[Treatment] New User Seeks Guidance

[Sleeper396]

My AHI is running under 5 nightly, now 60 days into treatment. 85% is coming from Clear Airway Apneas (with some likely SWJ). Overall doing better - last night only 2 awakenings (down from 5-6 nightly pre-APAP). Still tired in the evening after dinner. 

Question on settings:  If my 95% pressure is 13.9, and my average pressure is 9.8, should I remain with my current settings of 8/14.2, or should I bump them up above 8, and above 14.2?  I have no ramp or relief settings beyond that. 

Could also be some positional apnea, and I am getting a better cervical collar. Will positional apnea affect centrals?  

Any suggestions are appreciated.  Last night Oscar attached.

[Sleeprider]

Your Autoset pressures will track flow limitation, and may not be important to your overall therapy since obstructive events do not seem to be a significant problem. You are not using EPR due to the fact you tend to have higher CA and H events with pressure support, so flow limitations are unabated. You may benefit from a narrower range of pressure, and the only way to know is to gradually increase the minimum, and see if this has any adverse effects on your CA or how you feel. I don't know how you arrived at a maximum pressure of 14.2, but it appears you can reduce maximum pressure to 13.0 without impacting your obstructive apnea index.

[Sleeper396]

Thanks, Sleeprider.  Appreciate your guidance.

[Sleeper396]

Good morning, all.  I need help on understanding my last night's CA pattern.  Please see Oscar attached and let me know what happened this morning, when 15 of my 27 CA events for the night took place within approximately 30 minutes (upon my returning to bed from a bathroom break). Should this be characterized as SWJ?  What is happening that would cause so many events?  Should I discount those from the AHI for the night?   

Overall, my progress is very good for 70 days into my apnea treatment. I am seeing fewer, more comfortable sleep sessions (reduced bathroom trips -- a major accomplishment); feeling better the next day; AHI is averaging 4, versus untreated AHI of 15/35 supine; O2 (using SleepU oximeter) is 97% average/92 low. Still tired only after dinner and generally nodding off at TV time for 30-45 minutes.

In addition to your comments on the CA's last night, please give me your thoughts on the following.  I am still debating whether I will lobby for an ASV when I have my next appointment with my sleep Dr. in August. CA's appear to be my only problem now. They were present in my lab sleep study at about 40% of all apnea events. Do I tackle them, given that they are below 5 AHI (and I am 70 days into treatment), or should I stay where I am with my ResMed AutoSet 10?  In your opinion, if I am feeling better, which I definitely am, should I pursue even better results by pushing for an ASV, or should I be happy where I am for the time being?  I really would appreciate the team's expert input on this.

Thanks, as always.

[SarcasticDave94]

I'm inclined to mark these SWJ as you'd just started that session. But I'm not inclined to just completely sweep it under the rug. Note it as a symptom or complaint.

Now in regards to your CA and ASV, what you'll need to do is review a few things. Are you consistently more comfortable on your current PAP? And if not, what's exactly is not right? You did have 23 CA to 28 OA I think, so that and a stack of symptoms and complaints might leverage you into an ASV titration.

[Sleeper396]

Dave - if you could choose the machine for me right now, regardless of cost or insurance issues, would you prefer an ASV for my profile, or would you counsel me to wait longer and see what happens with my APAP? I view myself as 75% of the way to being fully-treated, with remaining issues being -- 1) continue to get up 2 times per night (would like to see one time), 2) tired at night after dinner and falling asleep in front of TV, 3) feel that I need to sleep another hour per night for maximum restorative sleep. From a comfort standpoint (disregarding the data), those are the remaining issues.

[SarcasticDave94]

I see what you've got now to be closing in on all the better it's going to become. It may take a bit of time for this to occur. But I'm thinking that eventually you'll need ASV to push you over into better, more complete therapy.

[Sleeper396]

I agree, Dave.  But, can I put you on the spot and ask you if, in your opinion, I should wait a few months, or move in the next 30 days to press the doctor for ASV (assuming no change in the treatment results from what I just described above, and CA's continually under a 5 index)? Not sure how to handle my upcoming doctor's appointment in Mid-August. I don't want to be premature in trying to make a switch to ASV, if there is a chance that I may wait this out with the existing APAP machine (say another 90 days) and see the further benefits that I am hoping for (also described above). But, by the same token, if ASV is a "miracle cure" for CA's, then I would want to exert pressure now.  I understand that you cannot predict with certainty what is the best answer, but what would you do?  Thanks.

[Gideon]

IMHO ask for an ASV titration " so you can see if that might be the solution". Partner with your doc. The odds are you will show improvements with the ASV this making it easier to justify and get an ASV.

An ASV works by maintaining the volume of air you breathe, vs maintaining the pressure of the air you breathe.

[Sleeper396]

Thanks, Gideon. Makes good sense!