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Could someone help me analyze my sleep test results? What kind of therapy is needed?
#1
Could someone help me analyze my sleep test results? What kind of therapy is needed?
Hi,

I am bit confused with whats happening with my sleep test results and I wanted to hear your opinions on this situation.

Maybe 2 years back I did a at home sleep test  and I was told that I did not have sleep apnea. I visited more or less every other specialist out there to figure out why I was constantly waking up exhausted and why I was tired the whole day, nobody could find anything ( I am also not even remotely overweight, eat fairly healthy, do sports etc ). So I did another sleep test but in a proper sleep lab and I was diagnosed with sleep apnea. 

I was put on CPAP and I have been using it for the last half a year. It helps a bit but not a lot, at least I do not wake up completely destroyed anymore with bad muscle pain in my whole body. 

Since the doctors from the first sleep lab were utterly useless after they sent me home and since they were unreachable, I decided to find a different sleep doctor. So I made the switch and we agreed on another sleep study so that we can check if I have UARS and to get a better overview of whats happening since the doctors from the first sleep lab just gave me very basic information. 

Now I got my results and my new doctor is suddenly telling me that based on the results of the first lab sleep tests she would not even put me on CPAP. And also that my new sleep test results are even milder so that she does not think I need it. 

My doctor also randomly told me that everyone has UARS and how the CPAP machines can not detect central apneas, that this only works with an EKG. So now I am utterly confused because my CPAP is sometimes telling me that I have 4/h OA and 4/h CA. Which is a fair amount and I think that if I have these numbers even with CPAP that then I definitely need therapy ?


So here is the info from my sleep lab tests:

Sleep lab test 1, without much info :

Number of apneas: obstructive 7; mixed 0; central 3; hypopneas 145  ( in total AHI 21/h )

Oxygen saturation: continuous (average value) 97.0%; minimum during sleep 94.0%; ODI 4.9%; PLMS index 6.3 /h ;


Sleep lab test 2, with a bit more info:

AHI: 7,5/h
Middle 02 saturation: 94%
Basal 02 saturation: 89%
Snoring index: 102,8/h

Number of central apneas in total : 1
Number of obstructive apneas in total : 5
Number of apneas each hour : 0.9
Number of hypoapneas : 46
Number of hypoapneas each hour : 6,6
number of RERA : 0
Arousal part ( TST )
total number : 38
Respiratory : 4
Motoric : 8 
Spontaneous : 26

I am translating all of this from German and dont really know the English words for some of these things, so hopefully you will understand what is what. I will also upload the pictures with the details results but they are in German. 


My doctor then gave me a somnotouch resp device that I slept with at home last night. It just had a thing that I put on my finger and a tube that I connected between my cpap hose and my mask. My doctor told me that they would like to see if CPAP actually makes things better for me and I will get the results from that in a week. They did not look at the results from my CPAP in the last couple of months so far.



So I am utterly confused now. Apparently because I mostly have hypoapneas my doctor does not think that I need CPAP. The amount of hypapneas I had in the original sleep lab was much higher but I havent done anything besides used CPAP since then. I dont understand how does it make sense that because on one night that I had a lower amount they think that I potentially dont need therapy anymore ? 


Am I missing something here? I have another appointment with my doctor in a week and I wanted to hear your opinions before I go back so that I can have a better idea of what I should tell them.


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#2
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
You have mild obstructive or complex sleep apnea, but moderate respiratory event arousal which includes the hypopnea. Hypopnea should be treated as it is nearly as disruptive to sleep as apnea, and it is in fact a component of AHI. With any sleep disordered breathing it is important that your physician respect the dysfunction that it imposes on your overall health and well-being. Your doctor certainly doesn't see the problem as life-threatening, and does not see concerned that it has caused you fatigue and disabilitiy in your daily life.

The specific mechanisms of your sleep disorder are difficult to interpret without seeing the respiratory flow traces, and unfortunately, your Prisma CPAP does not provide that. Your hypopnea may be obstructive from upper airway restriction which makes inspiration more difficult and results in more respiratory effort; or central, in which case your respiratory effort is increasing and decreasing causing an oscillating respiratory flow. We have no way to treat a central apnea condition with your current machine, so we will function on upper airway resistance and obstructive apnea. For obstructive hypopnea, the best solution is higher minimum pressure and some expiratory pressure relief. The Prisma has a feature called SoftPAP. Be sure that is turned on. Sleep and decide if you feel better with SoftPAP on or off. Your current settings are 7 to 14 cm-H2O. Try increasing minimum pressure in 1-cm increments, and evaluate how you feel as your minimum pressure increases. These measures can help minimize both obstructive apnea and hypopnea, but cannot treat central apnea. Also, without machine data we don't know anything other than how you feel.

One last thought. If you could obtain a Resmed Airsense 10 Autoset or S9 Autoset (older model), we would not have to guess because we could see the results on a breath by breath basis. Maybe it would be worth getting a different machine, which would free you from the ridiculous situation where your doctors decide if you feel good enough. No tests or guesses are needed with a full-data CPAP like the Resmed Autoset.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#3
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
Thank you for taking the time to type all of that out.

I have SoftPAP on max currently because when I started CPAP therapy I had issues with exhaling. Will give it a go without it.

I will also try to raise my minimum pressure today by 1.

As for the machine. Since I simply could not get the Prisma TS software to work, I did want to ask my doctor to move me to a different one. But they literally told me that I should not be looking at that data and that I should let them do that. Next time I visit for the last nights results I will see what they say and push for a device change. If they are not willing to do that I will consider just buying one on my own because knowing that there is so much more data that I cant reach is driving me insane.

Besides Prisma devices not being compatible with OSCAR, do you have any other selling points for that device which I could use in my conversation with the doctor?
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#4
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
I had a Phillips dreamstation bipap. It gave date but did not help me much. I was having any where between 20 and 40 event an hour. I got a Resmed aircurve VAUTO and my numbers have gone down to 5 -O events a night. Better sleep and I do feel better. A good machine does make a difference.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#5
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
First, since you are using SoftPAP, and it helps your comfort on exhale, I want you to continue using it as you raise pressure. let's deal with only one variable at a time.

Your doctor does not seem very receptive to your involvement in therapy decisions, however the reasons I like the Resmed Autoset ;for your case is this:
The Resmed Autoset machines are actually limited bilevel positive pressure devices. The use of EPR (exhale pressure relief) is identical to the VPAP bilevel pressure.  When you start to exhale, the pressure drops up to 3-cm, then the increase in pressure follows your inhale flow. This is pressure support and it specifically treats flow limitation from upper airway restriction, and the associated respiratory effort related arousals (RERA) and hypopnea by assisting your respiratory effort with pressure support. It is a game-changer.  

My wife also has mild obstructive apnea with mostly hypopnea. Look at the image below, and see how the Resmed Autoset assists my wifes respiratory effort.  Her breathing is the black flow rate line, and the mask pressure provided by the Autoset is the blue line. This is the kind of detail available to you with an Autoset and the free OSCAR software.  You can see in this screenshot that her respiratory flow is a bit restricted as shown in the flattened tops, but you can see how the Autoset is providing increasing pressure support through each breath to assist a more complete breath and reduce effort.  In the middle is likely a physical movement, and just shows how the Autoset adapts and slightly increases pressure, then follows along until respiration is again normal. Her original settings were like yours (7.0 minimum), but we found an increase in minimum pressure resulted in fewer sleep disruptions and lower AHI.

[Image: attachment.php?aid=9631]
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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#6
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
Mate, there's a VAuto on ebay for EUR485 from siartz. I bought 2 units from them before. Do yourself a favour and get it.
Make a 'Preisvorschlag' of 300 and see how low you can get it at.

I had the very same experience with a lot of the doctors in germany.
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#7
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
(08-04-2020, 09:38 AM)Sleeprider Wrote: First, since you are using SoftPAP, and it helps your comfort on exhale, I want you to continue using it as you raise pressure. let's deal with only one variable at a time.

Your doctor does not seem very receptive to your involvement in therapy decisions, however the reasons I like the Resmed Autoset ;for your case is this:
The Resmed Autoset machines are actually limited bilevel positive pressure devices. The use of EPR (exhale pressure relief) is identical to the VPAP bilevel pressure.  When you start to exhale, the pressure drops up to 3-cm, then the increase in pressure follows your inhale flow. This is pressure support and it specifically treats flow limitation from upper airway restriction, and the associated respiratory effort related arousals (RERA) and hypopnea by assisting your respiratory effort with pressure support. It is a game-changer.  

My wife also has mild obstructive apnea with mostly hypopnea. Look at the image below, and see how the Resmed Autoset assists my wifes respiratory effort.  Her breathing is the black flow rate line, and the mask pressure provided by the Autoset is the blue line. This is the kind of detail available to you with an Autoset and the free OSCAR software.  You can see in this screenshot that her respiratory flow is a bit restricted as shown in the flattened tops, but you can see how the Autoset is providing increasing pressure support through each breath to assist a more complete breath and reduce effort.  In the middle is likely a physical movement, and just shows how the Autoset adapts and slightly increases pressure, then follows along until respiration is again normal. Her original settings were like yours (7.0 minimum), but we found an increase in minimum pressure resulted in fewer sleep disruptions and lower AHI.

[Image: attachment.php?aid=9631]

This is super valuable information, thank you very much.


(08-04-2020, 09:53 AM)ardenum Wrote: Mate, there's a VAuto on ebay for EUR485 from siartz. I bought 2 units from them before. Do yourself a favour and get it.
Make a 'Preisvorschlag' of 300 and see how low you can get it at.

I had the very same experience with a lot of the doctors in germany.

That one is not working correctly, they are selling it for parts from what I noticed. I will give it one more shot with my doctor and then buy it on my own if they dont play along.
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#8
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
If you can afford it, you might consider getting a ResMed Vauto Aircurve right from the start. It does everything the Airsense 10 Autoset does, but you can increase the pressure support above 3. (There are some other setting options, but the PS is key.)

A different approach would be to start with the Autoset and see how you do with it. The if it isn't helping enough, you can sell it and buy a Vauto.

May I say I think you have been extremely poorly served by your sleep doctors. All of us who have had day after day trashed by sleep deprivation know how important thoughtful treatment of disordered sleep breathing is.
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#9
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
Wait this is really the only difference? The Vauto wont have anything missing? Like there is nothing that Vauto cant do that the other one can?
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#10
RE: Could someone help me analyze my sleep test results? What kind of therapy is needed?
The AirCurve 10 VAuto will do almost everything the AirSense 10 Autoset will do plus more. The ONLY thing the VAuto won't do, is report RERA's. For me, I can live with that.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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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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