Need some advice on setting the range

eljay · Post by **eljay** » Sun Oct 14, 2007 6:28 pm

Hello everyone. I've been reading this forum for about 6 weeks and have learned a lot from everyone. I've learned so much, in fact, that now I have a question I hope you can help me with.

First, some background. My primary care dr had me do a sleep study because I complained of excessive daytime sleepiness. During my sleep study I had an AHI of less than 1. Sleep dr said "patient did not meet criteria for the diagnosis of OSA....However it should be noted that at least 20% of patients with negative sleep studies for OSA if retested will have significantly different results. Since this patient had a very poor sleep efficiency (less than 50%) and delayed sleep onset that is certainly possible....Patient should discuss these results with patient's physician...I have no specific recommendations regarding this patient."

So I discuss with my Dr. She suggests trying CPAP for a couple of months to see if I feel better, I say ok. DME sets me up with an APAP with at range of 4 - 10.

So here we are 6 weeks later. I've gotten used to the machine, can get to sleep, wear the mask all night, don't wake up as much, don't have to go to the bathroom as much, but also don't feel any better during the daytime.

A couple of weeks ago I took my card to the DME and had them download the info. My 90% pressure for the month was 6.3, avg AHI 2.8. The Summary of Daily Events, for the previous week looks like this:
4 cmH20 for 61% of time, AHI of 1.8
5 cmH20 for 24% of time, AHI of 2.0
6 cmH20 for 7 % of time, AHI of 4.2
7 cmH20 for 5% of time, AHI of 4.5
8 cmH20 for 2% of time, AHI of 0
9 cmH20 for 1% of time, AHI of 0
10 cmH20 for 0.5% of time, AHI of 0

I'm confused about why the AHI goes up as the pressure goes up, and then drops to 0 at 8 cmH20. If the pressure needs to be that high, it seems like it would be there more than 3.5% of the time. But what do I know?? So that's why I've finally registered and am making this first post, cause I'm sure you all can help me out
Sorry to be so long winded, I'll try and be more succint in the future...

Wulfman · Post by **Wulfman** » Sun Oct 14, 2007 7:26 pm

Welcome to the forum.

Here's my take on what's happening.
You're having events at those low pressures, but due to the response of the machine and the way it works.....you have to have events before the machine can respond, so it's doing all of its responding at those lower pressures.....but it won't sustain itself at a higher pressure where there are no events (like 8 cm.)
I don't know about you, but I'd be starving for air down there.
If it were me, I'd set my bottom pressure at 8 cm. and the top at about 12 cm and try that for a period of time and see what the numbers look like then.

You might want to run that by your doctor first, but that's what your numbers are telling ME (at this point)......and I'm not a doctor.

Den

cflame1 · Post by **cflame1** » Sun Oct 14, 2007 7:27 pm

Some of it may deal with the pressure that you're starting at... you'll notice in your list you're at 4 for a lot of the time.

But... everybody has either a single number or a range that is good for them.

eljay · Post by **eljay** » Sun Oct 14, 2007 7:43 pm

Thanks, Wulfman. I see what you're saying about the pressure not staying up if I'm not having events, so it makes more sense now. I've seen a lot a people on this forum really freak out over a min setting of 4, but I've never had a problem with it. In fact, I like it better than an 8, which wakes me up and freaks me out! Not sure I could go with an 8 for the min, but might try a 6. I guess I should talk to my dr, but I'm not sure she really knows anymore than I do...

Wulfman · Post by **Wulfman** » Sun Oct 14, 2007 7:53 pm

eljay wrote:Thanks, Wulfman. I see what you're saying about the pressure not staying up if I'm not having events, so it makes more sense now. I've seen a lot a people on this forum really freak out over a min setting of 4, but I've never had a problem with it. In fact, I like it better than an 8, which wakes me up and freaks me out! Not sure I could go with an 8 for the min, but might try a 6. I guess I should talk to my dr, but I'm not sure she really knows anymore than I do...

Your overall AHI is "good" at your present settings, but I was thinking of two things as far as getting it up a little higher......CO2 washout.....depending on your mask, you may be retaining too much carbon dioxide at those low numbers......AND, just the ability to feel like being able to breathe.

I concur with your thought to try a minimum setting of 6. After all, you won't know till you TRY.

Good luck and keep us posted.

Den

jules · Post by **jules** » Sun Oct 14, 2007 8:04 pm

AHI less than 1 on sleep study, AHI now 1.1 approximately on cpap so not a whole lot of change

sleep better but still excessive daytime sleepiness

I would suggest seeing a board certified sleep specialist or two (and not at the sleep lab you went to) and having them review what is going on. There may be something else going on that the sleep lab missed. It might also be CPAP is the best treatment you can get and you have a bigger sleep debt to pay than you imagined.

Is your insurance paying for this CPAP?

Slinky · Post by **Slinky** » Sun Oct 14, 2007 8:18 pm

Eljay!!! Its C2! So good to see you post! There are some real savvy folks here. Keep checking this thread to see if there are any other suggestions too.

eljay · Post by **eljay** » Sun Oct 14, 2007 8:21 pm

[quote="jules"]AHI less than 1 on sleep study, AHI now 1.1 approximately on cpap so not a whole lot of change

sleep better but still excessive daytime sleepiness

I would suggest seeing a board certified sleep specialist or two (and not at the sleep lab you went to) and having them review what is going on. There may be something else going on that the sleep lab missed. It might also be CPAP is the best treatment you can get and you have a bigger sleep debt to pay than you imagined.

Is your insurance paying for this CPAP?

jules · Post by **jules** » Sun Oct 14, 2007 8:24 pm

what was the diagnosis submitted to rent the machine?

I ask because the insurance normally wants the sleep study and needs an AHI of at least 5 (some insurance need more I understand - perhaps one of the techs can clarify this) to pay with a diagnosis of OSA

You don't want to be stuck paying 100 % of the inflated rental fee when the insurance bounces the claim.

eljay · Post by **eljay** » Sun Oct 14, 2007 8:25 pm

Slinky wrote:Eljay!!! Its C2! So good to see you post! There are some real savvy folks here. Keep checking this thread to see if there are any other suggestions too.

Will do, Slinky. Uhhh, have we met before??

Slinky · Post by **Slinky** » Sun Oct 14, 2007 8:27 pm

Mebbe I was mistaken, Eljay. I know an Eljay at HW from MD. My apologies.

Wulfman · Post by **Wulfman** » Sun Oct 14, 2007 8:29 pm

I see that you're also using a nasal mask......make sure your're not mouth-breathing or mouth-leaking. If you've been reading this forum, you're probably aware of what to do to prevent that.
Leaking therapy air will definitely delay your "recovery".

Den

eljay · Post by **eljay** » Sun Oct 14, 2007 8:32 pm

[quote="jules"]what was the diagnosis submitted to rent the machine?

I ask because the insurance normally wants the sleep study and needs an AHI of at least 5 (some insurance need more I understand - perhaps one of the techs can clarify this) to pay with a diagnosis of OSA

You don't want to be stuck paying 100 % of the inflated rental fee when the insurance bounces the claim.

eljay · Post by **eljay** » Sun Oct 14, 2007 8:35 pm

No apology necessary, Slinky. Actually, it was kind of nice to have someone so excited to see me! I'm just disappointed that I didn't come up with a more original name... I thought I was being so clever!

eljay · Post by **eljay** » Sun Oct 14, 2007 8:43 pm

Wulfman, yes, I have been reading about mouth leaks, and the last couple of nights I used a stretchy headband as a chin strap. Both nights my AHI was 0.5, lower than the average, but the leak rate was about the same. (This is based on the readout on the machine. I've been resetting it every day and keeping a log of the stats - something I learned to do from reading this forum! I keep thinking of getting the Encore Viewer, but just haven't gotten myself to plunk down the bucks yet.) But I digress....

If I am mouth leaking, would I expect to see a difference in the leak rate? It's usually in the 13 - 17 L/min range, with a couple of days around 30. I don't know what it should be for my mask, the RT didn't give me the papers on the mask (and I didn't know enough at the time to ask for them) and I haven't had any luck finding it listed anywhere. I've also read about the polident and taping, but am a little reluctant to try those just yet. I do wake up with a dry mouth, but not a sore throat....