Still not understanding my stats

I had a pretty good night last night, for me.



I slept for more than 8 hours, which almost never happens.
My leak looks high, but it's coming down every day, thanks to the Dreamwear.
My CSR and CA are 0 most nights; I think it's what I've seen referred to as "junk."
My OA is 2.06, an all-time low! Go me!

So why is my AHI 6.30? No matter how low I can manage to bring all my scores, the AHI is almost always over 5. (6.30 is actually good. For me.)

There is stuff going on here that I guess I still don't get Any explanation would be much appreciated.

(Also, how do you get more of the factors - the colored bars under the big AHI - to show up? (I'm using a PC - hate it - and Windows 10.)

Cheers.

QueSera wrote:I had a pretty goof night last night, for me.

I slept for more than 8 hours, which almost never happens.
My leak looks high, but it's coming down every day, thanks to the Dreamwear.
My CSR and CA are 0 most nights; I think it's what I've seen referred to as "junk."
My OA is 2.06, an all-time low! Go me!

So why is my AHI 6.30? No matter how low I can manage to bring all my scores, the AHI is almost always over 5. (6.30 is actually good. For me.)

There is stuff going on here that I guess I still don't get Any explanation would be much appreciated.

(Also, how do you get more of the factors - the colored bars under the big AHI - to show up? (I'm using a PC - hate it - and Windows 10.)

Cheers.

First of all, did you have a prescribed pressure.......or how did you come up with the pressure range you're using?
Did you have an in-lab sleep study?
If so, did you get a copy of the sleep study?
Were there Central Apneas noted in the sleep study?

To me, it looks like too wide of a pressure range, possible issues with sleeping positions (do you sleep on your back?).
It's hard to tell what's causing what or if the machine is too slow to respond or if the increased pressures are causing your CAs.

Any further comments or information from you about what's happening in the report would be helpful.


Den

.

Excellent questions. I had two in-lab sleep studies, 10/2015 and 12/2015, and I have the reports. I just looked them over again to get the answers, and, knowing what I know now, I understand more of what I see.

The first study showed 9 obstructive apneas (whole night), 0 central apneas, 136 hypopneas, 6 RERA, for an AHI of 19 per hour. There were 40 snoring episodes with arousal. The lowest desaturation was 77%, with an average of 95%.

The doctor told me I had sleep apnea (19 AHI) and I had been sleeping with 77% of the oxygen I was supposed to have. She scheduled a second sleep study, with CPAP.

The second study showed 140 obstructive apneas, 8 hypopneas, 131 central apneas, 1 mixed apnea, 0 RERA. AHI 19.1 per hour. There were 4 snoring episodes with arousal. The lowest desaturation was 80%, with an average of 93%.

And then I saw, for the very first time, this:

"Patient displayed respiratory events during the study. Patient continued to display central apnea which was present before starting CPAP therapy. CPAP was switched to BIPAP due to central apneas. Central apneas continued with BIPAP, and patient was switched back to CPAP. At optimal pressure of 8 cmH2O, AHI was still 49.7 per hour. The optimal PAP pressure was not determined. At 8 cm H2O, the AHI was 49/hr. Patient continued to have obstructive and central apneas at final pressures."

I was prescribed Airsense 10 APAP at 8, so with a range of 4 to 12.

Pardon my French, but ... WTF?

Based on input here, I've adjusted my pressure settings, and I'm getting nightly AHI results way better than 19. But this looks to me now as if I was sent home virtually without treatment. I feel like I've been scammed.

I'm seeing the doctor in 3 days, for the last time, I'm thinking. If anyone has a great doctor in northern New Jersey to recommend, I'd love to hear about it.

Thanks for listening/reading, all.

QueSera wrote:Excellent questions. I had two in-lab sleep studies, 10/2015 and 12/2015, and I have the reports. I just looked them over again to get the answers, and, knowing what I know now, I understand more of what I see.

The first study showed 9 obstructive apneas (whole night), 0 central apneas, 136 hypopneas, 6 RERA, for an AHI of 19 per hour. There were 40 snoring episodes with arousal. The lowest desaturation was 77%, with an average of 95%.

The doctor told me I had sleep apnea (19 AHI) and I had been sleeping with 77% of the oxygen I was supposed to have. She scheduled a second sleep study, with CPAP.

The second study showed 140 obstructive apneas, 8 hypopneas, 131 central apneas, 1 mixed apnea, 0 RERA. AHI 19.1 per hour. There were 4 snoring episodes with arousal. The lowest desaturation was 80%, with an average of 93%.

And then I saw, for the very first time, this:

"Patient displayed respiratory events during the study. Patient continued to display central apnea which was present before starting CPAP therapy. CPAP was switched to BIPAP due to central apneas. Central apneas continued with BIPAP, and patient was switched back to CPAP. At optimal pressure of 8 cmH2O, AHI was still 49.7 per hour. The optimal PAP pressure was not determined. At 8 cm H2O, the AHI was 49/hr. Patient continued to have obstructive and central apneas at final pressures."

I was prescribed Airsense 10 APAP at 8, so with a range of 4 to 12.

Pardon my French, but ... WTF?

Based on input here, I've adjusted my pressure settings, and I'm getting nightly AHI results way better than 19. But this looks to me now as if I was sent home virtually without treatment. I feel like I've been scammed.

I'm seeing the doctor in 3 days, for the last time, I'm thinking. If anyone has a great doctor in northern New Jersey to recommend, I'd love to hear about it.

Thanks for listening/reading, all.

HOLY CRAP!!!
Sounds like you need to be on an ASV type of machine.

In the interim, I would suggest switching from the APAP mode to straight CPAP at a pressure between 8 to 10 or something like that and see what your reports look like. It appears that there are more events above the pressure of 10 cm., so I wouldn't set it above that.
I was noticing that your events went up as your pressures went up, so I don't know whether that means you're susceptible to "pressure-induced-Centrals" or whether it's a coincidence.

Anyway, you've now got some "ammunition" for when you go back to your doctor.


Den

.

My eyes are open now. I can't thank you enough.

After posting, I went back and read both reports carefully. My primary diagnosis after the second study was Central Sleep Apnea, which my doctor failed to mention. Also, after 4 weeks I was to be reevaluated for possible BIPAP or ASV. My prescribed pressure was 14/4 (my error, above.) At my 4 week follow up visit, my doctor said none of this, prescribed medication very, very reluctantly for my horrible insomnia (the reason I went to her in the first place), and chuckled a little when I mentioned Sleepyhead but didn't look at my printouts or spreadsheet. There's the punchline:

The doctor who reviewed my sleep study and recommended BIPAP or ASV, since the prescribed pressure probably wasn't going to help me anyway was ... my doctor!

I'm off to enjoy a lovely dinner with my daughter, after which I will have a very NCIS Tuesday night while googling 'best sleep doctor in new jersey.' Next step: 'best sleep doctor in new york city.' Hey, it's only 10 miles from here. It could be worse.

QuesSera,

Yes, it looks like you need a BiPAP, BiPAP ST, or ASV machine. But the culprit in why you currently have an APAP may be your insurance company.

Many insurance companies insist on having data that shows a patient has "failed" on APAP/CPAP before they are even willing to pay for a more expensive machine. You've clearly "failed" on APAP/CPAP.

NOTE: I hate the terminology that says you have failed on APAP/CPAP, because the truth is APAP/CPAP has failed to fix you.

At any rate, you might want to call your insurance company and find out what their rules are. It's possible that they're going to insist that you have a trial run on BiPAP/Auto BiPAP before allowing you to be bumped up to a BiPAP ST or an ASV machine. Essentially the insurance company wants to find out if a cheaper machine will fix your problem before going the very expensive ASV machines.

Robysue, thanks for the thought. Actually, my insurance is okay. (Although the DME they sent me to ...) My doctor selected my machine. Actually, she told me she was prescribing an Elite, and later she said that no, it was an auto machine, and I saw that when I got a copy of the prescription. I think this is the machine she orders for all her patients.

Last night I used CPAP mode at 8. I had 0 CSR and 1.08 central. But my obstructive were up to 6.26 and hypopneas 1.08, for an AHI of 8.42.

(Also had computer issues this morning, or I would be posting an image, sorry.)

I'll see the doctor in 2 days. I will be prepared.

Thanks!

Even with great insurance like I have, the need to see that a lower cost machine doesn't do the job for at least a 30 day trial is very common. My original diagnosis was complex sleep apnea and my original prescriber put me on an auto BiPap machine. I struggled with that for a few years getting my AHI down below 5 consistently but still feeling lousy in the morning. My doctor sent me to another sleep doctor for another sleep study to see if an ASV machine would help and my second sleep doctor wrote me a scrip for the current machine. (yep, I have two sleep doctors and I see them both for different issues ) Paid for the ASV out of pocket, put together the documentation, and sent it off my insurer. They paid without any question.

That's a long way around the barn to say it's likely that you'll get an ASV machine in the not too distant future.