"Clear Airway Apneas" Very Bad Shape. Need help!

[Therapist]

This is about member macewa. I do not have the knowledge to help her and I am afraid that her medical team may be doing her a great disservice.

Please look at this thread and see if you can help - viewtopic.php?f=1&t=75761&p=693264#p693264

Should she be using those high pressures if she is having clear airway apneas? Does she have mixed apnea? Would an ASV be necessary to treat her appropriately?

I am sure macewa will appreciate your help and expertise.

Thank you.

[Pugsy]

She needs the higher pressures for the obstructive component of her sleep apnea.

Not sure if she has complex sleep apnea though...she has times with no clear airway events and she has times where she has some major pain which causes restlessness and lack of sleep and periods of clear airway events which correlate to probable awake or semi awake times. The PR S1 clear airway events could be false positives from recent battles with pain and/or mask leaks throughout the night.

She has had some really good AHI nights...and some really crappy AHI nights. If there was a strong central component to her sleep apnea I don't know that we would have seen the really good AHI nights.
They should have all been crappy AHI nights.

I have wondered myself about those centrals and is the bipap the best option but until she can get the leaks and the pain under control so that she consistently sees same results in her data (crappy or not crappy)...it is really hard to say if she needs ASV type of machine or not.

Things are complicated for her in regards to going back to her sleep doctor (unable to at this time) for needed input.

With the leaks she is having which are known to wake her up often..we don't know if those clear airway events are the real deal or false positives due to sleep stage transition or even awake events.

So until we can get her to sleep through the night without pain or leak issues it is really hard to be able to truly believe the reports as they are now.

[Therapist]

Thank you Pugsy!

[macewa]

I slept for 7 hours last night. I am posting the charts. The first hour I was trying to use the nasal pillows and was half awake and half asleep and uncomfortable. You can see the gap from when I changed masks. The rest of the time I was on the FitLife Total Face mask and I slept the night without waking up and when I did wake up I didn't even realize I had my mask on or the machine going. I have lost quite a bit of hair where the straps go by the ears so I just started wearing a head scarf to sleep in order to help save my hair, but I think maybe it is also helping stop some leaks.

Thank you Pugsy!

[retrodave15]

I can relate to this as well, I had a total ankle reconstruction about a week ago, but ever since i messed the ankle up, my centrals when out of control. So much so I called my Doc on Friday. I just got back, she said that it was a combination of the following:
Narcotic pain meds
Pain - some nights i feel like my ankle got bashed with a hammer!!
Mask leaks - my leak line was off the hook - could have been from sweating as narcotics make me sweat

She recommended that since I am due for a new mask and already have unused new seal for the Mirage Quattro, that I try a new mask. We are going to watch the numbers - she knows I keep track of my therapy and told me to check with her in 3 weeks

I called the DME and they are coming out tomorrow night with a variety of masks including a Mirage Liberty and some other FFMs

Hopefully the change of the mask and slowly getting off the pain meds will help.

[macewa]

Good luck RetroDave! I think the pain plays a huge part as it keeps us either awake of half asleep/awake. Sadly to say, most of my time with this machine/mask situation I have had pain of some kind.

I can relate to this as well, I had a total ankle reconstruction about a week ago, but ever since i messed the ankle up, my centrals when out of control. So much so I called my Doc on Friday. I just got back, she said that it was a combination of the following:
Narcotic pain meds
Pain - some nights i feel like my ankle got bashed with a hammer!!
Mask leaks - my leak line was off the hook - could have been from sweating as narcotics make me sweat

She recommended that since I am due for a new mask and already have unused new seal for the Mirage Quattro, that I try a new mask. We are going to watch the numbers - she knows I keep track of my therapy and told me to check with her in 3 weeks

I called the DME and they are coming out tomorrow night with a variety of masks including a Mirage Liberty and some other FFMs

Hopefully the change of the mask and slowly getting off the pain meds will help.

[retrodave15]

one other pain issue that feeds into crazy AHI is my restless leg syndrome, I have the variety with pain. I just started gabapentin, as it is the only thing that keeps my pain under control. I went off it for a while, but I am on it again, hopefully city will get the leg pain under control again.

last night was a better night, I wish it wool cool down here a bit as I have rule about turning the AC on in Ohio in MARCH! but if it does not cool off soon it is going on so I can sleep better.

I hope that you get your pain and sleep issues worked out. I understand the issues you deal with and ho'w they disrupt your sleep

[macewa]

This weather is crazy -- here yhou are thinking about air conditioning and here we just had a winter storm with some snowl. Cold tonight. Got the wood stove going.

Good luck in getting your pain issues resolved too.

one other pain issue that feeds into crazy AHI is my restless leg syndrome, I have the variety with pain. I just started gabapentin, as it is the only thing that keeps my pain under control. I went off it for a while, but I am on it again, hopefully city will get the leg pain under control again.

last night was a better night, I wish it wool cool down here a bit as I have rule about turning the AC on in Ohio in MARCH! but if it does not cool off soon it is going on so I can sleep better.

I hope that you get your pain and sleep issues worked out. I understand the issues you deal with and ho'w they disrupt your sleep