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Time at Max Pressure
#11
I don't know what an AVAPS is, but mechanically forcing air into a patient in the hospital is different than spontaneous breaths, as the breathing we do normally is not a full deep breath.  Breathing during sleep is also much shallower than while awake.

I would concentrate on increasing the time you sleep, as you readings look good from the events standpoint.  There are adjustments that may make sense as you go.

If I had your readings from that one night, I would either leave it completely alone, or 6 to 11 as bonjour suggests, for now. 

Commonly used processes for choosing pressures here on the forum might have given you a recommendation of higher minimum pressure.  And that may eventually be more comfortable for you in time.  Those may suggest 8 to 12 as a better band.

But as Sleeprider says, we will see as more posts show what your particular pattern is.  Post a few more nights as you go.

Thanks,

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#12
You should be able to link complete images now:

[Image: ApemsYF.png]

These results are pretty darn good, so you decide if you're comfortable or if you want to improve.  If these are my results, the minimum pressure goes to 7.0, which seems to be the threshold where those flow limitations occur, and would give you a head start on the apnea, hypopnea and RERA that happened at 01:50.  

Your respiration rate is normal, and no one knows what your tidal volume should be without knowing your ideal weight and height and any pulmonary conditions that might restrict volume.  Tv is on the low side for most healthy males, but there isn't much you can do about it.  I would disregard the AVAPs comment for now.
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#13
(04-22-2017, 07:33 PM)quiescence at last Wrote: I don't know what an AVAPS is, but mechanically forcing air into a patient in the hospital is different than spontaneous breaths, as the breathing we do normally is not a full deep breath.  Breathing during sleep is also much shallower than while awake.

I would concentrate on increasing the time you sleep, as you readings look good from the events standpoint.  There are adjustments that may make sense as you go.

If I had your readings from that one night, I would either leave it completely alone, or 6 to 11 as bonjour suggests, for now. 

Commonly used processes for choosing pressures here on the forum might have given you a recommendation of higher minimum pressure.  And that may eventually be more comfortable for you in time.  Those may suggest 8 to 12 as a better band.

But as Sleeprider says, we will see as more posts show what your particular pattern is.  Post a few more nights as you go.

Thanks,

QAL

There may be a misunderstanding, I said to show this to and see a doctor 3 times in my 2 posts. The guy is an aussie, there is low cost private consultation and free public hospital treatment, there is no reason not seek medical support.
(avap is a home pap machine, it's not hospital ventilation) It wasn't suggested to go and buy one or that gr8 has any need for one.  The picture was given as an example of what the normal is for tidal volume, for different sized people. To show gr8 that the medium 380 is low and would benefit from a medical. I will be more clear in the future.
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#14
no worries AJ  -  Q
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#15
Hello ajack. I don't know what part of Australia you are in but since my sleep study with SNORE Australia, nobody has bothered with follow up, despite the fact the they claim to do this on their website. My GP admits that I seem to know more about treating OSA than he does and happily wrote a prescription for an APAP machine. My health fund, which is excellent overall, covers very little in the way of treatment for OSA. All my experience has come from this forum and thank heavens it exists.

It would be great to know if there are things available to me via either Medicare or my health fund that I haven't been aware of so your input here would be helpful for both me and the OP.
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#16
Do I really have to explain to you how our healthcare system works? Why would you be using a GP for sleep apnea? I was immediately given a referral to a private Respiratory & Sleep Medicine Physician. We agreed and I chose to do a home sleep study, medicare and $50 co-payment, through a sleep center. I don't have a health care card to receive a free cpap machine, but I could access free care and a Respiratory & Sleep Medicine Physician through my local public hospital outpatients dept. Like you, I self funded an auto cpap, I have since been back to the specialist for a review and have an appointment for a further review.

I would ask for a referral, if I were the OP or you, or has the GP offered and you declined? Generally a GP knows his limitations. A gp referral to a respiratory specialist, either private (medicare and small co-payment) or the outpatients of your public hospital is free, would be what I would do.

This takes nothing away from this forum and it has helped me a lot. It would be foolish to think it replaces a respiratory specialist. The data from the cpaps is insufficient for proper diagnostic and full ongoing care. My Father with what turned out to be PLMD, is a prime example of this.
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#17
All,

Not to ignore all the comments from fellow Aussie's on this forum, but here is my experience from 4 years ago.  Spoke to my GP and asked to be referred to a 'sleep specialist doctor'. He listened to what I had to say about my symptoms and immediately said 'You have Sleep Apnea' despite not being overweight, or have any other medical indications of being at risk of Sleep Apnea. $100 for the consult please. He did arrange for me to have an at home sleep study, and the results confirmed I had sleep apnea. "Please see my colleague in the next room who can sell you a CPAP machine, you have lots of leg twitching at night, here is a prescription for Gabapentin".

I tried the machine for a while, and felt better - there was a month from memory, where I would visit the Sleep Technician weekly (or was he a salesman) and he would look at my data on Resipironics software from memory, and tell me things were going great. I ended up buying the machine for around A$1500.

Since then - nobody has bothered to follow me up with 'how's it going mate?'. Not even my GP. In fact I only found out the other day that my GP has been writing my prescription for Gabapentin, by saying it is for treatment of Epilepsy - as this is the only way that I can get government discounts on the medication. There has been no mention of any follow up tests, and I believe I am now getting a better diagnose from the board here, than my GP, or phantom sleep doctor.

Sorry - I'm very cynical about paying somebody who is not actively treating me, and I don't know whether they would necessarily know anything more, than experienced people who post on this board. Plus - the fact that they were keener on selling me a machine, than ongoing treatment, doesn't give me a whole lot of confidence.

So... Every now and then I will post to learn more, whilst continuing to read.

The amount of sleep I get each night, feels about right. I go to bed when I'm tired, but usually by around 6:30 or 7 each morning, find myself tossing and turning, and not able to get back to sleep. If my AHI is low, and I'm not tired during the day, then I'm guessing it's probably around right.

I am interested to know however, whether anybody else has experience with Gabapentin for Apnea treatment. Personally I hate the drug (or hate being dependent on it) but for me, the withdrawl symptoms are insomnia, which really leaves me with difficulty functioning.

Lastly, my last couple of nights have been really good LOW AHI, so maybe the one night I posted should not be looked at in isolation!
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#18
"... maybe the one night I posted should not be looked at in isolation!"

that is a good deduction.

QAL
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#19
It sounds like your GP is at fault for not re-referring you to a sleep specialist. It sounds like he didn't offer and you refused. I would get another full study after 4 years, medicare allows one annually. The first appointment copay is higher, subsequent ones are about $50. If money is a consideration, get a referral to outpatients, where there are no copays and full in hospital overnight sleep studies.

My father was prescribed Sifrol, a parkinson drug, for his PLMD. Was your twitching diagnosed as PLMD or a 'twitch'? After 4 years, I would think it should be retested and a drug review is in order.
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#20
My sleep study showed over 89 limb movements/hour. The sleep doc wanted to wait to see if BPAP would help reduce those.

It didn’t and I know because I filmed myself for several nights and I was still moving around - a lot. So I called the doc and said what can we do to treat these movements? He ordered a ferritin test, one of the markers in a CBC panel. He said ferritin levels below 50 can contribute to PLM. Mine came back at 8.

He put me on liquid ferrous sulfate, because it absorbs better than the pill, and 100 mg Vitamin C because it aids in better absorption as well. He also said iron levels climb back up very slowly, over months and months. I’ve been on it about a month now and I believe it is making a difference in PLM and other factors as well. I take 5 ml of 325 mg (65 mg elemental iron) and 100 mg Vitamin C. The afternoon sleepiness is finally starting to fade too and I seem to have more energy. 

Good luck with your treatment.
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