Help needed

[SteveC]

Please see attached redacted study.

This was a home sleep study, Resmed don't do overnight in clinic studies here in oz anymore.

I am not sure how accurate this is, the night of the study I tossed and turned a lot and felt I did not get a settled sleep, probably only a couple of hours of settled sleep.

Interestingly, the report shows CA's, but the Dr's summary on page one talks about OA's.

Regards,

Steve


  Sleep_Study.pdf (Size: 626.98 KB / Downloads: 13)

[SteveC]

Hi all,

Here is last night's data. it is all over the place.

   

[Jay51]

Steve, I am still seeing the CA's lining up with leaks.  And since your sleep study showed moderate obstructive sleep apnea (and didn't even mention CA's), the bulk of time and energy should be directed at decreasing your leaks.  Do you like you current mask?  I have about 5 here that I tried before settling on one.  Not trying to persuade you to buy more, but just saying.  Also, reading and rereadiing the "Mask Primer" may help a lot at decreasing leaks.  Also, increases in pressure can cause leaks.  But pressure has to be high enough in your case to combat the OA's.  

And there is of course treatment emergent central sleep apneas that can occur with some new users of pap; and takes a little time for the body to get used to and adapt.  It is strange you are having so many CA's now and had very few (not even mentioned in your sleep study summary).

[Sleeprider]

Steve, even though your diagnosis was moderate obstructive sleep apnea, your sleep study would suggest a better conclusion is moderate complex sleep apnea. By far, your diagnostic study featured central and mixed events and hypopnea above obstructive apnea. Your treatment with CPAP has left you with as many, or more events than documented in your sleep study, so efficacy so far in nil. It is likely that you will eventually require treatment with ASV (adaptive servo ventilation) which is capable of treating central apnea and hypopnea with pressure support that results in normal breathing, even with low or no spontaneous effort.

We need to do something a bit more radical at this point, then move from there. I want you to set the minimum pressure to 6.0 and the maximum pressure to 6.0, resulting in fixed pressure. You need to turn EPR off. This will give us a baseline with low fixed pressure to see if that can resolve the CA events. If effective we will make adjustments according to what results from this fixed pressure trial. If central apnea continues to be a problem at these settings, you will need to approach your doctor for a bilevel titration that moves to ASV if needed. The conventional process of going through insurance and testing for ASV can be expensive if you have high deductibles or copay requirements. Let me know if you have good insurance or not, because we can also advise you on obtaining machines out-of-pocket.

[SteveC]

Thanks Sleeprider.

I have read through the leak wiki and made three adjustments last night. Loosened the mask, turned off EPR and repositioned the hose to hang over the bedhead instead of just letting it hang to the side. Contrary to advice, I made three changes at once. 

However, last night was a huge improvement, see below.

Re the mask, I have tried a number of masks and settled for the Resmed N30I. gives me the least amount of leaks.

I am in Australia, access to medical specialists is a real problem here, not to mention the cost, although our Medicare system does cover about 70% of the  cost.

I am not confident with my current specialist, he has made a number of errors interpreting my data and told me I need to shave my beard off even though the N30I, which he has seen, goes nowhere near my beard.

I tried to change to the guy who produced the report, but he is only taking on urgent cases ATM and delaying all others.

I have been using the S9 on and off for years, but now I need to show it is working as here in OZ correct treatment is a requirement for renewing my driver's license at age 75 in a few months.

For now, I will leave the machine settings as is for a few days and see if the AHI continues to drop, then I will make the next changes as suggested one by one with a few days beteen changes.

I also have the option of going direct to Resmed at no cost, their premises are only a few minutes drive from me, but in the past their suggested changes have not worked.

The cost of an ASV here is about $AUD3500 for a basic machine, of which my insurance will pay $AUD500. I have to get a prescription for it from my doctor though.

It is possible my requirements have changed, I used to get really good readings, I have also attached one of those screenshots.

Regards,

Steve

       

[Sleeprider]

Well, if your AHI remains this low, we may be onto something that avoids ASV. It sure looks more encouraging than the 33 AHI you posted before. I'll keep an eye on the thread and help where I can.

[SteveC]

An update.

Last two nights have been relativley low, here are the screen shots.

The AHI is quite low until I wake up to go to the bathroom. Then it seems to climb as I go back to sleep. I have no idea why this is so.

The 3 bursts of leak on the 25th Feb correspond to the times I took the mask off to go to the bathroom.

Tonight I will set the pressure as advised to 6/6 and see whre we go from there.  

Regards,

Steve

         

[Sleeprider]

Steve, let's try that fixed pressure at 7.0. Set minimum and maximum pressure to 7.0, and let's see if that cuts events. Based on your diagnostic study and continuing clusters of CA, ASV may end up being the better answer. We will want to discuss how to approach your doctor on this pretty soon. How long have you been on therapy now?

[SteveC]

Hi,

On and off for 12 years.  

Last night set to 6 and no epr, Ai was around 10 after 2 hrs. I turned the machine off at that point as I have a very busy couple of days ahead and ATM I feel the machine is making my sleep worse.

One point though, with the N30I I wonder if when side sleeping the tube on the side of my head gets squashed and causes false readings, even though the tube is flat and my pillow is soft.

I am going to try and stick to back sleeping, although I know it can cause issues with chin tuck. However, doing a few tests seems to indicate chin tuck is not an issue for me.

I will not be able to look at detailed data for a few days.

I will change setting to 7/7 and see what happens.

[Sleeprider]

Maybe our focus should change to getting you the right therapy.