Follow up: An AHI of 20.4 w/ Good Oximetry?

[MGoBlue]

Sleeping more on side now helps, but I am baffled at what I am seeing:

Still in apnea:



Yet oximetry data looks good (although heart rate could definitely be better):




Thoughts?

[Pugsy]

You are having a lot of events but not having a huge drop in O2. Not everyone will have huge desats with events. One of the reasons why oximetry, by itself, is not the best benchmark test for sleep apnea.

How about a picture of the daily detail graphs instead of the summary?

[MGoBlue]

You are having a lot of events but not having a huge drop in O2. Not everyone will have huge desats with events. One of the reasons why oximetry, by itself, is not the best benchmark test for sleep apnea.

Still, it is the desats that I should be most concerned about -- right?

How about a picture of the daily detail graphs instead of the summary?

Which graphs would be helpful (and from which program)?

Thanks!

[Treehorn]

I think apnea in the absence of significant desats can still be a problem. Stress to the heart may still be present and also the arrousals may prevent you from getting a good night sleep.

Is it me or is that snore index through the roof? Could this be part of the problem? Perhaps a papcap might help (if you dont already use one)? Just a guess.

[MGoBlue]

I think apnea in the absence of significant desats can still be a problem. Stress to the heart may still be present and also the arrousals may prevent you from getting a good night sleep.

Hadn't thought about stress on the heart, but you may right. I would have thought that it would only work harder during a desat, but perhaps mine is racing in order to avoid desat. It would explain my high pulse rate. I exercise a lot -- mainly weights, but intensely enough that I should be in pretty good shape cardio-wise. I would think my resting pulse rate should be MUCH lower.

Arrousals have never been much of an issue. Apparently I am all too comfortable with suffocating in my sleep....

Is it me or is that snore index through the roof? Could this be part of the problem?

[/quote]
I can eliminate the snores by increasing the pressure. I am still trying to find my optimal pressure until my next sleep study in a few weeks. On Auto the machine will go straight to 20 and stay there, but I have few events typically and no snoring at that pressure. Sleeping on my side seems to help a lot, but I am thinking I may need BiPAP.

Perhaps a papcap might help (if you dont already use one)? Just a guess.

I'm using a full face mask (Mirage Quattro).

[Pugsy]

On Auto the machine will go straight to 20 and stay there, but I have few events typically and no snoring at that pressure. Sleeping on my side seems to help a lot, but I am thinking I may need BiPAP.

The report that I was asking about is called Daily Details in Encore Viewer. It actually shows the graphs for the Pressure, Events (flow limit, OA, Hypopnea, and snores) as well as the leak rate graph.

I am thinking that with CPAP of 15 and those number of events that show, along with your comment that the auto unit wants to stay at 20 with few events, that if it were me I would be looking up BiPaps. At 15 cm of pressure you have still having more events than a good many people have without any pressure therapy. You are going to need more and at those pressures a Bipap would be much easier and likely better for you in the long run.

My comment about Oxygen desats, or lack of, was meant to indicate that just because we don't desat doesn't mean that we don't have a problem. Like Treehorn says, we are still having events and they will do damage despite the oxygen levels not dropping much. Not ever OSA patient will desat and not every desat means OSA. There can be other lung issues involved.
O2 levels can be helpful information but they must be looked at in correlation with the whole picture.

[MGoBlue]

The report that I was asking about is called Daily Details in Encore Viewer. It actually shows the graphs for the Pressure, Events (flow limit, OA, Hypopnea, and snores) as well as the leak rate graph.

I added it to the first post in this thread. Thanks for all of your feedback.

[Pugsy]

Yep, that is the graph and yep, it pretty much gives us a nice clear picture of what we expected to see based on that summary report.

I don't remember all the details of why you are on the auto and why you are trying cpap pressure of 15 but if that report is typical for you on 15cm then it obviously isn't doing the trick. If it were me I would switch it back over to auto and let it max out. Keep the minimum at 15 or so. You say you sleep through all those events and if the pressure changes don't bother you then you might as well prevent as many of the events as you can.

Curious though? Why another sleep study in a few weeks? What do they expect to gain from it that seeing the auto unit max out at 20 doesn't give? Maybe a BiPap trial?? Some insurance requires a failure at CPAP/APAP before allowing for BiPap.....

Your sleep quality has to be suffering like this despite your not awakening with all those events.

Did you have any history of central apnea events? You may have mentioned that but I had a rather bad night myself last night and I can't remember diddly this morning.

[MGoBlue]

I don't remember all the details of why you are on the auto and why you are trying cpap pressure of 15 but if that report is typical for you on 15cm then it obviously isn't doing the trick. If it were me I would switch it back over to auto and let it max out. Keep the minimum at 15 or so. You say you sleep through all those events and if the pressure changes don't bother you then you might as well prevent as many of the events as you can.

My prescribed pressure from my first (split) study is 14.

Once I started reading the data I found that my AHIs where 59, 47, and 54 at that pressure. I then started experimenting:

8/24 APAP 14-20 --> AHI=11.4, OAI=5.8, 90% pressure = 20, avg = 18.4
8/25 No data, forgot to put card in machine
8/26 APAP 19-20 --> AHI=22.9, OAI=16.4, 90% pressure = 20, avg = 19.9
8/27 APAP 15-17 --> AHI=28.3, OAI=21.0, 90% pressure = 17, avg=16.9
8/28 APAP 13-20--> AHI=21.5, OAI=17.4, 90% pressure = 20, avg=19
8/29 APAP 13-20--> AHI=24.2, OAI=19.7, 90% pressure = 20, avg=18.8
8/30 APAP 13-20--> AHI=34.5, OAI=31.4, 90% pressure = 20, avg=18.4 (on back all night, bad pillow setup)
8/31 CPAP 14--> AHI=28.3, OAI=23.9 (slept on side some)
9/1 CPAP 15--> AHI=36, OAI=33.1 (slept on back)
9/2 CPAP 15--> AHI=20.4, OAI=14.2 (slept on side some)

As you can see I am not having much success here...

Curious though? Why another sleep study in a few weeks? What do they expect to gain from it that seeing the auto unit max out at 20 doesn't give? Maybe a BiPap trial?? Some insurance requires a failure at CPAP/APAP before allowing for BiPap.....

It was an initial study, but I did so poorly they put me on CPAP that night and spent a few hours tweaking it. They want me to have a full month of "experience" in order to get used it before they do another study. Not sure why, but...

Your sleep quality has to be suffering like this despite your not awakening with all those events.

Probably, but when you're used to no CPAP any difference is an improvement.

Did you have any history of central apnea events?

Don't know. I do need to get my results from the first sleep study...

[Pugsy]

Pugsy wrote:Did you have any history of central apnea events?

Don't know. I do need to get my results from the first sleep study...

Yep, find out for sure if you had any centrals at either the initial study or the titration study. That fact is important to know one way or the other.

We look at the graphs to see if we can explain away less than optimal numbers due to leaks... in your case we can't. That leaves pressure as the other variable. Some people can reduce pressure needs by sleeping on their side but some people can't. It is hard to learn to stay on your side and even if you do, it may not be enough.

In my case I am worse in REM sleep (which is very common). Documented in the sleep study. Obviously I cannot eliminate REM stage sleep so I use a 10 cm minimum and 20 cm maximum. I sometimes hit 18 cm but most of the time I might go to 13 cm. I just figure I occasionally have some really nasty events in REM that need the higher pressure. It doesn't happen every night. My overall average is around 12 cm. I had no history of centrals so I am comfortable allowing the max. If some events are worse on my back then I figure what the heck, let the machine deal with them because it has to deal with the REM events too. Though I do try to sleep on my side as much as possible because of comfort issues.

If you try sleeping only on your side and it doesn't impact the numbers hugely then all that is left to try is increase in pressure. If it were me I would be thinking BiPap. You have no where else to go on your current machine.
Do you happen to have a report where you were in auto mode with max at 20 cm?