[Treatment] Next Steps for Treatment?

[dave100]

[attachment=2181][attachment=2180]Hi, I am a new member with some questions regarding my CPAP.

I have been using my CPAP for about 2 years after being diagnosed with moderate OSA (39 events/hour). The doctor won’t give me a copy of my sleep study, so I am going from memory from seeing the report in his office. I had moderate daytime sleepiness, so this is why I was diagnosed in the 1st place. With the CPAP, I noticed an improvement, but not a huge one. I use the machine every night and I don’t have any issues with the mask or machine.

During a regular follow up appointment in December, the doctor told me that I should not still be having daytime sleepiness, and he increased my pressure from 8 to 10, as the original sleep study showed fewer AHI’s at a pressure of 10 than at 8. I tried that for a few weeks and did not notice a difference, so he suggested I use a loaner autoCPAP machine for a week to record my results (my machine does not provide data), as I am not eligible for another sleep test until October. I used the machine for a week, but did not notice a major difference in the way I felt. Before I returned the machine, I downloaded the results with SleepyHead. After I returned the machine, the doctor told me that my average AHI’s were 8 for the week and anything less than 10 is good. He also said the results showed some central apneas, but without buying a very expensive $6000 machine that is not covered by insurance, there was nothing I could do about that. He has suggested I use a pressure of 9 which was what the APAP showed, and if I was still having daytime sleepiness, that was probably due to other factors.

The SleepyHead software seems to show some nights with and AHI of 10 and some with 6, so this appears to be where the average AHI of 8 came from. In addition to reducing my daytime sleepiness, I am also interested in lowering my AHI as much as possible, to reduce the long term effects of apnea on my health, so I don’t feel that an AHI of 8 is acceptable.

I am interested in obtaining some opinions on my options. Should I be satisfied with my current results and will a different machine possibly help? I have posted some images from the SleepyHead software

[PoolQ]

Some of your answers will depend on where you are (country, not state) and I don't want to make assumptions with that.
In the USA you have a legal right to see your health related documents.

" the doctor told me that my average AHI’s were 8 for the week and anything less than 10 is good" under 10 is not rotten, but not considered good treatment, that is typically set at 5 or less.

The graphs posted do not seem to have that many events, more centrals than OA's but still not a lot of centrals. If most of the time you are getting AHI of 8, then some adjustment can be made to get them down (people here can help with that)

You should be getting pretty good sleep with those numbers and since you are not, then it may be caused by some of the comfort settings. If you are not comfortable, you will not sleep well.

A data capable machine is pretty much required these days for adjusting your therapy. Without that you will have to be very good at evaluating small changes in how you feel in the morning, this is difficult at best.

Get into the settings menu on your machine and post all the settings. There are some suppliers listed above that offer slightly used machines at decent prices, so if it is decided that you would benefit from a different type of machine or you want to get a data capable machine, and you can afford it, you might check out the situation.

Hang in there, you have found a good place to get help.

[trish6hundred]

Hi dave100,
WELCOME! to the forum.!
Much success to you as you continue your CPAP therapy and hang in there for answers to your questions.

[OpalRose]

Hi, I am a new member with some questions regarding my CPAP.

I have been using my CPAP for about 2 years after being diagnosed with moderate OSA (39 events/hour). The doctor won’t give me a copy of my sleep study, so I am going from memory from seeing the report in his office. I had moderate daytime sleepiness, so this is why I was diagnosed in the 1st place. With the CPAP, I noticed an improvement, but not a huge one. I use the machine every night and I don’t have any issues with the mask or machine.

During a regular follow up appointment in December, the doctor told me that I should not still be having daytime sleepiness, and he increased my pressure from 8 to 10, as the original sleep study showed fewer AHI’s at a pressure of 10 than at 8. I tried that for a few weeks and did not notice a difference, so he suggested I use a loaner autoCPAP machine for a week to record my results (my machine does not provide data), as I am not eligible for another sleep test until October. I used the machine for a week, but did not notice a major difference in the way I felt. Before I returned the machine, I downloaded the results with SleepyHead. After I returned the machine, the doctor told me that my average AHI’s were 8 for the week and anything less than 10 is good. He also said the results showed some central apneas, but without buying a very expensive $6000 machine that is not covered by insurance, there was nothing I could do about that. He has suggested I use a pressure of 9 which was what the APAP showed, and if I was still having daytime sleepiness, that was probably due to other factors.

The SleepyHead software seems to show some nights with and AHI of 10 and some with 6, so this appears to be where the average AHI of 8 came from. In addition to reducing my daytime sleepiness, I am also interested in lowering my AHI as much as possible, to reduce the long term effects of apnea on my health, so I don’t feel that an AHI of 8 is acceptable.

I am interested in obtaining some opinions on my options. Should I be satisfied with my current results and will a different machine possibly help? I have posted some images from the SleepyHead software

You state that your doctor raised your pressure from 8 to 10, but the reports you posted here suggest you are using an Auto Cpap machine set at 7-15.

Yes, you have some CA's, but they usually settle down after a bit.

I would be looking at the amount of hypopneas, and you can treat those by raising your start pressure to 8.5 possibly 9. Leave max pressure where it is.

This is just my opinion, but your doc. doesn't know what he is talking about.
An AHI is consider treated at 5 and under.

[richb]

[quote='dave100' pid='151100' dateline='1455990919']
Hi, I am a new member with some questions regarding my CPAP.


I am interested in obtaining some opinions on my options. Should I be satisfied with my current results and will a different machine possibly help? I have posted some images from the SleepyHead software
[/quote

Hi Dave100

I would like to see some detail in 5 to 10 minute segments from your SH report. We could look to see if those Hypopneas lean toward Obstructive Apnea or Central Apnea. It appears that your pressures are on the lower side of the treatment range for Obstructive Apnea. However, they are high enough to convert some Hypopneas to Central Apneas. There is a chance that you have a more significant Central Apnea problem. If so your current machine is not going to treat your problem properly. As pointed out above, raising your pressure might eliminate the Hypopneas. If it doesn't and you have a rise in Centrals there is a good probability that your problem is more Central Apnea related. Also let us know what country you live in. There are people here who can help manage the insurance maze in different countries.

RichB

[dave100]

        Hi All,

Thanks for the replys. I live in Ontario, Canada. The results I posted were from a APAP machine that I had on loan for a week from my doctor, but my regular machine is a fixed CPAP without data.

I have posted two screen shots of 10 minute segments with some of the clear airway and hypopneas shown.

[richb]

Hi All,

Thanks for the replys. I live in Ontario, Canada. The results I posted were from a APAP machine that I had on loan for a week from my doctor, but my regular machine is a fixed CPAP without data.

I have posted two screen shots of 10 minute segments with some of the clear airway and hypopneas shown.

Hi Dave100,

Those SH graphs are interesting. It appears that you have significant episodes of Periodic Breathing and Central Apnea. I would bet that at lower pressures such as a straight 5 cm H20 you would show nearly all Hypopneas (periodic breathing). You show no Obstructive events on those posted charts. If they do show up at a lower setting you will need some pressure to control them. Your present machine is unable to treat the Centrals and periodic breathing that you show on the graphs. Those rising and falling patterns aren't always marked as Hypopneas since many are of short duration. The Hypopneas and Centrals are certainly interfering with your sleep quality. If you show the pattern of periodic breathing and some Centrals at lower pressure you are most likely a candidate for an ASV machine. This type of machine intervenes when your body forgets to breathe properly. It can also improve your sleep quality.

Edit:Your pressure is already quite low (9). You need a new sleep study and a titration on an ASV machine.
Rich

[dave100]

Hi Rich,

It looks like I need to convince my doctor that I would benefit from an ASV machine. Do you think an ASV machine would be overkill to treat an AHI of between 6 & 11 depending on the nights, if the events are mainly hypopneas and centrals? You did mention that it looks like they may be affecting my sleep quality.

Are there any drawbacks to an ASV machine (other than the cost)?

Thanks, Dave

[richb]

Hi Rich,

It looks like I need to convince my doctor that I would benefit from an ASV machine. Do you think an ASV machine would be overkill to treat an AHI of between 6 & 11 depending on the nights, if the events are mainly hypopneas and centrals? You did mention that it looks like they may be affecting my sleep quality.

Are there any drawbacks to an ASV machine (other than the cost)?

Thanks, Dave

An ASV machine isnt "overkill" for periodic breathing it is the "onlykill". If your sleep Doc. is unfamiliar with Central Apnea and periodic breathing, go to your University Medical Center. They should have someone there who can help you.

Rich