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[CPAP] New and need some help lowering AHI
#31
(12-02-2016, 01:32 PM)robysue Wrote: I know that the 16th seems like a very long time away, but it's not really that long. You may, however, want to call the sleep doc's office again and let them know that you are really struggling and that the problem seems to be a lot of CAs being scored by your machine. Certainly you need to give that information to the doc before you see him on the 16th: You want to make it clear that you need to talk to the doc about the CAs and not other problems because you want the doc to have spent some time thinking about the issue.

I would also suggest that you make sure the doc has a copy of the data before you see him on the 16th. Call the office and ask them how to get the detailed daily data to the doc before your appointment so that the doc has a chance to review it before he sees you on the 16th. You don't want to simply "surprise" the doc with the data that shows you're dealing with a lot of CAs when you show up at your appointment.

Also: what were your original settings from the titration sleep study? And were CAs mentioned in the titration sleep study report? If you don't know the answer, make sure you tell the office staff in the sleep doc's office that you need a copy of the titration sleep study report, including the summary graphs and data.

If you feel like you must tweak the settings on your AutoSet before your appointment, my guess is that you may need to limit the max pressure to something like 10cm and keep EPR =1. (In general pressure induced centrals seem to be a bigger issue when people are using pressures above 10cm.) Yes, that could replace CAs with OAs and Hs, and yes it might not eliminate the CA problem, but still that's the one thing you haven't done yet.

I'll definitely give a call and look into getting them the data asap. Also if I lower my Max pressure to 10 with EPR 1 should I still have minimum pressure at 7?

My sleep study was listed as an HST with the following results. (no full titration was done)
------
Patient was studied with HST device to evaluate complaints of excessive daytime sleepiness, snoring and witnessed apneas.

Total recording was 650 minutes.
Snoring was present/absent.

Respiratory analysis demonstrated 5 obstructed apneas and 6 mixed apneas with a total of 16 apneas at an index of 1.5. There were 103 hypopneas with an apnea/hypopnea index of 11.0. The lowest desaturation was 86 with 39 minutes of desaturation between 50% and 90%

Minimum Pulse 55
Maximum Pulse 107
Average Pulse 80

Diagnostic Impression:
This study shows Mid Obstuctive Sleep Apnea Syndrome (327.23) with mild hypoxia.
------
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#32
Hi again caseyfontneau. robysue makes a good point about alerting your Doc that you want to discuss Central Apnea / Central Hypopnea. It very well might be helpful to get some data to the Doc as well. The data from your sleep study showed a predominance of Hypopneas. Your Doc did not distinguish whether they were Central or Obstructive in nature. In my case I had an AHI of 44 all Hypopneas during my sleep study. I also had O2 desaturations down to 86%. My sleep Doc just assumed my Hypopneas were Obstructive in nature. I later found out that he did not treat Central Apnea at all. You can continue to experiment with pressures as I originally suggested or just leav things at the best presswure that you have found so far. If you like try lowering the IPAP pressure a step at a time down to the EPAP pressure. In my case I had nearly all Central events at any pressure combination of 9 CM H2O or above. I had nearly all Hypopneas at 5 CM H20. What you want to do for sure is look at the detail in 5 minute sections of your flow chart. I have here a link to The Journal of Clinical Sleep Medicine. https://go.aastweb.org/Resources/journal...events.pdf Take a look at figures 5, 6, and 7. They show the difference between central and Obstructive waveforms. Then compare to your own waveforms. Make sure that the waveform scale in sleepyhead is not too compressed. Looking at your waveform detail can confirm what type of Apnea you have and help you dealing with your present Doctor or a new one if need be.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#33
(12-02-2016, 04:56 PM)richb Wrote: Hi again caseyfontneau. robysue makes a good point about alerting your Doc that you want to discuss Central Apnea / Central Hypopnea. It very well might be helpful to get some data to the Doc as well. The data from your sleep study showed a predominance of Hypopneas. Your Doc did not distinguish whether they were Central or Obstructive in nature. In my case I had an AHI of 44 all Hypopneas during my sleep study. I also had O2 desaturations down to 86%. My sleep Doc just assumed my Hypopneas were Obstructive in nature. I later found out that he did not treat Central Apnea at all. You can continue to experiment with pressures as I originally suggested or just leav things at the best presswure that you have found so far. If you like try lowering the IPAP pressure a step at a time down to the EPAP pressure. In my case I had nearly all Central events at any pressure combination of 9 CM H2O or above. I had nearly all Hypopneas at 5 CM H20. What you want to do for sure is look at the detail in 5 minute sections of your flow chart. I have here a link to The Journal of Clinical Sleep Medicine. https://go.aastweb.org/Resources/journal...events.pdf Take a look at figures 5, 6, and 7. They show the difference between central and Obstructive waveforms. Then compare to your own waveforms. Make sure that the waveform scale in sleepyhead is not too compressed. Looking at your waveform detail can confirm what type of Apnea you have and help you dealing with your present Doctor or a new one if need be.

Rich

I gotcha. I called my doctor to see about moving up my appointment, but insurance requires I be seen after 31 days and not prior apparently so they won't see me prior to the 11th. Looks like that means it will still be the week of the 12th sometime but maybe sooner.

Doc was NOT pleased to hear I was making adjustments to the machine lol. Anyways that's not going to stop me from attempting to help myself. I'll keep y'all posted but I'm thinking titration sleep study is in my future.
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#34
(12-02-2016, 07:46 PM)caseyfontneau Wrote: Doc was NOT pleased to hear I was making adjustments to the machine lol. Anyways that's not going to stop me from attempting to help myself. I'll keep y'all posted but I'm thinking titration sleep study is in my future.

So he thinks default settings are better for you than an attempt to optimize? This makes no sense. You don't titrate a patient for pressure, give them an auto machine, and then criticize if they make setting changes? Sheesh!

Home sleep studies and auto machines kind of infer a need to self-titrate. It was actually written into my prescription. Not impressive on his part.
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#35
Keep working on this. You still have lots of work to do.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#36
(12-02-2016, 09:03 PM)Sleeprider Wrote:
(12-02-2016, 07:46 PM)caseyfontneau Wrote: Doc was NOT pleased to hear I was making adjustments to the machine lol. Anyways that's not going to stop me from attempting to help myself. I'll keep y'all posted but I'm thinking titration sleep study is in my future.

So he thinks default settings are better for you than an attempt to optimize? This makes no sense. You don't titrate a patient for pressure, give them an auto machine, and then criticize if they make setting changes? Sheesh!

Home sleep studies and auto machines kind of infer a need to self-titrate. It was actually written into my prescription. Not impressive on his part.

(12-02-2016, 09:23 PM)richb Wrote: Keep working on this. You still have lots of work to do.

Rich

That makes me feel a little better. I thought it made sense that self-titrate. Oh and I'm going to keep working on it. I'm staying optimistic for success.
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#37
(12-02-2016, 01:32 PM)robysue Wrote: I know that the 16th seems like a very long time away, but it's not really that long. You may, however, want to call the sleep doc's office again and let them know that you are really struggling and that the problem seems to be a lot of CAs being scored by your machine. Certainly you need to give that information to the doc before you see him on the 16th: You want to make it clear that you need to talk to the doc about the CAs and not other problems because you want the doc to have spent some time thinking about the issue.

I would also suggest that you make sure the doc has a copy of the data before you see him on the 16th. Call the office and ask them how to get the detailed daily data to the doc before your appointment so that the doc has a chance to review it before he sees you on the 16th. You don't want to simply "surprise" the doc with the data that shows you're dealing with a lot of CAs when you show up at your appointment.

Also: what were your original settings from the titration sleep study? And were CAs mentioned in the titration sleep study report? If you don't know the answer, make sure you tell the office staff in the sleep doc's office that you need a copy of the titration sleep study report, including the summary graphs and data.

If you feel like you must tweak the settings on your AutoSet before your appointment, my guess is that you may need to limit the max pressure to something like 10cm and keep EPR =1. (In general pressure induced centrals seem to be a bigger issue when people are using pressures above 10cm.) Yes, that could replace CAs with OAs and Hs, and yes it might not eliminate the CA problem, but still that's the one thing you haven't done yet.

Last night's sleep in chart below, but I made the adjustments and went to EPR 1 all time as well as 10 max pressure. Previously I had EPR turning off after ramp and max pressure was 10.8... Last night was 5.4 AHI, but looks like the majority of my events were in the last hour-2 before I woke up again. It seems to be that way a lot. The only thing I can think of is that a few nights I run out of water in the humidifier... Not sure if that would cause so many events or not.

When looking at the graph all broken up like that it's because I was told by my doc to use it in the middle of the day when I can to make up for the hours of days lost so I'm in compliance when I visit.

http://imgur.com/LXf5cYE

Thanks again Big Grin
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#38
Your chart is interesting. One thing that I notice is that you have clusters of CAs after you have had a pressure spike. The CAs seem to be occurring as the pressure returns to your minimum. It looks like the change (drop) in pressure is triggering CAs. I suggest that you try a range of single pressures starting at your current max and decreasing by 1 CM H20 over a few nights. You can try both EPR on and off. My original suggestion to you was to try a range of pressures to identify the point where Hypopneas begin to dominate. I also would like to see some blow ups of your wave forms. Highlight a 5 minute segment of your flow wave form and select it. This will give you a view of the individual breaths. We still don't have visual evidence as to the type of Hypopneas that you are experiencing.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#39
caseyfontneau,

How sound asleep do you think you were between 6:00AM and 9:00AM? Remember any extended periods of "dozing" or "tossing and turning" during that three hour period?

Since the obstructive stuff is very well controlled at the pressure range of 6-10cm, you might want to see what happens if you lower the max pressure just a bit: Try using 6-9cm of pressure. Pick EPR to make yourself most comfortable.
Questions about SleepyHead?
See my Guide to SleepyHead
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#40
(12-03-2016, 10:55 AM)richb Wrote: Your chart is interesting. One thing that I notice is that you have clusters of CAs after you have had a pressure spike. The CAs seem to be occurring as the pressure returns to your minimum. It looks like the change (drop) in pressure is triggering CAs. I suggest that you try a range of single pressures starting at your current max and decreasing by 1 CM H20 over a few nights. You can try both EPR on and off. My original suggestion to you was to try a range of pressures to identify the point where Hypopneas begin to dominate. I also would like to see some blow ups of your wave forms. Highlight a 5 minute segment of your flow wave form and select it. This will give you a view of the individual breaths. We still don't have visual evidence as to the type of Hypopneas that you are experiencing.

Rich

(12-03-2016, 12:40 PM)robysue Wrote: caseyfontneau,

How sound asleep do you think you were between 6:00AM and 9:00AM? Remember any extended periods of "dozing" or "tossing and turning" during that three hour period?

Since the obstructive stuff is very well controlled at the pressure range of 6-10cm, you might want to see what happens if you lower the max pressure just a bit: Try using 6-9cm of pressure. Pick EPR to make yourself most comfortable.

richb,

I had tried EPR off and it didn't seem to make a difference. When you say single pressure you mean just set it to just 9 or just 10 or something? Or a range of 1cm like 9-10? Also I'll blowup some CA cluster areas and post the results when I get home later.

robysue,

I'll look at possibly lowering to 9CM and EPR 1 seemed to be comfy enough, but was considering trying EPR 2. If richb is right about when the pressure goes down I have clusters I'm thinking that a more mild EPR of 1 might be better or even off. Also I kind of toss around all night to be honest. Flip or change sides or positions every couple of hours. As for 6am-9am I was a little warm so probably a little more restless than normal.
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