Disappointed in my sleep Doc

[Sleepstarved]

Thanks Sleeprider for making things a little clearer. Understanding the logic helps. Not more enjoyable, but at least I'm more willing to work through it. LOL

One of the things that I noticed right off is that when the number of RERA's and Hypopnea's go up they kick my butt the next day. I've had a couple of days where they've been <1 and those days I have felt my best even though my OA's may have been higher. This is definitely an adventure. I really thought I was on the right track by turning the EPA off based on what I had read and how I had reacted to it. I didn't like it and so I searched for information about it. Of course it's never as simple as it first looks. So onward and upward. I'll leave the setting alone for a while and see what happens over the next few nights.

[Sleeprider]

RERA and hypopnea are both sleep disturbance and it's hard to feel good if you are not sleeping well. I think we covered why bilevel pressure support can help you take a full breath when the upper airway is restricting flow. It's not an easy journey, but it might turn out that the sleep doc is on your side after all. Hang out, and we/ll try to see you through.

[Sleepstarved]

Your doctor may have made this change to see if it makes a difference, and whether you tolerate the bilevel pressure comfortably, and without the side effect of centrals.  I would have recommended the same thing, but would have discussed it.  Getting a bilevel is mainly about your tolerance and efficacy on CPAP.  You have to fail CPAP first.  There is every indication you may benefit from bilevel, but if you shut it down and complain it's not comfortable, then there is no reason to pursue it further.  If you want to have a shot at bilevel, give EPR a chance, in a higher pressure range where it can make a difference.  If it is beneficial in reducing flow limitation, and increasing comfort, then bilevel may well be the tool that completes the job.  In your charts, you appear to tolerate EPR, but it does not adequately treat flow limits and hypopnea, and you continue to have a high OA rate.  This suggests a need for pressures higher than 14/11, thus my suggestion for auto mode at 14-18 with EPR 3.  Once you go above 15 cm pressure, you are firmly in the realm where bilevel may be considered.  

How many nights over 5 constitute failure? What's strange is that when I first started therapy my numbers were real low <5. Then they started creeping up and that's when I decided to download sleepyhead. After I asked for the change from my doc, they've gone even higher. I did have 1 or 2 nights under five but the rest have been over. I still don't own the machine and at what point would the decision be made that this is the wrong one if it is? Just wondering. I have gotten used to the EPR and it really didn't take that long. A "quit fighting it" mindset worked wonders. LOL. I'll post some charts later today. One of the good days I forgot to put the card back into the machine so no data.... bummer.

[Sleeprider]

Looking forward to seeing the charts. I'm not aware of a use threshold where a machine is deemed ineffective. If you are uncomfortable, then your doctor should be told, and asked to make recommendations. You have done your part by using the machine and making your best effort.

[Homerec130]

We fired my wife's "sleep doc" a while back. The office looked like it was temporary, not the cleanest in the world. Dust rabbits in the corners. Staff never passed messages and so forth. The "doc" was a nurse practitioner working under the umbrella of the doc that read her original study. After one appointment she said everything looks good, see you 6 months. No mention of having to see her again at the end of the compliance period (found this our from the RT at the DME). When we asked her about my wife's apneas being mostly CAs vs OAs. She dismissed us by saying your machine will take care of it. We got my wife under my sleep doc, who is also her ENT. He took one look at her numbers and referred her to another doc who specializes in patients with CAs brought on my meds. Her first appointment with the new doc was an hour and she went over all the info from her machine. She also ordered a home two night oxygen reading - one without the machine and one with. She has also made changes to my wife's machine (we think based on her observations) and my wife is much happier.

See, there are some good docs out there as well as the bad ones.

Homer

[Sleepstarved]

New results from Sleepyhead I will await opinions  and thoughts   








[attachment=9232][attachment=9231][attachment=9233][attachment=9234]

[Gideon]

I see a positional element in the nights that have the higher numbers and not enough events in the others to see if anything positional is there.  
I would raise your pressure to 15 and increase your EPR to 4 cmw to try and minimize the flow limits.  Wait you can't try that without a BiLevel like the VAuto.

Your big issue is still the flow limits.

Do you want to optimize with this machine or go for the BiLevel?  If the latter I would not make any changes because besides your complaints your numbers over 5 regularly say you are having issues.

[Sleepstarved]

I see a positional element in the nights that have the higher numbers and not enough events in the others to see if anything positional is there.  
I would raise your pressure to 15 and increase your EPR to 4 cmw to try and minimize the flow limits.  Wait you can't try that without a BiLevel like the VAuto.

Your big issue is still the flow limits.

Do you want to optimize with this machine or go for the BiLevel?  If the latter I would not make any changes because besides your complaints your numbers over 5 regularly say you are having issues.

I don't remember if it was you or SR that said I had to fail CPAP to go to a BIPAP machine. I guess my question was what constitutes failure. If <5 is considered treated how many >5 is considered failure if I need a BIPAP.  My ultimate goal is to get the correct machine. I really don't want to waste my time with a machine that isn't going to solve my problem. But, I also understand having to prove that this is indeed the wrong machine, if it is. Just want to know how to go about doing that to me and the Doc.. I hope that makes sense.

[Gideon]

Unfortunately, it is up to your doctor's subjective opinion.
One form of failure is high AHIs.  Your numbers are close to OK.  I don't want to make them any better until you get the BiLevel or we know for a certainty that you are not.

The other form of failure is how you feel.  If CPAP treatment is not relieving your symptoms to the point it impacts your life, that is the other form of failure.  You will need to inform your Dr that you are not receiving the benefits that you are expecting and frequently informing him of such, even to the point of getting appointments before he said to see him again.  This is about the why you are on PAP therapy and the fact your are still having issues with sleep or your daily life resulting from sleep issues.  This is why we ask how do you feel.

[SarcasticDave94]

I'd agree with bonjour. Even with an AHI under 5, if the therapy is not giving you rest, is causing other issues, then convey them to the Doc. That is how I moved from CPAP to BPAP, in part because I stated I could not get used to single pressure, and I could not breathe out easily enough to meet compliance. Doc finally relented and had me try the BPAP.