Doc Says "Don't Worry About the Numbers!"

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
bsokal
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Doc Says "Don't Worry About the Numbers!"

Post by bsokal » Sat Jul 04, 2015 3:57 pm

I have been on CPAP for about 4 months now. I had a home study initially in which I was found to have an AHI of 55. I was put on a Resmed CPAP machine which lowered my AHI to average of 16 with pressure at 14. After a hospital study I was switched to a Resmed Bi-pap machine with pressures 20/14. What is frustrating is that after 45 days on the Bi-pap my AHI has actually worsened to an AHI of 18!

My sleep doctor says "Don't Worry About the Numbers" and said to see him in 3 months. He does not want to increase the pressure and wants to stay at the recommended pressure from the hospital sleep study. He says what is important is how you feel. While I appear to be less tired and not getting up multiple times at night to urinate anymore I don't know how much better I would feel if my AHI was under 10 or so?

So I am at the point do I resign myself to an AHI of 18 or do I see another sleep doctor and get a second opinion? Also what should an ideal AHI I should shoot for - 10 or under or 5 and under?

Thanks in advance for any suggestions.

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palerider
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Re: Doc Says "Don't Worry About the Numbers!"

Post by palerider » Sat Jul 04, 2015 4:00 pm

bsokal wrote:I have been on CPAP for about 4 months now. I had a home study initially in which I was found to have an AHI of 55. I was put on a Resmed CPAP machine which lowered my AHI to average of 16 with pressure at 14. After a hospital study I was switched to a Resmed Bi-pap machine with pressures 20/14. What is frustrating is that after 45 days on the Bi-pap my AHI has actually worsened to an AHI of 18!

My sleep doctor says "Don't Worry About the Numbers" and said to see him in 3 months. He does not want to increase the pressure and wants to stay at the recommended pressure from the hospital sleep study. He says what is important is how you feel. While I appear to be less tired and not getting up multiple times at night to urinate anymore I don't know how much better I would feel if my AHI was under 10 or so?

So I am at the point do I resign myself to an AHI of 18 or do I see another sleep doctor and get a second opinion? Also what should an ideal AHI I should shoot for - 10 or under or 5 and under?

Thanks in advance for any suggestions.
I'd say your doctor is an idiot.

then I'd say, get sleepyhead and take a look at WHY your numbers are so crap.

see link below.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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kaiasgram
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Re: Doc Says "Don't Worry About the Numbers!"

Post by kaiasgram » Sat Jul 04, 2015 4:02 pm

bsokal wrote:I have been on CPAP for about 4 months now. I had a home study initially in which I was found to have an AHI of 55. I was put on a Resmed CPAP machine which lowered my AHI to average of 16 with pressure at 14. After a hospital study I was switched to a Resmed Bi-pap machine with pressures 20/14. What is frustrating is that after 45 days on the Bi-pap my AHI has actually worsened to an AHI of 18!

My sleep doctor says "Don't Worry About the Numbers" and said to see him in 3 months. He does not want to increase the pressure and wants to stay at the recommended pressure from the hospital sleep study. He says what is important is how you feel. While I appear to be less tired and not getting up multiple times at night to urinate anymore I don't know how much better I would feel if my AHI was under 10 or so?

So I am at the point do I resign myself to an AHI of 18 or do I see another sleep doctor and get a second opinion? Also what should an ideal AHI I should shoot for - 10 or under or 5 and under?

Thanks in advance for any suggestions.
What type of events make up that AHI? And no, AHI of 19 (no matter the type of events) is not a good deal. Your therapy is not yet optimized -- 3 more months seems like too long to wait (doing nothing) given that you've already been on treatment for 4 months.

Welcome to the forum -- we'll do our best to help.

Edit: I see palerider posted about SleepyHead -- I agree. Let's see what's actually going on.

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bsokal
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Re: Doc Says "Don't Worry About the Numbers!"

Post by bsokal » Sat Jul 04, 2015 4:16 pm

I actually have been using SleepyHead software.

For the last 30 days it shows the following:

AHI : 19.19

Obstructive Index: 6.23
Hypopnea Index: 0.23
Clear Airways Index: 11.44

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palerider
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Re: Doc Says "Don't Worry About the Numbers!"

Post by palerider » Sat Jul 04, 2015 4:18 pm

bsokal wrote:I actually have been using SleepyHead software.

For the last 30 days it shows the following:

AHI : 19.19

Obstructive Index: 6.23
Hypopnea Index: 0.23
Clear Airways Index: 11.44
a 30 day summary tells nothing helpful, just that your therapy is ineffective.

post a few detail pages as shown on krelvin's pages linked below

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Last edited by palerider on Sat Jul 04, 2015 9:28 pm, edited 1 time in total.
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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kaiasgram
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Re: Doc Says "Don't Worry About the Numbers!"

Post by kaiasgram » Sat Jul 04, 2015 5:59 pm

bsokal wrote:I actually have been using SleepyHead software.

For the last 30 days it shows the following:

AHI : 19.19

Obstructive Index: 6.23
Hypopnea Index: 0.23
Clear Airways Index: 11.44
Is this the usual breakdown of events in your daily reports, with the predominance of clear airway events? Would be good to see a few typical daily SH reports.

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palerider
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Re: Doc Says "Don't Worry About the Numbers!"

Post by palerider » Sat Jul 04, 2015 9:30 pm

well, I briefly saw some charts, that showed mostly central apneas, which aren't treated by the machine you have.

also that you appear to be at a pretty high pressure support, and pretty high pressures, and straight pressure mode, not auto.

if it were me, I'd go to auto mode, lower the minimum epap, and lower the pressure support, and see if that lessened the centrals.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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kaiasgram
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Re: Doc Says "Don't Worry About the Numbers!"

Post by kaiasgram » Sat Jul 04, 2015 9:35 pm

bsokal -- First thing I noticed is that according to your SH reports you are not running at IPAP 20 and EPAP 14 as you indicated in your first post. There is no EPAP line in the Pressure graph and no EPAP numbers on the left under the Statistics. It looks like you have a constant pressure of 20. Is it possible the machine was not set up correctly by the DME? What does your Rx call for?

Edit: Why did you remove your reports? I thought I was seeing a correspondence between leaks and centrals but can't check it out now.

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bsokal
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Re: Doc Says "Don't Worry About the Numbers!"

Post by bsokal » Sat Jul 04, 2015 9:45 pm

Per your request below is July 3rd data from SleepyHead . Please let me know what info you glean from data or if you need more info. Two more days data will follow.

Image
Image
Image

JDS74
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Re: Doc Says "Don't Worry About the Numbers!"

Post by JDS74 » Sat Jul 04, 2015 9:55 pm

Do you have or can you get the two sleep study reports? There seems to be a disconnect between the numbers from the study which should represent effective therapy and the numbers you are getting from your machine at home.

So, if you know, what was the treated AHI and its breakdown in the hospital study.
What was the breakdown of the 55 AHI in the home study?
Can you post a SleepyHead report from a current night?

Sometimes additional pressure causes central apnea events to occur that weren't there untreated. That's called complex sleep apnea. Without some detailed data, its difficult to tell what is going on.

When I was using a Respironics Auto BiPap I got my AHI down well below 5 and I still felt crappy most days.
Now on a Respironics ASV, my AHI seldom gets down to 5 and mostly I feel much better.
I have some complex things going on that CPAP therapy helps but doesn't solve. It's a journey.

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Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
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palerider
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Re: Doc Says "Don't Worry About the Numbers!"

Post by palerider » Sat Jul 04, 2015 9:58 pm

kaiasgram wrote:bsokal -- First thing I noticed is that according to your SH reports you are not running at IPAP 20 and EPAP 14 as you indicated in your first post. There is no EPAP line in the Pressure graph and no EPAP numbers on the left under the Statistics. It looks like you have a constant pressure of 20. Is it possible the machine was not set up correctly by the DME? What does your Rx call for?
check the mask pressure trace, SH doesn't handle the aircurve machines 100%, since they came out after this version.

it seems to only pick up the ipap, not epap pressures.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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palerider
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Re: Doc Says "Don't Worry About the Numbers!"

Post by palerider » Sat Jul 04, 2015 9:59 pm

bsokal wrote:Per your request below is July 3rd data from SleepyHead . Please let me know what info you glean from data or if you need more info. Two more days data will follow.
before you do that, please look at this, and make ONE chart per day that is like the example:

https://sleep.tnet.com/resources/sleepyhead/shorganize

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Last edited by palerider on Sat Jul 04, 2015 10:00 pm, edited 1 time in total.
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

bsokal
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Re: Doc Says "Don't Worry About the Numbers!"

Post by bsokal » Sat Jul 04, 2015 10:00 pm

July 1 SleepyHead Data

Image
Image
Image
Image

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kaiasgram
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Re: Doc Says "Don't Worry About the Numbers!"

Post by kaiasgram » Sat Jul 04, 2015 10:04 pm

palerider wrote:
kaiasgram wrote:bsokal -- First thing I noticed is that according to your SH reports you are not running at IPAP 20 and EPAP 14 as you indicated in your first post. There is no EPAP line in the Pressure graph and no EPAP numbers on the left under the Statistics. It looks like you have a constant pressure of 20. Is it possible the machine was not set up correctly by the DME? What does your Rx call for?
check the mask pressure trace, SH doesn't handle the aircurve machines 100%, since they came out after this version.

it seems to only pick up the ipap, not epap pressures.
OK, I see that now -- thanks.

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JDS74
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Re: Doc Says "Don't Worry About the Numbers!"

Post by JDS74 » Sat Jul 04, 2015 10:08 pm

Looks as if your problem is almost all central apneas. Additional pressure won't fix that and may make it worse.
Can you drill down to look at a couple of those CA events and see how long they last?

_________________
Mask: Oracle HC452 Oral CPAP Mask
Humidifier: DreamStation Heated Humidifier
Additional Comments: EverFlo Q 3.0 Liters O2 PR DSX900 ASV
Oracle 452 Lessons Learned Updated
DSX900 AutoSV with HC150 extra humidifier and Hibernite heated hose
Settings: EPAP Min-10.0, EPAP Max-17, PS Min-3, PS Max-10, Max Pressure-20, Rate-Auto, Biflex-1.
Sleepyhead and Encore Pro 2.21.