AHI ranging from 3 to 24 averaging 9. Doctor says it's fine

[NK-H]

Hi, This is my first post.

I'm in Ontario, Canada. I've been on CPAP for 11 years. I was on a pressure of 8 for years and my AHI usually stayed below 5. An earlier sleep study had determined that higher pressures induced central apneas. I usually didn't feel fully rested and would often wake up with a headache but I figured my apnea was being controlled as well as could be expected.

A few months ago my AHI started increasing and my headaches and tiredness got worse. I saw my sleep specialist and he scheduled a sleep study (with CPAP) in March. He said that they would test to see if I still had trouble with central apneas at higher pressure. Apparently it was one of my good nights and they said that it was well controlled at a pressure of 9 so they didn't try going higher. They changed my pressure from 8 to 9 after my study and I had to wait two months for my follow-up appointment with the specialist. In that time my AHI continued to climb and I was getting more tired. I decided that my six year old ResMed S9 Elite CPAP might be malfunctioning so I arranged a loaner PR DreamStation Pro CPAP from my supplier. My specialist saw the data from the DreamStation and is happy leaving me on CPAP at a pressure of 9. The week of collected data he saw ranged from about AHI 3 to 14 with an average of 8. He says the average of 8 is fine and to just ignore any higher readings. He gave me a prescription for a regular CPAP (not Auto) and told me to lose weight (I'm 6'1" and 238 pounds). He said "Just eat less, like the rest of us.".

What do you think I should do? I'd like to try an Auto CPAP but my insurance won't cover it unless I get a different prescription. I have included my SleepyHead capture from last night with an AHI of 22.6.

Thanks,
Eric

SleepyHead data.jpg (814.9 KiB) Viewed 8161 times

[Julie]

Hate to ask, but have you been gaining weight? That often causes AHI to go up and should be considered if it already hasn't been. Taking any new (relatively) meds? Changed your mattress or pillow?

[TedVPAP]

Fire your doctor.
Get a new doctor or start treating yourself.
New machine must be full data; auto is preferred but not necessary.
You need more pressure to address your obstructive sleep apnea - you are undertreated.
Based on the data you show and your previous sleep studies, you probably don't have a central apnea problem so a standard cpap/autopap machine may be all you need. But that is just a guess.

[TASmart]

I'd get a new Dr, any Dr that thinks obesity is a simple matter of eating less is not currently in that field, it's way more complicated than that, although it is a simple truism that eating less is a solution, just much of a doable solution. Your shown data is not good, not only does it show a lack of sufficient treatment pressure, but you sleep night is from 5 am to 9:30 (or thereabouts) which is even with good sleep is typically not sufficient to feel rested. As far as the SA, clearly you need more pressure, and without a closeup of the waveforms, it may well be that the centrals are not central apnea bu arousals where you get an arousal then in the tossing and turning get transitional apnea.

I would start with few nights at a pressure of 10 and see what that looks like, then move the pressure up one cm H2O until you have cleared up the obstructive apneas and hypopneas. Then we can look at the central apnea situation and see if there is a reason to be concerned with that. In your case, as Ted said, fall data such as what you are using is an absolute must, and since your Dr is a dud, an auto would be nice to help zero in on proper treatment pressures quicker. But an awful lot of people get along just fine with a single pressure machine. In my case, I have an auto, but use the fixed pressure as I seem to sleep better that way.

[MrsRinPDX]

Sounds like your doctor is a jerk. Having an AHI that high is not fine. It's untreated sleep apnea.

I have an auto machine but had an excellent titration at the sleep clinic, so my machine is using fixed pressures. My AHI average is now below a 1, from an untreated 71. So as stated in posts above, you can get there without the auto machine.

[DavidY]

The good thing about buying an APAP (Resmed Airsense 10 for her or Philips Respironics Dreamstation Auto) is the price is well regulated as compared with other provinces. Currently,
There is an ad on Kijiji GTA selling new Dreamstation Auto for $500... he had 4 units to sell. Doesn't OHIP cover 75% of a new unit (every 5 years?)? That's about $200-$250 for your cost...assuming that an ADP approved sells an APAP for $800-$1000. However, a prescription is required for an APAP. Assuming you don't need to treat centrals, I recommend an APAP (see acceptable brands and models above) and using Sleepy Head software to make pressure and comfort adjustments. Get another doctor first as others have noted.

Dave

[Arlene1963]

I really do wonder about the sleep specialists here in Ontario. The sleep specialist I saw didn't think I needed XPAP with moderate OSA (AHI 16) and the only reason she considered prescribing XPAP was because I'd had an arrhythmia that landed me in ER. Had it not been for that she told me she would not have considered XPAP.

As for firing our sleep specialists, if only it were that easy! We don't really have much choice, unfortunately. Wait times are so long, and depending on the city you live in, it can take many, many months to see a new one.

My advice is take charge of your own treatment and forget about sleep specialists. If you can afford to do so, get a data capable used APAP and start monitoring your own data. That is what I did and I never regret saying "goodbye" to the sleep specialist.

[NK-H]

Hate to ask, but have you been gaining weight? That often causes AHI to go up and should be considered if it already hasn't been. Taking any new (relatively) meds? Changed your mattress or pillow?

No new meds or mattress. New pillow but the problems were also occurring with my old pillow. Weight gain was one of my concerns prompting the sleep study. I gained about 10 pounds between the sleep study and the follow-up appointment about 9 weeks later. I was already getting an occasional AHI in the teens around the time of the sleep study.

[NK-H]

Fire your doctor.
Get a new doctor or start treating yourself.
New machine must be full data; auto is preferred but not necessary.
You need more pressure to address your obstructive sleep apnea - you are undertreated.
Based on the data you show and your previous sleep studies, you probably don't have a central apnea problem so a standard cpap/autopap machine may be all you need. But that is just a guess.

I have made an appointment with my family doctor to get a referral to a different sleep doctor. I have 100% coverage for a full data CPAP but would like APAP so that I can better evaluate my required pressure. I suspect 9 is a good pressure when I am on my side but too low when I am on my back or perhaps when I am in REM sleep.

Thanks

[NK-H]

I'd get a new Dr, any Dr that thinks obesity is a simple matter of eating less is not currently in that field, it's way more complicated than that, although it is a simple truism that eating less is a solution, just much of a doable solution. Your shown data is not good, not only does it show a lack of sufficient treatment pressure, but you sleep night is from 5 am to 9:30 (or thereabouts) which is even with good sleep is typically not sufficient to feel rested. As far as the SA, clearly you need more pressure, and without a closeup of the waveforms, it may well be that the centrals are not central apnea bu arousals where you get an arousal then in the tossing and turning get transitional apnea.

I would start with few nights at a pressure of 10 and see what that looks like, then move the pressure up one cm H2O until you have cleared up the obstructive apneas and hypopneas. Then we can look at the central apnea situation and see if there is a reason to be concerned with that. In your case, as Ted said, fall data such as what you are using is an absolute must, and since your Dr is a dud, an auto would be nice to help zero in on proper treatment pressures quicker. But an awful lot of people get along just fine with a single pressure machine. In my case, I have an auto, but use the fixed pressure as I seem to sleep better that way.

Yes, my sleep doctor seems to be stuck in the yo-yo dieting paradigm. I've done calorie restriction in the past and I have always regained the weight. I am trying to control my weight through intermittent fasting/time restricted eating. I have been following the techniques championed by Dr. Jason Fung. Fasting for 16 hours and eating in an 8 hour window (16/8) I can maintain my weight. Fasting for 18 hours and eating in an 6 hour window (18/6) I can gradually lose weight. Unfortunately it's hard to maintain this eating pattern while I have poorly controlled sleep apnea. As you have noted my sleeping patterns are not ideal and this sabotages my attempts at weight loss. I often can't make it through the day without a nap. Even when I don't nap I seldom sleep for more than 5 hours, usually waking fully every hour or two. I imagine my cortisol levels are very high. Your strategy for finding my correct pressure sounds sensible. I'll see if I can finagle an APAP. If I am stuck with getting a standard CPAP I will make sure it has full data.

Thanks

[NK-H]

Sounds like your doctor is a jerk. Having an AHI that high is not fine. It's untreated sleep apnea.

I have an auto machine but had an excellent titration at the sleep clinic, so my machine is using fixed pressures. My AHI average is now below a 1, from an untreated 71. So as stated in posts above, you can get there without the auto machine.

I also think my doctor is a jerk. Fat shaming someone in hopes that they will lose weight so that they can can use a pressure that is currently too low does not seem right to me. When he said "Just eat less, like the rest of us." I noticed he had a bit of a belly and could lose a few pounds. I resisted the urge to say "So, how is that working for you?" It seems from what you and others have said, I can a address my AHI issues with an APAP (preferred) or a full data CPAP. This is encouraging.

Thanks

[NK-H]

The good thing about buying an APAP (Resmed Airsense 10 for her or Philips Respironics Dreamstation Auto) is the price is well regulated as compared with other provinces. Currently,
There is an ad on Kijiji GTA selling new Dreamstation Auto for $500... he had 4 units to sell. Doesn't OHIP cover 75% of a new unit (every 5 years?)? That's about $200-$250 for your cost...assuming that an ADP approved sells an APAP for $800-$1000. However, a prescription is required for an APAP. Assuming you don't need to treat centrals, I recommend an APAP (see acceptable brands and models above) and using Sleepy Head software to make pressure and comfort adjustments. Get another doctor first as others have noted.

Dave

Thanks for doing the pricing research! Between OHIP covering 75% and insurance through an employer covering the rest I am 100% covered for whichever machine my sleep doctor prescribes. With my current prescription I can get a full data CPAP. I'm definitely getting a new sleep doctor. I can get by with my six year old ResMed S9 Elite (though the detailed data function no longer works) until I can determine if I can change my CPAP prescription to an APAP. If I can't get an APAP prescription I'll probably get a ResMed AirSense 10 Elite and do my own pressure changes, monitoring my progress with SleepyHead.

Thanks

[NK-H]

I really do wonder about the sleep specialists here in Ontario. The sleep specialist I saw didn't think I needed XPAP with moderate OSA (AHI 16) and the only reason she considered prescribing XPAP was because I'd had an arrhythmia that landed me in ER. Had it not been for that she told me she would not have considered XPAP.

As for firing our sleep specialists, if only it were that easy! We don't really have much choice, unfortunately. Wait times are so long, and depending on the city you live in, it can take many, many months to see a new one.

My advice is take charge of your own treatment and forget about sleep specialists. If you can afford to do so, get a data capable used APAP and start monitoring your own data. That is what I did and I never regret saying "goodbye" to the sleep specialist.

I've heard that doctors who decide to become specialists often do so because they don't like people and therefore aren't happy in family practice. I think this may be true. They often seem lacking in compassion. I'm sorry to hear of your experience but I am happy that it turned out well in the end. I will try to find a better sleep specialist but I don't want to be completely dependent on them. I am taking your advice and plan to take charge of my own treatment.

Thanks

[Julie]

I recently read quite a scathing article on fasting as a diet to lose weight - not for the first time either. While the concept of fasting e.g. once a week (without some of the complex issues you mention) can be a good idea on a routine basis for some, it's not meant to be used as a 'diet' per se, more of a cleansing tool (which most in modern medicine don't believe is necessary at all). But if you want to lose weight you'd be much better off to put your energy into learning different and ongoing eating habits in general, ones that don't require 'willpower' at certain intervals, or strange food, or who knows what ... and which usually just end up being self defeating anyhow. 'Diets' don't work, knowledge and ongoing slow change of habits can.

[zoocrewphoto]

I would send a couple articles to your doctor to help update his education.

One that explains that sleep apnea is not always weight related. Many skinny people have sleep apnea, and often, the sleep apnea is what causes the weight gain. So, to lose weight, you need to treat the sleep apnea. Not the other way around.

And the other one that explains that AHI is the average number of sleep DISTURBANCES per hour. How would he like to be disturbed 8 times an hour??? That is okay???

BS. You need to be treated. Most doctors want to see it below 5, and even that isn't really awesome. Under 2 is much better.