AHI 7.9 need help adjusting

[Justbreath]

I have an old sleep study where they did titration couple years ago, I will post results

[Justbreath]

Sleep study report , I did have a follow up after but I couldnt sleep with all the stuff on me so it was a worthless study, the referring dr at that time told me that i was mild stage an not to worry, she dismissed me. Since then i have gotten much worse, feel like my throat is closing up sometimes, when I had the DISE procedure my surgeon said I had 100 percent blockage, he wants he to do the uppp, surgery and had also talked about inspire implant. I'm scared to do those things don't know what to do.
 Thats amazing that the dr says basicly what you said about the 6cm , you are a very smart guy, thank you for your knowledge, so what do you think i should try tonight?


https://imgur.com/a/GXhom

[Sleeprider]

Not much in that image you posted, but I don't see you as a UPPP candidate.

If I'm so smart, try setting your machine with a maximum pressure of 6 and see what happens. I'm right or I'm wrong, but we wont' know if you don't try it.

[Justbreath]

I'm sorry not sure why the pic messed up

https://imgur.com/linPMoq

[Sleeprider]

Thanks! This fully confirms my previous observation that you have a complex apnea syndrome, and should using CPAP limited to 6 cm pressure.

Let's be frank. You have a sleep study that verifies you have CPAP onset of central events. This will either resolve on its own, or your best course of treatment will be positive bilevel pressure with a backup rate that ensures you take a breath as needed. The technology is called "adaptive servo ventilation" ASV. We have a surprising number of members here that use it. ASV resolves obstructive apnea by keeping the airway open with a minimum exhale pressure, and as needed, applies pressure during inhale to cause a breath, if you don't spontaneously initiate one in your normal rhythm and volume. About 35% of people with this condition adapt to CPAP and do not need ASV, however they do best when very constant pressure is used, rather than varying CPAP pressure, and differences between inhale and exhale pressure.

You have a choice to make whether you want to optimize your current CPAP therapy, or just move onto more advanced ASV therapy. We can help you to minimize your central and obstructive events with CPAP, or not optimize pressures and move forward towards ASV. I know this is unfair, and take your time to decide how you want to go, but if you want your current CPAP therapy to succeed, you will use low pressure and no EPR to make it happen. If you want to move on to the $5000 machine that is probably best for your condition, then use a lot of EPR and lots of pressure range.

You are in this position because insurance requires that you fail CPAP before being authorized for ASV which is more expensive. Your best option is to fail CPAP, but there is that chance you won't. However you decide to proceed, we will support you on the forum and keep you as comfortable and with the lowest event rate possible.

[Justbreath]

So looks like im going backwards , altho i did do slightly better than last night. Now i would just be happy to be around 6 or 7ahi. I guess this is why they call it complex apnea.

Last night i did try turning EPR on halfway thru after I saw that my results were around 15ahi, i wanted to see if i could recreate my early on initial results. I remember the first few attempts i did not have hardly any centrals, I thought the machine was messed up.

last night
https://imgur.com/a/is1Mf

[Sleeprider]

It looks like with pressure set to 6.0 you had mainly obstructive events, and these occurred after the machine increased pressure. Are you using a long ramp, or is that quiet period where pressure is about 4 real? It looks like about 45 minutes in the machine detects flow limits and goes from 4 to 6 cm pressure in the first session. In the second session, that same 45 minute period is quiet and the machine then goes from 4 to 8.6 pressure. I suspect that there may be events while you are in ramp that don't get counted, however if you turn off ramp, then those periods will also be counted in the totals. Even when you had the earlier results with AHI less than 8, you were missing event recording much of the night due to the long ramp during which nothing is recorded. So even those charts are artificially low due to ramp. With 3-45 minute ramp periods last night, over 2-hours of events (about half the session) are not counted. Your actual AHI is higher.

My suggestion is that you inform your doctor that you have mixed obstructive and central events, and need to be evaluated for a bilevel with a backup rate such as ASV. Using low pressure, you have mainly obstructive events, but when pressure is elevated to where those are resolved you have mixed and central events. Your doctor already knows this is a problem from the test you posted, and included his recommendation for follow-up to evaluate ASV in the Recommendations section. I'm very certain he was expecting your call and will help you. Why did you wait? CPAP cannot treat you. Please turn off the ramp so your events are recorded and you get the help you need sooner.

[Justbreath]

that’s a kick to the nuts ,,super disheartening,Ok I will call my dr Monday, I did not know the ramping does not record data, i will turn it off..I only stop in the night because I have to go to the bathroom. Here lately its like 4 times a night. Im really tired of this, it’s been messed up for a long long time, and every time I try to get fixed I hit a roadblock. I just haven’t slept well in a very long time.
Does the asv mess you heart up,? I guess any breathing is better than none.. Would it be more logical for me to try bipap first then asv? I’ve seen a few resmed aircurves 10 for sale online. I also wonder if this cpap helps at all. Like u said when I clear osa events it causes central ones..

Thanks man

[Sleeprider]

ASV does not mess up your heart, but it is contraindicated in people with congestive heart failure and left ventricular ejection fraction less than 45%. The test for that is a simple echocardiogram. We have many members here using ASV, and a significant number of them achieve AHI consistently less than 1.0 and they talk about the machine giving them their life back. Modern ASV is a very cool technology that uses your own respiratory rate and volumes to help you maintain that through the night. Compared to what you're going through now, it's going to feel like a miracle.

I really think you could be setup pretty quickly. Your doctor included a follow-up for evaluating ASV in his recommendations. I suspect you just didn't understand it, and probably had difficulty adapting to CPAP and quit. Just guessing that you are trying to get back to it now because you feel like crap. What I really want you to know is that this problem is easily treated, once you have the right equipment. Treating complex apnea with a CPAP is like treating a broken leg with a running shoe...it just makes it worse. You will feel better and get your life back with ASV. Stick with this and get the right care. Your health and sense of well-being, perhaps your career depends on that. No one can function well with this problem untreated or improperly treated.

[SarcasticDave94]

Hey keep us updated, I know what the ASV will do. This looks and sounds to me like you need this. My AHI is always 2.1 or less now. Always. AND I'm beginning to feel better; it's taken a few months but OK it's working to help.

With a CPAP machine, sorry can't remember the AHI I got that long ago. BiPAP? 35+ AHI only because of losing 100 pounds. PSG for BiPAP registered 124 Central to 24 obstructive. Get the ResMed AirCurve 10 ASV if at all possible, but the Respironics DreamStation ASV is very good also, a close 2nd. FWIW the ResMed algorithm will work wonders.

Best to ya,
Dave