Lindanhotair Treatment review

[LindanHotAir]

I was referred for a home sleep study in August, 2017.  I was prescribed a Philips Dreamstation Auto CPAP. I, like a lot of people new to this forum, was unaware of this forum, Sleepyhead, or OSCAR and it was in July when I saw that the Auto CPAP was not doing a lot for central or complex apnea.  It responded to central events with pressure pulses, which very occasionally triggered breathing, but not enough to be useful.  I am posting a copy of my sleep study for background, with plain text followed by  graphics.

I obtained a DS1 bilevel ASV which I defoamed.  I have been experiencing mixed results on the AHI, running between 2 and 9, with the higher reported numbers from hypopneas. My oxygen saturation has stayed high, as does my minute vent and tidal volume.  I will post some examples of high and low number charts in additional posts for possible suggestions and analysis.
SLEEP STUDY REPORT FOLLOWS:

Pg. 1 is boilerplate.

Page 1 of 5
 
POLYSOMNOGRAPHY
SLEEP STUDY EXPLANATION
Kaiser Permanente Sleep Center
 
FINDINGS (Diagnostic)
These findings help us to make a diagnosis of Sleep Apnea through the following information:
1. RECORDING INFORMATION
Total Sleep Time: Indicates how long you slept during the first phase of your sleep study. Normally
this time is usually less than 3 hours.
2. RESPIRATORY EVENT SUMMARY
Obstructive Apnea: Number of times that you quit breathing and the longest time in seconds that you
did quit breathing.
Mixed Apnea: A combination of obstructive and central apnea
Central Apnea: Apnea that is not obstructive, but an event that occurs from the respiratory drive is not
getting any information from the brain to breathe.
Hypopnea: Airflow is diminished and is not very effective. After alcohol some of these hypopneas
will turn into obstructive apneas.
AHI: Apnea Hypopnea Index or RDI: Respiratory Disturbances Index
AHI or RDI is an average number of events (apnea and hypopneas) that occur every hour of sleep.
American Sleep Disorders Association Classification of OSAHS
Mild: AHI 5-15 events/hour of sleep
Moderate: AHI 15-30 events/hour of sleep
Severe: AHI >30 events/hour of sleep
3. OXYGEN SATURATION
Amount of oxygen in your blood while you sleep.
4. AROUSAL
An arousal is a shift in the brain wave that disrupts your sleep. You may or may not awaken with
these arousals.
5. ELECTROCARDIOGRAM (if applicable)
Report of the EKG during your sleep.
6. MUSCLE ACTIVITY (if applicable)
This will show any abnormal leg movement that is shown during the study.
CPAP / BiPAP TITRATION (Treatment or Therapeutic)
Indicates the time spent during a CPAP or BiPAP titration, to determine the correct pressure. The
titration will reveal a reduced AHI or RDI that occurred during the CPAP/BiPAP titration. Most cases
the AHI or RDI will be :~5 events per hour with the CPAP or BiPAP recommended pressure. Also
your Sp02 or oxygen saturation will improve from therapy. Normally the time spent in a Titration is
between 4 and 6 hours.
CONCLUSIONS
The physician who reads your study will indicate the degree of your Obstructive Apnea and what the
best pressure that your CPAP or BiPAP will be set.

END OF BOILERPLATE

Page 2 of 5

Description. 71 year old male Provider; Dustin M. Jacoby Department; NIr-Sip

Reason for Visit

SLEEP APNEA 1 00 NLR DTT EDS, STOP BANG, Pilot Lic, AHI

Reason for Visit History

Diagnoses

C;odes Comments

ADULT OBSTRUCTIVE SLEEP APNEA, SEVERE - Primary G47.33

Vitals Recorded in This Encounter

No data found.

Addendum Notifications

No notes of this type exist for this encounter.

Progress Notes

Ogunrinde, Olukayode 0, MD at .

8/16/201 . 7 . 1. 2:20 PM

Status Signed Ogunrinde, Olukayode 0. MD (Physician)

DIRECT REFERRAL TO TEST - NLR

Patient was seen 8/8/17 for a Home Sleep Study setup appointment. He

was shown how to apply and use the PDX Home Sleep Study device

HOME SLEEP STUDY RESULT

Interpreted by: Olukayode Ogunrinde, MD

Indication: Evaluate for sleep disorder breathing. Patient complained of snoring,

witnessed apnea, fatigue and daytime sleepiness.

Results: The study showed an overall AHI of 30 per hour. The lowest oxygen

saturation was 82%, average saturation was 93%, and 5.4

mins spent below 88%.

Snoring was noted.

Impression: Severe obstructive sleep apnea.

Recommendation: Positive airway pressure therapy.

Case manager to report result.

Data download in 4-6 weeks after PAP therapy setup.

 

Oiukayode Ogunrinde, MD.
Diplomate of American Academy of Sleep Medicine

Page 3 of 5

Patient returned the PDX Home Sleep Study equipment as scheduled. Analysis of the

data revealed the lowest Sp02 was 82% and the total AHI=30.1. SDB observed included

Hypopneas, Mixed Apneas, Obstructive Apneas, Central Apneas, Snoring.

Dustin M. Jacoby, LPSGT

 

Prior to going to bed, Patient answered the Bed Time Questionnaire as follows:

1 .Did you consume any alcohol today? Yes, small glass of wine with dinner 7pm

2. Did you take a sleep aid or pain medication today? No

 

Upon waking, Patient answered the Morning Questionnaire as follows:

1. How long did it take you to fall asleep last night? 8 hours

2. How long did you sleep last night? 8 hours

3. Did you wear an oral appliance for treatment of apnea during this test? No
Additional patient comments:

[Sleeprider]

There is a lot to unpack here. You have apparently been able to upgrade your prescribed therapy from an auto CPAP to a Philips BiPAP Auto SV by purchasing out-of-pocket and modifying the ASV by removing the polyurethane foam. Your sleep study showed some indication of complex apnea, and you were apparently not satisfied with the CPAP therapy, and upgraded. I think the next step here is to post some Oscar charts of the therapy so we can see where you are at in terms of settings and efficacy. It would be useful to contrast both CPAP and ASV results, and comment on your sense of how the therapy is working out. I don't see a question, so let's see where your data takes us.

[LindanHotAir]

Here are some examples on the Auto CPAP.  I would run out of energy in the early evening and doze off in front of the TV.
       

[Sleeprider]

Really interesting. I look forward to seeing the ASV results, but if this was all I had, I would tell you to read this wiki that characterizes these clusters of apnea as mainly the result of chin-tucking. http://www.apneaboard.com/wiki/index.php...onal_Apnea

[LindanHotAir]

Here are some screen shots of the ASV.  The AHI varies considerably. Here is a 2.99 AHI.
   
Here is last night.
   
Here is a 5 minute shot from last night.
   

The settings have not been changed significantly for some time, but there seems to be a lot of variance in the events.
Tidal volume and minute vent don't seem to vary as much as they did on the Auto CPAP.   My oxygen saturation stays high over night, typically 94 to 96. I don't often experience the tiredness in the evening that I did on the Auto.

Sometimes my patient triggered breath percentage goes to zero, and the machine forces ventilation.  That seems to happen quite a bit while I am starting to wake up.

My backup rate is set to 9 and that does not seem to be intrusive and I am not fighting with the machine.

Does anyone see anything that might need to be changed, or any improvements that could be made?  
I don't expect to chase the numbers to zero.  As for oxygenation, it seems to be doing its job.

[LindanHotAir]

I am currently using a ReLeaf soft neck support. I have a flat pillow that I use, but I change position during the night.

[Sleeprider]

Well, in my experience the ASV treats complex apnea nearly 100%, and when we see the clusters of OA and H events, we have to fall back on the positional apnea and soft cervical collar as a remedy. From what I have seen in my considerable experience with seeing these charts, you need to look at a different collar. You have mostly obstructive sleep apnea, and it comes from position (chin-tucking). How many pillows are you using? Do you sleep laying down or more upright in a sitting or inclined position?

[LindanHotAir]

Here are charts from last night. 


Overview:
   
Flagged events:
   
Unflagged breathing:
   

There are a few times when the Patient Triggered Breaths dropped to or near zero, and my respiration rate dropped below the backup rate of 9.
The event count for timed breath is 355. Last night I did not remember waking up and moving around, and the AHI of 4.23 was lower than some nights.

[Sleeprider]

I think the event you focused on at 03:52 looks positional. Your EPAP settings allow for a maximum of 22, but this chart does not exceed 14. I think the machine keeps EPAP above 15 in reserve for pressure support, so probably no need to keep settings above that level. For ASV, your pressure is relatively high compared to most. The best breathing of the night was at the minimum EPAP setting and PS.

[LindanHotAir]

The EPAP Min of 10 is the lowest pressure that doesn’t feel like I’m starved for air, and the 2.5 PS Min is comfortable unless my nose is congested. Then the machine increases it slightly. 

I will check out different neck supports to reduce positional apneas.

My mix of obstructive and central events can change significantly, with as many as 33 central events nightly, but on some nights obstructive events are higher. In most cases the hypopneas make up the bulk of the events.
Last night was 6 C, 7 O, 18 H. Last Saturday AHI 7.8, 20 C, 6 O, 41H.