[Symptoms] 1 year High bad AHI

[jquintero]

Hello everyone hoping someone can help me answer or see what may be happening with my treatment. Since October 2019 I have been under treatment for sleep apnea with poor results that do not seem to improve. I tried using CPAP for almost 10 months but it always fluctuated with most nights AHI between 18 and 20. Maybe 5 nights during the year with AHI under 10. After 9 months doctor basically said can't help you much all we can do is increase the pressure but that will create more centrals. Now I started another treatment using a BIPAP machine and similar results except my obstructions are almost all gone which was great, however, I am worried results will not improve. The problem now are my centrals. My centrals are the result of the treatment as my original issue was caused by obstructive apneas. Why do I have so many events the last 2-3 hours of the night? I have tried different pressures both with CPAP and now BIPAP. With CPAP pressures used were between 4 to 20 all options. Now with BIPAP, a month into treatment, I have tried all pressures and different pressure supports with horrible results. 

Machine takes away my snore.
I check for leaks and i am good on those. They can happen but not the norm.
I wake up 5-8 times at night. No improvement at all for this.
My actual treatment for CPAP was 14 to 20
Bipap is I 20 and E 16

[Gideon]

Welcome to the forum.
Can you reorganize your charts please.
First the AHI chart only tells us that you are having events, info the is repeated in the events chart. See the organise link in my signature.

In addition to the standard charts I'd like to see a detailed view, 5 minutes of an cluster of Central events.
Set EPAP = 12, IPAP= 15, we may well go lower, and repost. This is reacting to your Central Apneas seeing what we can get with your BiPap.
Also post a full redacted copy of your sleep studies so we can validate what you stated above.

Treatment Emergent Central Apnea is typically caused when your CPAP/apap/BiPap is performing too efficiently. And while it has improved your oxygen exchange it has also reduced the amount of CO2 in your blood to below your apneic threshold resulting in Central Apneas.
Pressure Support is the main culprit in this.

Bear with us as we eliminate this as a cause. Time, about 3 months should have had an impact on this. Which is why it is important to actually view all your sleep studies. Frequently the summaries are simply totally wrong. Actually saw one saying diagnosed with severe obstructive sleep apnea with only 1 single obstructive event the entire night.
Hang in there.

[Sleeprider]

This appears to be complex or primarily central apnea. I think we can help to reduce events significantly, however for future charts, please be sure the monthly calendar is turned off by clicking the triangle in the date line. The guide for how to Organize Your Oscar Chart is in the links in my signature.

It will be helpful if you can post the results of your sleep study and any titration study with the personal details redacted. This will show us what baseline condition is being treated and how you arrived at bilevel therapy. If you have an overview of other pressure levels you have tried, please provide that as well. In order to immediately reduce your central apnea and hypopnea, we need to start over with titration for pressure and pressure support (PS). It's pretty clear that 18.0/12.5 (PS 5.5), 20/16 (PS 4) is not working, however you should see that the greater the difference between IPAP and EPAP (pressure support) the worse the central apnea becomes.

I'd like you to back all the way down to EPAP 10, IPAP 12. That is a PS of only 2.0 and should at least start to reduce the CA events. It is possible we will need to reduce pressure or pressure support further, but we don't really know where to start. For results like yours, we will typically look to an Adaptive Servo Ventilator (ASV) for proper therapy, but the first step is to reduce the stimulus for the central apnea and see what is going on. Final question, have you advised your doctor of your severe continuing apnea?

EDIT: I see Fred posted at the same time as I did. We are both on the same page, but I have suggested lower EPAP and IPAP. Please use my lower pressure setting so we can see the results there, then we may go either way with future adjustments. Both suggestions are to reduce pressure and pressure support, but I'm being a bit more aggressive. Your choice.

[jquintero]

Excellent news. Thank you both for your input!!!!!
Unfortunately, the two doctors used all say just try different masks to eliminare leaks or increase pressure or now bipap. No direction at all. Past three months I have been aggressive in finding anwers to improve condition.

I will do as asked and will get back in a few days with what is being asked.

Thanks again!

[Gideon]

Yes, SR and I are on the same page. I am ok with his settings.

[jquintero]

Yes, SR and I are on the same page.  I am ok with his settings.

Hello the change of pressures seem to work much better than what I was prescribed. Seems that i am finally headed in the right direction. I do wake up a lot at nights, 5-7 times, hoping this gets better with an improved AHI result. Please see my exams and test results requested. the system is only allowing 3 pictures will try to add in a later posts. I did both pressures recommended just in case.

Thank you again. I am incredibly grateful for your help
[attachment=25234][attachment=25235][attachment=25236]

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Yes, SR and I are on the same page.  I am ok with his settings.

Hello the change of pressures seem to work much better than what I was prescribed. Seems that i am finally headed in the right direction. I do wake up a lot at nights, 5-7 times, hoping this gets better with an improved AHI result. Please see my exams and test results requested. the system is only allowing 3 pictures will try to add in a later posts. I did both pressures recommended just in case.

Thank you again. I am incredibly grateful for your help
[attachment=25237][attachment=25238]

---

Yes, SR and I are on the same page.  I am ok with his settings.

Hello the change of pressures seem to work much better than what I was prescribed. Seems that i am finally headed in the right direction. I do wake up a lot at nights, 5-7 times, hoping this gets better with an improved AHI result. Please see my exams and test results requested. the system is only allowing 3 pictures will try to add in a later posts. I did both pressures recommended just in case.

Thank you again. I am incredibly grateful for your help
[attachment=25239][attachment=25241][attachment=25242]

---

Yes, SR and I are on the same page.  I am ok with his settings.

Hello the change of pressures seem to work much better than what I was prescribed. Seems that i am finally headed in the right direction. I do wake up a lot at nights, 5-7 times, hoping this gets better with an improved AHI result. Please see my exams and test results requested. the system is only allowing 3 pictures will try to add in a later posts. I did both pressures recommended just in case.

Thank you again. I am incredibly grateful for your help

[Sleeprider]

The CA appears real and the proper therapy is ASV based on both diagnostic PSG sleep study and results on BiPAP. I need you to tell us if your health insurance is very good or if there are high deductibles and copay. I want you to pursue ASV therapy with a Resmed Aircurve 10 ASV rather than the Philips BiPAP SV. The question is whether it will cost less to go through insurance or to simply ask your doctor for a prescription for ASV and for you to source a machine through Supplier#2 for $1350.

Since OA is higher, please increase EPAP to 12.0 and IPAP to 14.0.

[jquintero]

Thank you for your response. I have good insurance, i think, and have met my deductable. The problem is both doctors say if i could get to AHI of 10 we should be happy. I could never get to this figure before and keep it at that level. Doctors have seen results and have not recommened asv. What do i tell any doctor to justify asv? My original test study said i only had obstructive. Guessing both cpap ans bipap create real cental aps and asv would not?

Thank you again at the very least the new setting 10 and 12 seem to give me good results versus before.

[Sleeprider]

AHI of 10 is far from satisfactory. You should raise the option of ASV with them. ASV works by stabilizing the airway against obstructive apnea then providing pressure support during inhale to assist or cause a breath. Therefor it completely resolved central apnea and will likely result in an AHI of less than 2 in most cases. Your diagnostic study clearly showed a significant presence of central pant, so you have complex apnea, and ASV is the machine designed and intended to treat that condition. If your doctors are unfamiliar or unwilling to help you get the therapy you need and deserve then the solution is to find one that will.

Meanwhile increase pressure to EPAP 11 and IPAP 13 to treat the increase in OA.

[BB63]

Has your doctor ever seen an OSCAR report? I don't think one can get from the sleep study to success without your doctor seeing the raw data from the CPAP and by taking it one step at a time. It's not the type of warfare that can be fought from the sidelines without a constant flow of raw data.

My doctor is a GP, but I am in the process of enlightening him about what OSCAR and the members of the forum have done for me!He certainly CANNOT argue once he sees the results and the most recent CPAP data.

Soon I will gave to ask him for a prescription for a different CPAP, hope that goes well.

AB