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Pressure adjusted but still tired
#1
Pressure adjusted but still tired
Hello everyone,
I've read several posts here and hope that someone can point me in the right direction.
Diagnosed with obstructive and central apnea in June 2012.
After being tired throughout the day despite using my DreamStation AutoCPAP with DreamWare Gel Pillows, I sought a new sleep doctor in September 2020 since I didn't feel my previous doctor listened to my concerns.
Oximetry tests showed no issues with oxygen levels.
My new sleep doctor did some checks and suggested that the pressure range should be change to 4-12cmH2O from 8-12cmH20.
His staff made the adjustments.

For the past several months, I feel even more tired than I did previously.
I see the doctor in two weeks and want to discuss other options with him.
I keep seeing a wide range in my AHI from time to time--any ideas as to why the big variance?
Last night AHI was 13.97.
Yet one week ago, my AHI was 4.67.
I noticed that my clear airway apneas and variable breathing were higher on the night with a high AHI.
Are these two things related?

Many thanks!
fumanshu


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#2
RE: Pressure adjusted but still tired
The first night was not too bad, Im sure one of the very experienced people can and will help you.  But on the 13.97 night take a look at the OA and H rows.  Up until about 640 it was normal but as the night went on see the events group together.  That is a sure sign of positional apnea.
 
What is positional apnea?  Quite simply it is when you cut off your own airway.  There are NO setting of any pap machine that can help this.  You have to find out why you are cutting off your own airway.  It can be as simple as sleeping on your back or too high of a pillow.  Those would be easy fixes.  The other way to fix it is with a collar.  Please look at the bottom of the post and click on the link for a collar.  In the link you will find people who had terrible problems without a collar and the same people who got a collar and improved dramatically.
 
You are “chin tucking” where your chin drops to your chest and it cuts off your air.    It is quite easy to lower your AHI number and get much better sleep when you can sleep without the chin tuck, and you did the night before.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Pressure adjusted but still tired
Your doctor is hoping he can treat complex or predominately central apnea with a CPAP machine, when what you need is ASV. Ask your doctor when he plans to schedule a clinical titration to evaluate ASV. ASV or an adaptive servo ventilator treats the mixture of obstructive and central apnea we see in your results by providing positive air pressure to hold the airway patent, and it treats the central component by providing pressure support (pressure increases above the exhale pressure) to supplement shallow breathing or cause a breath where one is missing. Complex apnea is fairly easy to treat with the right machine. If you doctor gets a blank stare when you ask him about it, find a doctor that actually knows how to treat it. MOST sleep specialists are not particularly useful, and you should be able to tell fairly quickly whether your doctor is one of those. What you need is the Resmed Aircurve 10 ASV, not a Philips Dreamstation CPAP.
Sleeprider
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#4
RE: Pressure adjusted but still tired
Agree fully with Sleeprider on the ASV. This is the wrong machine. It's akin to the Philips screwdriver on a hexhead screw... It won't work as you well know. You must grill the doctor ASAP on what plan is in place on treating CA. You've said you're already "Diagnosed with obstructive and central apnea in June 2012" and yet 9 years later CA still not treated. Thus far your doctors are failing you at treating CA by avoidance and the avoidance plan is not working.
Dave

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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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