Looking for help

[plongstaff]

I've used a cpap for a number of years. I do know that is is very successful in stopping my snoring. However, I still often wake up very tired and am tired all day, so the therapy is not working as well as it might. It is only recently that I discovered this forum and SleepyHead and was able to look at the data.

Here is a representative graph for a typical night.

[attachment=2028]

I do have leaks pretty well under control using a chin strap to control mouth leaks. I still have a high AHI. It is rare for me to have it under 5 and it is often in the 10-15 range.

My last sleep study was about 1 year ago. Today, I visited my DME supplier to upload the data to the clinic so the doctor there could look at it. I hope to have an appointment soon. However, I'd also like to tap into the practical experience here. Is there much that can be done with a CPAP to control CA events, or would I probably need something more than constant pressure?

Thanks,
Phil

[justMongo]

Straight CPAP with a lot of hypoapneas and quite a few clear airway apneas.
If you didn't have the CAs, an increase in pressure would likely quash the hypos;
however, in your case, that would likley increase the CAs.

You also have a rather long inspiratory time compared to expiratory.
On the median you are 2.68:1.72 = 1.56:1 I:E
Most people usually run a longer expiratory time when ratio compared to the inspiratory time. More like 1:2 I:E.
This may suggest some lung disease such as COPD. (Or not.)

My prima facie impression is that you need a different machine.
I'm thinking a Bilevel.

Keep in mind I am not a medical professional; and these are strictly opinions.
This may give you some talking points for your doctors appointment.

The best machine for treating CA is the Auto Servo Ventilator (ASV) which uses an on-demand increase in pressure to inflate the lungs when a skipped breath is detected.

Best Regards,

Mongo

[Sleeprider]

JustMongo took the words out of my mouth, but may have said it better. CPAP is not working. It has cleared up your obstructive apnea and left you with a mixed or complex apnea that still doesn't meet the definition of clinical efficacy. In "insurance" terms this means you failed CPAP. The next step is to evaluate bilevel therapy. I would suggest that the study evaluate bilevel and bilevel-ASV. If your funds to pay for studies are limited, be sure the next titration also includes ASV (adaptive servo ventilation), because this is the technology that triggers breaths when you don't

[trish6hundred]

Hi plongstaff,
WELCOME! to the forum.!
You might want to talk to your doc about the problems you are having with your treatment.
Hang in there for more responses to your post and much success to you.

[plongstaff]

I finally got an appointment to see my sleep doctor. He said ASV might be the ideal machine. However, I have some heart issues and he said he will not prescribe ASV for someone with heart issues. He said that there might not be too much more I can do with the breathing machine end of things to get my AHI from 6-8, which are what it usually is, to under 5. That is too much fine tuning. He said if I want to control the CSA, I should try to improve my heart function. He also said that my tiredness and lack of energy might be due to the medication I am on (beta blocker and blood pressure medication) which tends to, as he put it, "put my heart in the jacuzzi". In other words, if I is pumping less energetically to help extend its life, I may naturally just have less energy.

He did end by saying that if I wanted to try it, I could lower my pressure from 11 to 10. I've done that and am going to monitor the data to ensure OA don't get any worse, and I'll see what happens with CA.

He also gave me the reference to the AASM practice parameters document for dealing with CSA.

So, I am going to lower my pressure and will also try to get more exercise to get my heart functioning better. Maybe an improved diet will also all my GP to lower the dosage of the blood pressure meds.

Thanks for the help.

[Sleeprider]

Plongstaff, the issues with ASV and and heart issues are very very limited. They are applicable only to heart failure patients with a left ventricular ejection rate impairment of <45%. Even that result from a Resmed study that showed a 2.5% increased mortality risk with ASV in HF is being strongly questioned as that study used previous generation of ASV machines, and considered a person under therapy with as little as 3 hours per night. http://ac.els-cdn.com/S0012369215003505/...04104365ef

There are big flaws in the existing SERVE-HF study, and unless your problems are advanced congestive heart failure with LVEF, it does NOT apply to you. Your risks from central apnea, and having the most effective known treatment withheld are far greater than the risks of using ASV, especially if you do not fit the specific risk profile of the Resmed study, and may not be valid, even if you do.