Successful AHI reduction with APAP + TheraVent

[stcrim]

Hey Doc,

I don't really have a sleep doctor so to speak. My GP gave me a trial on an APAP at my request at which point it was obvious I had Apnea. I hadn't had a good night's sleep in 20 years until the first night on the APAP.

Adding the exhalation resistance has added to the sense of being well rested and it has further cut down on my nightly bathroom breaks.

I know all this is N=1 but I want to get this right. MY EPR is set at 2 and my pressure is 7.6 to 12. If I go higher the pressure becomes what disturbs my sleep.

I want to get this right and would prefer to do it without the added cost of TheraVent. I am quite comfortable with the resistance it provides but I have to tape my mouth partially shut and use a full face mask or tape completely with 2 inch 3M tape and use a nasal mask or pillow.

Are the CAs because the pressure is too high or too low?

[DocWils]

Please see a qualified sleep doc to get this right - a GP simply does not have the knowledge to get your script right for your needs, and frankly, I do not see how you can get anything resembling a true reading based on your current set up - I really think you need to see a proper specialist.

Your CAs would be most likely ( if you do not have complex apnoea, and it is impossible to tell without a proper clinical exam and overnight test) from too high a top pressure, however, there are too many variables here - an ill-fitted mask, mouth breathing, etc, so I really feel now would be a good time to see a specialist and get the testing done properly. Once done, it should be possible to adjust your therapy and your machine and mask requirements to give you the best possible outcome.

The massive numbers of CAs registered in the one sampling you posted might indicate not actual CA events but instead some other form of interrupted breathing or response pressure that your machine is interpreting as a CA. Only a combined pulse-ox and heart monitored testing system could determine that, combined with an EEG. For this you need a sleep clinic test. You have a good start, but you need now to move beyond proof of illness to a proper diagnosis and titration. Also you do not need to tape your mouth shut - there are chin straps to keep your mouth closed, but I am uncertain if they are necessary on full face masks.

[quiescence at last]

Can you make another screenshot of 10 minutes from each night.

7.6.15 03:22 to 03:32
compared to
7.7.15 03:08 to 03:18

Can you make another full night that has theravent as well?

It would be great if you could change your y-axis to -80 to +80.

thanks

QAL

[stcrim]

Hey Doc - I hate to sound complicated but without a little mouth tape I'll wake up several times in the night with the bottom of my AirSense F10 in my mouth. With nasal pillows and nasal masks, I can blow right past a chin strap. I have purchased the Ultimate Chin Strap but haven't tried it yet.

I went to my GP because a sleep study was $9,000 and my insurance deductible is $10,000. I'm kind of between a rock and a hard place. From having looked at several forums it looks like most sleep doctors are not extremely useful and are unwilling to devote their time to solving these kinds of issues at least here in the US. Although I feel better than I have felt in 20 years.

On a normal night on APAP alone my AHI runs about 7 or 8. That mostly from CAs and Hypopneas. My respiration rate median runs about 17 to 20 so I assume I'm way over breathing, perhaps causing the CAs by washing out Co2. (best guess) I am wide open to suggestions...

Hey QAL - I'm happy to print what you need. A random 10 minutes on either chart may be event filled of very quiet. Tell me what you are looking for.

[DocWils]

The problem is that you need someone who is a qualified specialist to take a look at your case - what you are doing is not a sensible solution and may ultimately do more harm than good (or may not). Even with a pulse-ox, we cannot see the amount of CO2 building up in your bloodstream and we can't see what is really going on - what I do know is there is a huge likelihood that using a Theravent together with a mask is simply hiding the real therapeutic results and that is not a good thing. As such, a specialist would be a better idea - please go to the nearest hospital that has a sleep lab in the respiratory medicine department, or if you suspect that you really have Central Apnoea rather than pressure caused CAs, in the neurology department, and get it checked out. I am afraid it will still be expensive, but even a table consult with a specialist in that department will be better than trying to guess things here with all the (very helpful and nice) locals pitching in, even without a titration, and that will not run you 9 grand.

[quiescence at last]

I explained the specific locations I was interested in (exact time on exact days). Thanks. You could send me a SD, but that would be really sticking my nose in.

You sounded like you wanted to state your case, and if you want to do this we can take it to the PM. I do that sometimes, especially if my interest is piqued. What you say is interesting.

QAL

[stcrim]

QAL - I am open to get to the bottom of this. I'm not sure if I did the images correctly, please let me know. I did not understand the axis of -80 to +80. I am also wide open to PM

http://candsnet.com/images/7.6.15ex.JPG
and
http://candsnet.com/images/7.7.15ex.JPG

[quiescence at last]

yep. I did not get axis on one. not real sure, but my interpretation is you were asleep on 7.6. (that 10 minutes) but were either awake or potentially in REM sleep in the 7.7. clip.

since your respiration was not faster 7.7. but the flow rate definitely appears much lower, I would say you were either awake or very light sleep, though calm. I would have expected less CA or any A in that state (just as you recorded). It does make me wonder whether your SpO2 was low in that timeframe.

tell my your minute volume for both clips, if you would. thanks.

QAL

[stcrim]

QAL - Here are the two charts you asked for:
http://candsnet.com/images/7.6.15MV.JPG
http://candsnet.com/images/7.7.15MV.JPG

At some point in time I would sure love to know how you are reading these charts an gathering information like asleep vs not asleep. I think it would be very helpful to understand those things as I progress.

Thank you!

[quiescence at last]

Can you make another screenshot of 10 minutes from each night.

7.6.15 03:22 to 03:32
compared to
7.7.15 03:08 to 03:18

Can you make another full night that has theravent as well?

It would be great if you could change your y-axis to -80 to +80.

thanks

QAL

It appears that you swapped these periods, can you try again. also right clicking on the axis part of the chart, you should see how to set y-axis overrides.

you should set overrides on all the charts you wish to compare one night to another.

thanks.

QAL