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[Equipment] Newbie question about AHI calculations.
#1
So. Much. To. Learn.

First of all, thank you so much for this wonderful resource.

My polysomnograph indicated an AHI of 30, and all of my apneas, with the exception of one, were central. Sleep doc referred me to respiratory clinic to rent a CPAP machine for a couple of months to see if it might help, and I was sent home with a Respironics DreamStation Auto with an attached humidifier and a full face mask.

Does it make me weird if I say I absolutely love this thing? Aside from the initial panic - OMG I CAN’T BREATHE OUT! - I eventually enjoyed how easy it was to breathe. In fact, my brain would get a little rattled when I disconnected the hose to go to the washroom because, for a few moments at least, it felt difficult to breathe unassisted.

So yeah, I love this thing.

I was happy to see my AHI go below 14 and thought to myself that I was making good progress, but now I’m wondering if that really is the case. I have significant insomnia (my sleep efficiency is around 50%), and I tend to wake about four hours after sleep onset and then ‘sleep graze’ until wake up time. I wear my mask all night though, regardless of whether I’m sleeping or not. Does anyone know if the new generation Philips machines are smart enough to know when I’m actually sleeping? I’d hate to think that my AHI was being skewed incorrectly by my being awake.

I’d be grateful for any guidance you folks can give.
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#2
I don't want to put a dark picture on this, but you were setup to fail. Central apnea cannot be treated with a CPAP, but insurance requires that you be given a trial of CPAP to see if you can achieve acceptable results, or if you will fail. In this case, failure means you will either go away and not cost them any more money, or you will tell your doctor you do not tolerate the CPAP and cannot breathe!

In the latter case, you will then be promoted to a study to evaluate bilevel and bilevel with backup rate. A person with predominately central apnea needs a bilevel machine with a backup rate that increases pressure on a breath by breath basis to cause you to inhale. The machine is a variation of CPAP called an Adaptive Servo Ventilator (ASV).

The game is to use your CPAP, but call your doctor every day to complain you are tired, exhausted, and cannot breathe with the CPAP. That will speed up the process to get the evaluation for bilevel with backup rate that you will ultimately need. You will need another sleep study for insurance to pay for this more expensive machine.

We can help you to research ASV, and to understand why CPAP does not work, and the strategy in getting the treatment you need. Meanwhile, it would help if you became acquainted with how to see your current CPAP results in software you can get for free. Download SleepyHead software, and read how to organize the data and post it to the forum in the first two links in my signature. You will need 4 posts to link the data.

You are not alone, and many have come here with the same problem. Your CPAP will probably not help resolve your apnea, but we can guide you to the correct and effective treatment. It's not fair that you need to learn this on a forum, but we're here to help, if you are willing to stick with the process to get the right treatment.
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#3
It is important that you request and obtain copies of your diagnostic sleep study and any titration study you have completed. You are entitled to copies of these studies and any related recommendations and prescriptions by the HIPAA law. You need these studies for your permanent medical record, and to support your request for upgrading treatment. Also, if you have any current opioid drug use or congestive heart failure you are aware of, please disclose it now as it affects how we advise you going forward.
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#4
It would be helpful to see data from your machine and from your sleep study. If you don't have a copy of your sleep study you should request one.  To post data from your machine you will need to install an SD card in the machine if it doesn't already have one. Then you should download free SleepyHead software from here: https://sleepyhead.jedimark.net/

You will then be able to see detailed data on your computer and post it in the forum.
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#5
As sleeprider said, CA won't be treated. Being a squeaky wheel is the answer. In the mean time, get some sleepyhead charts up to do the best you can on the machine. You are on a path to another machine, if they don't settle down. Some medication can cause them, anything that suppresses the central nervous system and the list is long, including pain opiates.

If you are laying there awake with the mask on, the machine will go nuts, recording awake breathing patterns. Some people turn their machine off and back on when they wake up, this leaves a mark on your sleepyhead chart. So you can ignore the time awake. If you really are wide awake, you may be better to get up and read a book till you are tired again, no blue light or screens. Google sleep hygiene.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#6
I'm totally with you on the PAPpy love. My APAP is not right for me, either, but I love mine, too! I can plonk it on when I'm anxious and it fixes me right up! It seems to smooth out my nights somehow even though my AHI struggles (it is in fact, better than it used to be). It's great with white noise... All kinds of wondrous features that maybe were not exactly intended. Even though I'm tired a lot and often feel like I've wrestled with the devil all night, at least it beats going PAPless, which makes me a complete wreck.

My Sleep Center wants to talk compliance with me every time I go (even though I'm 100% compliant), aka they're just looking for an excuse to treat me like a kindergartner. I think they're quite shocked when I insist that I actually LOVE the PAPbabe. It might as well be the best thing since sliced bread.

So I'm entirely with you on babying PAPoose and treating it with love and awe.
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#7
@Sleeprider,

Thank you for your candor, this journey has been so crazy right from day one. Am I the only person to draw a parallel between respiratory clinics and time-share sales people? There’s a complete lack of professionalism in so much of this industry.

As my device is a rental, an SD card was not included. I’ll grab one tomorrow and start recording my data. In the interim, I’ll grab a copy of Sleepyhead and familiarize myself with its functionality. What bothers me the most is that there is no insurance company involved: I paid for my sleep study, I paid for my device rental, and I’ll end up paying for whatever device is required.

I do have copies of my sleep study. I'm in Canada, so getting copies of test results is like pulling teeth, but is doable.

Man, I am just more than a little PO’d.

Thanks again for your post. I feel a little more justified in my frustration.

AJack and Melman, thank you both for your replies. I drove down to MT to see a sleep specialist who reviewed my prescriptions and, as far as I can tell, there's nothing on my list of Rx's that would causal for CAs.

And yes, I plan to do some significant squeaking.

Thanks Halfasleep! It's good to know I'm not totally weird!
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#8
I'll just say ditto to all the above. I've got the ASV, but no free t-shirt came with it. Keep on doing the CPAP with tweaks if possible. It creates a history of attempted use and failure, and that's important IMO. Squeak and complain about difficulties and problems, I'm assuming they'll exist. I made it through the hoops required via assistance here and hope you're soon to follow.
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#9
Thank you SarcasticDave94.

My wife and I were just talking about exactly that - the importance of documenting failure. There's an inherent triage in our Alberta healthcare system, and perhaps failing a CPAP trial is what's needed for the next step in my treatment. As I said, insurance is not a factor in my case, so perhaps I'll be punted to another tier of sleep specialist. And who knows, maybe the friggin' state will pay for this one.

Seriously, all I want is to stop falling asleep at my damn desk.
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#10
You're welcome.
Understand completely. Keep us updated and best wishes toward success.
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