5 weeks on CPAP first f/u visit next week what to ask

[Jjkbunny]

I have had my machine for 5 weeks and I have been able to be 100% compliant thanks to the information I was able to obtain from this forum, Apnea Board forum, etc. I did my own research before my first appt with my new Sleep Dr. And I am so glad I did. He and his staff and my Durable Medical equipment company have given little helpful advice advice and sometimes inaccurate information. One example, I asked the doctor to write a prescription for the Resmed s9 Autoset machine and he told me the medical equipment company would give me which ever machine I wanted. I told him I would feel better if the prescription was specific (I learned that here). He blew me off and said one of "the girls" at the front desk would take care of it. I gave them a copy of the information for them to copy onto a prescription pad. When she handed it back to me it did not have a pressure range ( another thing I learned I would need from here). I asked her to write a range and she took the prescription back and wrote 5-20. Again I knew this was too wide of a range, but the doctor was with another pt. I walked over to the sleep lab and a sleep tech took pity on me and got it changed to 8-15.
I will be going for my follow up appt in a week and I was hoping to get your options and advice about my results.
During my Sleep Study my AHI was 59 and it was recommended that my pressure be 14.
I do have the Resmed s9 autoset with humidifier and Climate control hose (very pleased). I was given a Mirage FX nasal mask at the Sleep Study and I chose the swift for her with Bella loops and regular headgear. I like both OK and switch between.
According to my machines Sleep QualityFunctions my last months results are:
Usage 7.3
Pressure 13.4
Leak 6
AHI 9.5
AI 8.9
CAI 3.7

My AHI has never been below 5. It is always in the mild apnea range and I'm not sure why. Does it look like I have a problem with central apneas? What would me some good questions to ask the doctor to improve my numbers?

Thank you so much in advance with any advice and wisdom.

[Pugsy]

Pressure 13.4
Leak 6

These numbers are 95% numbers when we get them off the machine's LCD screen.
It means that for 95 % of the night you were at OR below these numbers.

Your AHI is a little higher than I would want to see so that 8 cm minimum may not be quite optimal in doing its job of preventing the collapse of the airway (obstructive apneas and hyponeas).
Your Central index is 3 something...without seeing the reports and getting an idea as to where they might be occurring (like right near the time where you turn the machine on or off) it's difficult to figure out if centrals are a problem or not.
The machine doesn't know if you are asleep or not and it can and will flag awake/semi awake breathing irregularities as some sort of apnea event. When this happens it gives us a falsely elevated AHI because awake events aren't counted.
So if you spend quite a bit of time awake with the mask on then that might explain some of your events.
Now if you go to sleep within 5 minutes and never wake during the night and turn the machine off immediately when you wake up in the AM the we would get more concerned.
Since it is common for newbies to this therapy to have some fractured sleep or difficulties getting to sleep or staying asleep there's always the chance that some of that AHI is not real.

Centrals...the real ones when we are asleep for sure...it's normal to have a few centrals. It's normal to have them pop up in sleep stage transition like sleep onset. Everyone has them from time to time. They are only a problem when they either keep us from getting to sleep (repeated sleep onset centrals stopping sleep from happening) or they are in large enough numbers to cause desats or problems.
Also sometimes when we turn over in bed we hold our breath and don't realize that we are holding our breath but the machine picks it up as a cessation of breathing. It doesn't matter that we did it sort of on purpose because it is sort of a reflex, to the machine. It just reports what it senses and sometimes what it senses is not something that would be flagged in a sleep lab.

[Jjkbunny]

I went to the sleep doctor Monday and he was pleased with my results and did not want to make any changes in my treatment. I brought in my SD Card which they ran on Rescan. The whole report fit on one page and there were only four graphs.

usage was 100 %
pressure-cmH20 the median was 10.9, 95 %tile was 13.8 and Max was14.9
leak median 0, 95 %tile was 6.0 and max was 22.2
aHI & AI: apnea index 8.0, AHI was 8.5, obstructive 4.5, Central 3.0, Unknown 0 and Hypopnea Index 0.6

This seems like a very abbreviated analysis compared to the ones I see on this forum. My AHI at the sleep study was in the severe range ( mid 50's). my doctor thought this was an acceptable improvement and did not want to adjust any settings.
"You should me jumping for joy". He told me to come back in 3 to 6 months.
Am I expecting to be in the normal range too quickly? Should I look for another Dr that is more proactive?
I assume having sleep apnea in the mild range while on consistent APAP therapy is not the goal.
Thank You for any opinions or thoughts.

[robysue]

pressure-cmH20 the median was 10.9, 95 %tile was 13.8 and Max was14.9 ...
aHI & AI: apnea index 8.0, AHI was 8.5, obstructive 4.5, Central 3.0, Unknown 0 and Hypopnea Index 0.6
...
My AHI at the sleep study was in the severe range ( mid 50's). my doctor thought this was an acceptable improvement and did not want to adjust any settings.
"You should me jumping for joy". He told me to come back in 3 to 6 months.
Am I expecting to be in the normal range too quickly?

In my opinion you are not expecting too much to hope that your AHI should drop to the normal range. But in your original post you wrote:

When she handed it back to me it did not have a pressure range ( another thing I learned I would need from here) ....
I walked over to the sleep lab and a sleep tech took pity on me and got it changed to 8-15.
...
During my Sleep Study my AHI was 59 and it was recommended that my pressure be 14.(emphasis added.)

I wonder what the (fixed) pressure in the original prescription actually was. Was is 14cm as recommended by the sleep study? In that case, the sleep tech who changed the wide open range of 5-20 didn't really get the starting range optimally set in my opinion. My guess is that the reason you still have an OAI = 4.5 is that you're spending too much time at pressures that are far below what you need to control your obstructive events. Your titrated pressure was 14 cm. Even if you were somewhat over titrated, it seems as though you may be spending too much time at pressures below 10 or 11 cm since your median pressure was 10.9. I am wondering if many of those residual OAs are happening when your machine is at a pressure setting of 8-9 cm. It takes a cluster of two or more obstructive apneas in close proximity to trigger an increase in pressure in response to events. It could be that your minimum pressure should have been set closer to that titrated level of 14. Perhaps a min of 11 or 12 would bring the OAI down.

As to why the doc was reluctant to adjust pressures? Perhaps he's decided that since you proactively insisted on both an APAP and a range of pressures that you would not welcome a recommendation for a fixed pressure or a higher minimum pressure. (Not all doctors deal well with proactive, informed patients who are actively interested in managing their chronic medical conditions.)

If you don't want to simply change the min pressure yourself, you could put a call into the doc's office asking whether the doc would be ok with an increase in minimum pressure from 8 to either 10 or 11 cm.