(01-06-2015 10:20 PM)the_mad_man Wrote: I've had a few sleep studies done in 2014. I had to have the studies interpretted by two different doctors, and was finally diagnosed with a mild case of upper airway resistance syndrome (UARS). I'm told that my RDI is 12 and my AHI is 3. I am rather thin, so I didn't fit the profile of a sleep apnea sufferer.
I've been prescribed a Resmed S9 Autoset CPAP and I've used it for a few months, but I'm not seeing the results I want. As a matter of fact, I can't tell any difference at all in terms of how I feel....
I've been thinking about going to Dr Barry Krakow for another opinion about my sleep. Here's why: I've read his book "Sound Sleep Sound Mind". When I finished the book, I felt like I had read a book that was written personally about me and for me!
Hi the_mad_man, welcome to Apnea Board.
Yes, Dr. Krakow is really a very great researcher and therapist. Some day I hope to make time to read his books. There are several threads on Apnea Board which discuss some of his findings.
As you know, the classic treatment for UARS is bi-level therapy, and EPR (and, in Philips Respironics machines, A-Flex and Bi-Flex but not C-Flex) is a form of bi-level therapy.
So, I suppose you are already using EPR set to 3 (max), and your apnea events are still mostly obstructive? If not, I suggest raising EPR by 1 each week until EPR is 3. But do be on the look out in case increasing EPR causes the Complex Apnea Index (CAI, average number of central apneas per hour) to increase significantly, such as becoming higher than 2 or 3 per hour.
(01-09-2015 10:48 PM)the_mad_man Wrote: Next, I will answer the question about what the machine pressure does at night. At first, the machine was jumping to the maximum pressure almost as soon as I went to sleep. As a matter of fact, this tended to jolt me awake; taking sedative medications helps somewhat with this, but not 100%. What seems to help more is to sleep on my side, but this is not comfortable for me and I sometimes roll back into a supine position. With this, I seem to sleep a little bit better and have less mass leakage and flow limitation, *but* my Zeo unit indicates that I'm still getting only a tiny amount of slow-wave sleep. (I don't know how accurate it is)
This week, I've been mostly sleeping on my side, and Sleepyhead reports minimal flow limitations and AHI < 2. This morning, however, I woke up feeling crappy and with AHI 5.6 for the night. For about the last 90 minutes of my sleep this morning, I turned on my back and had AHI of almost 40 according to Sleepyhead!
It is very common that the AHI increases dramatically when we are sleeping flat on our back. Lots of forum members have learned they need to avoid letting themselves ever roll onto their back while asleep.
I use a thick foam mattress topper so that it is not uncomfortable for me to sleep on my side, and I wear a snug teeshirt with one or two tennis balls in pockets sewn between my shoulder blades along my spine, so that when I roll onto my back I wake up just enough to keep on rolling until I'm on my other side.
I, too, think that gradually raising the Min Pressure on your AutoSet may help a lot. I think there would be no harm in jumping the Min Pressure up to your present median pressure, unless that would be uncomfortably high, and then you could consider raising Min Pressure gradually higher from there, by 1 cmH2O per week, so there will be time to monitor the effect of changes for a week between each adjustment.
If after all the above you continue to suffer symptoms of excessive daytime sleepiness, and if your CAI is still low, you would likely benefit from a bi-level machine such as the Philips Respironics "System One BiPAP Auto with Heated Hose" machine which has several features which the corresponding ResMed model does not have.
I think it would be easy to obtain a great bi-level CPAP machine like the Respironics System One DS760 BIPAP Auto on the secondary (used) markets for well less than US$1,000, but if you would need insurance to help pay for it and if for some reason insurance declined, perhaps seeing an expert like Dr Krakow would be especially helpful while appealing the denial of coverage.
Take good care of yourself,