences.

Your help has been invaluable!

deb
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