[Diagnosis] Average AHI last month of 19.6 - WTF?

[okniswand]

This is my first post here, so please let me know if I'm doing this right! 
I was diagnosed this May with severe sleep apnea.  Am using a RedMed AirCurve 10 VAuto and have used 4 different style masks, now Philips Dreamware Full Face mask. 
My statistics haven't really improved since June.  I had a second titration study in Oct but am still having lots of events. 
 
This is part of my Oct study:

Indication: OSA Baseline AHI : 8.4 Minimum SpO2: 85%
Clinical Information: Height: 63.0 in. Weight: 140.0 lbs. BMI: 24.8
Respiratory Events: The Mean SpO2 during the study was 93% with a minimum
SpO2 value of 86%. Cheyne Stokes breathing was not observed.
The patient slept for 340 minutes, yielding a Sleep Efficiency of 77.3%. Sleep Latency was 12 minutes with a REM Latency of 291 minutes. The patient spent 57 minutes (16.8%) in Stage N1, 233 minutes (68.5%) in Stage N2, 0 minutes (0.0%) in Stage N3, and 50 minutes (14.7%) in Stage REM.
Interpretation: This was a BiPAP titration utilizing the settings of 8/3-11/6
cm of water. The BiPAP setting of 11/6 cm of water was effective in treating
the Obstructive Sleep Apnea. The AHI was 1.8 at this setting; minimum SaO2
was 90%; and no snoring was heard. REM achieved but lateral.
 
I've gotten no feedback from sleep Dr about my progress, so I would appreciate any help or advice.
Attaching 3 random charts.  I may be up reading during some of them, so not sure if that will skew things?  I am confused and getting discouraged.
           

[staceyburke]

You have 2 types of apnea shown on these charts.  The first are CA (clear airway) where there are no obstructions - you just are not breathing.  There are several people here that will give you suggestions on that and they know more about it than I do.

I will mention your obstructive apnea.  That is where there is something physical that stops you from breathing.  You have a lot of positional apnea.  Positional apnea is when you cut off your own airway by the position you are sleeping in.   No changes in pressure can help, only finding out how to stop getting into that position will stop them..

Think of it as a hose and you have a kink in that hose stopping water from going through.  That is what is happening to you.  You have to find a way to unkink the hose.  Some times that is as easy as not sleeping on your back or changing the thickness of the pillow you are using.

We call positional apnea chin tucking where your chin drops to your stratum and cuts off your air.  If you can't stop this by sleeping on your side or a new pillow set up, then you may need a collar to stabilize your neck.  PLEASE read the link I have in my signature on collars.  It shows people that have positional apnea without a collar and the same people with a collar.   It makes a huge difference.

You can see positional apnea when there are GROUPS or clusters of OA or H events and you have very noticeable groups of events in all of your nights.

[okniswand]

Hi, staceyburke -
I cannot thank you enough for your reply.  You are the first person to give me any sense of control over this.  I mentioned Oscar to my sleep Dr and they never heard of it.  I've tried looking at my Oscar graphs but so far I didn't know how to read them, but have been watching videos to try and figure it out on my own.  I read your link on the cervical collar article, and thank you, again.  I actually have a neck collar here and will see if it will be a good size for tonight.  I'm a side sleeper and don't move at all during sleep, so I hope I can make a real improvement soon. Today I've been reading articles and papers by anesthesiologists on airway obstruction issues so thank you for turning on a big light for me!

The central apnea is the next part of the puzzle now - I was hoping they were just false blips.  I will search the forums here for info on that now.  It seems like that is something I may not be able to improve, but now I at least have something concrete to work on.  

Bless you staceyburke, and everyone here on the Apnea Board, throwing lifelines to drowning people all over the world.

[staceyburke]

I’m really not well versed in centrals so look for advice from others on that BUT I have read that setting the “trigger” setting to high or very high ( I’m not sure of the exact wording on the setting.)

Setting the trigger has been known to help eliminate some of the centrals. I would give it a try.

[cathyf]

A beginner tip -- if you click on a graph and drag across, you will zoom it in. If you zoom in at like 2-3-4 minutes, then you can look at the flow rate graph and see individual breaths (or not-breaths!). Then use the right and left arrows and it's like watching the tape go by. :-)

Also, if you make the OSCAR window fill up your monitor, then you get the machine settings showing up on the screenshots, and some more graphs. And a big preference of mine (that most people here don't agree with  ) is if you right-click on the flow rate curve it will let you set the bottom and top of the y-axis in a much narrower range -- so dragging gets you a zoom in the horizontal direction, while resetting the y-axis zooms in the vertical. You are getting an auto-fit of -155 to 155, or -160 to 160. I use -40 to 40, or sometimes even -20 to 20.

Anyway, everything that Stacey says about positional apnea is right on. The folks here helped my go from an utter train wreck to pretty peaceful sleep with that magical cervical collar. (Yes, the most successful apnea treatment I've used is the $12 cervical collar!)

[clownbell]

Centrals are a very strange subject. There are very few concrete ways to cope with them, other than getting a super-expensive machine called VAuto which is called for only in serious cases. You may hear things like "XYZ has been known to help," or "XYZ works sometimes" or "you might try XYZ." Very few firm things. Many describe them as "consistently inconsistent." As I understand it, many people have a few here and there and they are no big deal unless you have lots of them and/or they disturb your sleep. May I suggest reading the AB Wiki on centrals if you have not already done so. And one of the experts will come along and give you better guidance.

[LindanHotAir]

She is currently using a VAuto and it does not appear to be handling the central apnea events. A bilevel ASV machine is specifically designed to handle complex (mixed) apnea and should probably be considered if the neck support and possible setting changes on the VAuto don’t improve things.

[Gideon]

1 work on the positional, it is the most important
2. set PS=3 Yes a big change but it should have an impact on your centrals.
3. provide a zoomed 10 minute segment so we can see if we can ID the character of your centrals.
4. Post your sleep studies so we can see any centrals you had there.

[Sleeprider]

We have written a couple Wiki articles because the positional apnea is so common and so easily solved. It is really chin-tucking and sometimes removing excessive pillows solves the problem, and other times a soft cervical collar is needed. Many members have trained themselves to avoid the chin-tucking which can occur equally on your back or on your side. Anyway, please read these articles and we can go from there.

Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

[SarcasticDave94]

Welcome to the weird club of Apnea, where doctors collect boat payments for ignoring you and your symptoms and complaints. Ditto the others as far as therapy. Another one for the CA funny farm maybe.

My one bit to add in, begin that therapy symptom and complaint diary ASAP. Mention the consistently inconsistent attribute of your Centrals, and the other failings of your PAP therapy, chronic fatigue, therapy discomfort, and wherever else negative there is that's beyond disliking masking up and the AWOL Dr. Dolittle. I'd do daily entries. This will be your important fact book IF an ASV is needed later.