Cannot Control AHI Consistently

[ronlsujones]

During the spring of 2012, I participated in 4 sleep studies over a 2 month period. The data resulted in a prescribed pressure of 26 mm water. Yes, that is correct 26 mm water. As I read most posting on this site and listen to people complaining about "high pressure" prescriptions of 10 or maybe even 15 cm water. Strap on 26 cm water for a while and you will understand high pressure. Just achieving that pressure is an amazing feat. Initially, it was next to impossible but I finally mastered using full face masks until they wreck the bridge of my nose then switching to nasal masks for a few days.

The pathetic thing about my situations is even with the compliance with prescribed pressure, AHI sucks most of the time. During a single week it varied from 3.2 to 35.8 and I don't have a clue about the causes of either the low or high results. I will have a night where I actually sleep continually and think that the index will be low but it isn't. I take a lot of medication including blood pressure drugs, blood thinners and a large amount of pain medication daily. Treatment for pain includes three 20 mg extended release Oxycodone pills along with four 15 mg Oxycodone pills per day because of a staph infection of the spine experienced a few years ago.

There are two things that cause me to be totally puzzled. The first is after a few months of therapy my BP medication requirement decreased to the minimum allowed then gradually increased back to maximum. I do not understand what caused it to drop but surely would like to know. The other confusing situation involves the dramatic variations of AHI. If I could understand what causes the AHI of 3.2 and learn how to maintain that performance, obviously my problems would be solved.

I just switched from the initial sleep doctor who seemed to know less about apnea than I to a highly recommended doctor who really seems to care. The problem I now have is after hoping that the new physician would have an answer to my questions I learned that he does now. When I switched, I fully anticipated being subjected to numerous sleep studies again but that did not happen. He spend significant time studying my initial studies and data I provided on performance during the last few months, said something about "being realistic with expectations" and suggested seeing him again in 3 months.

Hopefully, someone else had problems similar to mine and found a solution? I review my performance data frequently but there just doesn't seem to be any logic to what I observe. While I didn't spend a lot of time bitching about it, yes I fell like hell every day. On weekends, I often take a nap shortly after noon and during the week if I don't sleep for an hour at 5 or even 6 PM I am falling asleep by 8 PM. As mentioned BP medication is at maximum and obviously the doctors don't know what to do. There is little doubt in my mind that the problems are caused by apnea but I can't figure out a solution to the problem. Any help will be much appreciated.

Ron

[kteague]

I'm sure someone will come who who can talk with you about the specifics of yours treatment. I'm wondering why 4 studies in 2 months - did you end up having to get titrated on an ASV machine? I have a friend whose prescribed pressure is 25, and that high pressure triggered centrals and so he uses an ASV. Does your data show your events are obstructives or centrals? The suggestions you get will be more targeted and helpful with more information. Good luck pinpointing ways to make your treatment better for you.

[palerider]

During the spring of 2012, I participated in 4 sleep studies over a 2 month period. The data resulted in a prescribed pressure of 26 mm water. Yes, that is correct 26 mm water.

hmm, my machine starts out at 100mm of water... and goes up to as much as 250mm h20.

are you SURE you're correct?

[Tatooed Lady]

I think palerider is pointing out that these use cm of pressure, not mm. He's a real wisecracker. generally harmless, though.

[palerider]

I think palerider is pointing out that these use cm of pressure, not mm. He's a real wisecracker. generally harmless, though.

there's also the fact that there's a vanishingly small number of machines that'll go over 25cm, though it is possible. (I know of one in the resmed line) if he is using an avaps, then that is likely one of the few that will go up to 30cm

[Pugsy]

viewtopic.php?f=1&t=86579&p=789058#p789058
Supposedly using a Respironics ASV type of machine...humidifier points to a PR S1 machine if that is correct...so with the 2013 date..probably a model 950 maybe...I never could find where model was confirmed.

Would need to see some reports to offer any ideas why the wide range of AHI numbers but I suspect they are related to the opiate meds. Either centrals from suppressed respiration or obstructives due to opiates causing the airway tissues to really relax.
This much opiate meds is going to play hell with both centrals and obstructives.

Need to see some detailed reports from a "good" night with low AHI and a "bad" night with high AHI.

I take a lot of medication including blood pressure drugs, blood thinners and a large amount of pain medication daily. Treatment for pain includes three 20 mg extended release Oxycodone pills along with four 15 mg Oxycodone pills per day because of a staph infection of the spine experienced a few years ago.

[SGearhart]

Certain pain abatement drugs can act as a stimulant. At the same time, certain blood pressure medicines can act as a sedative, Are you taking these drugs at the same time of the day? If so, how long before you go to bed? Analyze your AHI's and when you took each drug for that day. You might find a correlation there. Keep posting your findings.

[Julie]

Yes, I believe the oxy's are probably having a huge effect and you might want to work on getting them down (with your MD's help) because I think you're fighting the machine, your body, the meds, etc. etc. I don't think you'll get anywhere reasonable until you address the meds and whatever else might be complicating things. Cpap is not a magic bullet and can only achieve so much (tho' it can certainly lower your BP all things being equal).

[Ogeo]

The data resulted in a prescribed pressure of 26 mm water. Yes, that is correct 26 mm water. As I read most posting on this site and listen to people complaining about "high pressure" prescriptions of 10 or maybe even 15 cm water. Strap on 26 cm water for a while and you will understand high pressure. Just achieving that pressure is an amazing feat. Initially, it was next to impossible but I finally mastered using full face masks until they wreck the bridge of my nose then switching to nasal masks for a few days.

I can relate to you and the "high" pressure bit. Mine starts at 21 and goes up to 25. I have to just laugh when people report that their "super high" pressure is 10. I actually like the force of the air blowing at me because I felt like I could breathe for the first time in my life. My biggest problem adjusting to my ASV was finding a mask that would stay on my face. I went through 8 before finding the one I'm using now. And believe it or not, it is a pillow mask. The FFM would keep me up all night with loud farting noises. If I tightened it, I was too sore to wear it or it put pressure on my eyeballs. I believe you are the first person I noticed on these forums that has higher pressure set than me.

With one mask, I actually added another strap around it to help hold it to my face so I didn't have to overtighten it. If you try something like that, then make sure the vent on the mask is left open and not covered with anything. You don't want to re-breathe your expelled air.