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[CPAP] Unable to achieve lower than 15 AHI
#11
RE: Unable to achieve lower than 15 AHI
They do bulk bill a Home Sleep Study here if recommended by a GP.
Been there-done that.
It was well run - I got hooked up at the clinic around 5pm and went home and returned the gear next morning.
I was diagnosed with Mod/Severe Sleep Apnea.
On the required follow-up the lady picked up what appeared to be a 3-4 page report - said I had Mod/Severe Apnea - put the report down - and without further ado went to the sales pitch - which model?
I  said I would get back to them.
I discussed this with my GP and he recommended an overnight Lab Study for a more professional experience and result.
Expensive and not rebated by my insurer.
The specialist associated with the lab set a prescription of 6cmH20 and that was never varied although I was not responding to therapy at all.
The result was after several non-productive visits I binned the CPAP - subsequently had a rethink - and that is where I am today.
I will never feed those chooks again.
I believe - with the help of knowledgeable people on these forums - that the problems I have can be solved.

My last - although brief  - session suggests I am getting close to a resolution.
Tonight: Amara View / 11cm H20 / C-Flex+ on 3 / Oximeter
             See if I can improve on AHI 8.07
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#12
RE: Unable to achieve lower than 15 AHI
Try wearing the mask while you are awake , like watching tv . It dose not have to be plugged in but this may help you with the feeling.
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#13
RE: Unable to achieve lower than 15 AHI
(12-09-2017, 08:14 AM)hwka Wrote: They do bulk bill a Home Sleep Study here if recommended by a GP.
Been there-done that.
It was well run - I got hooked up at the clinic around 5pm and went home and returned the gear next morning.
I was diagnosed with Mod/Severe Sleep Apnea.
On the required follow-up the lady picked up what appeared to be a 3-4 page report - said I had Mod/Severe Apnea - put the report down - and without further ado went to the sales pitch - which model?
I  said I would get back to them.
I discussed this with my GP and he recommended an overnight Lab Study for a more professional experience and result.
Expensive and not rebated by my insurer.
The specialist associated with the lab set a prescription of 6cmH20 and that was never varied although I was not responding to therapy at all.
The result was after several non-productive visits I binned the CPAP - subsequently had a rethink - and that is where I am today.
I will never feed those chooks again.
I believe - with the help of knowledgeable people on these forums - that the problems I have can be solved.

My last - although brief  - session suggests I am getting close to a resolution.
Tonight: Amara View / 11cm H20 / C-Flex+ on 3 / Oximeter
             See if I can improve on AHI 8.07

hwka, I am continuing to follow this, and want to let you know your last chart has the distinct appearance of complex or central apnea, and the period from 16:28 to 16:38 has some obvious periodic breathing.  Titrating this, or "adapting" to where apnea is reduced to an acceptable level will be difficult.   It would perhaps be helpful to review what settings have been attempted, and what the results have been to see if we can spot any trends. In Sleepyhead that is the Statistics page with the prescription and results history at the bottom.

Although there is definitely some ugly in this, it is an improvement over previous efforts.

[Image: BmxmR85.png]
Sleeprider
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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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#14
RE: Unable to achieve lower than 15 AHI
Thank you all for your interest.
Last night was interesting - although a singular result it is reassuring and suggests I am heading in the right direction.
The SPO2 figures I regard as critical to any analysis- and in this case are excellent.
There is a slight slippage in the time again- I recently corrected it but it continues to be a slight nuisance.
The actual start time was 23:58 for the CPAP and SPO2.
I believe the first 30 - 40 minutes could be largely discounted because I was having mask and position problems.
My next purchase is going to be a soft collar - I have read all those posts and see a lot of sense there.
If that is not satisfactory I will try a rigid collar.
I definitely tuck my chin during the night which is undesirable - and last night I spent considerable time getting into a neck arched back position I felt I could maintain.
02:30 - 02:40 was a break - I really hate FFM - and a break is like rebooting the system - in this case my system.
Last night: Amara View mask / 11cmH20 Fixed / C-Flex+ on setting 3
https://i.imgur.com/PoTQD8kl.png
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#15
RE: Unable to achieve lower than 15 AHI
You may need to chase this up more. I think you will find, all insurance covers an in lab sleep study. Mediacare will cover as many in lab sleep/titration studies as needed a year. I would want a titration study. In lab sleep studies are free at public hospitals, there are also several private labs that will bulk bill. Mediacare will only pay for one home study a year, so that's a separate thing.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#16
RE: Unable to achieve lower than 15 AHI
Not bad, but don't hesitate to back Flex off to 2.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#17
RE: Unable to achieve lower than 15 AHI
Getting there....AHI 4.04
I had to back-off on the pressure because I was swallowing air or otherwise somehow getting air into my system - so down to 10.5cm fixed.
Backed off also - as advised here - on the C-Flex+ to 2.
Continuing with the FFM Amara View.
The break just after midnight was due to a severely dry mouth and throat.
The SPO2 stays attached and shows a typical spike downwards - no idea why that happens - but pleased with the oximeter readings.
Why do the OA's and CA's cluster like that - cannot see a correlation in the charts.
Promised a call-back today re online enquiry on a week's hire of a high level machine such as a Resmed Autocurve 10.
https://i.imgur.com/WUJnPWel.png
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#18
RE: Unable to achieve lower than 15 AHI
The clusters are usually due to back sleeping and the chin tucking the closing the upper airway. These often raise AHI a large amount and when ironed out serves to improve the numbers.
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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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#19
RE: Unable to achieve lower than 15 AHI
Thank you for that input.
I suspected as much but had no way of proving it.
This is the difficulty of home analysis whereas a competent lab could nail that down immediately.
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#20
RE: Unable to achieve lower than 15 AHI
I know you said that you have tried all kinds of masks, but I'm wondering whether it still might be worth trying some more to make a nasal mask work.  There may be a subset of people who can't get AHI down far enough with a full face mask.

For example, see this case series: https://www.ncbi.nlm.nih.gov/pubmed/27306398

They describe four patients with high residual AHI as well as pressure requirements using oronasal mask and lower residual AHI and pressure requirements after swtiching to nasal mask.

Here is the PSG from one of those patients:

[Image: nasal2-png.60]

And here is the summary of their data:

[Image: nasal3-png.61]


See also this study:https://www.ncbi.nlm.nih.gov/pubmed/27448430

[Image: nasal-png.59]


Of course I know that full face masks work very well for lots of people, and I'm not saying it can't work for you, but if you haven't given at least a month to making a nasal mask work, I would try that first.
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