Latest Sleep Study - Even Higher Pressure

My first sleep lab was conducted roughly four months ago in mid-February. They woke me up less than three hours into the study when my O2 levels dropped to 53% and I was clocking 128 AHI's per hour. I was sent to a DME with a prescribed cpap setting of 16.

At the DME, I insisted on an auto unit because of my research on this forum however to justify the APAP that I purchased, the sleep doctor sent me back for a second overnight at the sleep lab .... that was last night ..... Happy Father's day!

This morning the sleep technician gave me a new scrip for the DME upping my fixed cpap setting to 18. I was also told that I would be contacted in about six to eight weeks to come in and review the data with the sleep doctor. Of course I have no need to visit a DME to change my settings and I'm even less certain that I want to go to a fixed cpap of 18 anyway.

My current apap settings are 14.4 to 18.4 and I haven't had a recorded AI in the last month and my AHI's are averaging less than 3.8 per night on a ResMed blower. According to my Rescan software, during the past month my median pressure is 14.6, the 95th percentile is 16.5 and the maximum was 17.8. Based upon a dataset established over the past four months using my own equipment, it seems counter-intuitive to raise the pressure to 18 and convert to fixed cpap.

My gut reaction is to hold off switching therapy settings until I have reviewed the data with the sleep doctor. I'm not anxious to convert to such high constant pressure if it is only needed to tweak out those last few AHI's that seem to occur only when I roll onto my back.

I'll welcome your opinions or suggestions on how to resolve this personal quandary.

Paul

I'm a newbie to all this, but I've read a bunch here and have to ask how you feel? With numbers like yours, many people feel good, but some don't.

One approach to trying to improve your therapy would be to slowly raise your lower pressure limit to see whether autoset can stop more of your events if it has less of a pressure "gap" to close. But locking in at a CPAP of 18 seems a bit extreme with the numbers you posted, especially if you feel good.

spitintheocean wrote:My gut reaction is to hold off switching therapy settings until I have reviewed the data with the sleep doctor. I'm not anxious to convert to such high constant pressure if it is only needed to tweak out those last few AHI's that seem to occur only when I roll onto my back.

I'll welcome your opinions or suggestions on how to resolve this personal quandary.

Paul

I think your gut reaction is sound. I'm not a doctor though. Just another "autopap" user.

If it were me, I'd leave the settings where you think best. Sounds to me like your therapy is working fine for you the way you already have it.

My response: follow your gut.

No reason to switch to fixed 18 -- unless pressure changes are bothering you.
O.

You data indicates that you are doing well on the settings you have. How are you feeling?

I also live in Ontario and, if you want a backup auto (hopefully with assistance from the ADP), you maybe should have the followup with your doctor and maybe get another autopap. It seems you already have an autopap.

Given what you have told us, it appears you have an autopap already. If the doctor knows you have an auto, the odds of getting another are slim to none.

At any rate, I wouldn't change anything, if you are feeling well because your data is good with your current settings.

As far as I'm concerned sleep studies are an educated guess at best. That's my opinion after having been through 1 diagnostic sleep study and 2 titrations in 7 years. I have to say, however, in my case, I did not sleep well or for very long at ANY of my studies.

A quick question while I'm at work and can't check the answer at home. Does the LCD reading on the Autoset II give the number of events per hour or per session?. After a month of no AI's you'd think I would be getting smarter!

In any event even if it is 3.8 events per hour at say 12 - 15 seconds per event = ~60 seconds per hour max versus 3600 seconds in an hour, or about 2% of the time I'm incurring restricted breathing. Compared to the 50% of the time that I had been labouring with airway restrictions/blockages, that still seems pretty good.

Hawthorne: You misread my original post ....... I'm not looking for a second APAP, I'm trying to make sure that the Provincial ADP will contribute the full subsidy for the one that I currently have. The subsidy is $780 for a CPAP and $1040 for an APAP unit. Furthermore, the ADP Program Co-ordinator has advised that they will not provide any subsidy at all if they suspect that an APAP machine was supplied by the DME without a proper prescription for same from the registered sleep physician who is prohibited from prescribing an APAP unless certain very specific circumstances exist. Bottom line, they don't want to see any APAP units issued to Ontario patients.

Thanks to everyone who suggested that I follow my gut and leave the settings where they are until I meet with the sleep doc. I might try tweaking the settings to 15 - 19 and see how that impacts my numbers. You'll know if has been unsuccessful because my posts will be grumpier.

I see what you are saying about the ADP in Ontario now. I agree with you on their "Bottom Line!!" Good luck!

By definition, AHI (Apnea Hypopnea index) AI (Apnea Index) and HI (Hypopnea Index) are always expressed as events per hour.

And AI + HI = AHI.