Wife tried machine, lots of flow limitations?!

[YouTakeMyBreathAway]

Sorry I think I'm not being clear. I am not saying she has a breathing issue, I am asking if she may have none. I.e. is it possible at all that the diagnosis is wrong given her RERAs were very low and given her AHI now is zero even at the lowest pressure settings with not a single hypopnea flagged yet.

[Sleeprider]

Okay, I understand. Her results suggest very mild sleep disordered breathing with only 8.4 events per hour, all hypopnea. This is borderline for treatment, and is usually put over the top for CPAP therapy by patient input complaining of fatigue and other issues. Your sleep study summary does not tell us the criteria for scoring hypopnea, but it is typically a reduction of 50 to 80% of normal flow with a 3 to 4% desaturation. It appears her events are accompanied by arousal, but again we are only looking at a transcribed summery. It will ultimately be her decision whether to continue therapy based on her perception of its benefits or lack thereof.

My wife has a similarly low AHI from her sleep test. She was diagnosed with "severe sleep apnea" with 92 events per hour, but when I reviewed the study it was obvious that the technician or doctor had missed a decimal point and her actual AHI was 9.2. Ever wonder why I look skeptically at this specialty? Anyway, we dialed her in and she has continuously used her Autoset at 8-12 cm EPR 3 for about 3 years, and she complains if something comes up like a power failure that would interfere with therapy. I don't know if our anecdotal experience is relevant to you or not, but the point is both experience mild sleep disordered breathing and will decide on continuing therapy based on their individual experience, probably with no significant health consequences if they decide not to use it. You are working to set her up to be as comfortable as possible, in the same way I did for my wife. Watch the results, listen to her input and make adjustments accordingly if she wants your help in that regard. She will certainly make her own decisions, and all you have to do is listen and obey

[YouTakeMyBreathAway]

She got the machine from the doctor now to do the CPAP titration. Overall looks similar to her result on my Airsense 11, but it adds SpO2 and HR data.



Anything notable?

The thing that stood out the most to me is that she has a lot of pulse change events at 54.48/h, this is three times my pulse change rate. What could be up with that?

[Gideon]

A settings change. Set Min pressure=7. This is to accommodate EPR=3 and her low pressure will remain at 4.

[YouTakeMyBreathAway]

This is the titration machine from the doctor, I assume probably should leave the settings for these 5 nights

[Gideon]

Please keep it in mind for later.

[Sleeprider]

My guess is the doctor will end up prescribing 8 to 12 pressure with EPR 3. Looks like it is working very well. Her qualitative input will be very important to the doctor as pertains to her comfort and whether CPAP is beneficial.

[YouTakeMyBreathAway]

Tonight was the last night of the titraion trial, let's see what the doctor says.

My wife still feels tired and complains of her nose being permanently blocked and difficult to breathe through. The flow limitations seem to back that up and tonight from 5:30-6:30 there was a stretch where the machine was at 15 cmH2O, yet flow limitations were very high (actually the highest they have ever been).

Obviously there is only data for 4 cmH2O minimum and maybe that is already helping her, but flow limitations do seem to remain just as high even at much higher pressures. 

I am wondering if the machine is helping her or if it does ~nothing and maybe her obstructions are anatomical, so pressure can't do much.

[YouTakeMyBreathAway]

Let her try your Vauto with EPAP min 5.0, PS 4,  max pressure 12.0 EPAP. Can you handle the swap?

I didn't remember the specific suggestion, but I tried her last night on VAuto with EPAP min 4.0, PS: 4.0.

It looks like this did decrease her flow limitations a bit! 

What do you suggest?

Autoset:


BiPAP:


Her flow limitations yesterday (AutoSet, top) vs tonight (BiPAP, bottom):

[Sleeprider]

That looks like greaet therapy with 95% FL going from 0.08 to 0.02 and triple zeros on events. I'd call that a win, but her comfort feedback is where the decision needs to be made.