Pokey49 - Therapy Thread

[Pokey49]

Well I was borderline on a home study in Oregon May 23. Then I did an in lab study July 24 and did not definitively show apneas but I only got in 4 hours of sleep. 22% of the time I was in REM.  I should go back and read that report. Then I did the home study from one of the online outfits 12/25 and they said I had an AHI 15.5. But then the last time I saw the local sleep doctor from hell, the one who ordered the July 24 study said she wasn’t sure I had OSA. But she was P*ssed at me for changing pressures without her approval and dumped me as a patient. 
Just about all my Oscar reports show no or very few OAs, Hs, RERAs. Mostly CAs. A bunch last night   So I don’t know.  I know im pretty fed up with it all. I am concerned about the CAs though. 
I’m tempted to forgo the pap tonight and see what transpires. And I am trying to find a new sleep doctor

[SarcasticDave94]

Do you have any of those detailed sleep study reports? You need to have these. Post them here, especially the event table with count and type, then the doctor recommendations. If you do post these, redact your personal info.

[Pokey49]

Sarcastic Dave:

Attached below is my home sleep study of 12/24. Its the study that put me on PAP. I did the same study in 11/24 but only got 4 hours worth of data so thought it warranted repeating

My May 23 home study while still living in Oregon was read by the sleep doc who ordered it and it basically ruled as maybe having mild OSA. It was inconclusive at best. All she instructed me to do was to use my MAD and use Flonase every night and suggested a PSG

My 2011 & 2017 studies I dont have access to, but they were both read as normal. No OSA. I was 62 & 68 when those studies were done

Last night I went to sleep with my MAD only. Didnt use pap,  went right to sleep only to awaken suddenly at 3a.m. I don't recall if I was SOB or not. I did not have the other troubling sxs I have been having when using PAP (headache, SOB, pain, restlessness). But I was done sleeping for the night. I concede that my anxiety level about all this is pretty high as I cant seem to find a "sweet spot" with the pap, and the CAs that have been emerging is worrisome for  me as well.

[lsparks1]

I looked at your sleep study and I cannot find the breakdown of your CA's, OA's, etc? Is that the full report? Mine is about 5 pages long.

[Pokey49]

lsparks1: That’s all there is for my home study. You likely had a PSG which includes a lot more data. I know my PSGs were more data rich. I don’t think the ever gave me the data sheets for my 2011 & 2017 PSGs. Not my 2024 either. But then I didn’t ask for them, just the diagnosis of each.

[SarcasticDave94]

pAHIc 3% equals Central Apnea, they recorded 6 of these versus 99 pAHI 3%.

I would say the 6 pAHIc means CA were present, but far more were obstruction based events. This 6 CA represents a small extra sensitivity to these Central Apnea, and likely increased your chances of having CA show on OSCAR.

You're still on AutoSet, is that right? You may need to go nearly static pressure at where your Obstructive Apnea are being treated, but no EPR and no Ramp. These variables may be adding to your likelihood to get CA.

[Pokey49]

Hummm. When I had a virtual visit w/an RT after my 12/24 home study I asked if there was any evidence of CA. She claimed there wasn’t, but maybe she didn’t know what all she was looking at. 
The doc who read my study has now written me a Rx for BiPap. It was at my request explaining how I was having so much trouble with APAP. Do you think BIPAP will be the same, do me well or make things worse?? 
Again thanks for your expertise and help
Pokey

[SarcasticDave94]

Assuming you're going to demand the ResMed AirCurve 10 or 11 VAuto, yes I think it can help you more than the AutoSet.

You probably won't want more than 3 to 4 PS, which replaces EPR as a pressure differential.

The big difference I'm thinking on is in regards to the CA is the Trigger setting, which you'll want to try High then Very High. It's a sensitivity setting which literally triggers inhale pressure faster than default. This increase should help avoid some CA.

[Pokey49]

Sarcastic Dave: 
Looking at the RX I got from the outfit that did my home sleep study the RX for BIPAP reads as follows:  Auto-BPAP (min-6max I-25 PS4) followed by "Titrate to comfort". Does this sound like a reasonable starting point. I just watched an informative YOU-TUBE setting up  a VAuto and I interpreted it as  saying setting the max pressure to 25 would be unusual, something to the affect that high pressures can cause CAs but I will admit I was baffled by what all the settings were for and how to set them.

[SarcasticDave94]

It should be just fine. You can edit as needed yourself. Myself, I would investigate the machine that you'll be getting, calling your DME to request what exact machine they are going to issue. Again just me, I would make it clear that I want the ResMed AirCurve 10 or 11 VAuto. Do not get ResVent, etc. which is a much cheaper Chinese brand. Get exactly what I've typed in bold.

PS don't forget to order a free clinical manual for the new bilevel.