Is it Working?

[shinkdavid]

I have been on a CPAP for five years at a pressure of 20. My sleep study results indicated my AHI was 161. Since using a CPAP, my numbers are always very low (normally less than 1), however, I still feel tried all the time. It seems it is doing the job in regards to preventing apneas but hasn't increased the quality of life very much. My sleep doc said for some, the brain becomes conditioned to wake up and the CPAP can't do anything about that. All it can do is keep my airway open. Any advice?

[DeepBreathing]

An untreated AHI of 161 is one of the highest I've seen. Likewise, running at a constant pressure of 20 is unusual, and not likely to be conducive to restful sleep. Perhaps you can expand on your condition and share any details of your experience, symptoms etc. In particular, do you get central apneas or is it completely obstructive? Do you have any other conditions which might contribute to your tiredness, such as thyroid problems?

I'm not sure what to make of the doctor's comment - the brain is plastic and can be retrained, though it gets harder as we get older. I'm wondering if a bilevel machine might not be a better fit for you. Has this been suggested?

[shinkdavid]

Honestly, I do not know what the difference is between central sleep apneas and obstructive. The doc downloaded my data and said everything looks good. I have never had it explained to me in that sort of detail. 

He seems to think 20 pressure is fine. I actually know very little as they don't explain a whole lot. As long as things look good on their end, they don't say much. And if they did, I don't think it would make much sense to me as the 'lingo" is confusing.

[shinkdavid]

I have to say, it is interesting how little education they provide in regards to sleep apnea. They run the tests, give you a dx, tell you your AHI, give you a machine and send you on your way. I am a firm believer in patient education and it just doesn't seem to be a priority and it should be. I should know what these terms mean. I have been on a CPAP for five years. But everything has been going well so I didn't bother learning on my own and no one cared to explain things in a way that makes sense to the average person.

[Timur]

.. running at a constant pressure of 20 is unusual, and not likely to be conducive to restful sleep.

.... I'm wondering if a bilevel machine might not be a better fit for you. 

I agree.

[Gideon]

Some titration protocols state that a CPAP pressure of 15+ should be considered for a shift to BiPap.

That said you may be doing fine at a constant 20, but if we could look at your charts we may see something.  So if you would download SleepyHead and upload your charts we will be able to interpret them and give you our thoughts on what is going on.  Be sure to ask about any details we bring up that you do not understand as we will be happy to break them down.

See my signature for the how to.  

Fred

[shinkdavid]

Some titration protocols state that a CPAP pressure of 15+ should be considered for a shift to BiPap.

That said you may be doing fine at a constant 20, but if we could look at your charts we may see something.  So if you would download SleepyHead and upload your charts we will be able to interpret them and give you our thoughts on what is going on.  Be sure to ask about any details we bring up that you do not understand as we will be happy to break them down.

See my signature for the how to.  

Fred

I followed your directions and here is a graph from when I was using my other machine. Obviously, it is just a snapshot of one night. Let me know if this provides you with anything useful. Thanks, David

[Sleeprider]

Shinkdavid, the above chart shows 20 cm fixed pressure with 3 cm of EPR produces very good results for you. The EPR works effectively like a limited bilevel, and affords you some greater comfort than a fixed pressure without pressure relief. A bilevel could certainly be justified for you because you are at the top of the pressure capability of CPAP, and clearly benefit from "pressure support", in this case a bilevel pressure of 20/17. you might find auto bilevel, or fixed bilevel with PS 4.0 may be even more comfortable. Hopefully your pressure needs are stable, but if the obstructive index were to increase, you really have no place to go with CPAP other than to start limiting EPR.

[OpalRose]

Have to agree. Have you had a discussion with your doctor about a bilevel in your future?
There is nowhere to go with a pressure of 20. Your comfort level should be the topic of discussion with your doctor.

[sonicboom]

In the end how you feel is much more important than obtaining the lowest possible AHI.  For example, many times people report feeling much better with a higher AHI score than with a lower AHI score.  Clearly, although your score is around 1 you are not feeling any different.  Therefore, something else is likely going on.  The definition of insanity, it has been said, is doing the same thing over and over again but expecting a different result.  Time to get with your doc and insist on further medical evaluations that would account for your on-going symptoms despite effective PAP therapy.  Its been 5 years and you report still feeling tired all the time.  Welcome to the Board.