AHI'S getting no better

[Ditner]

I have been on CPAP now for several months. I started out with a nasal pillow and auto pressure  between 5 and 15.  No good results.  Then went to a constant pressure  of 14 and a different mask. Again no good results. I had a tritation study done and found out I am a mouth breather and need a full face mask.  So I got a Amara full Face Gel Mask . No good results.  The doctor then changed my pressure back to auto  between 14 and 20. The last 4 nights my mask leaked all night long. My doctor only deals with one company so the DME said my choices are limited. Could my problem be the mask? Since starting this therapy I have lost 67 LBS. Also I  have a small hiatal hernia. I have read that certain masks should not be worn for people who have this condition. Is this true?   My acid reflux is under control with medication.

[Gideon]

Based on the continued elevated presence of CA events over several months I believe that you have Complex Apnea.  I would say I know you have Complex Apnea but in my past as an EMT a Dr (what do they know) said I was not qualified to diagnose a fracture.  (Pt had is lower arm angulated midway at about 45 degrees with jagged bones protruding)

This means that you have the wrong machine for treatment.  You need an ASV machine.

Fred

[Sleeprider]

Do you have results from your sleep study you can relate to us or post? If your diagnostic study showed central apnea, there is almost no doubt you need ASV to treat this problem. That chart is painful to look at with all the apnea, and progressively worse leaks until it just loses control. Have you ever considered using a soft cervical collar to keep your head and neck aligned and stabilize the mask?

[Ditner]

https://i.imgur.com/LbC8GPg.jpg



I hope I did this correctly. There are three images. At one time I bought a cervical collar and I wore it for a little bit then took it off. This pressure upsets my stomach a little bit. I feel so hopeless with all this.  Hopefully at some time I will start to feel better.  Thanks

[Ditner]

Thanks for your input.  I was wondering if it was my machine.  Complex apnea is something I didn't know anything about and I will look up this information.

[Sleeprider]

I was able to view one page of your sleep report.  This page of the study identifies apneas hypopnea and RERA as well as PLM, but does not differentiate obstructive or central apnea.  All trials were fixed with the same IPAP/EPAP and started at 7/7 and went through 14/14.  At 11 cm a full face mask was applied and trial length was extended.  The most striking aspect of this test is that you had suppressed SpO2 at all CPAP pressures and the lab should have evaluated bilevel to improve oxygenation, or at least commented on these poor results.  With nasal therapy between 7 and 11 cm pressure your best result appears to be at 11.0 with 5 hypopnea, and the best SpO2 of the entire test at 91%.  That still represents an AHI of over 10!

During the longer FFM titrations, your results varied with the lowest AHI at a pressure of 14, but this corresponded with the lowest SpO2% at 87%.  While I would like to see more of this study, what this tells me is that the titration failed to identify CPAP pressure that was effective for you in reducing AHI and adequately ventilating and ensuring an acceptable blood oxygen level.  Your continuing experience on auto CPAP confirms that you do not tolerate CPAP and are getting unacceptable results.  The next logical step is to evaluate BiPAP and ASV as possible effective therapy.  This additional study is justified for insurance reimbursement by the failure to achieve a successful laboratory titration with CPAP, as well as your current trail on Auto CPAP therapy which is also failing.  Your job is to inform your doctor that it time for him to do his job.

Seriously, you need to call your doctor and inform him of your terrible results.  Discuss the sleep study with him as I have done above and get his thought on ordering a bilevel and ASV evaluation.  If you feel you need a different doctor or your current specialist is unresponsive to this, then get a different referral; however you need to address this sooner than later.  Based on what I see, you will ultimately require ASV.  Your doctor will have a higher level of proof required for him to come to that conclusion.

[kiwii]

You came to the right place, Ditner. There are people here that care and are so helpful. Hang in there just a little longer!  

[Ditner]

Thank you ever so much. I am going to call the doctor right now.

[AMESS]

oh my gosh. Get to another Dr who deals with a medical place where you can have your choice of machine and mask.