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New user questions about AHI
#11
Update;
I shaved and seem to have gotten the leaks under control. AHI is now even higher, all CA events.


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#12
logandzwon,

Yes, this night the leaks were under control! This leak line is a really, really nice leak line. That's significant progress. You want all your leak lines to look like this one. (But from a practical perspective, they're not all going to look this good. With some practice you'll learn when the leaks are "good enough" even if they're not "great".)

So now we need to start thinking about those CAs.

Some questions:

1) How restless were you during the night? In other words, were you drifting in and out of a light sleep a lot of the time? In particular do you remember any long wakeful spells---particularly between midnight and 1:30 or between 3:00 and 4:00?

2) Have you gotten a written report of the results of your diagnostic sleep study and/or your titration study? Do either of them mention anything about central apneas? If you don't have the written report from your sleep studies, you need to request them from the sleep doctor. Note that since you are in the US, you have the right to obtain a copy of these things, but some doctor's offices will give you some run around. Typically you cannot make the request for the written reports over the telephone. The request needs to done in person or be done in writing. You want both the written summary and the summary data and the summary graphs. The whole report will be somewhere between 3 and 7 pages for each study. You may have to pay a small per page fee in order to obtain the results.

3) Were you originally put on a plain CPAP or APAP and then switched to the VPAP? If so, how long did you use the CPAP/APAP? And do you have any idea on why you were put (or switched to VPAP)?

Without knowing what your official diagnosis is, I don't want to speculate on the clinical significance of those CAs being scored by your machine. For now you need to keep using the machine. And if you do NOT already have a follow up appointment scheduled with the sleep doc, you need to schedule one so that this data can be properly evaluated in a month or so.

You have to understand: There's a reasonable chance that as you get used to sleeping with the machine, the number of CAs will start to decline over the next several weeks, in which case they're of no long term importance. In the best case scenario, by the time you have your follow up, the number of CAs will have dropped to near 0 and you'll feel like you're starting to sleep pretty decently with the machine each night. But there's also a good chance that the number of CAs won't start to decline, and in that case, the CAs are of clinical importance. In a worst case scenario, you'll wind up being switched to an even fancier, more expensive machine called an ASV machine in a few weeks or months if the CAs continue to remain this high. (Your insurance company's rules may factor into how long you have to be on the VPAP before they'll pay for an ASV machine.)
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#13
(11-24-2013, 10:30 AM)robysue Wrote: logandzwon,

Yes, this night the leaks were under control! This leak line is a really, really nice leak line. That's significant progress. You want all your leak lines to look like this one. (But from a practical perspective, they're not all going to look this good. With some practice you'll learn when the leaks are "good enough" even if they're not "great".)

So now we need to start thinking about those CAs.

Some questions:

1) How restless were you during the night? In other words, were you drifting in and out of a light sleep a lot of the time? In particular do you remember any long wakeful spells---particularly between midnight and 1:30 or between 3:00 and 4:00?
The way I remember, I went to sleep proper about 11:20pm. Something startled me awake shortly there after for about 30 seconds, but once I realized what it was I quickly feel back asleep. I woke up about 4:20 with some mild aerophagia problems and removed the mask for the rest of the night, (I get up for work at 6:00am.)

(11-24-2013, 10:30 AM)robysue Wrote: 2) Have you gotten a written report of the results of your diagnostic sleep study and/or your titration study? Do either of them mention anything about central apneas? If you don't have the written report from your sleep studies, you need to request them from the sleep doctor. Note that since you are in the US, you have the right to obtain a copy of these things, but some doctor's offices will give you some run around. Typically you cannot make the request for the written reports over the telephone. The request needs to done in person or be done in writing. You want both the written summary and the summary data and the summary graphs. The whole report will be somewhere between 3 and 7 pages for each study. You may have to pay a small per page fee in order to obtain the results.
I do have the reports from my sleep studies. One initial one, the following MSLT, and the follow-up titration study. The initial study showed 3 obstructive apnea, 15 central apnea, and 74 hypopapnea.

(11-24-2013, 10:30 AM)robysue Wrote: 3) Were you originally put on a plain CPAP or APAP and then switched to the VPAP? If so, how long did you use the CPAP/APAP? And do you have any idea on why you were put (or switched to VPAP)?
Durning titration the technician could not find a suitable CPAP pressure. I was put straight onto BiLevel.

(11-24-2013, 10:30 AM)robysue Wrote: Without knowing what your official diagnosis is, I don't want to speculate on the clinical significance of those CAs being scored by your machine. For now you need to keep using the machine. And if you do NOT already have a follow up appointment scheduled with the sleep doc, you need to schedule one so that this data can be properly evaluated in a month or so.
  I am actually working with a neurologist. When I tried to ask her about some of the concerns I had with PAP she basically told she just signs whatever the sleep study's Docs send her. I'm thinking I need to find a sleep specialist. As it stands today I see her again 12/12/13.

(11-24-2013, 10:30 AM)robysue Wrote: You have to understand: There's a reasonable chance that as you get used to sleeping with the machine, the number of CAs will start to decline over the next several weeks, in which case they're of no long term importance. In the best case scenario, by the time you have your follow up, the number of CAs will have dropped to near 0 and you'll feel like you're starting to sleep pretty decently with the machine each night. But there's also a good chance that the number of CAs won't start to decline, and in that case, the CAs are of clinical importance. In a worst case scenario, you'll wind up being switched to an even fancier, more expensive machine called an ASV machine in a few weeks or months if the CAs continue to remain this high. (Your insurance company's rules may factor into how long you have to be on the VPAP before they'll pay for an ASV machine.)
Thank you for this information, I wasn't sure if I needed to be imminently worried about the high CAs.
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#14
(11-24-2013, 11:08 AM)logandzwon Wrote: I'm thinking I need to find a sleep specialist.
+1
btw do you take any pain medication with opioids

Titration protocol reference guide (the guide explain what machine and treatment required)
http://www.sleepapnea.com/downloads/1002...fGuide.pdf
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#15
(11-24-2013, 11:25 AM)zonk Wrote:
(11-24-2013, 11:08 AM)logandzwon Wrote: I'm thinking I need to find a sleep specialist.
+1
btw do you take any pain medication with opioids

The only medication, prescription or OTC, I take is 150mg nuvigil.

As an aside, I think there is more going on with me, narcolepsy or something. Since Apnea did come up in the study, the DR wants to see it corrected before addressing anything further.
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