[Treatment] New member question

[mowork]

My husband just got the results from his sleep study today. His AHI was 65.2 . The Doctor explained anything above 30 was severe.  Said sometimes mouth appliances or surgery could help apnea but said he felt my husband's was too severe for those options.  He explained the Cpap  but also the Bipap.  He has scheduled him for another sleep study next Monday and they will try a Cpap and a Bipap if necessary to see which one would best correct his problem.

I am concerned he is 71 and a heart patient.  He had a quadruple bypass 3 years ago.  I have a few questions: has any one you had an AHI that high or higher that has gotten it under control?  If so do you use a Cpap or Bipap?   Then in general what brands are best to get?  Will Medicare pay for it?                                                          Thx in advance

[Gideon]

ONLY 65?  hey, you got it easy.  My Original was in the 90s (2003), and I managed to drop that to 77 about 2 years ago.  I'm normally around .5 treated, sometimes I'm up to about 2.5.


BTW Welcome to the forum.  Compared to him I'm just a young kid born in 1950.  I don't have the heart problems he has (doesn't matter) but Knees and back are my problem, actually just my back now (knee replacement).

Your Questions
has any one you had an AHI that high or higher that has gotten it under control?  Yes
If so do you use a Cpap or Bipap?   I've used both
Then in general what brands are best to get?  ResMed
Will Medicare pay for it? Yes, to the limits of Medicare

You have said nothing about the specific breakdown of his Apneas.  Without the breakdown I'll assume there is no significant Central, Complex, Mixed, Emergent Apneas, meaning virtually all of his Apnea is Obstructive.  And no notable respiratory issues like COPD.  That said, you want one of these.
ResMed AirCurve 10 VAuto, this is the BiLevel,  It is like an APAP or Auto CPAP on steroids. It is better than the AutoSet I mention below.
ResMed AirSense 10 AutoSet or AutoSet for her.  This is the APAP I mentioned above.  Auto is important because this lets the machine adjust to changes thru the night and over the months and years you will be under treatment.  Both machines have manual modes and both have detailed data down to a breath by breath basis for the entire night.  

[sheepless]

cpap therapy is non-invasive, benign, easy compared to quadruple bypass, for example. many of us have severe apnea. my last test put me at 72.4 per hour, an equal mix of obstructive and central events (obstructive means physical constriction of the airway, central is a neurological failure to breathe). pap machines can be quite effective in reducing apnea - my nightly ahi is usually under 1 now. different machines are designed to treat different forms or elements of disordered breathing, like obstructive vs central apnea. choice of machine type and maybe brand depends on your husband's particular issues. many take to it easily without comfort problems and respond well to initially titrated settings. others take a while to adapt and/or to settle on optimum treatment parameters. if lucky it can be days; months if not. it can be a nuisance but it isn't hard. it's confusing at first but you will find practically everything you need to know and more here as well as a lot of very kind and informative members. the 'system' - medical community and insurers - isn't particularly responsive and our best interests aren't always as much of a priority as we'd like so it's good you found your way here. as you go along your questions will become more specific. ask and folks will respond.

[Big Guy]

I turn 65 this October. Last summer, I had an in-lab sleep study. My AHI number was 70 for regular sleep, and 60 for REM. 

I was prescribed a CPAP and my numbers have all been well below 5 ever since. Generally speaking, I'm under 3 for the most part.

[DeepBreathing]

Hi mowork. Welcome to Apnea Board.

As you can see, a high AHI is not uncommon (mine was 62). I think that getting the AHI under control will place less strain on your husband's heart. At the moment he is effectively being strangled every minute - that can't be good for the heart! In every apnea event the body tries to counteract the lack of breathing by releasing a shot of adrenaline - which puts further strain on the heart. So treating his sleep apnea is a priority in helping his heart recover.

The good news is that CPAP (in its various forms) is a very successful therapy. It's far better than a mouth device for the great majority of patients. Some people are really lucky and take to it very easily and see instant results. For most of us it's more like a journey, one step forwards, two steps back - but we get there in the end. It's not easy learning to breathe in a whole new way with a plastic alien strapped to your face!

As for the machines, there is a good summary of makes and models listed here: http://www.apneaboard.com/wiki/index.php...ne_choices

Generally the members here have found that Resmed machines have the edge over Philips Respironics. There are other brands on the market, but Resmed and Philips dominate.

Given your husband's history, I think it's highly likely he will have at least some central apnea, which may require treatment with a different type of machine. If possible, post a copy of his sleep study report (with name and other identifying information blacked out) and we'll have a look for you. If central apnea is an issue, it's best to get it addressed right up front, otherwise you might be subject to years of misery as you work through the system to get the right machine.

Just to explain about the types of apnea:

• Obstructive apnea is by far the most common. It occurs when the soft tissues of the upper airways collapse during sleep, leading to a physical obstruction.
  
• Central apnea occurs when the brain doesn't send the "breathe now" signal to the lungs. Your body literally forgets to breathe. This can be neurological in origin, or caused by a reduction of CO2 in the bloodstream (see below for treatment-emergent apnea).
  
• Complex and mixed apnea are a combination of the above.
  
• Treatment-emergent or pressure induced central apnea often occurs to people who are new to therapy. It's caused by an imbalance of oxygen and CO2 in the blood as the body adapts to breathing under pressure. Often it just goes away after a while but may need special settings (or even a different machine) if it's persistent.

Hope this all helps - the world of apnea can be confusing and contradictory, but there are plenty of good people here who will help you and your husband every step of the way.

[DarciWantsToSleep]

Hi there,

I had and AHI of 81 at my sleep study and with an auto set CPAP I now usually average 0.3-1. The therapy will help him. And attitude going into treatment makes all the difference. 

Best,

Darci