I need some advise please [on AHI results]

[Jarhead1947]

Good Afternoon,

This is my first post, other than a reply. A bit of background info might be fitting. I am a 71 y.o combat disabled Marine. Among other ailments I have severe sleep apnea. I was originally diagnosed in 2004, (as i remember, 47 AHI events were noted) tried a machine for about 2 months, could not get used to it and stopped using it. I probably had sleep apnea since 1981 when the symptoms of PTSD hit me, but I was running around like  crazy man trying to figure out what was wrong with me. I did not realize at the time the adverse effects sleep apnea could have on the body and psychic. Fast forward to November of 2007. I had gone through a lot of therapy both chemical and psychological but could never find a solution as to why I was continually tired and fatigued. My primary care physician at the VA suggested some of my symptoms could be caused by sleep apnea and he advised a sleep study. So I had an in-house sleep study at the Lake Nona VA Hospital in Orlando, Florida, which suggested sleep apnea with 31 AHI events. I was put on a ResMed Air Sense 10 CPAP machine. I have tried 4 different Res Med Masks but after changing masks and having my pressure changed many times, I was not able to stop the leakage nor get my AHI numbers lower than 30. I was switched to my current machine, ResMed AirCurve 10 VAuto and using the Resmed airfit N20 small. Still after an adjustment, my AHI is at 28. I have attached screen shot of the sleepy head parameters. I am being followed with a Sleep Medicine physician and Nurse Practitioner and communicate with them weekly via secure messaging. I have not showed them this weeks results but thought an opnion by those in this board might be wise before I talk to them again.

So, to make a long story short, I am asking for your collective opinion on what might be causing no decrease in AHI and what to try to do about it.

Thank you in advance for any advice you might be able to give

I remain, respectfully,

Hal Burke
Semper Fi

[gwc2795]

Hal
Welcome to the forum

And THANK YOU for your service.

Some of the guru's will be along shortly.

In reading your info the only question that comes to mind is have you tried a full face mask?

Gerry

[Jarhead1947]

Gerry,

Thank you for your reply and you are welcome.

I tried it for the first week and could not sleep with it. Now that I am comfortable sleeping with the nasal mask, i am not adverse
to switching.

Let me hear what others say.

Thanks again, Gerry.

Hal
SF

[gwc2795]

My concern was the leaks. They could be positional but I am not sure, that is why I am waiting for the guru's.

[Ron AKA]

Some observations. Your AHI is almost entirely OA events. The CA events are very low. You are having many events when the machine is maxed out at 22 IPAP or 18 EPAP. From a machine adjustment point of view as a first step, I would reduce the pressure support from 4 cm to zero. Leave Max IPAP at 22. I believe that will give you 4 cm more pressure to help reduce the obstructive events. 

One question. Have you tried a cervical collar to see if that helps reduce the obstructive event frequency?

[Jarhead1947]

Ron,

Thank you. I have a flex cervical collar and will try tonight.

Thanks for the advice on pressures.

Best

Hal
SF

[Sleeprider]

Jarhead, I disagree with Ron on the idea that your problem requires pressure increases.  You have severe flow limitations, and we don't know entirely why, however all of your obstructive events begin when pressure rises.  I think you need to limit the maximum pressure, increase pressure support (the difference between EPAP and IPAP) and consider the use of positional therapy to prevent your airway from being closed by a poor alignment of your head and neck.  This positional therapy would consist of a soft cervical collar, and I know some other members with PTSD issues needed to ease into that due to stress it can provide.

What we can see in this chart is that you do pretty good at your starting pressure of 19/15. At about 22:30 there is a significant increase in flow limitations which increases your pressure to 22/18, and your airway basically shuts down.  We see a continuous string of OA at this high pressure.  

In order to try to prevent the flow limiations, I'm going to suggest a revision of settings as follows:
EPAP min 14
PS 5
IPAP max 22.

This will still allow your pressure to rise, but increases pressure support. In part we want to learn if the lower pressure initiates OA or if you tolerate that lower pressure, and we will watch the flow limitation and see if that is improved.  If you feel you can tolerate a soft cervical collar (2-1/2 to 3-inches tall and just enough comfortable support to prevent chin-tucking) then I think that might help matters. 

[Jarhead1947]

Ron and Sleeprider,

Thank you both for your advice. I made one change last night and that was to wear my flex collar. It was more than a bit claustrophobic, but i muddled through. I did not want to change more than one variable at a time. I will wear the flex collar for a few days before i make any changes.

I am attaching the sleep report for yesterday May, 4. I do not think it captured all the sleep data as it says I woke up at 4am. I did but went back to sleep till 0700. It shows myAHI went from 28 to 2. Im not sure if i believe those numbers but will look at it as one point in a continuum of points.

Once again thank you for your input and,

I remain, respectfully,

Jarhead,
Hal Burke
SF

---

Ron and Sleeprider,

Thank you both for your advice. I made one change last night and that was to wear my flex collar. It was more than a bit claustrophobic, but i muddled through. I did not want to change more than one variable at a time. I will wear the flex collar for a few days before i make any changes.

I am attaching the sleep report for yesterday May, 4. I do not think it captured all the sleep data as it says I woke up at 4am. I did but went back to sleep till 0700. It shows myAHI went from 28 to 2. Im not sure if i believe those numbers but will look at it as one point in a continuum of points.

Once again thank you for your input and,

I remain, respectfully,

Jarhead,
Hal Burke
SF

[JesseLee]

Jarhead,

Unfortunatly the last posts data inclusion was incomplete and inaccurate I believe as well.

I know that it is desirable to get immediate results and I like your course of limiting changes to one aspect at a time. I don't think you will hinder your troubleshooting capability if you change pressures per Sleepriders advice and wear the collar. The pressure change is good advice in my opinion and the collar is good advice as well. The min and max will not be so drastic a change in feel as the pressure support increase will be. I believe that getting used to the collar will be the biggest hurdle and the differences in therapy might help in events and in turn you will be better set to get used to the collar if that makes sense.

[Jarhead1947]

JesseLee,

Thanks for the feedback. It is ppreciated.

Jarhead
Hal