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The journey continues........
#1
So, I had 2 appointments yesterday, one with my DME to look at and try on some new masks, and then later in the day with my sleep doctor to talk about my progress so far.

Unfortunately, the DME really didn't have a good selection to pick from (and this was at their office). My Mirage Quattro is too leaky (or so I thought). Anyway, I ended up with a Respironics Amara. Man, what a disaster! I couldn't stand it for more than about an hour. First, I could not stop the leaks around the chin area, and worse than that is the vent. The vent on this model is on the hose swivel. Every time you move, that air blows in another direction. On top of that it's one of the loudest masks I've tried. I think because the vent holes are really, really small, so forcing alot of air out of it makes it noisy. I'm back to my Quattro, I could not believe the difference in the noise level, I had it on for 10 minutes and fell asleep.

Now, on to the doctor's office. I've been on an APAP for a little over 3 weeks, set at 8-17, because I couldn't sleep during my titration study so they didn't know what I really needed. Over that 3 weeks my AHI is still averaging around 14-15. I got down to 10 one night, but not since. (sleep study was 44).

He changed it to a straight CPAP with a pressure of 14. Rather than wait for the DME to do it, I changed the settings myself last night. Even with that, my AHI last night was 14.26, virtually unchanged.

I realize one night isn't enough to really tell, but man, I was really hoping it would have been at least a little better.








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#2
(12-13-2012, 11:03 AM)ImReallyTired Wrote: So, I had 2 appointments yesterday, one with my DME to look at and try on some new masks, and then later in the day with my sleep doctor to talk about my progress so far.
Unfortunately, the DME really didn't have a good selection to pick from (and this was at their office). My Mirage Quattro is too leaky (or so I thought). Anyway, I ended up with a Respironics Amara. Man, what a disaster! ...
Now, on to the doctor's office. I've been on an APAP for a little over 3 weeks, set at 8-17, because I couldn't sleep during my titration study so they didn't know what I really needed. Over that 3 weeks my AHI is still averaging around 14-15. I got down to 10 one night, but not since. (sleep study was 44).
He changed it to a straight CPAP with a pressure of 14. Rather than wait for the DME to do it, I changed the settings myself last night. Even with that, my AHI last night was 14.26, virtually unchanged.
I realize one night isn't enough to really tell, but man, I was really hoping it would have been at least a little better.

In my experience DMEs don't stock a very big selection of masks. I have used two different DMEs here, and neither carries more than half a dozen different masks. I suspect it is because the therapist has developed familiarity only with a few different models. Or maybe it is because of the cost of maintaining a large inventory. However, at least my present DME will order any mask I want. I can also just buy a mask directly online, but then I can't get insurance to pay for it.

Regarding your high AHIs, have you checked to see if there is a correlation between the AHI and the leak rate? I notice that my AHI is always higher when the leak rate is higher. I'm not sure if that is causal - i.e, is the leak rate higher because the pressure went up in response to an event? Or is the AHI higher because the higher the leak rate the less accurate the machine reporting?
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#3
Hang in there..really tired
Give the 14 a week and then take a look at your 90 or 95% pressure on the sleepyhead. Then maybe make a change. Make the change in small increments and at least a week in between to analyze the results.Just maybe its something else thats keeping the AHI up. Emotional issues, stress, excitement, who knows, but a week will maybe help make a determination.

JJJ makes some good points about your mask. They are the devil in disguise.
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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#4
JJJ - I'm not really seeing any correlation between leaks and my AHI. I think in the beginning there may have been, but now that I think I have the mask figured out I'm able to keep the leaks pretty flat.

JudgeMental - You raise an interesting point, excitement, stress, whatever you want to call it, but all I can think about as I'm going to sleep is getting up in the morning to check my numbers. Are they going to be high, are they going to be low, what do I do if this happens, or that happens, etc. etc. My wife is pretty sure I've lost my mind. I wonder if that could be having an effect too.

This is getting complicated.

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#5
can you post some apap graphs
whats the breakdown of AHI

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#6
Hi ImReallyTired,
I'm sorry you are having such a rough time with your CPAP therapy.
Could it be that you are obsessing over the numbers?
Best of luck to you on your CPAP journey and I hope things level out for you.
trish6hundred
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#7
I was just curious if you are on any medications? Some do tend to relax the intake area more than normal when on medication causing higher AHI's. I noticed this with experiments on my medications. Some will show a higher AHI when taken before bed. Seems pretty consistent, unfortunately at times I have to take the meds but I've been blessed to be just a little over 5 AHI compared to no meds, 0.89-1.9. Hope things work out soon, sounds like you are doing things right, a little at a time for comparison. We're all with you, hang in there!
Tim
Finger Lakes Region, NY
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#8
(12-13-2012, 02:36 PM)zonk Wrote: can you post some apap graphs
whats the breakdown of AHI

It looks like it's OA, then the H's, then the CA's. For example, last night was 56 OA's, 24 H's and 20 CA's. That ratio is relatively stable. I've also noticed that I'm getting a huge number of OA's in my last hour or so of sleep, again using last night, out of the 56 events around 25 of them were between 4 and 5 AM, and I get up at 5. Don't know what that means but it's been like that for a quite a while.



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#9
(12-13-2012, 03:46 PM)ImReallyTired Wrote: It looks like it's OA, then the H's, then the CA's. For example, last night was 56 OA's, 24 H's and 20 CA's. That ratio is relatively stable. I've also noticed that I'm getting a huge number of OA's in my last hour or so of sleep, again using last night, out of the 56 events around 25 of them were between 4 and 5 AM, and I get up at 5. Don't know what that means but it's been like that for a quite a while.

Are you taking prescription sleeping pills or some type of Benzodiazepine to help you sleep or a narcotic pain med or muscle relaxant?

These have all caused my AHI to be much higher in the past and I've subsequently read articles about sleep studies that say the same thing.


Ren
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#10
(12-13-2012, 06:50 PM)TheWerkz Wrote: Are you taking prescription sleeping pills or some type of Benzodiazepine to help you sleep or a narcotic pain med or muscle relaxant?

These have all caused my AHI to be much higher in the past and I've subsequently read articles about sleep studies that say the same thing.

Yeah, that's got to be it, I'm on methadone, 45 mg/days for quite a few years now. Actually just yesterday I decreased my dose by 5 mg. Probably not enough to make a huge difference here, but we'll see. Funny, I make sure I tell any doctor I see that I'm on it, the sleep doc never mentioned that it might be a problem, but now that I think about it, I'm sure it's affecting my OSA treatment.

This is gonna be a tough one. Getting off methadone is a long, painful process, but it may be that, or deal with ongoing sleep apnea issues.


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