Trying CPAP one last time... AHI looks really bad

[Dormeo]

Thanks for explaining. This makes more sense to me. I do truly hope the new doctor and the new test will help you. And maybe the Emory center is another option down the road if you need one. Keep us posted, would you?

[gsilver]

So, I got the results from the take-home sleep study that the new doctor ordered. It will take just over a more month in order to get into his office again to discuss the results and treatment options, so I'll be here in the mean time. I did the study using the oral appliance. I'm noticing that the AHI is higher than my previous sleep study without using the appliance, and that there are zero central events.

AHI 25.6
OAI: 4.2
CAI: 0.0
Hypopnea index: 21.3

Average breaths per minute: 12.98
Apneas: 27
Hypopneas: 136
Snoring events: 14

ODI desaturation index: 26.9
Average saturation: 93
Lowest desaturation: 89
Baseline saturation: 95

No of desaturations: 172
Saturation <= 90% 1 min
Saturation <= 85% 0 min

Minimum pulse: 47
Maximum pulse: 92
Average pulse: 55

Proportion of probable CS epocs: 0

I'll try to get an actual scan of the report.


So, it looks like the bipap machine that I started with was indeed the culprit for all of the central events, so an ASV might not necessarily be the correct treatment. Since the AHI is no lower than untreated, it also looks like the oral appliance isn't actually helping.
Subjectively, I've felt better in the last month (using the oral appliance again) than in the previous one (using the ASV machine) for what it's worth. Though neither month was anywhere as close to functional as I'd like to be, needing lots of naps both after, during, and sometimes even before work hours in order to get through the day.

I still have the ASV machine, as the bipap was through insurance and was returned.

[mper6794]

Hi, there all
looking through all this, particularly up post # 32, I was wondering if central apneas reported would not be false events, during awakenings, and following closely flow restrictions (either FL or others; typical untreated UARS).
Could you plot some enlarged 10min-windows, covering central apneas clusters? particularly, ncluding flow rate and Tidal volume (maximum 1000, and with the median reference line) waveforms?

good luck

[gsilver]

Here are some zoomed in views of when I was trying the bipap machine. I'm skipping over the first three days, since those were so vastly higher than the rest.
The flow limit graph was a flat zero for every night on the bipap, so I didn't include it.

[mper6794]

Hi, gsilver
Sorry, not possible to get there yet. If you don't mind, let us try again, say, in your full night as of may, 25th, taking 10min windows from around 0:05 and the right; 2:18, and 3:18.
What is the Idea? To put your centrals in context; is there something triggering them, as usually os the case?! Most of the time they are just syntomes, artifacts, and not core causes. In general these possible triggers could be increasing pressures, pressure suport, unbalance between EPAP min and PS, awakenings/awakeness due to whatever reason, and so on....then, the choice for tailored machine would depend firstly of such understanding.
Good luck.

[mper6794]

It would facilate a lot If you plot and scaled charts, like this:
Full night chart, top downward:
Don't need events
Pressure
FR (-120 to 120)
FL (compressed)
Tidal volume (max 1000...MEDIAN REFERENCE LINE IS CRUCIAL)
Leak
Snore( If you have significantly)

Thanks

[gsilver]

Update after a long time...
I ended up getting an oral appliance from SomnoMed.
They adjusted it a few times, and the followup sleep study showed an AHI of around 7, and only one oxygen desaturations below 90% was seen, and it lasted less than 30 seconds.
And, most importantly, I can actually sleep through the night with it.

So, I should be good now as far as apnea is concerned... but I'm still tired, still need to take naps every day (usually multiple), still down for days with fatigue :|
On the plus side, I don't seen to need to actually sleep as much during said naps.

I saw a new doctor, and he said that one of the EPV markers (I forgot which one and don't have the paper work right now; it was the middle of three, and the early antigen one was low) was over 600, and suggested that that was at the root of my problems (which did not contradict one of my sleep doctors, who told me that while he saw some apneas / hypopneas that did warrant treatment, he thought that the cause was something else, especially when I didn't respond to PAP therapy) and a few other things that were a little off. He thinks that the EBV was at the root of it, and damage to my gut biome after taking antibiotics and the sleep apnea both contributed to it getting as bad as it is.
He had me start a ton of supplements and alternating IV treatments (vitamins and ozone).
I'm a couple of months into using the oral appliance and 3 weeks into the supplements.

He told me to be patient, since it might take a while to see any results.

This is probably beyond the scope of what is discussed here, and the doctor has basically cleared me as far as sleep apnea goes with the oral appliance.

[Dormeo]

Nice to hear from you again. I'm glad you may be making progress with a new doctor on treatment related to Epstein Barr. I see, from a trusted web site, that EB can cause sleep disorders:

https://www.cdc.gov/epstein-barr/hcp.html

I'm also glad you're sleeping comfortably with your oral appliance.

I do want to register my sense, however, that an AHI of 6 may be contributing to your daytime tiredness, sleepiness, and fatigue. That's potentially quite disruptive to your sleep architecture. Do you know what your sleep cycles look like (e.g., how much in REM and in deep sleep)?

[gsilver]

The doctor said that they could adjust it a little further, but I'm about as far forward as I think that I feel comfortable with.

Re: sleep cycles: The sleep study that they did most recently was a basic one that only measured apneas and a few other metrics. Sleep cycles aren't on there, but I'll scan it when I get home to see if you guys have any insights.

Looking at the list, I see "Blockage of the air passages in the nose and throat" ...Sounds like that can directly cause sleep apnea.
Sinusitis is on there, as well, and I've had a lot of problems with that (my sinuses are mostly breathable after about 4 surgeries).
I also had tonsillitis repeatedly when I was a kid, and it looks like it contributes to that, too.

Damn. It seems like everything I've been dealing with revolves around this is some way. Kind of scary to think that 95% of the population has been exposed to it, yet somehow almost everyone else is just fine.

[mper6794]

The doctor said that they could adjust it a little further, but I'm about as far forward as I think that I feel comfortable with.

Re: sleep cycles: The sleep study that they did most recently was a basic one that only measured apneas and a few other metrics. Sleep cycles aren't on there, but I'll scan it when I get home to see if you guys have any insights. ....could you please post this study?

Looking at the list, I see "Blockage of the air passages in the nose and throat" ...Sounds like that can directly cause sleep apnea.
Sinusitis is on there, as well, and I've had a lot of problems with that (my sinuses are mostly breathable after about 4 surgeries).... 
I also had tonsillitis repeatedly when I was a kid, and it looks like it contributes to that, too.....according to Dr. Steven Park's book (Sleep Interrupted) both syntoms could be somehow associated with untreated UARS.

Damn. It seems like everything I've been dealing with revolves around this is some way. Kind of scary to think that 95% of the population has been exposed to it, yet somehow almost everyone else is just fine.

Hi, gsilver


I have just taken a look at your data. It looks to me you had intolerance to too higher P.S, but maybe would not have to much higher EPAPmin, while on Air Curve 10 (mode S).

I was wonder on the viability to go for some more tests with the VAUTO (mode VAUTO).

all the best