Confused by sleep doc's attitude towards AHI

[rosevader]

SO I went in to see the sleep doc today (about 4 weeks in) because although the pressures I've been using have been raised multiple times, my AHI is still in the teens most nights. When the autoCPAP pressures were set 15-20, I ended up with pretty nasty aerophagia and ended up backing down to 10-12 as advised by Pugsy. I figured that he would switch me to a biPAP machine. Instead he talked about how I hadn't been on CPAP for 2 months, and some patients took that long to get benefit (I am still feeling pretty horrible, not seeing any obvious signs of improvement physically or mentally yet). He also said he knew of some patients who had really high AHI who didn't feel sleepy at all. SO what the heck can I make out of that? Is measuring AHI a waste of time? Should I expect it to take another month before I see any changes? I've been using CPAP every night for 7 hours at a time. The doc also says I should sleep 8 hours instead, as that might be the main reason I'm still tired? Color me confused and exhausted.

[Julie]

Does your software report leak data?

[Pugsy]

I would be coloring your doctor an idiot. No amount of time is going to make you need less pressure than you need. Time can work some miracles for sure but it can't work that good of a miracle. Now maybe we can work a small miracle by easing you into the needed pressures slowly without causing so much gi distress.
Sigh......
How's the belly doing now? I know the AHI is high with the lower settings but you had to back up and let the belly heal.
I have been wondering how you have been doing.

[rosevader]

I have no leaks. Everything should be great except its not. The 10-12 setting at least doesn't give me bloating. I still feel horribly tired though every day.
Should I be looking for a new sleep doc?

[jaw]

About the correlation between AHI and sleepiness / fatigue / fogginess: my AHI is easily 0.5% although I still feel dead tired with my head/brain almost all the time viewtopic/t112231/100-compliant-to-CPAP ... hing-.html.

I've met one patient whose pre-CPAP AHI was 70, and he said he did not feel tired at all, he came to the doctor only because his wife complained about his snoring.

[Julie]

Jaw - to be fair you have other issues rosevader might not, and why discourage him/her about their experience unnecessarily?

[Pugsy]

For past history go to Rose's other thread.
viewtopic.php?f=1&t=112261&p=1079486#p1079486
It's not all that long and no sense in me typing all that again so go read it if you aren't familiar
Leaks are NOT an issue.

She needs higher pressures and the doc has been making leaps and bounds increases but the higher pressures are causing significant GI issues...much more than farting all day. The plan is to back up and let the belly heal and then start with higher minimums and try to limit the maximums in an effort to better control those apnea events and maybe get lucky and not cause the GI distress. So we backed up to 10 min and 12 max knowing full well it wouldn't be enough for the AHI but in this situation actually getting some sleep and not causing major GI distress took precedent over tweaking the pressures....She did try 12/16 on June 10 but that report is useless because she didn't sleep and the data looks like no sleep awake breathing.

Her best AHI was one night June9 with pressures 15 min and 20 max...and it gave an AHI of around 7 but the resulting GI distress was significant.
For some reason I can't get the screenshot to stick on my desktop but it was barely 4 hours (if that) so it's not a good example..but it trended like the others...worse later on in therapy. Probably related to supine sleeping but due to shoulder surgery/pain staying on her shoulder/sides all night isn't going to happen so we deal with it.

Here are a couple prior nights with lower pressure settings.

pressure settings 12 min and 16 max


pressure settings 8 min and 16 max

[Pugsy]

Should you be looking for another doctor...well, I would be.... but getting in to see a new doc will most likely take some time.
If you are willing and the belly is up to it I think that while you are looking for a new doc that it might be worthwhile to check out some pressure settings that the doctor skipped over when he made that huge leap to 15/20.

[rosevader]

When I talked with the doc yesterday, he didn't even remember that the pressure changes had been made (he must have authorized them?) and he didn't look at any of the sleep graphs from data recorded by the autoCPAP either. He stated that he found my situation unusual, and that he thought maybe the auto CPAP couldn't ramp fast enough to catch up to my OA (must be speculating as he didn't look at any graphs from the machine while he was talking about this, and I got the vague impression that he wasn't really clear on how much data the autoCPAP is capable of recording). SIGH.
Pugsy, I set the machine at 10-13 for 7.4 hours last night resulting in AHI of 13 (OA 71, CA 13, Hyp 14. Hey, better than AHI of 17, I guess) What further pressure changes do you think I should step through (until I find a less clueless sleep doc?) Thanks for any help.

[BlackSpinner]

He stated that he found my situation unusual, and that he thought maybe the auto CPAP couldn't ramp fast enough to catch up to my OA (must be speculating as he didn't look at any graphs from the machine while he was talking about this, and I got the vague impression that he wasn't really clear on how much data the autoCPAP is capable of recording).

And he doesn't understand how an APAP works.

I think you need a new doctor who is a REAL sleep doctor and not someone making money off a new specialty.

[rosevader]

Actually, he's an old school sleep doc who talks about treating CPAP patients before auto CPAP. Maybe he just hasn't kept up with the technology??

[BlackSpinner]

Actually, he's an old school sleep doc who talks about treating CPAP patients before auto CPAP. Maybe he just hasn't kept up with the technology??

APAPS have been around for a while now. They weren't new when I started 7 years ago.

[chunkyfrog]

If you work in IT, you have to keep up with the latest-software, data, etc.
Why is it that keeping up seems to not be a priority,
WHEN LIVES DEPEND ON IT?

[Pugsy]

Lots of docs, young and old, don't understand exactly how the apaps work. He probably doesn't have a clue.
He is correct about one thing though...the machine can't respond fast enough because it has to go too far from the minimum to get the job done. That's why the minimum is actually more important than the maximum.
ResMed machines will respond a wee bit faster but I don't think that changing to a ResMed at this time is the secret...it would also have trouble with the minimum. We need a higher minimum to give the machine a better head start on where it needs to go.

We need to get that minimum pressure up but let's go slow.
How about minimum 10.5 and max of 13.5? See how the belly does.

The real bugger is the supine sleeping I think and that's unavoidable right now so we just deal with it.

I forget...are you using AFlex? If not, use it and set it to 3 if you are comfortable with it at 3. If you think it is rushing your breathing...try 2.

[rosevader]

Okay, I'll up the pressures to 10.5-13.5 tonight. I switched AFlex to 2 as you suggested and that worked better for me.
Thanks for the help!