My Story and Advice Needed

[seeker_here_in]

Hi All,

Thanks a lot to all members here for their continued guidance. This is my first post here. I want to post my story and get advice on way forward.

I am 38 year old male, 75 kgs. I have been a heavy snorer for many years. Friends also told me I was gasping in my sleep. I always suspected that I have sleep apnea but kept postponing the sleep test.

Finally, in June 2018, I had a sleep test and had a AHI of 70 (severe OSA). I got prescribed a Philips AVAPS BiPaP machine and have been using it ever since. I think I feel better, feel I have more energy but it could also be placebo.

With the machine, my AHI levels are much lower (though not under 5 consistently). My average leak rate and % of time under large leak seems very high, though it is getting better recently. I do not have access to a doctor where I live now, but I hope the group members can comment on my numbers and tell me how to proceed forward.

Screen Shot 2019-03-04 at 1.39.30 PM.png (143.4 KiB) Viewed 674 times

Really look forward to your guidance

[Pugsy]

Welcome to the forum.

Large leaks (if you have any) will show up as flags on the Events graph and are a product of the machine.
Those are correct....the SH statistic is just a product of some calculations and isn't from the machine and in your situation with your brand of machine...it's wrong.
Ignore it and base your leak evaluation on the presence of large leak flags on the Events graph...the LL on the events graph...that's large leak.

The statistic reporting the % of time in large leak is based on a ResMed calculation number and that number won't work for your Respironics machine.
Open SH and go to Preferences and then the CPAP tab. SH Defaults to a red line leak threshold of 24 L/min which is a ResMed leak number...won't work with your machine. Your red line threshold number is more like 85...so change the 24 to 85 or just turn off that statistic by removing the check mark.

[seeker_here_in]

Thanks a lot for your answer.

About my current AHI level of around 5-7, do you think it is acceptable? Or are normally under 1 with the CPAP machine?

[Dog Slobber]

Under 5 is considered treated.

For many here 5-7, or even under 5 is not good enough.

Read the following link on how to present your SleepyHead charts:
wiki/index.php/Sleepyhead:Organize

Read the Stickied topics on the main page.

With the help of the experts, I'm confident your AHI can be improved. My healthcare team was content with my AHI about 3.5, with the help of CPAPTalk I'm consistently at about 0.35.

[Pugsy]

About my current AHI level of around 5-7, do you think it is acceptable? Or are normally under 1 with the CPAP machine?

I wouldn't be happy with it myself but I don't know that I would strive for an "under 1" goal either.
A lot depends on how I felt and how I was sleeping.

And you aren't on a normal run of the mill Cpap machine. You are using very special high end machine and those aren't usually dispensed unless the person has something more than the plain ordinary OSA.

The bulk of your AHI seems to be mainly OAs and hyponeas...usually more EPAP is what is used to deal with those kind of events.

Did you have more going on besides severe OSA to earn you this special machine?
Any issues with some central apneas or some sort of lung disease going on or maybe some sort of neuro muscular problems with breathing in general?

[zonker]

Hi All,

welcome to the zoo. to get all the good advice from the experts, they will need more info from you. the post that dog slobber told you about is here-

viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

good luck!

[seeker_here_in]

About my current AHI level of around 5-7, do you think it is acceptable? Or are normally under 1 with the CPAP machine?

I wouldn't be happy with it myself but I don't know that I would strive for an "under 1" goal either.
A lot depends on how I felt and how I was sleeping.

And you aren't on a normal run of the mill Cpap machine. You are using very special high end machine and those aren't usually dispensed unless the person has something more than the plain ordinary OSA.

The bulk of your AHI seems to be mainly OAs and hyponeas...usually more EPAP is what is used to deal with those kind of events.

Did you have more going on besides severe OSA to earn you this special machine?
Any issues with some central apneas or some sort of lung disease going on or maybe some sort of neuro muscular problems with breathing in general?

No other problems as far as I know. I remember the doctor saying I need Bipap not cpap as there was a need for differential pressure.

I'm quite happy to come down from 70 to the 5-7 range, but want to know how to get it down even more. I'm feeling better, maybe I'll start feeling great!

[palerider]

I'm quite happy to come down from 70 to the 5-7 range, but want to know how to get it down even more. I'm feeling better, maybe I'll start feeling great!

5-7 is like having your sleep disturbed by someone poking you with a stick every 9-12 minutes. Even if you're not having oxygen desaturation damage, you're not getting much sleep.

It's like saying "well, I did have two broken legs and two broken arms, but now I've only got a broken ankle, I'm much better! Yes, you are better, but you're still not what anybody would call 'good'. right?

[Pugsy]

Well it would be nice to know why you need so much differential pressures.
Where are you located?
Any chance you can get a copy of your sleep study results?

Did you have a diagnostic sleep study done in a lab or did you have a home study?
And did they bring you into a lab for the sleep study to come up with those pressure settings? If so...might be nice to get a copy of that report also.

[seeker_here_in]

Well it would be nice to know why you need so much differential pressures.
Where are you located?
Any chance you can get a copy of your sleep study results?

Did you have a diagnostic sleep study done in a lab or did you have a home study?
And did they bring you into a lab for the sleep study to come up with those pressure settings? If so...might be nice to get a copy of that report also.

Thanks a lot for your help.

I am based in India and got the sleep study done at a lab.

Attaching my reports (3 pages at a time, as per the limit here)

[seeker_here_in]

Adding pages 4-6 of the report

[seeker_here_in]

Adding pages 7-9

[seeker_here_in]

Adding last 2 pages (there were some graphs in the last page, havent posted that - will post if you feel it is needed)

[palerider]

Well, according to your sleep study, they recommended the wrong machine, and you're not even using what they recommended, what you're using is worse.

You should be on either an auto cpap, or an auto bilevel machine, and you're not on either.

You had *two* centrals, that's certainly no justification to put you on a S/T machine, or an ASV, and certainly not an AVAPS.

Do you have any lung disease, such as COPD?

[Pugsy]

Well.....I have no idea why they put you on the machine they put you on. From the looks of things a regular cpap/apap/bilevel machine would have worked out fine.

The model machine they gave you (and the S/T mode being used) is usually reserved for people with major central apnea issues because it will force you to breathe if you don't breathe or make an effort to breathe on your own.
Central apneas are when there is no effort to breathe....the airway is open but you don't even try to breathe.
You did have a few centrals during the diagnostic part of the sleep study but no where near an alarming number if you had done the sleep study here in the US. Now in India they might have different criteria for when they want to step in with a machine like yours for people who have a few (or a lot) of centrals and maybe that's why they did what they did.
Some behind the scenes protocols or criteria that they follow which they use to determine which machine to finally use.

Do you know which mode they are using and what the back up rate might be.
The pressures of 12 exhale and 18 inhale...means you have a PS (pressure support) of 6....which if they were really wanting to treat centrals isn't usually enough.

So I am sitting here scratching my head why you have that machine because it's like using the atom bomb to kill a fly when an ordinary fly swatter would accomplish the same goal....unless you have some sort of lung disease not mentioned in the report.

You are using SleepyHead....can you get me a screen shot of a typical night...not the best and not the worst but a typical night that you see most of the time?
Format the graphs per the instructions in this thread. One image will show me all I need to see if you follow the directions.
viewtopic/t158560/How-to-post-images-for-review.html

You can still use this machine and probably we can improve that AHI a little with a minor little setting tweak.
Most likely just 1 or 2 cm more EPAP and no other changes.