CPAP or Dental -supine

activensleepy · Post by **activensleepy** » Thu Feb 28, 2008 9:37 am

Almost 6 months on CPAP and my AHI is avg 10-18 no matter what my pressure. Automode from 8-14 and avg about 10.8 pressure and never went over 12. Tried straight CPAP at 10.5, same results. Now I'm attempting auto at 6-9 pressure so far same numbers on AHI, 10-18.

My last sleep study (diag) I tried my dental and 98% events were on my back (AHI 3.0)RDI (20.0). Since I'm more of a hypopnea/UARS person, I'm stumped on how to get these numbers down. Feel like trying the dental again and staying off my back, even with the tee-shirt ball thing, still hard to do. Of course, PLMD messes up the feeling good part- finally taking meds again for this disorder, starting to turn corner perhaps.

If my desats are good, stay off my back, perhaps CPAP is an option? I guess another lab someday to prove it out. Any tips out there?

ozij · Post by **ozij** » Thu Feb 28, 2008 10:02 am

Automode from 8-14 and avg about 10.8 pressure and never went over 12.

Doesn't seem to me like it's positional.

Have you tried fixed pressure at all? Some people respond with hypopneas and / or arousal to having the pressure changed, they do better on fixed pressure or a narrow range.

If you've tried fixed pressure, and it hasn't helped, you may want to consider the following:

Automatic machines made by different companies respond differently to the same breathing patter. It is possible that you will respond better to another company's self adjusting algorithm, or, more correctly put, another company's machine will respond better to your breathing pattern. If you can get your hands on another company's auto for a 2 week trial, that might be worth your while.

A third possibility - take a look at BarryKrakowMD's thread - is that your UARS need much more pressure on inhale, and less on exhale - which brings a bi-level machine to mind.

O.

Wulfman · Post by **Wulfman** » Thu Feb 28, 2008 11:03 am

Are/were you using Ramp, Settling, EPR (in CPAP mode)?

If your biggest problem is your sleeping position and you can't stay off your back, I'm not sure what to suggest......other than some type of wedge pillow or something to keep you on your side. If you have a thick pillow and your head is being pushed forward as you're laying on your back, that would have a tendency to shut off the air at your windpipe......you could try a thinner pillow or none.

Den

Snoredog · Post by **Snoredog** » Thu Feb 28, 2008 11:38 am

My opinion:

-you will always end up with a higher AHI using that machine
-you are more likely to end up with a AHI in the 6-12 range than lower using the autoset mode, most of that residual score made up of Flow Limitation/Hypopnea data while AI data would/should be lower part of that score.
-AHI may be higher than normal levels if your pressure requirement is greater than 10 cm.

-it all depends on your SDB situation and what you are trying to fix.

if you are only trying to obtain the lowest AHI score, you may have to switch to another machine to see that,

if you are chasing fatigue only looking at obstructive sleep apnea aspect, one should consider or place greater weight in other possible sleep disorders such as PLMD, RLS, UARS etc. once your Obstructive events are controlled.

sleep medicine in my experience likes to take a "wait-n-see" approach to addressing fatigue, that is stick them on cpap and hope it fixes the fatigue,

rarely does that work as most will attest here.

So my suggestion is:

- your obstructive sleep apnea appears under control and/or being addressed with CPAP
- consult your PSG and look for other disorders such as PLMD that you mentioned and ask your doctor what is being done to treat that aspect
- if UARS is suspected (possibly indicated by residual spontaneous arousals), was there any sign of it during your last titration, have you been titrated on bi-level which may/may not address the aspects of UARS.

My daughter is a Dentist, I'd love to see you go to a dentist, but the fact remains a dental device is not going to pump oxygen into your system if it needs it, that is one beneficial aspect of cpap that cannot be ignored.

The point to this madness is CPAP has gotten you down to near normal levels, having a AHI of 1 or even 10 is not going to be the cause of daytime fatigue, other disorders such as RLS, PLMD and even UARS may be that cause, you need to address each by elimination.

But be forewarned, go back to your doctor asking to be diagnosed/treated for UARS may result in that request being declined by your insurance. While you should be able to discuss the possibility with your doctor, your doctor should be experienced enough to retitrate you with Bi-level to circumvent or eliminate that question, again your doctor would most likely need to see on past PSG's the presence of spontaneous arousals or similar artifact to lead them in that direction.

Goofproof · Post by **Goofproof** » Thu Feb 28, 2008 12:17 pm

Control your mouthleaks!, then check your numbers. Jim

activensleepy · Post by **activensleepy** » Thu Feb 28, 2008 12:26 pm

snoredog-

spot on; using the Resmed I've had the readout hit 8 or so one night and 18 the next, I suspect more time on by back in those situations. Realizing this machine over reports, if I can get under 10 (its probably closer to 5) I'm happy.

As for spontaneous arousals, sort of high with a 27/hr (168) on my last study and that's using the dental device. PLMs 30/hr (184) were noted although not scored as arousals which I find suspect. So what is that, like 60/hr on the arousals?

Thanks for the bi-level bit, my doc has been pretty cool on writing what I want, will have to see what insurance will do. Got to find a med that will stop my PLMD, currently trying anti-convulsants.

activensleepy · Post by **activensleepy** » Thu Feb 28, 2008 12:31 pm

As for mouthleaks, zero most nights to very low. I use a chin strap %$$#%
I might try dental snoreguard with CPAP and check my numbers, probably pretty close to average is my guess. I think there is more going on than OSA (UARS/RERA) for me.[/img]

Goofproof · Post by **Goofproof** » Thu Feb 28, 2008 1:23 pm

ResMed's have to be set to the correct mask to read leaks close to correct, probably most machines are set incorrectly. Jim

Guest · Post by **Guest** » Thu Feb 28, 2008 3:53 pm

Thanks for the Resmed mask reminder; no problem there as I have had Swift set since day 1.