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enzo1 Therapy Thread
#1
enzo1 Therapy Thread
Hello, 
this is my forst post in this forum. I am a 21 year old non overweight male. I am waking up multiple times in the night, but before i would attribute those awakenings to other health problems like my bronchitis or the gastritis and reflux which i dealt with over the years, because of that  i would also attribute my incredible fatigue and more or less debilitating brain fog to these conditions. After many years of not getting proper treatment from the docs in germany finally someone mentioned the possiblity of sleep apnea. So i went and got tested for that.

I had one sleep test done at home and multiple in the sleep lap (2 different sleep labs to be precise). 

-The home sleep test came back positive (even tho i only slept 4 of the 8 hours the device measured). (20.06.22)
-The first in lab sleep test  came back negative (25.06.22 and 26.06.22), but the sleep test used weird guidelines (R&K and 4 % desaturation) which apparently leads to many false negatives, so i went to another sleep lab (11.07.22) and sure enough it came back somewhat positive (AHI of 3.5 or sth but many Arousals and RERAS ,  they still used R&K but 3 % desaturation). Since i got told multiple times that i should get an in lab with AASM 1A guidelines since those are the best i called the second sleep lab and asked whether they could rescore the test using AASM 1A. I am not sure what exactly they did but they rescored it ( but i dont think they used AASM 1A, it feels like they only wanted me to get over an AHI of >5) and then the same test came back with an AHI 0f 5.9 same RERAS and Arousals obviously.  
- Today i went in for a titration, but it was so weird. They didnt titrate at all they just put a range of 5-15 and said the machine would do the rest, why would i have to go to a sleep lab for that ... After the titration i talked to the doctor and he told me the results came back good, i asked him whether i could need Bipap since most people suggest a BIPAP for UARS but he said that an APAP which they used for the titration is way better and BIPAP is only for really overweight people, and he said that he is completly certain, that BIPAP would cause irregular breathing. I told him that i read that since BIPAP enables less respiratory stress since the exhale pressure is lower that it often decreases flow limitations (i prolly have very limited understanding of this topic, my brain really doesnt work properly anymore and it feels like that is because of the sleep apnea or UARS) but he assured me that  that is not the case.
Being at home now i went through the PSG from the titration and even tho the AHI and the RERAS went down there is still flowlimitation of 20 % and basically no deep sleep or rem cycle he didnt mention those parts at all. He even went as far as to say that there is no doctor in germany who dealed with more patients in need of PAP therapy to credit his opinion.
Also somewhat weird the nurse told me to not play with the settings of the apap. 

To be quite honest i am at my wits end and am somewhat loosing my mind. It feels like the overwhelming majority of Physicians in germany are thrash, even more so when it comes to sleep medicine. I got prescribed a RESMED Airsense 10 Autoset and will try to post my Oscar results of the first night ... 


I am sorry if my english or my writting style is unbearable (i am somewhat mentally fatigued and english is not my mother language)


I will include all of the Polysomnographs. 


I would really appreciate any help from you guys.


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#2
RE: Pretty lost at this point. Help would be greatly appreciated
Here is a link to all the PSG´s  :   https://we.tl/t-d5lZiplXuO
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#3
questions to my new apap
Hello guys,
this was my first night with my apap and i have some questions. I have a Resmed airsense 10 autoset.
My doctor was absolutely against the usage of bipap since he thiniks that it worsens UARS. He claims that he is the leading sleep Physician in germany since he dealt with the most patients (germanies health care system seems kinda thrash honestly). My questions are the following :

1)I cant remove the plastic in place of the humidifier its kinda stuck. Any idea how to remove that ?
2)Normally i wake up multiple times a night. With the apap i only woke up once in 8 hours of use. After the 8 hours i removed it and slept for another 6 hours, and am still tired. Any ideas where to go from here ?
I have to add i went in for titration but the doc and his team were incredibly lazy. They just put the pressure at 5-15 and said the APAP automatically does the rest lol.
I will include an Oscars of my first night and a pic of the APAP and the part which i need removed.
I would really appreciate your guys help.


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#4
RE: questions to my new apap
As I guess since I don't have the cover plate. Press down on the center ribbed section and pull it out and pull off the cover plate.

As a general rule your doc is wrong about UARS and BiLevel. BiLevel is the medical treatment of choice for UARS in the CPAP family though it is more expensive than the CPAP.
In your case your doc may be correct in that you have a fair amount, not a critical amount of Central Apnea and it is ok to assume that an increase in PS or EPR on your AutoSet, may, ONLY MAY, increase your Central Apneas. The only way to know for sure is to try it and if too many central occur then back off and reassess.

Also you are talking UARS. UARS is all about the flow limits, the hard part is to know when you have chased them enough, this is mostly a subjective choice. We like to see your 95% Flow Limit Stat at 0.03 or lower and rely on how you feel for a subjective analysis. UARS is best treated by increasing EPR or PS on a biLevel.

Therefore
Set Min = 7
Set EPR = 3
Try over night and repost
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#5
RE: questions to my new apap
(07-19-2022, 12:35 PM)enzo1 Wrote: With the apap i only woke up once in 8 hours of use. After the 8 hours i removed it and slept for another 6 hours, and am still tired. Any ideas where to go from here ?

Stop doing the part where you sleep with it removed. That's the fastest way to get yourself feeling better again. It's likely not going to happen in a day or even a few days.
Sleepster

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: questions to my new apap
This is my second night. I think the flow limits are better now, but subjectively i dont feel better yet.
Let me know what you guys think. I think i woke up more today than yesterday tho.

Is there any way to control in which stages of sleep i have been, since my deep sleep phases were so low?


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#7
RE: questions to my new apap
Not specifically. Minimizing disruptions is our goal. This means minimizing, within reason, not shooting for zero, events.
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#8
RE: questions to my new apap
Your flow limits are better, your central apnea is not worse with the increase in EPR. That is proof, that for you BiPap is not worse. Not me or anyone else saying it, but concrete physical proof based on your charts.

I don't see a need for an ASV, but the trigger function available in the VAuto may reduce your centrals.


You will not feel better overnight
I'd actually keep these settings for a while and expect a very gradual change in how you feel.
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#9
RE: questions to my new apap
What exactly is the trigger function ? And why are my central apneas with the mask at home 3.2/h but in the sleep lab 0.5/h ? Is it possible that those are other apneas but are missinterpreted by the machine or the software?
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#10
RE: questions to my new apap
Is my Leak rate normal ?
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