Flow Rate Graph, Mini Arousals - Experts Needed

[mper6794]

We strongly recommend that members not give or seek advise privately off the forums.  No one here shoud be pretending to be so expert that there can't be a second opinion from other members.  There are a lot of reasons, but it is actually a policy among the forum staff we won't do this, and while I'm sure Mper means well, this is not something you should pursue.

.....got the message, Sleep Rider. Thanks.
.....I was just trying to answer what I had interpreted as had been requested. No problem with other opinions, whatever the content; learning a lot in this Forum, including rewiring myself.

ALL the best

[Sleeprider]

Hallra, we have a wiki that describes our preferred organization for your OSCAR chart because that information is the most helpful in interpreting any issues. http://www.apneaboard.com/wiki/index.php...ganization. From most to least importance are:
Event Flags
Flow Rate
Pressure
eak Rate
Flow Limit (Resmed only. Respironics includes Flow Limitation in Events)
Snore

Your last chart has most of that information, so what we see is, wth pressure 6.6 to 20 with EPR 3, a very low AHI of 0.59 conssting of some sporatic CA and H events. Respiratory volume is normal to high, and respiratory rate is below normal at less than 10 bpm which meets your minute vent needs. There is no evidence of obstruction or noticeable flow limitation, and I would guess the few events you have are mostly a result of a normally snow respiration rate. Respiration rate was slightly higher with EPR at 2 earlier in this thread and I don't see a significant benefit to EPR 3 vs EPR 2, so use whatever is more comfortable. I don't see any need for higher pressure support from bilevel, and I don't see the UARS arousals Mper has talked about. No close-up chart posted to date shows any restriction in airflow. There continues to be no evidence of upper airway restriction that would require a MAD or changes to therapy.

My conclusions and analysis of your therapy have not changed much since post #11. That does not mean you don't experience disruptions to your sleep or poor sleep quality, but it is my opinion those problems are not related to the CPAP therapy which shows good effectiveness in every observable way. Something I commonly see when people start CPAP therapy, they connect all sleep and health issues to that therapy. I think your therapy is consistently good and you need to look at other aspects of your health, sleep etc.

[hallra]

hallra, I don't know your English health system so you have to fill in blanks that are appropriate in your area of the globe. Here in the US, most doctors can script a CPAP machine in the various styles available. This is after you obtain a patient/doc working relation. Here in the US we have primary docs, specialists, dentists, etc that could write a PAP script and make patient notes of medical necessity. The goal is to get health insurance to pay for a PAP machine.

I don't know yet if the editing of settings of the current CPAP has met its limit in attempts at giving you the therapy necessary to fulfill your unique needs. We each need PAP therapy to match our specifics, so this is not just unique to you. There is a time factor in getting the proper therapy dialed in and another time factor in getting used to it. I personally think these 2 time segments are ones you set on the line of I'm willing to allow this much time to gain a benefit and such similar concepts. The total package of therapy needing to address your sleep health includes a PAP package and needs to allow things that address other health needs as applicable.

Right, I will try to explain as best I can, it is very different to the US...

We have two different systems, one public and one private... I'm currently taking advantage of the private one but will eventually end up under the public one...


Private

Through my work, I have private medical insurance that I pay for, that has history disregarded, which means my medical history doesn't rule me out from receiving treatment... However there is an out patient limit per year of £3000, which means I can only see consultants in clinic to the value of £3000 in one year and then no more until the next year.... Certain diagnostics tests come out of that £3000, certain tests don't... However there are other clauses, once a condition is diagnosed and it then becomes known thing that requires long term monitoring, the insurance company can walk away and remove cover, this is where the Public system takes over.... 

On top of this my work policy has specific clauses for sleep apnea, that are applicable for the life of the policy:

 1 Overnight Sleep Lab Test to Diagnose Sleep Apnea
 Upto 4 Overnight Sleep Lab Tests to test CPAP Machine
 
The policy does not cover any equipment, drugs, etc, this means that I have to pay for the CPAP machine myself...
- The policy does however pay for the cost of CPAP trials.


Public

This is the one run by the Government, pay for by the Tax system, it is free, everyone has access to it, it is the fail-safe, it is where I will eventually end up with my sleep condition, it is very good, however it is badly under resourced, underfunded, which means it can be very slow, equipment is provided free but isn't necessarily the best available, there are lots of restrictions, the criteria to get equipment is somewhat impossible to meet, impossible to qualify, criteria is written on financial terms not on medical needs...

The Government is deliberately destroying the public system on the sly, to move to an American style health care system, whilst telling the public it would never do such a thing...  

I've only ever got one home based study in 16yrs out of the public health care system, no sleep lab test, then anti-depressants were chucked at me, because that's was a cheaper method of treatment...



The problem I have now is that even on the private side, cost cutting by both the private insurance companies and the doctors themselves is driving down the quality of treatment to such an extent, that I'm simply not getting any effective treatment whatsoever... hence I'm here today in this mess of seeing a sleep doctor who is more interested in fleecing me for profit than actually treating my sleep issues effectively...

[SarcasticDave94]

Not a lot different than here then.

[hallra]

Hallra, we have a wiki that describes our preferred organization for your OSCAR chart because that information is the most helpful in interpreting any issues. http://www.apneaboard.com/wiki/index.php...ganization. From most to least importance are:
   Event Flags
   Flow Rate
   Pressure
  eak Rate
   Flow Limit (Resmed only. Respironics includes Flow Limitation in Events)
   Snore

Your last chart has most of that information, so what we see is, wth pressure 6.6 to 20 with EPR 3, a very low AHI of 0.59 conssting of some sporatic CA and H events. Respiratory volume is normal to high, and respiratory rate is below normal at less than 10 bpm which meets your minute vent needs.  There is no evidence of obstruction or noticeable flow limitation, and I would guess the few events you have are mostly a result of a normally snow respiration rate.  Respiration rate was slightly higher with EPR at 2 earlier in this thread and I don't see a significant benefit to EPR 3 vs EPR 2, so use whatever is more comfortable.  I don't see any need for higher pressure support from bilevel, and I don't see the UARS  arousals Mper has talked about. No close-up chart posted to date shows any restriction in airflow.  There continues to be no evidence of upper airway restriction that would require a MAD or changes to therapy.  

My conclusions and analysis of your therapy have not changed much since post #11. That does not mean you don't experience disruptions to your sleep or poor sleep quality, but it is my opinion those problems are not related to the CPAP therapy which shows good effectiveness in every observable way.  Something I commonly see when people start CPAP therapy, they connect all sleep and health issues to that therapy.  I think your therapy is consistently good and you need to look at other aspects of your health, sleep etc.

Thanks for your input and don't worry, I am not letting any ones particular input drive me off on any particular tangent, i'm an old hat and too experienced with doctors doing that to me, let alone strangers on an internet forum... 

i'm just taking in all information and treating it all with caution...

As you will know, I've done the charts as shown on the Wiki pages, Mper asked for a different layout and I've entertained him as I was intrigued to see what he is coming up with... This is a open forum and as such different opinions should and must be encouraged.  

Your own conclusions are valid and are agreeable, I'm just going through these things at an early stage due to my sleep doctor pushing this dental solution, when I think he shouldn't be, I should be given time on CPAP and see how things go....

[slowriter]

Well, and pay attention to, and try to optimize, all the other variables that impact sleep: exercise, consistent sleep schedule, diet, medication, stress management, etc.

If the maintenance insomnia is primarily a consequence of the CPAP therapy, or is significantly exacerbated by it, you could always ask for prescription sleep meds to help with the adjustment?

That's what I did; I only took them on nights before particularly intensive days at work though.

Or consider CBTI (cognitive behavioral therapy for sleep), a primary component of which is sleep restriction therapy (basically constraining your sleep schedule so as to result in one consolidated block, and then gradually expanding it until you get the right amount of sleep).

[Sleeprider]

The graphs suggested by Mper were useful and confirm a pretty steady respiration rate and volume. I would have expected some spikes with arousals. Please don't take my disagreement of his conclusions as any disrespect. We have both agreed and disagreed before.

[slowriter]

The graphs suggested by Mper were useful and confirm a pretty steady respiration rate and volume.  I would have expected some spikes with arousals. 

FWIW, hallra, I was diagnosed with UARS last Summer based on an in-lab sleep study, and started with APAP then, and migrated to bilevel (a vauto).

Your charts now look better than mine with a highly-optimized bilevel.

[jaswilliams]

Hallway I am in the UK and I feel your frustration but bare in mind that as others have said not all sleep issues are sleep apnoea. I consider the Autoset machines give us the equivalent of an overnight sleep study every night. I see nothing here that shows your poor sleep as sleep disordered breathing. Sorry but that’s my thoughts looking at your graphs, I would be looking elsewhere such as medications, sleep hygiene and similar

[sheepless]

hallra, it appears no one else thinks the hairbrushy flow rate you posted in your earlier thread is an issue. I thought there might be something there but apparently I was wrong and that's good for you! many things besides apnea can cause lingering fatigue. as one example, while things are much better for me, I'm still struggling after more than 3 years of papping - in my case largely due to periodic limb movements. I've never tried it but they say cognitive behavioral therapy helps pin down and resolve some issues (not sure but I think issues related to sleep hygiene). otherwise you might keep a journal looking for hints and/or use a digital video camera to see if that turns anything up.