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Pulmonologist: What to expect
#1
I had two sleep studies and was diagnosed with severe sleep apnea last year with AHI over 100. I have been using a ResMed S9 VPAP since June 2015. My pressures are high (E/I = 20/26). My compliance runs over 95% and I use SleepyHead software to monitor my results. Also, I use a CMS 50D+ Finger Pulse Oximeter about one third of the time and import the results into SleepyHead.

My AHI now ranges from 2 to 50. The last 30-day average was 15. Well over 75% of my AHI is “Unclassified Apnea” per SleepyHead and the balance is “Hypopnea.” I no longer feel tired all the time, but have never felt that “great feeling” that I have read about.

My pulmonologist seems to only look at the AHI results. In our last visit, he said, “Your AHI is 12; that’s great. Come back in 6 months.”

He does not analyze my breathing patterns or anything else that I can tell.

What should I expect from my pulmonologist? Also, how can I educate myself?

Thank You!
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#2
Try the ResScan software as well.

If I had a diagnosis of COPD and was using that much pressure, I would expect more from a pulmonologist.
Lung capacity tests... Imaging (even if just x-ray.) Perhaps inhalers to relieve resistance.
For me, “Your AHI is 12; that’s great. Come back in 6 months.” just wouldn't cut it.
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#3
Results Report attached


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#4
(03-08-2016, 03:16 PM)justMongo Wrote: Try the ResScan software as well.

If I had a diagnosis of COPD and was using that much pressure, I would expect more from a pulmonologist.
Lung capacity tests... Imaging (even if just x-ray.) Perhaps inhalers to relieve resistance.
For me, “Your AHI is 12; that’s great. Come back in 6 months.” just wouldn't cut it.

My diagnosis is Severe Sleep Apnea, not COPD. Am using ResMed S9 COPD BiPAP due to high pressures (26/20). ResScan software works with S10, but not S9 (I think).
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#5
G'day Sprite60.

Your AHI is still clinically untreated if averaging 15, though obviously a heck of a lot better than your original untreated number. That may be one reason you're not feeling refreshed. Secondly the high pressures you're using will put some stress on your body. Less stress than stopping breathing 100 times an hour!

The ResScan software does work for the S9 - I use it myself as a check. Though I don't believe it gives you anything that SleepyHead doesn't.

As to what to expect from the pulmonologist, I would be surprised if they didn't at least look at your flow rate chart. My RT always looked at the charts and was able to discern patterns, trends and details that allowed for a tweaking of the settings to improve things for me. Now, with the knowledge I've gained here at Apnea Board I'm able to do that for myself.

I think you need to take steps to improve your treatment still further. Maybe post some Sleepyhead charts from a recent night so we can try to see any details that might help. Also avoid sleeping on your back - apneas are generally better controlled if you can sleep on your side.

Good luck.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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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#6
First data column doesn't make sense. (Most Recent)
AHI should = OI + HI + CAI. It doesn't add up.
25.9 ≠ 0 + 1.15 + 0

Perhaps Sleepyhead is not parsing the data correctly?

edit: corrected paring to parsing.

Addendum: This may be a good case for using ResScan for comparison.
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#7
None of the columns add up. These data look very suspect to me. I would not rely on any of it including the AHI. Is there therapy data available from the LED display on the machine? I would trust that more or maybe data from ResScan.

Best Regards,

PaytonA
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#8
Quote:First data column doesn't make sense. (Most Recent)
AHI should = OI + HI + CAI. It doesn't add up.
25.9 ≠ 0 + 1.15 + 0

Perhaps Sleepyhead is not paring the data correctly?

Quote:None of the columns add up. These data look very suspect to me. I would not rely on any of it including the AHI. Is there therapy data available from the LED display on the machine? I would trust that more or maybe data from ResScan.

The Sleepyhead statistics page doesn't have a line item for unclassified apneas, and the original post stated that 75% of the events are unclassified apneas. Therefore they don't specifically show up in the stats page but they are taken into account in the total AHI. In contrast, ResScan doesn't differentiate between apnea types in its stats - it just lumps them all together in the apnea index. From this point of view (and many others) SleepyHead is the superior software.

I'm not familiar with the VPAP COPD but I suspect it's like the Adapt which doesn't bother to classify apnea types - it just gets on with the job of helping you breathe.


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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#9
Hi sprite60,
WELCOME! to the forum.!
You might consider getting a second opinion if you are unhappy with the doc you are seeing now.
Hang in there for more responses to your post and much success to you as you continue your CPAP therapy.
Good luck.
trish6hundred
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