Seeking Cpap specialist north suburbs of chicago

I am looking for a sleep disorder specialist near the north suburbs of Chicago. Lately my sleep apnea has been worse and I'm stuck between needing more pressure, but then I experience aerophagia. I haven't seen a sleep doc in years, but my last sleep doc suggested I keep my pressure set to 9-14. With that, I was seeing an hourly AHI number around 10. I slowly increased both numbers and the number got down to around 3 once I got the pressure to 18. If I set the top pressure range up to 20,the pressure will get there at times, but I wake up with stomach pains some nights. Now even with the pressure at 18, I have an AHI around 8 when I sleep on my back, with snoring. Most of my apnea events cluster together and almost look like periodic breathing on Sleepyhead.

Any suggestions are greatly appreciated.

Post some graphs through Imgur and link them on this thread.

Too many possibilities to guess at here, lots maybe having nothing to do with OSA or Cpap - have you had a good checkup lately? With labs? Gained any weight? Gone on any meds - which?

Don't sleep on your back - it'll provoke lots more apneas.

Great questions. I know contributing factors are meds and some weight gain. Specifically I've had to take what are supposed to be nonsedating antihistamines and I've gained a few pounds.

Sleeping on my back is much more comfortable, but I'm working on sleeping on my side. I always have to sleep on my left side, otherwise my mask blows air on my wife.

I'll post some screen caps from sleepyhead tonight. Any specific things the images should focus on? I assume an overview and also close up wave forms of my breathing during apnea episodes.

See the 1st Tutorial on front pg here for more info, but also browse pg for others' postings... don't enable the calendar or pie chart on the lt because you want the stats underneath to show up.

See all three pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

and for examples of how we like (and what we like to see) the graphs, etc
viewtopic/t103468/Need-help-with-screen-shots.html

I've gone ahead and added some screen shots. Let me know if any other views would be helpful.

Obviously you need more pressure.
Unfortunately more pressure causes the old ugly aerophagia monster to rear its ugly head.

It appears you are using AFlex exhale relief...what setting are you using?

I am thinking you are a good candidate for a bilevel pressure machine.

I'm pretty sure I have the relief setting turned off. When I've tried various pressure relief settings, my AHI would increase slightly. I guess I could increase the max pressure and turn on pressure relief and see how I do.

The example I posted was one of my worse nights. When I can keep myself on my side, my AHI seems to stay below 5 pretty regularly.

I appreciate your comments. Regarding bipap, I would love to try it which brings me back to the title of this post - is there a good specialist in the Chicago area. I'm hoping I don't need another sleep study to show that I need bipap. I never seem to need as much pressure in the sleep lab, but it has been a few years.

I don't know if adding more pressure in conjunction with adding some exhale relief will help or not in terms the aerophagia or not. The maximum that Respironics can give is 2 cm drop during exhale and it might not be enough to ward off the aerophagia and still do a half way decent job of preventing the apneas. I do believe it is worth trying.
Sometimes adding exhale relief will help reduce aerophagia symptoms. Bilevel machines offer more exhale relief along with the higher pressures and that's why bilevel is the first thing we think of in situations like yours.

It's not unusual to have it be where our OSA is worse when we are on our backs and/or need more pressure when we are on our backs. The same thing can be said of REM stage sleep. You can't always prevent rolling over onto your back (and it might not even be comfortable to stay on your side and if you aren't comfortable you can't sleep well anyway) plus we have zero control over REM sleep. My OSA is worse in REM and I often need pressures up around 18 just for REM sleep.
I did some experiments with sleeping on my back and on my side and the pressures really didn't change much with position..just the time where I was probably in REM and on my first sleep study it was documented that in REM sleep my OSA is about 5 times worse than when in Non REM sleep.

I am sorry but I have no connections in the area where you live when it comes to any sort of doctors.
So I can't help with that part of your problem at all. Maybe we have a forum member who lives in your area that might have some ideas.
If it has been a very long time since your last sleep study I would almost bet my last dollar that a new doctor would want repeat sleep studies all the way around and you would likely have to jump through all the usual hoops before getting a bilevel machine....plus most likely another sleep study using a bilevel machine after a titration sleep study using a regular cpap machine. There might be some doctors out there who would accept these reports and your subjective complaints and give you bilevel but most won't unless they were the original doctor prescribing cpap way back when..then maybe they would do it.

Would it be possible for you just to buy another machine privately if we could find a bilevel that wouldn't be horribly expensive? If you haven't met your insurance deductible this year and if it's substantial I imagine we could probably find you a suitable bilevel that would cost less out of pocket if you compare your deductible and any copays into the equation.

If you want to consider private purchase...send me a PM. I might know of some options and I will explain them.

I think your analysis is probably right. I was thinking I may need bipap both for the higher pressure plus the chance that it'll be better tolerated at those high pressures.

I appreciate your time. I'm hoping one of the forum members would know a friendly sleep specialist in the area who would be willing to prescribe based on sleepyhead data. I'd be willing to do another sleep study if I thought it would ultimately help.

This was me on bipap. Wondering if I have more centrals that the respironics didn't detect.

No way to know for sure. Too many variables.
Different night. We don't sleep the same each night and there can be a wide variance just because of the sleep or lack of.
Different machine that uses different algorithm in how it goes about its job.
Different pressures from what was used on the other machine.

I have a strong suspicion that the bulk of your centrals are probably SWJ centrals and not the real deal.
For sure the first ones at the beginning of the night...bet you weren't asleep.
Wouldn't be surprised if those are semi awake breathing irregularities SWJ...bet you were sort of waking and going back to sleep during that last couple hours of the night.

I raised the epap minimum to 13 to see if that would help with some of the obstructive events and it did seem to help. The events marked as centrals were also fewer last night, and it very well could be swj in the morning hours. I noticed being awake a few more times this past night.

Also, no signs of problematic aerophagia - yet. Hopefully

I also raised my humidifier settings from 3 to 4.5 as I had very bad dry throat in the morning yesterday. Not sure if it's the start of a cold, etc. It was better today. I'm still getting used to the h5i humidifier. I'm using it with a standard cpap hose for now (will switch to a heated hose soon). This morning, when I turned off the machine, the unit said "cooling down", but the light in the humidifier was orange. Yesterday morning, the light was blue when it said cooling down. I'm not sure if the orange light today in cool down mode signifies a problem?

I have never been able to get what the colors meant. I just know they can change and it doesn't mean much.
Maybe someone else knows off hand what they mean.

If your OSA happens to be worse in REM it's possible that the OA events are contributing to the restlessness in those wee hours of the morning (where we tend to have more REM) and once OAs are better prevented the restlessness will decrease and thus the SWJ (that we think are happening here) centrals will decrease.

Play around with the humidity...what setting were you using on the PR S1 machine...I know it was a non heated hose.
Another advantage of the heated hose....more consistent humidity delivery at whatever setting you choose.
Without the heated hose extra control humidity delivery is more dependent on the machine and the ambient humidity which can vary a lot and makes figuring out what your nose likes a little more difficult.
Maximum humidity without a heated hose is less than maximum with a heated hose.

If a hot steamy shower feels good and helps the nose...you might be like me and prefer snorting water. so I use maximum humidity available with the heated hose.
Some people do better with less added moisture. There's really no right or wrong with what someone prefers...there's just what the nose wants for each individual.