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usually high AHI last night, advice
#1
usually high AHI last night, advice
I realize that I shouldn't make to much out of a single night, but I was concerned this morning when I saw that my 16 year old son's AHI last night was 16. 
Brief background info:
Diagnosed in Sept 2017 mild to moderate OSA & hypoxemia. 
AHI 13.9   CAI 6.9   OAI .1  HI 6.9
Began CPAP in November at pressure of 5, later raised to 6
He had a titration study fairly recently; the doctor has ordered a pressure increase to 8 and will likely raise pressure to 9 after a couple of weeks.

It's been a little over a week since the doctor ordered the pressure increase, but the DME claims they have not received the order yet. The DME has been a nightmare to deal with, I'm not going to wait for them to increase the pressure when I can do it myself. I haven't raised the pressure yet because my son is in the middle of finals and he worries that making changes may further disrupt his sleep. 
Which brings me to my questions.
How disruptive to sleep are pressure changes? Tomorrow my son has math and chemistry finals. Do you think it is best to bump up his pressure tonight, or should I wait until after he completes all his finals? Any thoughts on why his AHI was so high last night?
I have attached screenshots from both last night and the night before, which was more of a typical night.
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#2
RE: usually high AHI last night, advice
If I may be blunt (on the iPhone). Your son needs BiPap,Vpap. I will gladly explain later when not on the phone. The Dreamstation is the worst choice and an Autoset might actually address the hypopnea and other issues.
Sleeprider
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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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#3
RE: usually high AHI last night, advice
(05-10-2018, 12:33 PM)Sleeprider Wrote: If I may be blunt (on the iPhone). Your son needs BiPap,Vpap. I will gladly explain later when not on the phone. The Dreamstation is the worst choice and an Autoset might actually address the hypopnea and other issues.

Thank you for your input Sleeprider, I really appreciate you sharing your tremendous knowledge!

I will be blunt as well. 
I keep asking what does my son need, but the question I really should ask is how do I get my son what he needs? 
A little more history:
I raised concerns about my son's sleep with his doctors for years, but my concerns were always dismissed. Finally a year ago my son's neurologist ordered an overnight oximetry test. At the follow up appointment she told us she was very concerned because my son's oxygen was under 88 for over an hour which could do tremendous damage to both his brain and his heart. She said that in a perfect world she would send my son out of the door with both CPAP and oxygen, unfortunately we don't live in that perfect world. 
Long story short... it took some time, but finally we jumped thru the right hoops and my son got finally got his CPAP machine in late November. 

If it is necessary I would be willing to pay out of pocket to get my son the machine he needs. My preference is to work thru the system, my son is nearly an adult and I don't want him to saddle him with the burden of paying medical expenses out of pocket. 
My son's sleep doctor is great, but busy. His next appointment isn't until July. His doc is the type of doctor who will take the time to listen and will review any data I present to her.
So if you have the time, I would very much appreciate further elaboration on your thoughts about the best course moving forward for my son's treatment.

Once again, thank you so much for your input!
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#4
RE: usually high AHI last night, advice
Your son has the Philips Respironics Auto CPAP. It is a very good machine for those with simple obstructive apnea that can achieve efficacy with fixed pressure. What we immediately see with your son's treatment is an AHI that is above acceptable levels of less than 5 AHI. While the Dreamstation appears to treat obstructive apnea reasonably well at about 6.0 cm H2O pressure, we continue to see a high level of hypopnea. With CPAP, our only choice is to increase the pressure to resolve these remaining events. With the Dreamstation Auto, a more appropriate setting may be Auto mode, with pressure range of 6.0 to 9.0. This might resolve the apnea and hypopnea much more completely.

The use of Auto CPAP mode at 6-9 pressure is a better first step than jumping to the bilevel option. My preference would be to have a Resmed Airsense 10 autoset which has the ability to produce bilevel pressures with up to 3-cm between exhale and inhale pressures. At least using the Dreamstation, I would want to enable the auto pressure function in a limited range of 6-9 cm. There is no possibility that using the auto CPAP algorithm carries any risks. Assuming you are checking everything with the doctors, go ahead and get permission, but if this was my child, I would not hesitate to set the mode to auto and the range to 6-9.
https://www.apneaboard.com/dreamstation-...structions
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#5
RE: usually high AHI last night, advice
As I stated on your other thread, you son's OSA is not adequately treated. He needs an increase in pressure. You can either increase the CPAP or switch to auto mode. I recommend auto.
His pressure is so low and your son is young so I think a pressure increase will likely not bother him at all.
If you want specifics to the exact changes, please let me know.
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#6
RE: usually high AHI last night, advice
Thank you Sleeprider and Tedvpap for the great advice!
I think you are both spot on with your assessments The sleep tech who ran my son's titration sleep study felt so strongly that my son's pressure should be increased and his machine should be  set at APAP mode that she broke the cardinal rules and  recommended to me that I increase his pressure and utilize auto mode. Following my son's titration study I considered following the sleep techs recommendations and created a thread on this forum seeking advice, but the advice I received was all over the place. In the end I decided the best path was to wait for my son's doctors recommendations.
In the long run I'm glad I decided to wait to make changes to my son's therapy. My son's sleep doctor is crazy busy, but she has been a good advocate for my son and I don't want to burn bridges by straying outside of her advise. 

Thanks Ted for reassuring us about raising the pressure. Tonight my son and I reviewed sleepyhead and the replies I have received to the couple of threads I have created and he decided an increase is that increasing the pressure tonight is the best course of action. 

Thanks again for all your help!
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#7
RE: usually high AHI last night, advice
Coloradomom, I think the higher pressure will resolve a lot of issues and end up being more comfortable. Good luck to you both, and glad to see you are including your son in his therapy decisions.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#8
RE: usually high AHI last night, advice
(05-11-2018, 09:33 AM)Sleeprider Wrote: Coloradomom, I think the higher pressure will resolve a lot of issues and end up being more comfortable.  Good luck to you both, and glad to see you are including your son in his therapy decisions.

Thanks again for all your help Sleeprider! My son's AHI last night was only 4.1, the pressure increase last night really seemed to help.
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#9
RE: usually high AHI last night, advice
(05-11-2018, 10:04 AM)ColoradoMom Wrote:
(05-11-2018, 09:33 AM)Sleeprider Wrote: Coloradomom, I think the higher pressure will resolve a lot of issues and end up being more comfortable.  Good luck to you both, and glad to see you are including your son in his therapy decisions.

Thanks again for all your help Sleeprider! My son's AHI last night was only 4.1, the pressure increase last night really seemed to help.

Progress   -  but you are not yet done. 
In a few days, post some charts.  With a little effort and tweaks, I expect he can lower his AHI much more and will likely feel the benefit.
My AHI was 60 prior to treatment 8 years ago, now it is 0.4.
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#10
RE: usually high AHI last night, advice
It's been 5 nights since I raised my son's pressure from 6 to 8. The first night at the increased pressure was the only night his AHI was below 5. His AHI's since increasing the pressure:
4.1  7.6   6.1  5.4   9.1
I have attached data from last night, I was surprised by the thick clustering of obstructive apnea events. I notice when I zoom in there are breaks in the flow line. I don't see a change in the leak line during that time period I zoomed in on, but I wonder if the gaps in the flow line signal leaks? Anyone have any input on the clustering of OA events last night?
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