So, I won't go into very much past history, just a quick review. My mother age 84 was diagnosed with complex sleep apnea in October 2014 (approximately) by her primary care doctor from a home sleep study. The doctor's prescription was for an APAP with pressure settings wide open (4 to 20). Well, the very first night, when the pressure ramped up to 17, mom took the mask off and threw it across the room. That's when I got on the apneaboard, and intensely studied sleep apnea.
I turned the top pressure down to about 10, which was a pressure that mom could tolerate. Unfortunately, her OAs were still way above 5. So, gradually, VERY gradually, I turned the top pressure up, and up, and up. It is now up to 20 with an expiration relief setting of 3. Her AHI can still be anywhere from 3.4 to 10, with the average around 5.
I also very gradually turned up the lower pressure because it was obvious that a lot of apneas were happening while the machine was slowly increasing pressure. So, her settings now are 14 for the lower pressure, 20 for the higher pressure AND a 10 minute RAMP that starts at 10.
The problem is: mom can't tolerate the 20 cm H20. She wakes up frequently because of the pressure (which came up because she has A LOT of flow limitation). She hits the off/on button, it goes into ramp mode, and she goes back to sleep. Within 20 minutes it usually goes up to 18 to 20 again and she wakes up again. Lately, she has been getting up, going to the bathroom, and goes back to sleep without the APAP machine, (she says the mask feels like a vise on her face).
Her primary care doc wanted her to have a sleep study at a sleep lab last winter. Well we are two little old ladies that live high in the snowy mountains. To get to a sleep lab, we have to travel over a treacherous mountain pass and we weren't willing to do that in the winter time. But now, spring is here and the passes are "doable" so we have an appointment with her primary to ask her to refer mom again to the sleep lab. Certainly mom really needs the help of a Sleep Doc that knows his stuff. The primary knows very little and wasn't even sure if she should prescribe the APAP or not. She actually told us it was up to us. Our thoughts were, mom's home sleep study showed she spent MOST of the night with O2 saturation under 88 so we were determined to do SOMETHING. So, we went with the APAP.
Here is my question for the Board: Mom feels like she can't breath OUT when the pressures are up to 20. Would a bilevel APAP work better for her? If so, how do I convince her primary doctor tomorrow to switch to an auto BiPap? I think she will be very uncertain about it.
The appointment with the sleep lab and titrating is probably a month or more away and mom is fading fast on being able to use her APAP. Suggestions?
Thanks for being here. All of you have been a great help. I have to go to work but will check back tonight.