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[Treatment] Spr0ut's Treatment Thread
#1
Spr0ut's Treatment Thread
Hello and thank you; I have learned more from the Apnea Board than I have from any of my healthcare professionals about sleep apnea.

 
Symptom and Treatment History:
I have always had trouble with sleep, for as long as I can remember.  When I was younger, I would fall asleep during the day and struggled with excessive daytime sleepiness.
 
In early 2021 I was diagnosed with clinical depression and anxiety, after many years of mental health therapy, this was acute, and I needed medication.  In late 2021 I started working with my PCP on my excessive daytime sleepiness.  I originally thought I had narcolepsy, but a polysomnogram test and following multiple sleep latency test in late 2022 showed that I did not have REM onset in any of my naps.  These two tests were performed while I was taking Pristiq and Wellbutrin for the depression and anxiety.
 
The polysomnogram showed AHI 2.85 and a RDI 11.24, the pulmonologist recommended I pursue OSA treatment and that my insurance would cover it because they would consider my RDI.  I chose a dental appliance for treatment.  In determining adjustments for my dental appliance, I had a home sleep study over two nights with a MediByte Jr type 3 device: AHI 11.3 and 13.6, RDI 23.9 and 29.2.
 
The dentist read the results and had me do a follow up home study because they needed a baseline without my dental appliance since my home study did not match my lab study.  The second two-night home study using the same device resulted in AHI 28.7 and 17.4, RDI 45.1 and 36.0.  The dentist wanted to pause adjustments and have me follow up with the pulmonologist before proceeding.
 
During this time, I was still struggling with excessive daytime sleepiness, depression, and anxiety.  I postulated that the accumulation of short days of Winter was overcoming my mental health meds and vitamin D supplement.  Pulmonology ordered a third at-home sleep study and prescribed Provigil.  The first day on Provigil was life changing. The excessive day time sleepiness nearly vanished, and along with it the depression and anxiety.  My wife was in near tears believing it was too good to be true that I was out of bed, working a task list with purpose and determination.  
 
The third at home study with a WatchPAT yielded pAHI 9.9 and pRDI 15.5.  Pulmonology and I agreed to try a CPAP; they were content to leave me with my dental appliance, but my mental health still felt fragile to me.
 
Prescription: I was prescribed an APAP (ResMed AirSense 11) at 5-20 cm H2O and received my machine and started using it on May 18, 2023.  I continue to wear my dental appliance every night.  I was also referred out to an ENT for eustachian tube dysfunction, throat congestion, and an acid reflux evaluation.  I have that appointment on June 1st.
 
Current Symptoms: I am eleven nights into my APAP dating, and I am sleeping terribly.  My sleep is shorter and much more interrupted than it was before APAP.  I feel like a zombie most of the day.  I no longer feel like life and situations are mentally overwhelming like I did before Provigil, but I now physically cannot get through an entire day.  I found OSCAR and decided to keep doing therapy to get the data rather than quit.
 
It still bothers me that Pulmonology and DME are sent far more detail about my therapy and bodily response, every day, than I can see on the machine that I am intimately dating.  I called both on Friday and was told to call back this week.  Pulmonology and DME are either unconcerned or were wrapped up in their holiday weekend plans.  I received no response from either.  My pulmonology follow-up is scheduled in 4 – 5 weeks.  I am a fighter, but it is always nice to know how big and tough your opponent is before fighting.
 
Concerns and Questions:
 
I will post my sleep studies in this thread shortly.
 
My APAP data is showing a lot of central apneas and I seem to be working my way to a greater AHI than before APAP.  Should I be concerned about the number of CAs the data shows?  Do I need to continue therapy as is for another four or five weeks before I have pulmonology evaluate my data?  Is this normal acclimation to PAP therapy?
 
DME told me if they found any pressure settings that varied from my prescription, they would change them back.  They also said my particular pulmonology will not take any pressure suggestions from them, and that I need to follow up directly with pulmonology for any changes.
 
From my forum education, it seems my data shows a large leak problem, most likely from mouth breathing. The machine always says my mask seal is great.  I will see if I can change to a ResMed AirFit F30i tomorrow, unless anyone thinks I am misinterpreting the data.
 
Does my data show a chin tuck problem?
 
I would like suggestions on my future path.  Since being prescribed mental health meds over two years ago, the diagnostic, treatment, and evaluation procedure of almost all health care professionals seems to be: get an appointment in six weeks, try a prescription for six weeks, evaluate and make a small change or refer to another specialist for further information, and follow-up in six weeks.  Will an APAP work for me?  Will I need to go through the process to get an ASV to experience symptom relief?
 
I really appreciate all the direct and candid resources this forum provides.  This community are heroes in my opinion.  Apologies if the length and detail of my history is irrelevant or unhelpful.  Now off to wrestle my body during another round of sleep.


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#2
Polysomnogram November 2022
My first sleep study.


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#3
Home Sleep Studies March 2023
Second and third sleep studies.


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#4
RE: Spr0ut's Treatment Thread
Welcome to ApneaBoard.  I will take a shot at this.  Others may want to comment also if they see something different. 

I see a lot of variance in all of the data.  A very large range from I think 2 (Lowest AHI on 1st sleep study) to 30 or so on another one and with your new machine.  I do see a lot of leaks.  Getting the leaks under control should help get AHI down.  Your Spo2 is not bad on any of the data (that is a very good and positive thing IMO).  

It looks like you do better with the dental appliance than not with it.  I do see a lot of CA' s on your 1st OSCAR post.  This could be treatment emergent CA (that usually goes away in a few weeks or so); or it may be permanent - in that case you may need to try to advocate and move on to a machine similar to an ASV, etc.  I think time will tell (by comparing OSCAR data in the next week or more).  


Another big thing is how you feel after using your machine.   Do you feel rested and good?  Or do you not?  This could be a pointer as to what direction to take.  

You ask some great questions, and IMO, time will tell the answers to these:  do your CA's decrease significantly?  Does your AHI and Spo2 remain good?  

These are the major highlights I personally see from all of your data.  Others may see somethings different.  Thanks for posting all of that.  Very thorough.  Thorough usually comes out on top in the end from my experience.  More evidence for sleep Dr.'s, RT, PCP, etc.
Download OSCAR
OSCAR Chart Organization
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