4 year old daughter... sleep study and CPAP

[jgjones1972]

Does anybody have any idea how the obstructive events could have increased with PAP? Am I reading the polysomnography report right? It sure looks to me like centrals are well under control and hypopneas aren't that bad, but OAs have dramatically increased with PAP use.

This I don't understand.

If you look at the link to leak stats, it sure looks like leaks aren't bad enough to cause the OA reporting to be far from accurate.

[RonWessels]

That might be simple. With the sleep study, you are in a strange place, on a strange bed, surrounded by strange people. It would not be surprising if you did not relax as fully as you would at home. And, of course, relaxation is what causes the soft palate tissues to obstruct the airway.

I was titrated to a pressure of 13. At home with an auto-CPAP, my 90% pressure level is actually 17.

[shifco]

...
I wish I could shed some light on what's going on with the AHI, but I just can't make sense of the numbers.

Please let us know what the sleep technologist makes of this.

Sorry I couldn't help, I know this must be very challenging.

...Does anybody have any idea how the obstructive events could have increased with PAP? Am I reading the polysomnography report right? It sure looks to me like centrals are well under control and hypopneas aren't that bad, but OAs have dramatically increased with PAP use....

We met with the sleep tech today. She pretty much said they didn't believe the data to be correct. It didn't make sense because her sleep study stated "central apneas" were more the concern, but the CPAP data is saying "Obstructive Apneas" are now the concern -- which mirrors what everyone here seems to say.

...
I also agree that the treatment pressure probably wants to be increased. This would be a good topic of conversation with your Sleep Technologist. The periods of constantly repeating OSA events are pretty much exactly what happens to me if my pressure is set too low. And it's absolutely murder on sleep patterns. It's virtually impossible to get into N3 (so-called "delta") sleep, which is the really deep restorative sleep phase. Consequently, despite being in bed "asleep" for over 8 hours, she only get the same benefit as perhaps an hour or two of sleep.
...

I missing this info and wasn't able to ask the sleep tech. They didn't mention anything about the pressure. (They had us start at 4 for tolerance). They only mentioned the "CPAP data is not right / doesn't match up". Next step is another sleep study in 1 month with CPAP (titration study?).

Could her low pressure cause obstructions?? This is insanely concerning.
Maybe we'll call tomorrow to see if it makes sense to bump it up to 5 or 6??

Thanks again

[shifco]

...Maybe we'll call tomorrow to see if it makes sense to bump it up to 5 or 6??...

Just read more about pressure settings and the titration testing.. Will only consider bumping to 4.5 or 5. Hope to god we don't have to wait a month if the low pressure is causing a big issue...

[jgjones1972]

It seems to me that either the sleep study was flawed, or the machine is malfunctioning. I lean toward the idea that the sleep study may have been flawed and for the reason Ron mentioned - that sleep patterns were atypical due to the discomfort of the environment.

Is there any way you could import the waveform data from the SD card in the machine and post it? The data can be imported into the free Sleepy Head software. I'm wondering what the flow resistance looks like.

Did the tech look at the waveform data or simply look at the stats?

[shifco]

Regarding "I'm wondering what the flow resistance looks like.", I'm not entirely sure what you mean or where I look, but see this image that I progressively zoomed in on ---> i.imgur.com/zrn0zAu.png

The tech only looked at stat numbers, no wave data. They had a printout that they took to the doctor. Doctor concurred the numbers didn't look right. THat is about all the information we got. "Come back in 1 month" for Sleep Study w/ CPAP.

[Tez62]

shifco, just to put your mind at ease a little, a low pressure won't cause obstructive sleep apnea, it just basically won't do anything or just help a little. The pressure setting are designed to be strong enough to keep her throat open enough to allow her to breathe normally in constant mode. In some people if a pressure is too high, it has been know to cause central sleep apnea. When I say too high I am talking like around 20.
It sounds like they didn't do a titration test in the first place? The titration testing determes the correct pressure setting she requires, some specialist don't do them and use an auto adjusting CPAP to monitor the data and then change the pressures if required.
Your daughter obviously needs that in a month but you can still post her data and we can look at it for you and give advice.

[bwexler]

If your machine is an auto PAP, you might try a range of 4to 6 and see what the report tells you. After a week you may be able to make some miner adjustments, as 4.5 to 6.5 depending on the data. By the time you go back for titration you will be able to present several weeks worth of data. You may come armed with wave form print outs and if you learn how to read them with help from those here who know more than I, you can help educate the docs.

[jgjones1972]

I'm not a doctor, but the charts sure seem to support the data...I don't think there is any way a malfunctioning machine could fabricate an obstruction/resistance pattern like this. The sleep study seems to be the odd one out here.

Here is a video that I think is particularly helpful in understanding what to look for.

http://www.youtube.com/watch?feature=pla...DorWmdxnZE



Given the circumstances, I would probably raise the pressure to 5cmH2O and leave it there for 2 weeks to see what happens with AHI.

Is the machine she is using an Auto?

[RonWessels]

To reiterate Tez62's point, even though 4 is a low CPAP pressure, without the CPAP unit, it is as if the CPAP pressure setting is 0. So it's no worse than normal room pressure.

You list your machine as "Philips Respironics". That is like saying that your car is a Ford. Depending on the specific model, there may be some things you can try. Right underneath the LCD display, there should be some printing. It may say something like "REMstar Plus C-Flex", "REMstar Pro C-Flex+" or "REMstar Auto A-Flex". I'm guessing it's a Pro, given you were able to get useful data from it. If you are interested, that machine can be configured to perform just like an Auto-CPAP machine (ie. it will automatically adjust the pressure setting according to what is necessary for treatment, subject to the minimum and maximum pressure limits that are set). You might want to consider using that mode to provide a variable pressure between 4 and (say) 6 cmH2O as an initial trial.

If you are interested, I have that very same machine (my old machine which I used in Auto-Trial mode to determine that I really needed the full Auto machine that I have now) and I can walk you through the settings. This, by the way, is very similar to what will be happening for a titration. Your daughter, your choice.