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Completed First Month - Is this the right therapy? - Moconfed - 06-03-2015
Just completed my first month of treatment. My AHI has improved slightly in the past week vs the past month and has varied from 5 to 25, averaging 14.37 for the month. MY Obstructive Index has improved as well as my Hypopnea Index with my Clear Airways Index not improving much and clearly dominating my apnea.
When I did my sleep study it was almost 60 events an hour so 14 was so much of an improvement that I could immediately tell I felt better, had more energy and even lower blood pressure. The morning I woke up following my AHI of 4.73 I felt better than I have in years. Would love to get back to those lower numbers.
Is this the right therapy or should I be looking into an ASV machine? I can't get in to see my doctor for another month and was wondering if there was anything I might try to do to improve the quality of sleep in the meantime using my ResMed 10 AutoSet currently set for APAP 8 min 20 max pressure with no autoramp.
Thank you in advance for your suggestions.
RE: Completed First Month - Is this the right therapy? - DariaVader - 06-04-2015
Did you have mixed apnea on your sleep study report? or are the CA events a result of the therapy? since you say that you felt much better when the number of them was lower, I would assume they are real events and not something happening when you are awake, or a breathing pattern that "fools" the machine.
For CA that are a result of therapy, you can try turning down or off EPR (your image doesnt show the EPR setting you have, but I think the default is 2) and narrowing/lowering the pressure and range which it looks like is set for a range of 8 to 20. Sometimes CA are caused by shifting pressure, or excessive pressure.
If you had mixed apnea in your sleep study, then yes, IMO you have the wrong machine.
RE: Completed First Month - Is this the right therapy? - Sleeprider - 06-04-2015
You appear to have complex apnea that may be induced by CPAP pressure. ASV is the best solution if that is the case. It might be helpful if you posted a typical night detail data as show in the examples here: http://www.apneaboard.com/wiki/index.php?title=Attaching_Images_and_Files_on_Apnea_Board
With your AHI running that high, you are not showing that CPAP has efficacy in the treatment of your apnea. You should be scheduling a consult with your doctor to show him these results and decide on the next course of action.
Did you have a titration study? Some patients are issues an APAP and instructed to self-titrate. CPAP induced complex apnea occurs in about 15% of all OSA patients that begin therapy, so if you're one of them, (and this appears true) you need to be evaluated for complex apnea and get a different machine. We have a number of members here that use ASV machines and do extremely well. It is considerably more complex, and of course the machines are more expensive. Hopefully your insurance is good. If not, there are some options with used machines.
RE: Completed First Month - Is this the right therapy? - DeepBreathing - 06-04-2015
You say your centrals are not improving much, which implies you already had them prior to treatment? Did they show up in your sleep study? If so, then as Sleeprider said you will probably need an ASV machine.
On the other hand, if they did not show up in the sleep study then they are caused by the therapy itself. You might be able to overcome this induced central apnea by adjusting pressures and turning off EPR, if you're using that. Try reducing your maximum pressure to around 14 for a few nights and see if that makes any difference. Don't make any further changes for a week or so until things have stabilised, then review. You might be lucky and they'll go away with time. If not, then an ASV machine would be indicated.
As mentioned above, ASVs are expensive (twice the cost of an APAP) and take some getting used to, but can be remarkably successful. In my own case my S9 VPAP Adapt brought my AHI down from over 60 to consistently less than 2, mostly less than 1.
RE: Completed First Month - Is this the right therapy? - Moconfed - 06-04-2015
I have no idea what my sleep study report showed. I received a call from the center that I had 59.7 events with the longest period of not breathing of 37 sec then provided me with information on getting my machine.
Medical care in rural areas is whatever you can get and sometimes not to effective. Thankfully this forum helps one to be their best advocate. My first visit with my doctor, who also is on a CPAP, is next month. Hopefully I'll have some informed questions to ask, thanks to you all.
My EPR is on Auto Full Time setting 3.
RE: Completed First Month - Is this the right therapy? - Sleeprider - 06-04-2015
I think you've got CPAP induced central apnea. Just to rule out that pressure variation is causing centrals, try turning off EPR (set to 0) for a night and see if makes a difference. I doubt it will, but it's kind of like checking the battery terminals when the car doesn't start. It's easy to do, and it might work.
RE: Completed First Month - Is this the right therapy? - Moconfed - 06-04-2015
(06-04-2015, 11:13 AM)Sleeprider Wrote: I think you've got CPAP induced central apnea. Just to rule out that pressure variation is causing centrals, try turning off EPR (set to 0) for a night and see if makes a difference. I doubt it will, but it's kind of like checking the battery terminals when the car doesn't start. It's easy to do, and it might work.
Sleeprider,
Tried to send you copies of Tuesday night results. Imgur worked great and the preview post was what I wanted, however when I tried to post I had a message I wasn't allowed to post images or links.
I am taking everyone's suggestion that I change auto to 8-14 and turning off EPR.
Thanks
Dan
RE: Completed First Month - Is this the right therapy? - storywizard - 06-04-2015
(06-04-2015, 12:08 PM)Moconfed Wrote:(06-04-2015, 11:13 AM)Sleeprider Wrote: I think you've got CPAP induced central apnea. Just to rule out that pressure variation is causing centrals, try turning off EPR (set to 0) for a night and see if makes a difference. I doubt it will, but it's kind of like checking the battery terminals when the car doesn't start. It's easy to do, and it might work.
Sleeprider,
Tried to send you copies of Tuesday night results. Imgur worked great and the preview post was what I wanted, however when I tried to post I had a message I wasn't allowed to post images or links.
I am taking everyone's suggestion that I change auto to 8-14 and turning off EPR.
Thanks
Dan
re images: I think you have to have posted a few times to be able to post images...as far as I can remember...
S
RE: Completed First Month - Is this the right therapy? - Sleeprider - 06-04-2015
Moconfed, if you reply to this post, your post count will increase. I think the ability to post links is somewhere around 8 as a spam prevention.
Nice to see Storywizard here. He went through this. He was prescribed a CPAP twice, and was unable to get good treatment results. His AHI was very high. When we looked at his data the apnea were mainly CA and H. His doctor refused to believe he had complex apnea. Ultimately he bought his ASV on his own dime. The apnea went away, but he is still working on feeling rested.
As I said earlier, you're not alone. You are way ahead by having a doctor that is open minded and knows his stuff first-hand.
RE: Completed First Month - Is this the right therapy? - Moconfed - 06-04-2015
(06-04-2015, 01:37 PM)Sleeprider Wrote: Moconfed, if you reply to this post, your post count will increase. I think the ability to post links is somewhere around 8 as a spam prevention.
Nice to see Storywizard here. He went through this. He was prescribed a CPAP twice, and was unable to get good treatment results. His AHI was very high. When we looked at his data the apnea were mainly CA and H. His doctor refused to believe he had complex apnea. Ultimately he bought his ASV on his own dime. The apnea went away, but he is still working on feeling rested.
As I said earlier, you're not alone. You are way ahead by having a doctor that is open minded and knows his stuff first-hand.
Thanks Sleeprider,
Last night was a good night with AHI of 10. Got up feeling like I wanted to get something accomplished. Wife working today, I'm off so a couple of loads of laundry, filled dishwasher and cleaned. Then off to the farm for a couple of hours of mowing while my 90 year old father was running the weed eater. Can't imagine what I can get done with AHI of under 1!!!
Dan
Attaching some info from last night. If it will let me do this.