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Help Pls. AHI 29 feeling bad and not sure I am headed right
#1
First an overview :
29 Day on therapy
11 days over AHI 10 or plus -Max of 29.20 (today)
6 days above 5 or above AHI but below 10
12 days below 5 AHI

All 29 days without exception, Clear Airway events were more than ~ 3/4 of the total events .
Clear Airway events avg. 57 with a high of 190 (last night) the CAs are mostly in groups i.e. last night the largest group was 1 Hr & 20 Min1/2 hrs
2nd group was 40 Min remaining groups 3-5 min.

Obstructive events normaly run low.
Hypopnea & Unclassified events are small and never in groups

Below is Data from when I started (29 Days)

Median 95th Percentile Max
IPAP 7.6 11.2 12.25
EPAP 5 8.2 9.6

Apnea Index 10.2
Hypopnea
Index 0.3
AHI 10.4

Events
Per Hr.
Obstructive 1.6
Central 7.6
unknown .01

Sleep Study Results :
Due to a lack of time, optimal pressure was not obtained. At 11/6 his index was still elevated @27 per Hr. with the lowest oxygen saturation of 87%
I just couldn’t make myself go to sleep both times and knew I needed to sleep, just a different environment.

I was sent home with the settings of 4/15 from the supplier and PS 4.0
I have adj. pressures to 6.4 / 12.6 & PS 4.0

Hope I did not include stuff not needed, on the other hand if anyone would like to have additional Info. to help in the evaluation I will get it with pleasure.

My questions are:
1. Does the setting need to be tweaked?
2.Should I be concerned with oxygen saturation , if so, give me some recommendations .
3. Do you think I can expect improvements from where I am today . Ballpark #s ?

Not for sure this is need but better more than less.
I have AFIB and have had an ablation in Sept. of last year, but haven’t seen an improvement the I was expecting.
Hope this VCAP machine will help bring the help needed
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#2
I can't help but wonder why, if at the pressure 11/6 you were still having a lot of events, they sent you home with a setting of 4/15. Makes no sense to me. How long have you been using your machine? You said that most of your events are centrals....did you have any centrals on your sleep study report? why were you not brought back to find the optimal pressure rather than sent home with arbitrary pressures? If you have central or mixed apnea, the machine you have will not help you. How often did you have desats in your sleep study? Your profile says your pressure is 15 and 4 and your PS is 4. IS this correct? I would like to see the data points showing the results of each pressure they had you on during your sleep study.
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#3
Hi BigBob. As me50 asked, did you have the central apneas during your sleep study? This is really important: central apneas can be the result of PAP therapy (in which case you can expect them to reduce or go away) or they can be endogenous. If they are endogenous you need a different type of machine, a VPAP Adapt ASV or the equivalent Aircurve or Philips. If your centrals are caused by PAP pressure and don't go away, then you may also need to consider and ASV.

Typically pressure derived centrals are sen at higher pressures. You could try lowering your IPAP max a few points an see if this makes any difference.
DeepBreathing
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#4
(02-07-2015, 05:29 PM)me50 Wrote: I can't help but wonder why, if at the pressure 11/6 you were still having a lot of events, they sent you home with a setting of 4/15. Makes no sense to me. How long have you been using your machine? You said that most of your events are centrals....did you have any centrals on your sleep study report? why were you not brought back to find the optimal pressure rather than sent home with arbitrary pressures? If you have central or mixed apnea, the machine you have will not help you. How often did you have desats in your sleep study? Your profile says your pressure is 15 and 4 and your PS is 4. IS this correct? I would like to see the data points showing the results of each pressure they had you on during your sleep study.

ME50 I agree with you the setting did not make sense after much reading of this (thanks given to) Board.
The date posted above comes from the 29 days I have been using the machine .
I did not get to see the details of the sleep study. I received a summery.
I did't know at the time to ask for more. Now I plan to.

What if anything they plan to do now will also be a question . One would think if they planned to do additional studies I would have to be asking.

I have not updated my profile. Currently 12.6 / 4 PS 4 Updated now.


Your question "How often did you have desats in your sleep study?"
I don't understand the term destats

Thank your interest
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#5
(02-08-2015, 11:13 AM)BigBob2 Wrote: Your question "How often did you have desats in your sleep study?"
I don't understand the term destats
Oxygen level dropping; the desaturation of your body's oxygen level. When you don't breathe your blood will lose its oxygen. This is expressed in a percentage value. Based off of published material and observations the "normal" range is 88% to 98%. I've seen a 99% but that was after the person had hyperventilated and was getting spacey.
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#6
(02-07-2015, 07:39 PM)DeepBreathing Wrote: Hi BigBob. As me50 asked, did you have the central apneas during your sleep study? This is really important: central apneas can be the result of PAP therapy (in which case you can expect them to reduce or go away) or they can be endogenous. If they are endogenous you need a different type of machine, a VPAP Adapt ASV or the equivalent Aircurve or Philips. If your centrals are caused by PAP pressure and don't go away, then you may also need to consider and ASV.

Typically pressure derived centrals are sen at higher pressures. You could try lowering your IPAP max a few points an see if this makes any difference.

DeepBreathing
I plan on asking for the details of the study on Monday. I understand it MY records and I should have a copy.

In your comment where you say "this is really important" I am not for sure i understand. Are you saying if the centrals showed in the study that it would be endogenous? But if centrals were not showing in the study that it MAY be the result of PAP therapy that I am now taking?

I will reduce from 12.6 / 6.4 to a 10.6 / 6.4 with a PS 4. Do this and monitor? Would give a ball park number of when I could seen an improvement ?

If I am understanding correctly whether the centrals are caused as a result of PAP therapy and do not go away OR if the centrals are endogenous I would need a VPAP Adapt ASV or the equivalent
type of equipment to treat my apnea.

I am keying of the comment from the sleep study " At 11/6 his index was still elevated @27 per Hr. with the lowest oxygen saturation of 87% "
Should I be concerned low oxygen saturation?

Just a side note: I have been keeping a log of when my AFIB is acting up and when it does my centrals are also high. But my centrals can be high and no problem with AFIB. Any thoughts on this ?

I appreciate your knowledge depth and your time to respond.


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#7
(02-08-2015, 11:51 AM)sgearhart Wrote:
(02-08-2015, 11:13 AM)BigBob2 Wrote: Your question "How often did you have desats in your sleep study?"
I don't understand the term destats
Oxygen level dropping; the desaturation of your body's oxygen level. When you don't breathe your blood will lose its oxygen. This is expressed in a percentage value. Based off of published material and observations the "normal" range is 88% to 98%. I've seen a 99% but that was after the person had hyperventilated and was getting spacey.

Thanks for the information.
The only part of the study I have seen said "the lowest oxygen saturation of 87% "
Should I be concerned with 87% of maybe the just the frequency of the 87% ?

Monday I will be asking for the full report and will know more then.
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#8
@Bob - It would help a bit to show us an overview of these last 30 days, like the following:
[Image: QodtmZQ.png]

I will mimic some past posters comments about your settings and their affect on CA. Some more knowledgeable folks will be along at some point and give even better help...

If I had your scores and had not just made a change in the last 3 days, this is what I would do - (assuming your current setting is min EPAP = 4, max IPAP = 12.6, PS range = 4 min 4 max. Ramp 4 for 15 minutes.)

I would increase min EPAP to 6, leave IPAP at 12.6, change PS range to 2 min 3 max, and ramp OFF. leave for 7 to 10 days. report results.

This would start me at inhale of 8 cmH2O, exhale at 6 cmH2O.

From this change I would expect that my AHI average for the 10 days would be as low as 3 and high as 10, and the CA component of the score would be less than half. My guess is that there will be 0 days over 10, 7 days between 5 and 10, and 3 under 5.

That would be a great baseline to build upon.

QAL




Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#9
(02-08-2015, 12:19 PM)BigBob2 Wrote: Should I be concerned with 87% of maybe the just the frequency of the 87% ?

I wouldn't be worried about it. You do have your affairs in order, don't you? Dielaughing

Seriously, You need to see what the average or median value is along with whatever percentile, usually 90 or 95, they use for reporting. The minimum just means the lowest recorded value. You can accidentally knock the probe off and have a value of 0% as the lowest.
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#10
Check how long your CA's last. Long ones are a lot more worrisome than short ones. Also, CA's aren't necessarily more harmful than OA's, just harder to eliminate.

Go into the daily tab on SH, go to the events tab, and break out the CA list. You can click on individual events and it will zoom in on the time and you can look at the flow rate waveform.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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