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Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
#21
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
your description sounds much like sounds and movements I made in the worst throes of apnea.
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#22
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
I requested a copy of the sleep study a while back but instead of the actual sleep study I got another written statement of the study. They said this is the only study report they are able to send me.  

''NOX-at home polygraphy - Time 22.55-06.59. BMI 29, ESS 0, DEPS 6.
Some technical issues during the study: removed a period of one hour during which pulseoxymetry was disconnected. In addition some intermittent disconnections of pulseoxymetry and nasal sensor. Handscored AHI 7.0/h, of which obstructive AHI 5.9/h; AHI while sleeping on back 7,2/h, sleeping on side 7.0/h. Backsleeping 33.3% of time. SaO2 average 94,7%, lowest drop 81.0%; cumulatively 1% of time spent under 90% SaO2. Pulse average 53/min (41-89).

Some pressureprofile shape variation and angular damming? (this is my attempt of translating Finnish medicine jargon, so it might not be understandable) regardless of position. Very little snoring. A lot of changing position and other movement connected to reactive short periods of periodic breathing. The first reactive periodic breathing left out and possibly others, incase of excessive movement. A notable part of scored breathing events are tied to these periods. Almost no periodic breathing is not apparrent during calm breathing. Scored events are mainly hypopneas, somewhat mixed and sentral and a single obstruktive apnea. SAo2-falls ad 88% regarding scored breathing event. No clear unusual periodic movement.

Evaluation:
The (AHI) during the study technically qualifies mild obstructive sleep apnea regardless of position. Still it needs to be noticed that over 50% of scored events are related to movement or shortterm periodic breathing caused by change of position, so it is subject to interpretation should these be counter in the index at all. Mild partial obstruction apparrent now and then regardless of position. Otherwise no clear periodic movement.''

I have some updates since last time I posted. The tretment pressures were titrated (by very unmotivated nurses with intervals of raise lower pressure by one, wait 1,5 months, raise lower pressure by one, wait 1,5 months). The pressure is now at 11.0-15.0. My average AHI is now at 3.5/h. I had my first septoplasty, which was unsuccesful. 1,5 weeks ago I had my second septoplasty which was more succesful although my turbinates will probably still need to be operated on so I can truly rely on nosebreathing. So after the second operation I moved to a nose mask airfit N30i, which I enjoy a lot over the old ffm. I probably have some leaking during nights since my nose gets stuffed from time to time, but I cant bare use the ffm anymore and I started having even bigger leaks with it on.

The attending doctor commented that I should have felt an effect on my energy by now and that the AHI of 3,5/h is as good as it gets. They said they don't believe im benefitting from the CPAP treatment but can continue it if I want to. They think sleep apnea can not be the cause of my fatigue. A ENT sent me an admission note for dental clinic so I can be made a MAD device for my treatment instead of CPAP. They said the anatomy of my jaw and throut could benefit from it.

I put last nights charts on attachment.
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#23
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Compared to other charts, this looks like a good one. Lower CA, but they'll do this as it is. Centrals are highly consistently inconsistent, up and down without setting changes.

Unfortunate it sounds like your doctor's taken medical training with US doctors. Most can't see CA, nor do they believe CA are needed to be treated. Not that I gamble, but I'd not be at all surprised if your CA present themselves in force again tomorrow.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Yes. I have not even once met with this doctor or talked to them. Only contact has been through the sleep clinic's nurses, who have discussed with the doctor. Thus it's been impossible to even voice my concerns over the treatment. It's frustrating since I have barely the energy to work 20 hour work weeks and after that I can't push myself to do anything else. So are my hands tied at this point? Is there no way for me to affect those centrals myself? If that is the case I dont think there is any reason for me to continue CPAP treatment since it does not improve my well being and only causes hassle. I hope the mandibular device helps since I have such a mild OSA.
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#25
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
On a sidenote:

The CA has been consistent 3 for a long time now. Here are last two nights and one night from the start of september. It never really fluctuated in the last 3 months. Sounds like that is not normal?
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#26
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
It just sounds to me like you're predisposed to have higher Central Apnea than others, much like myself.

Sometimes you can use an "avoid CA" plan when on anything other than the ASV or your local machine equal to ASV. But your usage trend says it's not successful in avoiding CA.

ResMed is still your best brand, but really you'll need the ASV model or your local equal to actually treat these. One big key ingredient to the ASV success is backup rate and its algorithm. Now note that at times other PAP machines with backup rate can treat CA reasonably. Example is ResMed ST-A with ResMed's variant on AVAPS mode called iVAPS. That's the direction I'm headed myself, as ResMed's ASV doesn't have manual time controls for therapy.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#27
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Thanks for your input. 

I'm almost certain there is no way my doctor will give me an ASV. I have my first appointment with them in about month, although its only a call appointment. It's the only sleep clinic in my town and I can't afford to go private route. For now I'll probably stop using the CPAP and start pursuing the dental.
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#28
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
this may or may not apply to you. I had 3 nights over a weekend with the at-home sleep test equipment. when I went in to learn my results, the tech said none of the results were valid because the monitor kept shutting off. I had to explain that their monitor was fine but my sleep is very fragmented & I frequently removed the mask & stopped the monitor, in part to catch my breath & in part to document the fragmentation. so they used the data but completely ignored the fragmented sleep issue from then on. at my overnight titration, i had terrible restless legs. the tech came in several times commenting how restless i was. the detailed reports documented my restlessness & even identified significant periodic limb movement arousals. the sleep 'specialists' have never volunteered a word about it & mostly ignored me when i later learned about it & called it to their attention. (they also diagnosed osa when my test returned oa & ca in near equal numbers.)

anyway, I think your next step is to learn as much as you can about your movements. are they contributing to disordered breathing or vice versa? what do the movements look like? how often do they occur? what else is going on at the time? can you associate movements with anomolies in your oscar charts?

it's tough to get someone to monitor a night's sleep. the best alternative is to audio/video record yourself.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#29
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
Thanks sheepless!

You might be right, but I don't think I have the energy or recourses to pursue the knowledge myself. I don't feel I have enough authority to question the doctors treating me. And even if I gathered enough knowledge to understand my condition better and was convinced I am right, I know I would be instantly dismissed just as I have been til now.
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#30
RE: Please help: Day 9 with CPAP and AHI still over 7 (Oscar data included)
I'll just include this, ask your doctor to listen to your complaint that you're not getting a benefit from PAP as is. You can include data if you want, but think on what I'm saying. Plan a discussion that is about how you feel with the CA affecting you. State symptoms and complaints, and maybe not much on data.

Example: Things you might want to say to your doc are... with CPAP I am still very fatigued, not well rested, I don't feel better with PAP use, "I'm considering not using the PAP as it's not helping", I don't see where it's a benefit, and so on. And maybe "doctor are you going to help find out why?"
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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