Not sure if I really need treatment

[dbcyclist]

I'm new to all this and am beginning to wonder if I even need to be treated for Sleep Apnea. I am a 59 year old male, 5'6", 135 lbs. I exercise regularly and am in excellent health, except for mild high blood pressure - 135/90 (untreated). I went to a sleep clinic because my wife said several times during the night it seemed I wasn't breathing, and sometimes gasped to catch a breath. I also snore occasionally.

I had an overnight sleep test at a clinic and was given a lengthy report, which was very hurriedly discussed with me by the doctor during follow up. My results were an AHI of 7.6 and an OA + OH index (AHI) with 3% + 4% OH's of 12.76 (these are taken verbatim from the report). There is a lot of other data I can provide if useful.

I fall asleep quickly, wake up at 5:00 AM ready to go, sleep well overnight, etc. I rarely feel tired during the day, and never take naps. My energy levels are great. I wrote all of this on my pre-appointment questionnaire.

At my follow up, I was immediately prescribed CPAP therapy, which I am in my second week of. I'm adjusting fairly well, but am sleeping a little fitfully. But the more I read, the more I wonder if I really need it, or (I hate to be suspicious) if I was needlessly prescribed treatment. I'm willing to stick with it if there are benefits, particularly if if lowers my blood pressure and keeps me off medication.

The ResMed MyAir tracking that my machine supports says I'm having 15 Events (AHI) per hour some nights, which is twice what I had during my sleep test when I wasn't using a CPAP. Maybe that's attributable to restlessness overnight?

Any opinions on this would be most welcome. As I said, I have a full copy of my report and can furnish more information as needed. Thanks in advance for any help figuring this out!

[Crimson Nape]

Hi dbcyclist!



Based on an initial reading of your numbers, I don't see anything that would lead me to think you would qualify for a CPAP. I would suggest that you get #SleepyHead to see a more detailed review of your numbers. Also, Did your report include any SpO2 levels?

[Sleeprider]

It's concerning that MyAir is showing you are having more events than prior to starting therapy. It could be restlessness, but I think 15 events per hour (over 100 events per night) is quite high for that explanation. My suspicion is that you are perhaps experiencing clear airway (central) apnea.

Your sleep study suggests mild obstructive apnea. It appears you were prescribed an auto adjusting CPAP machine and give instructions to self-titrate, rather than having a sleep study to determine your pressure. We really need to get to the bottom of this. About 15% of patients prescribed CPAP for obstructive sleep apnea develop mixed or complex apnea symptoms when put on CPAP. This would be characterized by numerous central apnea and hypopnea (CA + H).

The answer to this lies in your machine. You can look at the machine data by downloading #SleepyHead, installing it on a computer, and uploading the SD card in the side of your machine. My signature has links showing how that data can be organized and posted. Alternatively, your machine will give summary efficacy data. Look at your machine's display and use the knob to select your sleep report, then scroll down. You should see total AHI, OA, CA, H as listed events. If those are not visible, then the reporting module may be set to "Essentials" in the options menu. To change that to Plus, you need to press the control knob and home button at the same time. This puts the menu in provider mode. Select Settings and scroll down to where it says Options: Essentials. Select essentials and select Plus. Then Exit. Your machine will now show detailed sleep data on-screen.

I look forward to learning what your breakdown of events are (CA, OA, H), so we can help further. If what I suspect is true, then you do probably need to discontinue CPAP and consult your doctor regarding CPAP induced complex apnea.

[zonk]

[should say "AutoSet, AutoSet for Her, Elite or CPAP"]

The name of the machine listed in your profile (Machine: ResMed Airsense 10) is not complete
Please take a second and add the model name, so we know what sort machine are we talking about
Also, add pressure settings, if unsure, here is a useful link shows in pictures and how to get the clinical manual for your machine http://www.apneaboard.com/resmed-airsens...setup-info

[richb]

I second Sleeprider's initial suspicion. Install Sleepyhead and find out what is going on.

Rich

[bons]

What is the breakdown for AHI? Your sleep study results should give you an overall AHI plus one for each sleep position. For example my average AHI was 9 but when I was on my back it was 29. So even though my average was mild sleep apnea the breakdown indicates that cpap was needed.

Like you, my AHI doubled when I started therapy. I was quickly bumped to an ASV and my AHI is below 1 now. My

[dbcyclist]

Hi Zonk. All it says where you highlighted in the photo is AirSense 10, then below that it says CPAP. I'll add "CPAP" to my profile.

Thanks.

[Sleeprider]

That machine does not provide useful efficacy data, A.K.A. "brick".

I would call the doctor's office and let them know you are having an unspecified AHI up to 15. Unfortunately they gave you the bottom of the line machine. How did they determine the pressure to set it at? Did you have a titration study you didn't mention?

[dbcyclist]

Thank you for your quick and thorough reply. I've attached the first 3 pages of my sleep study - the remaining 5 pages were graphs. I did have another overnight where they fitted me for a CPAP and adjusted my pressure. I don't have any results, but have a follow up appointment in 3 weeks. I do see on the bottom of the machine, they put a sticker saying my pressure is 7 cm H20 with a 20 minute ramp period.

My first night was last Saturday, but I hadn't signed up for the MyAir app, so I don't have any information. Sunday I had 4.7 events/hr, and got 11 of 20 points for mask seal (higher is better). Monday I had 16 events/hr, and 12 of 20 points for mask seal. I had been using a ResMed Mirage FX nasal mask and was having significant problems with mouth breathing and/or air expelling through my closed mouth, so I switched to a ResMed Quattro Air full face mask starting Wednesday.

Tuesday I didn't use the machine because I hadn't received the fulll face mask yet. Wednesday I had 15.3 events/hr, but 20 of 20 points for mask seal, so it seems the full face mask took care of that problem.

My machine doesn't have an SD card. It transmits data wirelessly presumably through the cellular network. I will work on installing SleepyHead software, but I don't know if I can get the data without an SD card. I did change my machine setting to "Plus" for reporting. It does display some additional data at the bottom of the report (Leak 30 L/min, and AHI 10.9), but I think those numbers are since I started using the machine. Now that it's set for Plus data, hopefully it will display detailed information specific to each night starting tomorrow.

I really appreciate everybody's input.

[Sleeprider]

I'm pretty sure there is a SD card hiding behind the upper door on the left side of the blower. All the machines can transmit data by wireless CDMA back to Resmed, so your provider can view it. If you have the CPAP model rather than the Elite or Autoset, the data will be minimal.

Since you were able to navigate the settings menu to set the data on Plus, you can also see the pressure and other settings like EPR (exhale pressure relief). It's still very early in your therapy experience, but I would not normally expect to see events at a higher rate than your sleep study. If that trend continues, you will need to discuss with the doctor. Meanwhile, I would get in touch with the sleep clinic or doctor and get details of the study where they determined your pressure. It will show what pressures were tried, and the results of those trials and types of apnea observed while on CPAP.