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[Treatment] HIGH AHI
#1
Hi, I've been on Cpap auto for 15 months. I started with a sleep study recommending 8 cm because my apnea was 14 AHI average. Since then my AHI's have gone to an average of 25-30 AHI, sometimes 75 AHI. The Doctor said i should just stop using it. My wife says when I do I gasp all night long and snore terribly. I have no mask leaks, and I've set my auto cpap to 8-18cm, and it still averages 17-20 AHI. Occasionally I will have a good night of 6-9 AHI. I've tried every setting of pressure between 6-20cm/H20. Nothing really changes this wide swing with the high the norm. When I go above 16cm I get blow out on the masks. I've tried five different masks the best to date is the Fisher PAYKEL Simplus. I've gone to three doctors and all of them don't seem to be concerned, they either just say keep using it, or stop all together. I am not tired during the day too much, one way or the other, but can easily sleep if sedentary. I use sleepyhead data. Am I just crazy? I have two machines too, and either one will bring the same results, so the machines are not malfunctioning. Anyone have some recommendations?[attachment=2024


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#2
I don't understand why three doctors would not show some concern.
The flow pattern is, well for lack of better words, just crazy.
During the periods where the machine is flagging many OAs, the peak flow amplitude is about 3X normal.
Now, it's possible that you stop breathing; then follow that by a big breath.
It might help if you could post a plot zeroed in on several breaths so the actual waveform can be seen.
What is your EPR set to? I'm guessing 3 from the graph.
Right now, don't know what to tell you.
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#3
(01-09-2016, 02:17 PM)Dennis Finnan Wrote: The Doctor said i should just stop using it. My wife says when I do I gasp all night long and snore terribly. I have no mask leaks, and I've set my auto cpap to 8-18cm, and it still averages 17-20 AHI. Occasionally I will have a good night of 6-9 AHI.

I think your doctors should have focused on referring you to someone with greater expertise, not advising you to ignore the problem just because they do not understand what else to recommend.

Firstly, Obstructve Sleep Apnea is usually strongly positional, and flat on our back (supine) is usually the worst position, strongly increasing our pressure needs, leading to Large Leak if mask is adjusted slightly too loose than needed to maintain proper mask seal at high pressures. (However, it is important that the mask not be tighter than whatever is needed for the upper pressure limit.)

Many of us have found that we need to take precautions to assure we will not roll over onto our back (and remain in that position) while asleep. Some of us wear a snug teeshirt with a couple tennis balls in pockets or socks sewn along the spine between the shoulder blades and higher. Others wear a light knapsack with something in it light but bulky like some tubes of tennis balls, to assure they don't roll onto their back while asleep. Others use super long "body pillows" under the sheet to help control sleep position. Others find they they cannot sleep on their side and must sleep on their back and find it helps to sleep in a comfortable reclining chair so the spine and neck are aligned but elevated.

Available by prescription is a new positional sensor device called Night Shift Sleep Positioner http://www.advancedbrainmonitoring.com/sleep-medicine which is a vibro-tactile device worn on the back of the neck, which silently vibrates progressively more strongly to alert us when we are in the supine position, to gently arouse us enough for us to change position and easily fall asleep again. This can be used along with a CPAP machine, or, if our OSA is mild enough, might be sufficient on its own to train us to avoid the supine position and achieve restful sleep.

Secondly, it looks like your upper pressure limit (14) is too low to stop the obstructive apneas, which are the dominant problem. But if you can totally prevent sleeping in supine position, perhaps you won't need to raise the upper limit higher than 14.

Thirdly, your central apneas look to me like they are mostly occurring at high pressures. This is good to keep an eye on, because in your case raising the upper pressure limit too much may strongly increase the number of central apneas. I suggest a goal of reducing the overall AHI (which includes obstructive apneas, central apneas and hypopneas). If controlling your sleep position does not solve the high AHI problem, I think raising the upper pressure limit would be appropriate if obstructive apneas continue to be the dominant form of apnea.

I think central apneas if short are less harmful than obstructive apneas, because as soon as we try to breathe a central apnea ends, in contrast to obstructive apneas which generally require strong effort and result in strong stress on the heart and strong sleep disturbance, leading to daytime sleepiness and long term damage.

If central apneas are usually outnumbering obstructive apneas and if we are usually having more than more than 5 central apneas per hour, I think an Adaptive Servo Ventilator (ASV) type of bilevel CPAP machine would be needed. ASV bilevel machines are more expensive than standard bilevel machines but are able to prevent both obstructive and central apneas.

Take care,
--- Vaughn.


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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#4
Hi Dennis Finnan,
WELCOME! to the forum.!
It sounds like yet another doc is in order since the 3 you have already gon to do not seem to be concerned with your sleep apnea.
Hang in there for more suggestions and answers to your questions.
Much success to you with your CPAP therapy and getting it fine tuned to meet your needs.
trish6hundred
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#5
Once again Vsheline is easy to agree with. Your obstructive events look to have positional triggers...you're sleeping on your back. With the number of obstructive events you're having, there is no reason to cap the max pressure of your machine at 14. In fact I would increase the minimum pressure to 12, and allow the machine to run up to 20 as needed.

I think you will soon find you are near the maximum pressure of 20 and that a bilevel is a much more appropriate choice for your therapy. In terms of leaks you're doing great, but you need to increase your pressure (especially with the EPR you are using), and you probably need to stay off your back.
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#6
Needless to say, you need a new doctor.
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#7
(01-09-2016, 08:38 PM)Sleeprider Wrote: Needless to say, you need a new doctor.

I agree. In fact I'd consider reporting him for malpractice.

Ed Seedhouse
VA7SDH

The above is my opinion.  It is just possible that I may, occasionally, be mistaken.

I am neither a Doctor, nor any other kind of medical professional.

Everything put together sooner or later falls apart.
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