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New DX of OSA (AHI 103.1)
#1
Hi,

So, I just received a call from my doc who says I have severe sleep apnea. AHI = 103.1/hour. During the study they put on a CPAP and were able to get it down to 10.9/hr over this portion of the study. I guess these numbers are pretty bad??

Recommendation:
1. Trial of Auto-BiPAP 6-18 cm H2O
2. Weight management and regular exercise should be initiated.
3. Return to center for re-evaluation after 4 weeks of therapy

Been browsing this site for the last few days waiting on my results and look forward to starting therapy so I am not so darn tired during the day. I have an appointment on the 27th with a DME to pick up equipment/training. Is there anything I should know before that appointment? Any equipment or masks to avoid? Any other input for a newly dx'd PAP user that might make this experience a bit less stressful?

Kind Regards,
SleepyInFL
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#2
Hi sleepyinFL,
WELCOME! to the forum.!
Hang in there for answers to your questions and good luck to you as you start your CPAP journey.
trish6hundred
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#3
Welcome

103 is impressive! I think you will like therapy. I am glad that was not me!
Weight management did not happen for me. OSA sure did. :roll eyes:

Someone has a URL for a list of machines, I don;t have it handy. In a nutshell you want one with an SD card that records data. I have no idea if any BIPAP machines do not have that. Stick around for more details.
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#4
G'day SleepyInFL, welcome to Apnea Board.

An AHI over 100 is a bit scary to be honest. The target under treatment is an AHI under 5, which is achievable. Make sure you get hold of the full sleep test report for your personal records. Ask your doc to go through it with you and see what your central apnea index was like - it seems people with very severe apnea often have a high central component which may need a different type of machine to treat. (So ensure your purchase arrangement allows for an upgrade if necessary).

Stick to Resmed or Philips Respironics machines - they're not necessarily the best available (they are very good) but they command the market and it's much easier to get support for them. I'm pretty sure all bilevel machines on the market now will have full data capability. Download SleepyHead software so that you can monitor your progress in detail. http://sleepyhead.jedimark.net/

Masks are the hardest part to get right and there's no one right answer - it's a matter of try it and see. The Resmed P10 nasal pillows is popular as is the F&P Simplus full face mask - that's a good place to start, but you may need to try several before you get the one that's right for you.

Ask lots of questions and always have a healthy scepticism. As one of our members says "If a DME tells you it's dark at midnight, go outside and check for yourself".

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
Thanks for the reply and Info. Here is a little more details from the actual report I got today.

Initial testing (no-cpap) 2.0 hrs in bed, 0% REM
AHI index - 103.1 (and i was on my side almost the entire time. I tried to go to sleep on my back - but that wasn't happening so they said sleep how you sleep at home. Can you tell me how they got 103.1/hr if I had 63 Obstructive events in 2 hrs and no mixed or central??
63 Obstructive, 0 mixed, 0 central)
O2 sat down to 82%.
During titration portion 6.2 hrs in bed 53.5% REM
AHI index to 10.9/hr
central sleep apnea index was 1.3/hr.
The most appropriate setting of CPAP was not determined. Respiratory events persisted at all settings. <-- I am assuming this is not good ??

I am starting to get a bit worried to go to sleep now... My appointment is not until next week. I guess I have made it this far, but... It appears I am dying every time I sleep without a mask. This is some scary stuff.

Kindest Regards,
SleepInFL
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#6
OK your central index is pretty low in proportion to the total, so there's no need to jump to an ASV machine straight away. A lot of people do develop central apnea once they start therapy (it's to do with the balance of CO2 in the blood) but in most cases that will go away after a while.

Your AHI is made up of obstructive and central apneas, plus hypopneas, all divided by the time you were actually asleep. It sounds like you weren't sleeping for the full two hours so the technician has discounted that time in calculating the AHI.

The fact that respiratory event persisted under therapy is disappointing but it's not the end of the world. It does mean that you might need to be more proactive in managing your therapy to optimise the settings and ensure maximum refreshment and comfort. (The SleepyHead software I mentioned above will help in that regard).

You've made it this far so another week isn't likely to kill you. Sleeping on your side will help, and you are already doing that. A lot of people sleep in a recliner, with the more upright position helping avoid airway collapse.

Good luck, and keep us posted about how you get on.


DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
Hi,

Thanks again for all the information, I really appreciate the time that you took to reply.

So, I picked up my machine & mask yesterday and have one night of data. The machine is a ResMed Airsense 10 VAUTO and the first mask is a ResMed AirFit F10 (full face).

I have to say, the first night was a bit rough to start with. I think they have the unit setup as a APAP BiLevel. Which seems to be completely different than the titration portion of my sleep study... as far as how it feels to breathe on. Making it a bit of a challenge to fall asleep. I only woke up once (restroom break). WOW... how refreshed I feel today!! I know one night is not necessarily a good indicator of success but my AHI was 3.4 last night compared to 103.1 during my study so it looks (and feels) like success. My wife reported "100% better night sleep for her too".

I do have a little discomfort in my chest today. Is that normal?? At the start, it seems like at some points the machine was trying to breathe for me which was quite annoying and made it difficult to fall asleep. After a while, I was able to get use to it and it seemed to synch with my effort to breathe vs. against it. Very odd feeling initially but tolerable later.

I would post a screen shot but I guess I can't until I post more.

Thanks for reading and any advise is much appreciated.

Kindest Regards,
SleepyInFL
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#8
(07-28-2016, 09:52 AM)sleepyinFL Wrote: Hi,

Thanks again for all the information, I really appreciate the time that you took to reply.

So, I picked up my machine & mask yesterday and have one night of data. The machine is a ResMed Airsense 10 VAUTO and the first mask is a ResMed AirFit F10 (full face).

I have to say, the first night was a bit rough to start with. I think they have the unit setup as a APAP BiLevel. Which seems to be completely different than the titration portion of my sleep study... as far as how it feels to breathe on. Making it a bit of a challenge to fall asleep. I only woke up once (restroom break). WOW... how refreshed I feel today!! I know one night is not necessarily a good indicator of success but my AHI was 3.4 last night compared to 103.1 during my study so it looks (and feels) like success. My wife reported "100% better night sleep for her too".

I do have a little discomfort in my chest today. Is that normal?? At the start, it seems like at some points the machine was trying to breathe for me which was quite annoying and made it difficult to fall asleep. After a while, I was able to get use to it and it seemed to synch with my effort to breathe vs. against it. Very odd feeling initially but tolerable later.

I would post a screen shot but I guess I can't until I post more.

Thanks for reading and any advise is much appreciated.

Kindest Regards,
SleepyInFL

There is no Airsense 10 Vauto, but there is an Aircurve 10 Vauto. It may be set to Vauto mode, which is the auto-titrating bilevel. You should access the settings to see exactly what they have done. In that mode, there will be settings for max IPAP, min EPAP, and PS (pressure support). You should know those for reference and as a starting point for discussions here.

If you have the Airsense 10 Autoset, then in Autoset mode, it will have a minimum pressure, maximum pressure and option for EPR. Both machines have many more settings and options, but I think it would be helpful if you correctly identified the unit you were dispensed.

All the sensations you reported are normal for new users, and I suspect you will quickly adapt to where the machine is normal, and sleeping without it is uncomfortable. I think following your next post you will be able to post links and attached images. This tutorial explains how to post a useful chart:
https://sleep.tnet.com/reference/tips/imgur

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
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#9
Congratulations on pappin night 1. You will notice more energy more stamina during the day. Your AHI of 3.4 puts you in the treated zone (<5). There is no cure however so you will stay treated as long as you are pappin. There is a lot of useful information on this forum and a plethora of knowledgeable folks willing to help with any questions. Welcome to our community.
Coffee
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#10
Hi Sleeprider,

You are correct! it is a ResMed AirCurve VAUTO machine. Here are the settings.
Mode = Auto
Max IPAP = 18
Max EPAP = 6
PS = 4
TiMax = 2.0
TiMin = .3
Trigger = Med
Cycle = Med
Mask = Full Face
Ramp = 10mins
etc...

(Testing attaching images) Here is a screen shot of the data last night. Probably a little premature to analyze data since I only have one night under my belt, but I wanted to see if it would work.
   
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