pressure plateau

[SarcasticDave94]

I think most feel worse when they first start apnea therapy. It's how you begin to feel in about a month. However, it's not too late to begin making therapy adjustments as optimization is almost always needed.

[milboltnut]

MEDICALLY, any AHI under 5 is done/complete/no further changes are needed!!!  You are doing perfectly and all is well!!!   Your CAs are well under control and not a bother and your obstructive apnea is in the same condition.  By definition, you are treated with 'perfect' results.  Thank you and be sure to schedule your annual appointment so I can make some more money off you.

I might show 1 good night (under 5 AHI) out of every 20 bad ones because everyone gets lucky sometimes.

Early on, at my first Dr. visit, after a month... which I know I should have had legitimate centrals, that he saw.. he said.. "I want to see your AHI 5 or under", never mentioning what was going on or asking me how I really felt. AND his, thee "CPAP person" to talk to if you have questions about how to work the thing.. said,"oh you're doing alot better, than you were before you were on the machine" Not sharing any information about my daily progress...... You wanna know YOUR progress YOU have to use OSCAR to show your progress. If I didn't have it, then I would be on the wrong machine alot longer than I should have. Could I have argued with my Dr. about the hold up? He gave the excuse he didn't want to argue with my insurance company, which is called an appeal,(which I won in a 5 minute conversation with an Ins Rep). They had 180 days to appeal from the denial of my titration sleep study. Once I found out that my APAP wasn't cutting the mustard, thank you again Fred Bonjour for cutting 5 or more months down to 3......I called my Dr's office to tell them I had it with the machine I was on. The gal I talked to said come on in !.... Instead of waiting until july... she said if your not feeling good, then you need to come in asap. That's when I asked her about the second sleep study that i was prodded to have done...titration included. I was told that they ordered a titration study but I was denied. So after a few phone calls I found out who contacted my Ins. Co. to get a copy of the denial letter. The letter stated that non supportive information wasn't supplied for a titration study, and was not deemed necessary due to I only suffered from obstructive apnea and that the APAP would do the job. The Ins.Co. had used the excuse and used a "research of thier own" to back this up. The gal I talked to at the Ins. Co. told me it was bogus... and that they should have approved the Titration test. But because they wanted the cheap way out now it's proven they were WRONG. NOW they wasted thier time and money, pity. My sleep study revealed centrals and a RSV PAP was needed along with a titration study. It gonna get done now due to it's had to be shown to them, that the APAP didn't manage my Central Apnea, but managed my obstructive Apnea.

So.... good thing for a site like this, and for OSCAR analysis software that's free by the way, worked to my advantage and was and IS my ace in the hole.

[Gideon]

Reading this thread and the last comment makes me wonder if Sleep Disorder doctors should be call CPAP salesmen as it seems they are only focused on 1 issue of sleep problems and throw their hands up if you are a challenge. Maybe I'm too new to the game, only just completing 2 weeks of therapy, AHI number is way down, but I feel worse during the day than I did before.

The goal of the medical community is to treat your apnea.  That occurs when your AHI/RDI is less than 5.

Around here we don't stop there, and we go considerably farther for individuals that are sensitive to small irregularities.

If I were to meet you on the street and asked you "How are you feeling?"  how would you answer?  I doubt it would be " I am tired all the time, I sleep all night but I don't feel rested, I can't even pay attention to simple tasks like shopping."  It would be something on the order of "I feel fine."  

Talking to a doctor it is imperative to relay all the bad stuff as they are symptoms.  Thus the higher AHI is more important than the lower ones.

[milboltnut]

Even though an APAP didn't manage my CA's..... has it, for others?

[Sleeprider]

We have seen members that had an initially high CAI improve with time using CPAP. There are a certain percentage of people that can get good results on CPAP, even though it does not address central apnea. I think that is a large part of the reason insurance wants a fair trial of CPAP before failing.

[milboltnut]

We have seen members that had an initially high CAI improve with time using CPAP.  There are a certain percentage of people that can get good results on CPAP, even though it does not address central apnea.  I think that is a large part of the reason insurance wants a fair trial of CPAP before failing.

I can't see how... considering that you need a machine that counter reacts expiration. CPAP or APAP is just Inspration.

How can it work for some and not for others, when does bilevel PAP come in and why? Does it have to do with an individuals ability to breathe with sufficient CPAP alone and the bilevel is added assistance ?

In S-mode each patient breath is assisted by machine-delivered IPAP when the machine senses the change in airflow triggered by the inspiratory (effort of the patient. (Laboring to breathe)...


I tried to read on a gov't site but it's way over my head.... I need lamens terms. You guys asked for my sleep study... I forgot to get it friday. I have to call monday for it through email.

[milboltnut]

https://www.sciencedirect.com/topics/med...y-pressure

maybe someone can help me break this down...

But maybe this is it in a nutshell....

Bilevel positive airway pressure devices (e.g., BiPAP) can provide different pressures during inspiration and expiration.4 Expired positive airway pressure (EPAP) helps maintain end-expiratory lung volume and airway patency, similar to CPAP. The pressure difference between EPAP and inspired positive airway pressure (IPAP) serves to increase tidal volume and hence minute ventilation

[Gideon]

Sometimes your body simply adjusts.
With treatment emergent your body adjusts and lowers the apneic threshold.

[milboltnut]

Sometimes your body simply adjusts.  
With treatment emergent your body adjusts and lowers the apneic threshold.

Your respiratory system recovers? Or compensates? 

Why do I stop breathing? I learned about carotid receptors sends a signal to your brain when the Co2 level raises above a certain point..(and you don't inhale) and it wakes me up to inhale. What causes me not to inhale? Is it too much to explain ?

[milboltnut]

Bilevel positive airway pressure devices (e.g., BiPAP) can provide different pressures during inspiration and expiration.4 Expired positive airway pressure (EPAP) helps maintain end-expiratory lung volume and airway patency, similar to CPAP. The pressure difference between EPAP and inspired positive airway pressure (IPAP) serves to increase tidal volume and hence minute ventilation

minute ventilation... elimination of C02...
Minute ventilation (VE) is the quantity of air moved into and out of the lungs in a minute and dictates CO2 elimination from alveoli.

Sounds like bilevel EPAP is what I lack. How would CPAP manage CA's then? As I raised minimum pressure it increased CA's.