[Diagnosis] Frustrated

[Gary K]

I have been using c-pap, bi-pap for over 5 years and have never been able to achieve the goal of AHI of 5 or under. I started using nasal pillow mask, and other than short term trials with full face masks have used only the pillows for 4 or 5 years. I have always suffered with nasal stuffiness which affects me whenever I lay down. I was starting to achieve limited success a year ago) (consistently under 10 for several months). In order to continue efforts toward goal of 5 AHI my doctor suggested switching from my Phillips System One, to my current machine AirCurve 10, with full face mask. This change was made because my doctor discovered that I could breathe through my mouth with the nasal pillow and the full face mask would correct this. The AirCurve 10 also is supposed to automatically adjust pressure as needed. This change to date has not been successful. My AHI has consistently been over 10 since this change. Two issues confuse me. First my doctor insists that in order to reduce my stuffiness problem I should keep my humidifier on max; others (including some on this forum) state lower humidifier settings will help with stuffiness. I tend to agree with the others. Secondly, I believe because of my ability to breathe through my mouth while wearing the nasal pillow the AirCurve 10 machine does not see the air intake though my mouth and interprets this as an CA apnea event. This seems to be supported by the fact that my doctor always discounts the CA events and considers only the OA events. For the past few weeks I have not been able to keep the full face mask on more than 4 or 5 hours per night because of the stuffiness. Last night I became frustrated and switched back to the nasal pillow. I did this because I saw a members post yesterday that stated the nasal pillow maybe be better for the stuffiness because it more directly applies pressure to the nasal passages helping to keep the airway open. After switching to the nasal pillow, I had the best sleep in several nights (mask on for 8 hours); however, my AHI was 22. Upon examining the AHI of 22 with SleepyHead software I discover that the breakdown is CA 11.8, OA 8.75, unclassified 1, and Hypopnea .58. Question; is my doctors and my assumption that the CA is discounted legitimate and if so why does the Sleepyhead and AirCurve software count it? Any other thoughts from all you experience apnea sufferers out there?
Thanks for all responses in advance.
Sleep apnea is no picnic

[Sleeprider]

Read about EERS and let's talk how it might help. http://www.apneaboard.com/wiki/index.php...ace_(EERS)

[Gary K]

Sleep Rider

Thanks for the reply. I have read your link. Interesting, however, does it appear to you this applies to my situation. It does not seem to address the CA issue which I believe is created by the mouth breathing with a nasal pillow.

[Sleeprider]

Mostly it would apply to actual CA caused by CPAP or VPAP use. Do you have any Sleepyhead closeups of the flow rate to verify you are exhaling around the mask? This should appear as an unbalanced I/E flow rate, and possibly reduced tidal volume or flow rate when this happens.

[Gary K]

Not sure how to interpret this data or if it is what you are asking about OR if the image will even come through. If the image comes through okay, does it provide the info you asking for?

[Sleeprider]

We could look at a closer 2-minute zoom, but so far, these apnea look real, and not an artifact of breathing around the mask.

[Gary K]

Thanks, here is a two minute zoom. So do you think I should pursue the EERS thing?

[Sleeprider]

If you're handy and can do it at reasonable cost, I think it could have a positive effect. another option might be cutting back a bit on pressure support. I don't know what took you to a bilevel machine, and hoe this compares with CPAP results, so I'm a bit at a disadvantage. Do you have diagnostic or titration tests that pointed to a need for VPAP, or are you more comfortable with it?

We have a member 'Foxfire' that brought the EERS approach to my attention,and his story of disrupted sleep and central apnea actually qualified him for ASV. His doctor is the foremost reseaercher and advocate for EERS, and it resulted in him going back to CPAP and having very good sleep. http://www.apneaboard.com/forums/Thread-...light=eers http://www.apneaboard.com/forums/Thread-...light=eers

[Gary K]

Hmmm, interesting. I am not sure why my doctor in Florida switched me to bi-pap shortly after I started on the c-pap. It was a Doctor Adi in Fort Myers Florida. I questioned this myself just before my current doctor at Kaiser in Atlanta switched me to the AirCurve 10. I had noticed that with my old machine (Phillips system One) the closer I adjusted the EPAP and IPAP the better results i had. Then I went to this $2,000 machine and my results got worse.

[Gary K]

If you're handy and can do it at reasonable cost, I think it could have a positive effect.  another option might be cutting back a bit on pressure support.  I don't know what took you to a bilevel machine, and hoe this compares with CPAP results, so I'm a bit at a disadvantage.  Do you have diagnostic or titration tests that pointed to a need for VPAP, or are you more comfortable with it?

We have a member 'Foxfire' that brought the EERS approach to my attention,and his story of disrupted sleep and central apnea actually qualified him for ASV.  His doctor is the foremost reseaercher and advocate for EERS, and it resulted in him going back to CPAP and having very good sleep.  http://www.apneaboard.com/forums/Thread-...light=eers http://www.apneaboard.com/forums/Thread-...light=eers

Also, I don't understand how you can determine whether I am breathing around the mask from the Sleepyhead software which come from the AirCurve machine that does not see the air intake through my mouth. It seems to me that if I am breathing though my mouth with the nasal pillows stopped up the machine would think I am not breathing at all, right?