Second Sleep Study, oh oh...

[justMongo]

Having the tech decline to answer what pressure she is using at the moment is akin to being in the hospital and having a nurse take your blood pressure; then refuse to tell you what the reading is. I would have extricated myself from the facility immediately; and told the tech, "kiss your license goodbye."

No one treats me without my ongoing consent; which is contingent upon me getting full cooperation.

Live Free or Die.

[SnuffySleeper]

Having the tech decline to answer what pressure she is using at the moment is akin to being in the hospital and having a nurse take your blood pressure; then refuse to tell you what the reading is. I would have extricated myself from the facility immediately; and told the tech, "kiss your license goodbye."

No one treats me with my ongoing consent; which is contingent upon me getting full cooperation.

Live Free or Die.

Well she gave me a whole story on how she told someone and that person got all P*ssed off at the doctor why he didn't set the pressure correctly in the first place.

It wasn't really THAT important, as it would not have changed anything and I'll find out when I go see my doctor and get the sleep study report.

There was definitely a problem she had, but she didn't want to tell me and I felt a little sorry for her. Plus it's Canada, so it's free, no need to bust balls over it but I see your point.

*edit for grammar

[vsheline]

He's even said he doesn't like Apap as it's too late by the time the apnea is detected to be effective, and said he prefers constant pressure. So we'll see what he says. At least now I can be armed with more knowledge and better questions for him.

Point out that the minimum pressure setting can still be set at a level which is only a little below the pressure which a fixed-pressure CPAP machine would need, and the high pressure can be set high enough to provide extra protection in case you go into REM while on your back.

Even a small difference in pressure sometimes can significantly reduce aerophagia.

Also, point out that the ResMed Enhanced AutoSet algorithm adjusts the pressure faster than Philips Respironics machines do. (Some prefer more gradual adjustments and some prefer faster.)

[cant_sleep_in_nj]

im at a constant 14 and never a problem. i dont even bother with the ramping, i found it annoying. full blast, put the mask on and go to sleep LOL

[SnuffySleeper]

Well, just got back from my follow up appointment. Results were interesting. Seems with me, anything above a pressure of 10 causes Central Apneas. As my doctor puts it (I lose my will to breathe when the pressure is at 10 or above).

So that was why the tech had such a problem. She wasn't sure what to do, as the higher the pressure increased the Higher my AHI became topping out at a pressure of 15 with ALL central apneas at 47.8 per hour at that pressure.

So all that and my Doctor is just upping the pressure to 9 and calling it a day. Which I am happy with too! Needless to say it was an interesting second sleep study and I could see why the Tech could not tell me what the pressure was at since it did more harm than good.

I found it odd, has anyone ever heard of this? When the pressure reaches a certain point it causes more Central Apneas and a higher AHI than even without Cpap? Right now my AHI is fine at 9 but what happens when I need an increase? Is it just not possible with me?

[vsheline]

Seems with me, anything above a pressure of 10 causes Central Apneas. As my doctor puts it (I lose my will to breathe when the pressure is at 10 or above).

So that was why the tech had such a problem. She wasn't sure what to do, as the higher the pressure increased the Higher my AHI became topping out at a pressure of 15 with ALL central apneas at 47.8 per hour at that pressure.

So all that and my Doctor is just upping the pressure to 9 and calling it a day. Which I am happy with too! ...

I found it odd, has anyone ever heard of this? When the pressure reaches a certain point it causes more Central Apneas and a higher AHI than even without Cpap? Right now my AHI is fine at 9 but what happens when I need an increase? Is it just not possible with me?

Hi SnuffySleeper,

If this was your first titration study (if the doctor prescribed CPAP without your having been titrated first) then I don't understand why the doctor failed to originally prescribe an autotitratng (APAP) machine. The autotitratng feature can always be disabled and the APAP operated in basic CPAP mode if the non-adjusting mode is found to be best for a given patient.

Be that as it may, in a significant minority of patients CPAP therapy can induce central sleep apnea. This is sometimes called Complex Sleep Apnea or CPAP-induced Central Sleep Apnea.

This can be treated with bi-level Adaptive Servo Ventilator ("ASV" mode) CPAP machines or with bi-level "ST" mode CPAP machines which have a back up respiration rate, but I think unless our treated AHI is at least 5 or 10 or 15 (depending on insurance company) and unless the Central Apnea component is at least 5 per hr and makes up the majority of apnea events, treatment with an ASV or ST class CPAP machine is usually not covered by insurance in the USA.

Also, some (most?) patients find ASV machines to be harder to get accustomed to than standard CPAP, APAP or BiPAP machines, both because although the machine will try to synchronize itself to our breathing, sometimes it seems to have a mind of its own until we learn not to fight the machine, and also because higher pressures are usually needed, sometimes leading to worse aerophagia, higher leaks and the need for tighter straps, etc.

If a fixed CPAP pressure of 9 (with or without EPR) works for you at present and your AHI is staying below 5, your doctor's present treatment approach is likely best, at least for now.

One important thing you have learned is you need to be very sure that all night you are staying off your back, or a pressure if 9 will be inadequate.

Take care,
--- Vaughn

[SnuffySleeper]

Interesting. I guess I didn't need the apap since anything above a pressure of 10 would be harmful to me?

I am just not clear why this happens? asv sounds like a nightmare to me, being I am in my thirties and a regular cyclist, (I know I have a great set of lungs over others as I can do long bike races in my 20's without as much effort) having a machine that does ALL the breathing for me I would hate that.

My ahi tonight was .8 on a pressure of 9, so that seems fine. Even at 8 i was at 1.8 to 2.5 daily.

When I mentioned to my doctor about sleeping on my back he literally changed the subject...lol I don't think he wanted to tell me not to sleep on my back, but this is the impression I am under. Not a problem because I have not slept on my back for years now and am use to it.

Is there any reason why people get central apneas from a pressure more than 10? Why can some people manage these insane high pressures and with me a pressure of 14 induces 48 central apneas an hour? I guess I'll have to keep an eye on this, will this cause me problems when I am older?

Thanks,

[glfredrick]

I find it odd when people think that they cannot live with pressures in excess of ___. I cannot live with pressures below 18!

[SnuffySleeper]

I find it odd when people think that they cannot live with pressures in excess of ___. I cannot live with pressures below 18!

Well, it's scientific fact for me. Anything above a pressure of 10 induces central apneas. So literally I can't live at a pressure of 18 or I would have so many central apneas it would cause damage. Odd or not, it's not how I feel or find odd, my body just loses the will to breathe.

This is not just my opinion or how I feel, it's a fact that was diagnosed in a sleep study.

[CHanlon]

I find it odd when people think that they cannot live with pressures in excess of ___. I cannot live with pressures below 18!

Well, it's scientific fact for me. Anything above a pressure of 10 induces central apneas. So literally I can't live at a pressure of 18 or I would have so many central apneas it would cause damage. Odd or not, it's not how I feel or find odd, my body just loses the will to breathe.

This is not just my opinion or how I feel, it's a fact that was diagnosed in a sleep study.

Pressure induced central apneas aren't uncommon. Thats one of the reasons they spend so much effort on proper titration.