New -Maybe too soon to ask for another study?

[lhfarm]

I am brand new to this sleep apnea world.  I'm 71, mostly healthy (on mild BP and prostate meds only) and physically active.  I underwent the sleep study because of my severe snoring.  My wife has been forced to wear noise canceling earbuds for the last couple of years.  No other sleep problems and I always felt rested and refreshed.  Normally slept 8-9 hours.  I am also a mouth breathing side sleeper..

I underwent the first study in December.  I was sure I didn't have sleep apnea, just a snoring problem.  I was wrong.  Because I was so sure, I hadn't done my research and went into the process completely uninformed.  I did ask the doctor if I might try weight loss before getting a machine and he said he didn't think I need to loss that much weight 

Here is the summary of the test -
RESPIRATORY SUMMARY: Diagnostic: Apneas: Obstructive apneas 46, mixed apneas 1, central apneas 0. Hypopneas: Obstructive hypopneas 69. Apnea-hypopnea index 30.2. Oxygen saturation low 87%.  

And the second study -
IMPRESSION: Obstructive sleep apnea, severe, diagnosed on study of 12/13/2017, apnea-hypopnea index 30.2, oxygen saturation low 87%. Incomplete CPAP titration was part of that previous study. Obstructive sleep apnea responsive to BiPAP. The patient was unable to tolerate CPAP and required BiPAP. During titration to higher pressures, while the patient experienced REM sleep, he developed treatment emergent central apnea. At BiPAP of 20/15, the patient had central apneas 14, obstructive apneas of 5. Severe snoring pretreatment improved during positive airway pressure treatment. Severe periodic limb movements improved at higher BiPAP pressures.  A trial of BiPAP at 20/15 is recommended with close monitoring of the status of his central events with review of compliance reports. Alternatively, a VPAP titration study may be ordered to initiate treatment with VPAP due to treatment emergent central events. Consultation with a sleep physician may also be beneficial. 

I was given a PR Dreamstation BiPAP with pressures at 20/15, a full mask and little to no instructions.  The first few nights were terrible, until I found this site and started reading.  I downloaded SleepyHead and began monitoring each night.  I reported the improvements in my first note to this board.  With slightly lowered pressures  17/12 and a CPAP pillow I am sleeping well with my AHI readings less than 3.0.
 
My major concern is the number of clear airway events.  Are these indicators of central apneas?  Should I be concerned? Should I be pushing for another study  or is it too soon?  Or should I try a gradual lowering of the pressures?  I don't have a follow-up appointment for six weeks.

Thanks,
Barry

[Walla Walla]

I would put your machine in auto mode. Set your minimum pressure to 12cm and your maximum pressure to 20cm and reduce your Pressure Support to 4cm.
That will allow the machine to adjust for obstructive event and the reduced PS should help with the CA's.

[lhfarm]

I would put your machine in auto mode. Set your minimum pressure to 12cm and your maximum pressure to 20cm and reduce your Pressure Support to 4cm.
That will allow the machine to adjust for obstructive event and the reduced PS should help with the CA's.

Thanks!  Since I've only been at this 3 weeks, do you think I'm getting ahead of things?  I have just sort of freaked about the numbers, without a full understanding of what all this means.

Barry

[freetime]

I would put your machine in auto mode. Set your minimum pressure to 12cm and your maximum pressure to 20cm and reduce your Pressure Support to 4cm.
That will allow the machine to adjust for obstructive event and the reduced PS should help with the CA's.

Thanks!  Since I've only been at this 3 weeks, do you think I'm getting ahead of things?  I have just sort of freaked about the numbers, without a full understanding of what all this means.

Barry

Is your snoring under control?
It is easy to get freaked out by something we are not accustomed to measuring. You went from 46-30 AHI to under 3. That is a good start for 3 weeks in. Can Walla suggestion help you, probably yes. Your idea, of lowering Max pressure might help too.
If this was me and my snoring was under control, I would wait another week or two.
I would not get another sleep study. How would it help, and what would you do with the information?

[lhfarm]

I would put your machine in auto mode. Set your minimum pressure to 12cm and your maximum pressure to 20cm and reduce your Pressure Support to 4cm.
That will allow the machine to adjust for obstructive event and the reduced PS should help with the CA's.

Thanks!  Since I've only been at this 3 weeks, do you think I'm getting ahead of things?  I have just sort of freaked about the numbers, without a full understanding of what all this means.

Barry

Is your snoring under control?
It is easy to get freaked out by something we are not accustomed to measuring. You went from 46-30 AHI to under 3. That is a good start for 3 weeks in. Can Walla suggestion help you, probably yes. Your idea, of lowering Max pressure might help too.
If this was me and my snoring was under control, I would wait another week or two.
I would not get another sleep study. How would it help, and what would you do with the information?

Snoring is under control.  My wife is still wearing the earbuds because of the machine noise, but not my snoring.   I have no points of reference, so without looking at the data can't really tell if I had a good night or not.  As I stated I wasn't having problems sleeping and now when I wake, my face feels puffy and I feel almost drugged.  It isn't horrible and I am getting better with each night.

I was so uncomfortable my second test, that I don't believe it was accurate.  I have a mustache and the first mask never fit.  I rang the buzzer and asked for a different mask.  That helped a lot and is the same mask I'm using now.  However, I've not slept on my back for years and still can't comfortably with the machine.  I never relaxed during the test.  I wondered about a repeat test with my mask and pillow.  I'm sure I can replicate the process by starting to gradually lower my pressures and see what happens.

Bottom line is I am really concerned about the report statement "he developed treatment emergent central apnea."  Seems to me the treatment has created a more of problem for me than the benefits of stopping the snoring.

Barry

[jaswilliams]

There is no need for another sleep study, if you are open to making changes and regularly posting graphs we can help you settle in and get better ahi figures. If the CA’s are pressure induced they will diminish after up to 12 weeks

[lhfarm]

There is no need for another sleep study, if you are open to making changes and regularly posting graphs we can help you settle in and get better ahi figures. If the CA’s are pressure induced they will diminish after up to 12 weeks

I am open to making changes and to posting results.   I'll go back to my original question.  Am I expecting too much too soon?  Should I stay at the current 17/12 pressures for another week or so and then post again or drop back  to say 16/11?

[Walla Walla]

Yes your expecting too much too soon. It takes time to get the machine zeroed in. It also takes awhile for you to feel the benefits. But don't worry you'll get there. In your going to stay at a fixed pressure, I would at least drop the pressure support (PS) to 4. If that doesn't help clear up the CA events in the next day or two than drop it to 3. A lot of times a large pressure suppost will cause CA events.

[Sleeprider]

Ihfarm, treatment emergent central apnea is not uncommon, and the usual recommendation is to start the individual on conventional therapy, and re-evaluate after a month or two to see if the central apnea is still present. In your case, the chart you posted shows an AHI of 2.51 of which 1.5 events per hour are central. That is actually pretty good. You report that at 17/12 (PS 5), you are sleeping comfortably and AHI is less than 3.0. That's great.

The suggestion for auto-pressure is a good one, but another alternative might be fixed pressure with a little less PS at 16/12. Varying pressure can increase CA events, but increase comfort by keeping pressures lower. It might be worth a try.

[lhfarm]

Thanks everyone!  I feel much better and certainly more comfortable with where I am.  I'll be back in a week or so with some more results.

Barry