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[Diagnosis]  6 Months and no help
#1
Sad 
Diagnosed with severe sleep apnea after first sleep test in May. Used cpap for 48 days with pressures set at 22 and 15. Nearly smothered to death. Dr. changed to an Auto BiPap and after 100 days AHIs only averaging 14.9. Nowhere near a 5 or less. Now I have lost my Flight Physical and Dr. wants to give me a 3rd sleep test. Pressures will probably be reset again. I dont think that will fix it. Cant use my machine or mask for test because not hooked up to their computer. What if my machine is not working? For 6 months have not felt any difference in the morning. Central Apneas have actually increased during therapy. Any ideas?
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#2
Welcome

Your new sleep test may be to test you on a machine called an Auto Servo Ventilator (ASV.) They are a premium machine used to treat mixed and central apnea. Not uncommon to have jump through CPAP to BiPAP to ASV.

Is your flight physical for operating an aircraft or being part of a flight crew (civilian or military?)

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#3
G'day Lost53, welcome to Apnea Board.

I don't like to second-guess doctors, but I can't see what would be achieved by a third sleep test that wasn't already covered in the first two. However, if your flight certificate requires you to follow certain procedures, then you're probably obliged to do it. (I speak as a layman who's not familiar with the requirements).

Your pressure of 15 - 22 is way too high to start out on, and you should have been brought up to that pressure in gradual steps. This may also be the reason your central apneas have increased - too much pressure messes the blood gas proportions (especially CO2) and suppresses the urge to breathe. You brain doesn't detect sufficient CO2 to trigger an exhalation, so it literally forgets to tell you to breathe.

This raises a very important point - what was the central apnea index in your sleep study (ie without the machine). If you already had a high CAI, then you probably need an adaptive servo ventilator (ASV). These are specially designed to treat centrals. They are expensive and you will need to jump through hoops to get one approved by your insurance company. However they do a remarkable job.

If you only had limited centrals without the machine, then what you're seeing now could be pressure-induced. The standard treatment in that case is to lower the max pressure in gradual steps to see if the centrals will reduce without increasing obstructive apnea. You may also try reducing the EPR setting if that's applicable to your machine. It's a bit of a balancing act.

By the way, could you include the model of your machine in your profile, please? It's printed on the machine itself just near the power button. Knowing what machine you're using will help us understand your situation better.

Good luck, and please don't hesitate to keep asking questions.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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#4
Yes, operating an aircraft.
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#5
Original test results: AHI 69.0 RDI 75.9 OI 245 CA 9 HYP 28 MIXED 87 in 321 total minutes of sleep during study
Second test results: AHI 18.7 RDI 18.7 OI 12 CA 30 HYP 41 Mixed 0 in 266.5 total minutes of sleep during study
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#6
(11-26-2015, 09:10 PM)Lost53 Wrote: Yes, operating an aircraft.

Any condition that impairs alertness; or interferes with the exchange of oxygen will be a denial on the flight physical. You may have to appeal to the Federal Air Surgeon after you get your apnea under control.

Work on the apnea first then appeal the loss of your medical cert.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#7
I agree. The problem I have had is having to comply with their protocol. Now that it has been denied I hope I can try different things to get it under control without upsetting the protocol. Wish me luck. Thanks for the encouraging words.
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#8
read up on how to get your data and post plots. You will get lots of help with that.
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#9
Have about 100 days of rescan and sleepyhead charts in notebook. Very interesting data but not sure the doctors care to see it. Some of the lengths of the CA's and OI's are scary. As long as 34 seconds. Should I still be alive?
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#10
Hi Lost53,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you with your CPAP therapy and good luck to you with getting your sleep problems straightened out.
trish6hundred
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