[Diagnosis] Help Required- Type of Equipment required

[rchandrasekhar1975]

Hi All,

I am a new member & this is my first post. 
I had been diagnosed with obstructive sleep apnea with AHI index of 31, 5-6 years back and had been using Philips CPAP with a H20 flow of 11cm. I have no explanation other than brain freeze that I never looked into generating & checking with doctor on the reports subsequent to use of the machine.
Well today, the machine is not in a repairable condition and I opted to go for self-sleep study through Res-med where they couriered a machine & after the self-sleep study, the report was sent to me ( attached herewith).
The Resmed sleep coach explained that my AHI now is 67 and hence, normal machines with pressure of upto 20 will not suffice & i require a bi-level machine.
The report shows that I was in supine position most of the time during the sleep study due to the fact that with machine attached to my chest, I could not sleep in my favourite position which is either to left or right but not supine.

My queries are for which I request your support.
1) Would the sleep study report have been compromised due to my forced to sleep in supine position unlike my normally favoured sleep position of left or right
2) Do I actually require the bi-level machine as it is an expensive one. I would have preferred the machines with pressure upto 20 (costing less) but I am being told by the Resmed sleep coach that I require pressure above 20 
3)  Which other company brand will be much more affordable ( I am  posting from India)

 I sleep with 2 thin pillows under my head & over the course of the sleep, I remove one pillow.

Links to my sleep report are given below:



.
Looking forward for your advice/revert on above queries.

Thanks,
Chandrasekhar

[Gideon]

While you slept on your side you had severe Sleep Apnea of 49.
The only way to absolutely tell if you need a BiLevel is to fail on a CPAP/APAP.
The Sleep Study suggested a ResMed AirSense 10 AutoSet at 4-20, I'd suggest 7-20 EPR=3 FullTime Review after a couple of nights because it will need adjusting.
The ResMed devices cost more than other brands but the efficacy you get with them is better than other brands and you want something that is compatible with OSCAR.
The VAuto, an Auto BiLevel would be the next machine in line for treating OSA because its PS is much more flexible and extensive than what you get with an AutoSet.


IMHO the sleep study was not compromised.

[SideSleeper]

I was concerned with something I know a little more about--breathing rate. Your average was 102--anything over 100 is tachycardia--fast breathing. Your high rate was over 200--that is dangerous! Have you ween a heart doctor (cardiologist)? I have congestive heart failure and for awhile had bouts of tachycardia which has subsided with the heart failure medications I now take. I'd advise talking to your doctor about that.

[Gideon]

SideSleeper, tachycardia is fast heart rate, not breathing rate.

[pholynyk]

Gideon - the numbers sidesleeper quoted were off the heart rate line in the ResMed report, so the caution about calling a cardiologist is warranted.

[Gideon]

Agreed, but he was repeatedly calling it a breathing rate.

[Sleeprider]

First, the sleep test appears to be a diagnostic test without therapy pressures being used. The prescription is a default 4 to 20 pressure which can be provided by CPAP and has nothing to do with bilevel pressure. What we really need to see is data from sleep with therapy pressure in use. I can see from the test results, the worst apnea occurs while supine and looks positional. The apnea hypopnea index is severe, with very severe desaturation consequences.

The advantage of using bilevel therapy would be increased comfort and control of flow limitation and hypopnea, however your test prescription is a simple CPAP with default pressures. If you can obtain a Resmed Airsense 10 Autoset and use a pressure range of 9.0 minimum to 20.0 maximum with EPR 3 (exhale pressure relief), you would be getting bilevel pressure within the parameters recommended by the doctor. I am nearly certain that if you do this and post results, we can help you to optimize the treatment to get very low AHI. The Resmed Aircurve 10 Vauto allows for more pressure support, and maximum pressure to 25 cm, however that is not a component of the prescription. We need to see what your results look like under therapy pressure, and if the "positional" apnea continue, we may just suggest an aid to keep you from tucking your chin.

You can get good results with auto-CPAP, preferably Resmed, and your doctor may be prescribing BiPAP, but his prescription has no BiPAP component in it.

[rchandrasekhar1975]

Hi All,

I am a new member.
I had been diagnosed with obstructive sleep apnea with AHI index of 31, 5-6 years back and had been using Philips CPAP with a H20 flow of 11cm. I have no explanation other than brain freeze that I never looked into generating & checking with doctor on the reports subsequent to use of the machine.
Well today, the machine is not in a repairable condition and I opted to go for self-sleep study through Res-med where they couriered a machine & after the self-sleep study, the report was sent to me ( attached herewith).
The Resmed sleep coach explained that my AHI now is 67 and hence, normal machines with pressure of upto 20 will not suffice & i require a bi-level machine.
The report shows that I was in supine position most of the time during the sleep study due to the fact that with machine attached to my chest, I could not sleep in my favourite position which is either to left or right but not supine.

My queries are for which I request your support.
1) Would the sleep study report have been compromised due to my forced to sleep in supine position unlike my normally favoured sleep position of left or right
2) Do I actually require the bi-level machine as it is an expensive one. I would have preferred the machines with pressure upto 20 (costing less) but I am being told by the Resmed sleep coach that I require pressure above 20 and those machines are substantially higher in cost
3) Which other company brand will be much more affordable ( I am posting from India)

I sleep with 2 thin pillows under my head & over the course of the sleep, I remove one pillow.

The links to my reports are:
https://imgur.com/qmXsBW4
https://imgur.com/qEM198o
https://imgur.com/IyUYqAZ
https://imgur.com/Cu4HxJl

Today, I visited a "Sleep Specialist" and I have been advice to undergo a titration study basis which what pressure of air is required and what type of machine is required will be clear.

I will be getting the titration test done in this week.

Looking forward for your advice/revert on above queries.



Thanks
Chandrasekhar

[Sleeprider]

Chandrasekhar, I merged your last thread with the previous thread concerning your question on what equipment you need. I interpreted your sleep study that was included in the original thread, and also the new one, and this new post simply expands on the previous information, so my answer in post #7 still applies. The additional information seems to confirm that the use of two pillows may encourage a positional apnea as discussed in this wiki article.

Your immediate need is to obtain a CPAP or bilevel therapy device, and I continue to believe the Resmed Airsense 10 Autoset CPAP or Resmed Aircurve 10 Vauto bilevel are your best choices. As you properly note, the bilevel is much more expensive, however, the Autoset also has a feature called EPR that gives you limited bilevel therapy with up to 3-cm difference between inhale and exhale pressure, and provides up to 20 cm pressure consistent with your prescription. It is my recommendation you try to hire or purchase a Resmed Airsense 10 Autoset. I already suggested a minimum pressure of 9.0, maximum pressure of 20.0 and EPR 3.