Can Sleep Apnea decrease after years of CPAP use?

After 7 successful years of using a CPAP machine, I went in for a new sleep study last month to see if anything needed to be changed. I had the study done at a Sleep Medicine franchise. (Note: my experience wasn't great at this facility in that it felt like they were much more interested in increasing profits than treating patients individually based on needs, so much so that I wasn't sure if I could believe what the Dr was telling me.) But, I may be wrong in questioning them, so I wanted to check in here to see if I could get some advice. Here's my story:

In 2008 I was diagnosed with severe sleep apnea with an RDI of 43. Significant hypoxemia was noted with 38 minutes of a 320 min study at between 85-90%. I started sleeping with a cpap machine then set at a pressure of 8 and all went well.

Last month I had the new sleep study not because anything was wrong, but rather to just confirm all was what it should be. The Dr ordered a split study, but surprisingly, the tech never came in to put on the cpap mask during the night. In the morning she said I didn't qualify for the use of the machine based on the # of sleep interruptions. That night I had 364 minutes of sleep. During the 6 hours of sleep I had 36 episodes: 13 apnea 23 hypopnea or 5.9/hr. Total RDI (because of 67 RERA, which I don't totally understand) was 17/hr. My time spent below 90% saturation was less than 1%.

When I went in for the test results today, the Dr said I had moderate sleep apnea because of my #'s including oxygen sats below 90%. This diagnosis puzzles me since it appears I am just qualifying for the sleep apnea diagnosis now with 5.9 (the oddest thing was that most of the activity happened within a one hour period). I was below 90% for only 3 minutes for the study.
I'm not sure if I am reading the report correctly (or maybe more important, interpreting it correctly) but I guess I have a question now about whether this Dr and team are concerned only about my best interests. They want me to come back for another sleep study in order to re-titrate the machine pressure.

I've read such savvy comments from posters here in the past. I'd appreciate any thoughts or advice.

Quick question - did you use your own machine up until the night prior to testing? If so, test results are more likely to be invalid because without having stopped Cpap for longer before testing (at least a few days) you can't know for sure what your test meant (apart from whatever it did find). And how reliable do you think your orig. testing was - not to say it wasn't, but just something to think about. What are your AHI's like normally, and how do you feel most of the time? Do you use software like SleepyHead (downloadable free from the first note at the top of the forum page), because de-sats aside, it would tell you a lot more than you've been told so far.

Have you lost a fair amount of weight since the original test? Sleep less often on your back than you might have then? Been tested routinely for other conditions like thyroid or blood problems, etc.? And what equipment do you use - make & model of machine & mask?

Plus - it sounds like you've only ever been on straight Cpap rather than A(uto)pap... is that true?

What Julie said. And does your detailed report say that the consolidated period of events was while you were supine? If so, you may have positional sleep apnea. If you did not spend some time in REM while supine, the study may not have captured your worst case scenario.

emilyLA wrote:After 7 successful years of using a CPAP machine, I went in for a new sleep study last month to see if anything needed to be changed. I had the study done at a Sleep Medicine franchise. (Note: my experience wasn't great at this facility in that it felt like they were much more interested in increasing profits than treating patients individually based on needs, so much so that I wasn't sure if I could believe what the Dr was telling me.) But, I may be wrong in questioning them, so I wanted to check in here to see if I could get some advice. Here's my story:

In 2008 I was diagnosed with severe sleep apnea with an RDI of 43. Significant hypoxemia was noted with 38 minutes of a 320 min study at between 85-90%. I started sleeping with a cpap machine then set at a pressure of 8 and all went well.

Last month I had the new sleep study not because anything was wrong, but rather to just confirm all was what it should be. The Dr ordered a split study, but surprisingly, the tech never came in to put on the cpap mask during the night. In the morning she said I didn't qualify for the use of the machine based on the # of sleep interruptions. That night I had 364 minutes of sleep. During the 6 hours of sleep I had 36 episodes: 13 apnea 23 hypopnea or 5.9/hr. Total RDI (because of 67 RERA, which I don't totally understand) was 17/hr. My time spent below 90% saturation was less than 1%.

When I went in for the test results today, the Dr said I had moderate sleep apnea because of my #'s including oxygen sats below 90%. This diagnosis puzzles me since it appears I am just qualifying for the sleep apnea diagnosis now with 5.9 (the oddest thing was that most of the activity happened within a one hour period). I was below 90% for only 3 minutes for the study.
I'm not sure if I am reading the report correctly (or maybe more important, interpreting it correctly) but I guess I have a question now about whether this Dr and team are concerned only about my best interests. They want me to come back for another sleep study in order to re-titrate the machine pressure.

I've read such savvy comments from posters here in the past. I'd appreciate any thoughts or advice.

So, you DO or do NOT question their "monetary motives"?
I agree that if you didn't stop using your machine for a number of nights before your sleep study, the results were probably bogus. There have been known to be residual effects when not abstaining from the use of the machine.

AND, have you been using a fully-data-capable machine all these years and how do you know that "all went well" and your therapy was "successful"?
If you had been using a data-capable machine, you would have been able to see the nightly results and would have known all along how well your therapy had been doing........and would not have "needed" another sleep study.

But, if you've been stuck with a "brick" (non-data-capable machine) all these years, your doctors are definitely benefiting monetarily by keeping you in the dark.


Den

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Can someone explain the residual benefit of cpap? If the tx carries over a few days it should be ok to nap without the machine or go to hospital without it? Need to know the mechanism here. Merci.

Elle wrote:Can someone explain the residual benefit of cpap? If the tx carries over a few days it should be ok to nap without the machine or go to hospital without it? Need to know the mechanism here. Merci.

I don't know if I can adequately explain it or not (more likely NOT). And, I strongly suspect that it would vary from person to person.

For me, personally, I can breathe alot better using it night after night and through the days, too, but having never really tried to stop using it for any number of nights, it's more "theory" for ME. In reality, I can't sleep without my machines. I've tried taking even a few short naps in bed without the machine and even that was horrible. I used to be able to take short naps in my recliner, but even that has had its limitations. But, yet I read of others stop using theirs or giving up on it and that is actually beyond my comprehension.

But, I have read where sleep labs request that patients who are supposed to have sleep studies refrain from using their machines for a number of nights beforehand.


Den

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Weird, thanks den. I was admitted from emerg to hospital where they 'say' they didn't have loaners and i couldn't get my own. I woke with blue lips every morning. I really don't like not using it.

I'm surprised to read of this.

Elle wrote:Weird, thanks den. I was admitted from emerg to hospital where they 'say' they didn't have loaners and i couldn't get my own. I woke with blue lips every morning. I really don't like not using it.

I'm surprised to read of this.

That is so not right! I would insist on using my own--or going home!
And I would already be on the phone to the media!
Or my doctor!

I have never had any such thing. If I miss one night of machine use I am miserable.

Chunky, I had no one to go retrieve my own but was allowed to use it if I could get it to the hospital. I don't believe them that they didn't have one in the respiratory dept.

Outrageous! What would have happened, what would they have said if you didn't wake up one morning! Glad you did, but

The first night I demanded a pulse ox. The second night I turned it off because it alarmed every time I dozed. The nurses were not interested because I was 'off service'. I had had diverticulitis (went to emerg for pain and fever) and was put on the ward to wait to see if I would need surgery. I was kind of in their way. I had a feeling the nurses knew nothing about sleep apnea and probably believed that I would have found a way to get my machine if it was that urgent. My daughter was in Korea and I wasn't going to ask someone to come get my keys and try to figure out which parts to bring without wrecking stuff or spilling water in my machine. I decided to wing it.

BUT, the point was I don't understand being asked to do without cpap for days before a sleep study. It doesn't make sense. I can see stopping a drug that stays in the system for a few days but air pressure doesn't stay in the system. Does anyone know of any links to explanations?

I also have my doubts about that idea. I certainly have never experienced any sort of thing.
If I take an unplanned nap (sans machine) I always snore very loudly, and wake up with a
headache that could melt tungsten.

Wulfman... wrote:

emilyLA wrote:After 7 successful years of using a CPAP machine, I went in for a new sleep study last month to see if anything needed to be changed. I had the study done at a Sleep Medicine franchise. (Note: my experience wasn't great at this facility in that it felt like they were much more interested in increasing profits than treating patients individually based on needs, so much so that I wasn't sure if I could believe what the Dr was telling me.) But, I may be wrong in questioning them, so I wanted to check in here to see if I could get some advice. Here's my story:

In 2008 I was diagnosed with severe sleep apnea with an RDI of 43. Significant hypoxemia was noted with 38 minutes of a 320 min study at between 85-90%. I started sleeping with a cpap machine then set at a pressure of 8 and all went well.



AND, have you been using a fully-data-capable machine all these years and how do you know that "all went well" and your therapy was "successful"?
If you had been using a data-capable machine, you would have been able to see the nightly results and would have known all along how well your therapy had been doing........and would not have "needed" another sleep study.

But, if you've been stuck with a "brick" (non-data-capable machine) all these years, your doctors are definitely benefiting monetarily by keeping you in the dark.


Den

.

Den, can you please tell me what a "data capable machine" is and why it is so important? I have a Respironics System ONe. It has a small slide in thingie in the back. Not sure what it is called. A card. But I don't see any data. It doesn't tell me how many apeas I have or anything. It only tells me how many HOURS or DAY or WEEKS I've used the machine and I've had this thing since 2011. Not sure when these data capable machines were available, but I'd like to know what BRANDS I should ask my doctor to RX the insurance so I can get one. I don't want to be left in the dark. I hope the bipap machine I get has that ERP or EPR or whatever it is called.

Guest wrote:Den, can you please tell me what a "data capable machine" is and why it is so important? I have a Respironics System ONe. It has a small slide in thingie in the back. Not sure what it is called. A card. But I don't see any data. It doesn't tell me how many apeas I have or anything. It only tells me how many HOURS or DAY or WEEKS I've used the machine and I've had this thing since 2011. Not sure when these data capable machines were available, but I'd like to know what BRANDS I should ask my doctor to RX the insurance so I can get one. I don't want to be left in the dark. I hope the bipap machine I get has that ERP or EPR or whatever it is called.

You would need to look on the bottom of your machine to check the actual model number to be sure.

Data capable machines are the models that record leaks, snores, hypopneas and apneas among other things......and are stored on the little SD cards. However, the non-data-capable models also use the SD cards but only store the hours used.
Some of those machines are straight CPAP and some are APAP (adjust within a range of pressures OR can be used in straight pressure mode).

In the Philips/Respironics System One line, the data-capable models are ones with model numbers of 450, 460, 550, 560 or higher. The "50" series models came out in about 2010 and were replaced a couple of years ago by the "60" series models. The "60" series models also have the capabilities of using a heated hose. Models 450 and 460 are straight pressure, but record all sleep data. Models 550 and 560 are "Auto" (APAP) machines and are capable of working in a range of pressures and record all sleep data. Bi-PAP machines made by PR generally start with model numbers like 750 and 760 (and higher).

If the model is a lower number than "450" (like 250, 260, 150 or 160) , then it's not fully data-capable and only records hours used.

"EPR" is an exhale pressure relief technology used by ResMed machines. The "Flex" (A or C variants) technology is the exhale relief technology used by Philips/Respironics CPAP machines. In Bi-PAP machines, the exhale relief used in the Philips/Respironics machines is called "Bi-Flex". All Bi-PAP (Bi-Level) machines currently made by both companies (P/R or ResMed) are fully data-capable.

Fully data-capable machines are capable of using software like ResScan (ResMed) and Encore (Pro, Basic, etc.) (Philips/Respironics) and both can use "Sleepyhead" software.......developed by one or more of the forum members.

Hope that helps.

PS. I mainly focused on the Philips/Respironics machines because that's what you already have. However, in the ResMed line, there is the S9 series and the newer A10 series. In the ResMed CPAP machines, the fully data capable machines are the "Elite" (CPAP) and "Autoset" (APAP) models.


Den

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