Seeing Doctor Tuesday

[Whitewabit]

Have an appointment with my sleep doctor who is also my pulmonologists on Tuesday next week.

What should I expect from him ?? at my present machine settings which are 4-3-8 my AHI has been less then 2.5 on most night with only a few above that while I was first getting use to the mask but have reduced to the 2.5 number the past 14 days .. with one night at 0.0 ..

My apnea average is .4, hypopnea average is 2.1 and my AHI average is 2.4 .. this is for the past 2 weeks (14 days) according to the Resmed program ..

Should I lobby to leave the settings alone or to allow him to tweak the settings some ?? and if he does want to change them how much should be allowed and should the pressures go up or down ??

Just been doing this for a month now .. with really only the past 2-3 weeks on the machine .. wasn't able to use it the first week due to the high pressure it was first set at which caused me chest and lung pain due to over inflating my lungs .. had to rest several days with out using it to recover !! Have slowly increased my time each night till I am using it between 5-7 hours a night ..

Any and all suggestions' will be appreciated !!

[retired_guy]

I don't think he'll want to change much of anything. Since you have the pain med complication your ahi might go up or down because of what's going on there. I think he'll figure 2.4 is way good, you're sleeping pretty well, so all is golden.

I do think a very small increase in pressure might dump on the remaining hypop's, but if it were me and I was getting ready to swap out a pain patch, I think I'd hold where I'm at so I could see what impact if any that has. Once past that, then maybe change up a little.

[PhyllisBalboa]

Yep, I agree with Retired Guy. Leave it alone for awhile, maybe even several weeks or so. You've really come a long way and through a lot, Whitewabit. Your chest pain has diminished or is gone now, your numbers look good, you're sleeping some good hours, and you're finally feeling better. These are all things you've been fighting for. Let that good sleep start mounting up, then you'll really start feeling the difference.

[vsheline]

Hi Whitewabit,

Your AHI numbers are "good" but I think it would be a missed opportunity if the busy doc just pats you on the back and says keep up the good work.

I suggest you have a list of questions or points to discuss, to hand to the doctor.

I think a big question is, if IPAP is allowed to go higher, what is the risk to your lungs and what danger signs should you be watching for?

No need to change anything soon, but eventually I think your sleep quality would likely be improved either by allowing EPAP to go higher (by giving EPAP a range like 4 to 5 or 4 to 6, without lowering the PS settings) to allow obstructive events to be treated more strongly, or by increasing the Max PS setting to allow both central and obstructive events to be treated more strongly. However, either of these approaches (allowing EPAP to go higher without lowering PS, or allowing PS to go higher by raising Max PS) would require allowing IPAP to go higher.

Is your present low Min EPAP setting of 4 at all uncomfortable? If not, the Min PS setting of 3 probably should get the credit. A lower Min PS setting may make you uncomfortable, as if it is slightly hard to breathe in enough air. A higher Min PS setting would tend to increase the average amount of ventilation you are getting and would tend to increase your average blood Oxygen levels during sleep.

I occasionally wear a Pulse Oximeter at night to monitor SpO2. I think average SpO2 between 94% to 96% is ideal while asleep, with average SpO2 as low as 90% being acceptable. (By "average SpO2" I mean not counting the short occasional dips in SpO2 occasionally caused by apneas.) I used to have my Min PS set at 6 cm H2O until I got the Pulse Ox and saw that the Min PS of 6 was keeping my average SpO2 at 98% or higher most of the night.

[Peter_C]

Hi Whitewabit,

Your AHI numbers are "good" but I think it would be a missed opportunity if the busy doc just pats you on the back and says keep up the good work.

I suggest you have a list of questions or points to discuss, to hand to the doctor.

I think a big question is, if IPAP is allowed to go higher, what is the risk to your lungs and what danger signs should you be watching for?

No need to change anything soon, but eventually I think your sleep quality would likely be improved either by allowing EPAP to go higher (by giving EPAP a range like 4 to 5 or 4 to 6, without lowering the PS settings) to allow obstructive events to be treated more strongly, or by increasing the Max PS setting to allow both central and obstructive events to be treated more strongly. However, either of these approaches (allowing EPAP to go higher without lowering PS, or allowing PS to go higher by raising Max PS) would require allowing IPAP to go higher.

Is your present low Min EPAP setting of 4 at all uncomfortable? If not, the Min PS setting of 3 probably should get the credit. A lower Min PS setting may make you uncomfortable, as if it is slightly hard to breathe in enough air. A higher Min PS setting would tend to increase the average amount of ventilation you are getting and would tend to increase your average blood Oxygen levels during sleep.

I occasionally wear a Pulse Oximeter at night to monitor SpO2. I think average SpO2 between 94% to 96% is ideal while asleep, with average SpO2 as low as 90% being acceptable. (By "average SpO2" I mean not counting the short occasional dips in SpO2 occasionally caused by apneas.) I used to have my Min PS set at 6 cm H2O until I got the Pulse Ox and saw that the Min PS of 6 was keeping my average SpO2 at 98% or higher most of the night.

+1

[trish6hundred]

Hi Whitewabit,
You are doing so well, I wouldn't change anything for a while, just enjoy for a bit before you make any changes.
Keep up the good work and good luck to you at your Dr. appointment.

[Whitewabit]

vsheline
I occasionally wear a Pulse Oximeter at night to monitor SpO2. I think average SpO2 between 94% to 96% is ideal while asleep, with average SpO2 as low as 90% being acceptable. (By "average SpO2" I mean not counting the short occasional dips in SpO2 occasionally caused by apneas.) I used to have my Min PS set at 6 cm H2O until I got the Pulse Ox and saw that the Min PS of 6 was keeping my average SpO2 at 98% or higher most of the night.

My O2 levels stay at 97-98 % while using the machine .. I have spot checked with my oximeter at night and that is what I have found ..

[Whitewabit]

my pressure runs between 7 and 12 .. my EPAP of 4 is not uncomfortable most of the night but when I first start treatment I can feel the pressure my lungs are pressing against .. about 10 minutes later that feeling of fighting it goes away and I fall asleep .. I do sit up in bed for a few minutes before laying back if I don't the EPAP does seem too strong .. I have to kind of get use to it before laying down and turning on my side .

The oximeter I use records the readings but won't download to anything .. I have put it on and fell asleep and then looked at it the next day and have gotten 4 hours before it fell off (didn't tape it) and my O2 level goes between 96% and 98 % and occasionally up to 99% for just a few seconds at a time. After falling sound asleep it stays between 97% and 98% . Varying slowly back and forth . My at rest O2 level runs between 93% and 96% according to weather conditions and my allergies (Asthma).

The lowest I have seen it go was 90% but it could go lower though all of my events have been under 30 seconds . and I don't tend to string my events together usually not more then 2 or three in a row over 10-15 minutes. Then a period of restful sleep before another one ..

[DeepBreathing]

Whitewabit, have a look at the graphs and see when those hypopneas are occurring. From your description of your sleep routine (sitting up for a while then lying down for 10 minutes before dropping off to sleep) I wouldn't be at all surprised if all the hypopneas are occurring during that pre-sleep period. In which case you can safely ignore them and you're left with a residual AHI of 0.4 - which is extremely good.

As the others have said, only make one tweak at a time, including any change to your meds. Don't change machine settings and meds at the same time as that will confuse the outcomes.

[Whitewabit]

Whitewabit, have a look at the graphs and see when those hypopneas are occurring. From your description of your sleep routine (sitting up for a while then lying down for 10 minutes before dropping off to sleep) I wouldn't be at all surprised if all the hypopneas are occurring during that pre-sleep period. In which case you can safely ignore them and you're left with a residual AHI of 0.4 - which is extremely good.

As the others have said, only make one tweak at a time, including any change to your meds. Don't change machine settings and meds at the same time as that will confuse the outcomes.

DeepBreathing .. yes sometimes I do have a hypopnea showing before laying down when I look the next day and I have been discounting those,.. which lowers my AHI even more usually down a few tenths ..but my AHI has been running in the 2.0 to 2.5 range all this week .. I also have had one with in just 2-3 minutes of waking up ..

My meds don't change ! My pain patch infuses medication continuously 24 hours a day .. the medication in the patch last for 72 hours through release through the skin.. I change them every 3 days in the evening .. .. but the medication doesn't change .. maybe a slight lowering of the amount in my blood as the medicine runs out the days I change it ..