3 Nights in…Need Settings Advice

[bnephew]

Hello everyone!!  This is my first post….thank you in advance for any help you’re able to provide.  I am brand new to the sleep apnea thing.  I’ve been reading this board for the last month trying to educate myself on all things SA.

Some background…I am a 40 year old male and I’ve known that I snored and stopped breathing since I was a teenager.  I’ve always been tired in the afternoon and drowsy at inappropriate times.  I never took it seriously or did anything about it until I began dating a nurse earlier this year.  It didn’t take many nights together before she came right out and said that I needed to see a sleep Dr. because she wasn’t going to lie beside me and watch me kill myself in my sleep.
 
I had an initial consult with a pulmonologist last month and he scheduled me for an in-lab sleep study on September 12th.  I had my follow-up appointment with the Dr. on September 18th.  At the follow-up the Dr. indicated that I had stopped breathing 87 times per hour during the study and that my oxygen level fell as low as 68%.  He indicated that I had severe obstructive SA.  He recommended that I come back in for a titration study but I insisted that I didn’t want to wait another month for that and said I wanted to start treatment right away with an APAP.  He agreed and wrote me a prescription for a ResMed A10 set at 5-20 and scheduled a follow-up appointment in a couple months.

I left the office and called the DME only to be told they would get ahold of me in a week or 2 once they obtained the info from the Dr. office.  I walked back into the office and got a copy of my sleep study, prescription, and chart notes and drove directly to the DME.  I told the representative at the DME that I had the afternoon off and wanted to get everything taken care of immediately.  She got on the phone with my insurance to make sure everything was authorized and their nurse was fitting me with a mask an hour later.  I went home that afternoon with everything I needed to begin the APAP treatment that night.

I’ve now had 3 nights on the APAP (which I set at 6-20 with EPR and Ramp off) and my AHIs have been  7.23, 4.31, and 5.31.  I’m happy that these numbers are way down from the 87 AHI at the sleep study but I’m a perfectionist and would like to see them under 1.  Also, I’m concerned because most of the events from the last 3 nights are clear airway events.  The Dr. never even mentioned anything about Central SA but after I got a copy of my sleep study I noticed that I had 57 central and 213 mixed events on the night of my sleep study.

SO….I’m satisfied that my AHI is coming down but is there anything I can do to try to get it lower with this machine?  Could changing the pressure settings help bring those clear airway events down?  Any advice would be appreciated.

Lastly, is the ResMed AirSense 10 AutoSet even the right machine for me?  Shouldn’t the number of central events I had in my sleep study have been discussed with me?

I will try to post pictures of my sleep study and the sleepyhead data from the last 3 nights in a reply by adding a space to the links since I don't have enough posts to do pics/links.

[bnephew]

Adding a space didn't work to allow me to post links/pics...any other advice to get those on here without posting 5 times?

[SarcasticDave94]

Adding a space didn't work to allow me to post links/pics...any other advice to get those on here without posting 5 times?

Hi bnephew,

First, welcome to the Apnea Board. Others will chime in soon enough, but unless I'm mistaken, until you meet the 4 post quota, manually type out the link in full and add the space somewhere within said link to accomplish the task for now. We can see the info, post for you, and work on assistance. Best wishes on the APAP doing the job to help you get the sleep you need.

Dave B.

[bnephew]

Thanks!  Here's my attempt to post the links to my sleep study and sleepyhead data:

Sleep Study Page 1:  http://imgur.com/moCBUDu
Sleep Study Page 2:  http://imgur.com/J0aPjTw
Sleep Study Page 3:  http://imgur.com/QfPDG2C
Sleep Study Page 4: http://imgur.com/gHDxZLl
Sleep Study Page 5:  http://imgur.com/8A3L1IC
Sleep Study Page 6:  http://imgur.com/hl7725R

9-18 Sleepyhead:  http://imgur.com/xiNq8Xk
9-19 Sleepyhead:  http://imgur.com/xT7FlGA
9-20 Sleepyhead:  http://imgur.com/Pirq3AA

[SarcasticDave94]

bnephew,
Would you like these posted as is, or would you like to redact personal info, etc beforehand? I was able to view your first link so far, then I felt the need to ask. BTW: I'll post for ya, if you want to redact, edit images in imgur and it'll be good to go

[bnephew]

Yes, thank you...I had created one with personal info blacked out...feel free to create the links.

Sleep Study Page 1:  http://imgur.com/VqwqSzX
Sleep Study Page 3:  http://imgur.com/BkBrrtS

[Gideon]

Higher pressures tend to show more CA events,

I would like to see your high set to 14 and see what happens for a few days.

To get ASV you will need to fail at CPAP, and possibly fail at BiPap first,  just ask Dave.

Fred

[SarcasticDave94]

Higher pressures tend to show more CA events,

I would like to see your high set to 14 and see what happens for a few days.

To get ASV you will need to fail at CPAP, and possibly fail at BiPap first,  just ask Dave.

Fred

Fred/bonjour is correct about typical insurance pathway for the ASV is to fail both CPAP and BiPAP. If you wanted to have more patience, you'll get to practice having your wish granted.

[Sleeprider]

Thanks to Dave for making the links easier.  Bnephew, you were diagnosed with severe obstructive sleep apnea, but this page shows us you actually have mixed or complex apnea even before using CPAP:



That is a lot of central and mixed activity, so a certain amount of central apnea is not unexpected in your case, and it won't respond to increases in pressure in CPAP.  The number of central events is diminishing, and results are actually better than I might have expected given the amount of central activity in your test.  Let's take a look at these charts starting with the most recent.





Your pressure range was set from 6-20, and you used nearly all of it.  You are using simple auto CPAP pressure with no EPR, so that is probably helping, however your CA events are actually worse as pressure gets higher. From these two most recent nights, we know that you have very little obstructive apnea.  The pressure is increasing on snoring and flow limitation, so the machine is behaving exactly as we would expect.  If the objective is to lower AHI without increasing obstructive activity, I recommend that we tighten up the range of pressure, to increase the minimum pressure and decrease the maximum pressure which seems to have its own problems.

I'm going to suggest a minimum pressure of 8.0, and maximum pressure of 12.0.  We may need more maximum pressure depending on how this trial works out, but I think this will avoid most of the OA and might lower the CA events quite a bit.  By the way, excellent leak results and you're off to a great start. Looks like you're getting up for work early, and I don't miss doing that since retirement.  

[SarcasticDave94]

No problem; glad to assist.

BTW: not that I'm questioning Sleeprider, just saying assuming the assessment is accurate, not that I'm doubting accuracy either, but if enough evidence can be in a concrete fashion, this can fast-track one onto ASV as I understand it. It didn't apply in my case, as evidence wasn't as apparent initially.