Help for a Neighbor

[azpilgrims]

My neighbor Larry is 75 years old, went through a sleep study and even though he mustered about an hour or so of actual sleep in his sleep study, they did determine he has OSA. The titration study was similar, he had a hard time sleeping. The Doctor prescribed him a Respironics APAP set between 5 and 15 to get him started. I went with him to the Dr. Appt & the DME. Afterwards went back to his house to get him a set up, installed SleepyHead on his computer, and ordered him some Pad-a-Cheek items as well as an Oximeter so we can get him going in the right direction soon.

Here is the weird issue, 1st night AHI was 17.4, next night was 14.6, then last night he was clear up to 23.2 - his numbers broke down pretty evenly between Obstructives, Hypopnea's, and Clear Airways. I dont have access to post his charts as of this minute, but thought he would be heading downwards a bit being on an APAP. I am wondering if he possibly needs on a BiPAP or just give it more time to see if his numbers go down.

[Pugsy]

Is he sleeping decently with the machine and mask on? Or is he having difficulty getting to sleep and staying asleep.
If he is having trouble sleeping then a lot of those flagged events could maybe related to awake/semi awake breathing irregularities.
His minimum pressure may be too low to adequately prevent the obstructive apneas and hyponeas.
Need to see his detailed reports to see what the pressure is doing or wanting to do.
The clear airways...could be post arousal CAs from the large number of OAs and hyponeas and if the OAs and Hyponeas are reduced then maybe the CAs will reduce...could also be related to pressure but I would assume that if that were the case the titration study would have caught it but maybe not if there wasn't much sleep.

[azpilgrims]

Is he sleeping decently with the machine and mask on? Or is he having difficulty getting to sleep and staying asleep.
If he is having trouble sleeping then a lot of those flagged events could maybe related to awake/semi awake breathing irregularities.
His minimum pressure may be too low to adequately prevent the obstructive apneas and hyponeas.
Need to see his detailed reports to see what the pressure is doing or wanting to do.
The clear airways...could be post arousal CAs from the large number of OAs and hyponeas and if the OAs and Hyponeas are reduced then maybe the CAs will reduce...could also be related to pressure but I would assume that if that were the case the titration study would have caught it but maybe not if there wasn't much sleep.

He said he sleep pretty good the first two nights, his leak rates were low, and he said he felt pretty good. Last night he did not sleep well. I asked him if he was taking any sleeping pills and he said yes, depending upon the pill it may be causing it possibly. I will grab some screen shots when I head over there this afternoon and post them up. I might go ahead an bump his minimum pressure up so he has a tighter range to deal with the obstructives.

[Babette]

My red flag raises on that bottom pressure. Just for grins, try setting him at 10-20 and let him lay there and see how that feels.

Might be too much for him, but what the hey.

Pugsy's advice is far better than mine, BTW.

Good luck and thanks for being such a great neighbor!!!!!!
B.

[robysue]

Without looking at the pressure graph or the events table, it's hard to say for sure, but like Babette, I'm wondering if that min pressure needs to be increased. Although I would NOT recommend jumping from 5-15 to 10-20 in one fell swoop. But maybe bumping that min pressure up to 7 might be a good starting place.

[Babette]

Oh, I'm not recommending trying to sleep ALL NIGHT at that pressure. But laying there for awhile, and maybe playing with different pressures, until one seemed like it might be worth pursuing all night, might be an idea.

Cheers,
B.