Airway and diagnosis

[Paula McCabe]

Go to the Sleepyhead folder (probably on your C: drive) and double-click the Sleepyhead-brokenGL.exe file. Does the program start?

Hi, I finally got it! Thanks!

[Sleeprider]

With Paula's permission, I am posting the most recent night of therapy, and opening up some discussion. We started with no data or knowledge of her settings, and now we at least know some things. She was unable to find the auto Bilevel mode, so we are currently in fixed bilevel at EPAP 5.0 / IPAP 9.0. I would still like to get her machine configured to auto bipap with a PS of 3.0-5.0.

Last night she had a total AHI of 2.84. Most of that was clear airway events (1.55) which is normal considering you are adapting to the pressure support. OA was only 0.52 and a Hypopnea index of 0.77. Zero flow limitations or RERA, however close examination of the flow wave-form shows some chronic flow limitation. There are 4 breaks in therapy where she removed the mask, which seems typical. Breaks in therapy were preceded by a clear apnea, and in one case, a long period where she appear to be awake. The large leak index was only 0.91 totaling 254 seconds (4-minutes). Room for improvement on leaks, but nothing terrible. Total use last night was 7.75 hours which is much better than average, but she always has fragmented sleep, and this is the crux of the problem. Since 2012, she has averaged relatively few hours of therapy, and always fragmented into multiple sessions.

I think we can further optimize her therapy, but no matter how good we tune the machine, sleep fragmentation may be a problem. I am skeptical that it is apnea related or that it will be helped by surgery. Here is why; based on the data, she doesn't snore, no flow limitations and apnea is therapeutically insignificant. Tidal volume is good (median 440 mL). Based on data collected by the machine, at the most recent settings she doesn't even have RERA, but did prior to June 2014.

I think she needs to look at sleep hygiene and other potential causes of fragmentation. I'd like to hear other opinions.

[eseedhouse]

It looks like the clock is not set correctly unless she works the night shift!

[Sleeprider]

No way to reset the clock that i'm aware of, and my computer machine is on a 3-hour time difference. That might have something to do with it.

[eseedhouse]

No way to reset the clock that i'm aware of, and my computer machine is on a 3-hour time difference. That might have something to do with it.

The clock can be reset from the "clinician" manual and should have been set for your correctly when you bought it. Just hold the Home button and the Round button down together for five or ten seconds to bring the clinician menu up. I update it fairly often because the internal clock tends to "drift" even when the power is on continuously.

[Sleeprider]

Um, Ed? This is Paula's machine.

[Paula McCabe]

No way to reset the clock that i'm aware of, and my computer machine is on a 3-hour time difference. That might have something to do with it.

Hello SR (and everyone),

Hope you are well.

I began an anti-depressant a few weeks ago and my sleep has greatly improved. In fact, I've not even been using the XPAP and I am getting some of the best sleep in ages!

I am not 100% but I no longer am waking feeling "hungover" with tight, sore muscles of the neck, shoulders and back. I will get back on the machine to create some readings for the sleep specialist I am now seeing to reevaluate.

I was also anemic which I understand is linked to apnea and saw good improvement after taking iron.

And it is now looking like I will not need MMA surgery!

Best to you and everyone here!

Paula

[Sleeprider]

That's great news. I hope your improved sleep and health continue.

Thanks for checking in. Don't be a stranger.

[quiescence at last]

I had not heard that anemia was an expected outcome of apnea, nor have I heard that anemia brings on apnea or makes it worse. hmmmm. something to look up.

Thanks for the tip.

QAL

ps. so the only study I have found in the last few minutes is one that shows AOA (age related anemia) became slightly more severe when comparison is made between values after 1 year of xPAP treatment and pre-treatment levels. It did not correlate with the level of AHI or % change in AHI. See http://www.ncbi.nlm.nih.gov/pubmed/20162370.

But also see http://www.ncbi.nlm.nih.gov/pubmed/24881587 for how morbidity changes (reduced) drastically due to effective ASV treatment in chronic heart failure (CHF) patients that are also anemic.

[DariaVader]

googling anemia and apnea got me several links. first one, from Livestrong
http://www.livestrong.com/article/449004...eep-apnea/