OSA have increased significantly in very short time-Cause?

Thanks everyone. This group is great. I rechecked and reseated the seal with my CPAP and it was fine. The leak from the machine was tiny when I mentioned it to my DME. I am very very picky and notice these things. I always reseat the humidifier and ensure it's tight as possible. Last night, no leak at all, or at least that I could detect.

I think Julie is on to something (can you send me some links on it?). Earlier in the month, I went to a walk-in clinic because my GP is in downtown and I couldnt go see him. He prescribed some Naproxen for the spasms. I took a few doses over a few days and I felt some tingling and numbing in my upper lip a few hours later after taking. This went away when I stopped taking it. My GP said that the numbing was likely to do with my anxiety, which I developed as a result of poor treatment for my apneas. However, researching the drug, the side-effects of NSAID's is cardio problems or exasperating cardio problems. I had quite a bit of PVC's recorded in my sleep lab the second time. If I had no cardiac issues, I likely wouldnt experience the side-effect. So, I do think my GP has tunnel vision...and he is suppose to be one of the better ones.

This morning, I downloaded the data. Changing the ramp time to 0 made a difference; however, AHI, especially the OAI was still high. this is contrary to what my "normal" apnea events are: hypopneas. This time the AHI was 10.6 and the machine did ramp up to 15cm for a minute, at which I awoke. I had night sweats where I changed my shirt three times. Night sweats returned ever since my neck and back pain/spasms. My snore index did go up a bit to 5. I also had a few non responsive apneas. I am surprised to hear the M series has full ramp features.

Even with the APAP adjusting for apneas at the 4 hour mark (previously), my AHI were typically around 4-7 which still makes me believe that there is correlation with my increase in AHI and my shoulder/neck pain.

Justin,

It's not surprising that your AHI would be higher since you've been "untreated" for a good portion of the nights.....for several weeks. It would almost be like starting over.
You didn't say what range you have it set for now, but if the pressure increases are waking you up, you might want to narrow the range a bit or try a fixed pressure setting.

Best wishes,

Den

Justin_Case wrote:(snip)

So, I do think my GP has tunnel vision...and he is suppose to be one of the better ones.

(snip)

GP's are exactly that: general practitioners of medicine. They are trained to hear hoofbeats and think horses, not zebras. Plus, there is so much information and research around now that it is nearly impossible for the doctors (or any other medical professionals) to stay on top of it all.

Heart problems can have many unusual symptoms. This is one of the problems with identifying women with heart disease; they tend to have very different and unusual symptoms in comparison with men.

Why not phone your own doctor and ask for a referral? If you have seen him/her regularly, such a phone request should be taken seriously. If the screening by his office staff is hard to bypass, think of what one would do with an evil DME provider and get through! (It is football season....)

I have a friend whose husband just had an angioplasty because some anomalies in his bi-annual truck driver's physical made the doctor order a stress test. They figure it possibly saved his life, if not avoiding a debilitating event--possibly on the road.

Also, you may wish to consider finding an internal medicine specialist for yourself. Their job is to treat adults and diagnose, then refer to specialists as needed. My internist has been a true lifesaver.

Thanks Wulfman, I hope you are right!

Looking at my stats, my HI has been within the range of .61 to 8 (short night) prior to my shoulder issues, with an average of 4.336, while my OA average has been 4.

After my vacation the average is 4.3 for AHI and 6.6 for OA. My pressure was set at 8-18. My best numbers during the rough period is 5.20 just before chiropractor treatment and the CPAP range was 10-20.

Thanks birdshell, my sleep doc, who i can only see with a referral is an internist I also went to see another one a while ago. My GP has an associate diploma as an internist (ABIM), not sure what that means though. I did send him an email a few days ago for a referral to a cardiologist and he hasnt responded back. I think an internist is a great idea. I have an appt with my sleep doc in a few weeks. Hopefully, I will be ok until then.

Justin,

You might want to try a range of 10 - 15 for a few nights to see where your pressure wants to go. I looked again at your other chart that you posted and even at that many hours at 8 cm, you had a pretty low snore level, so I would guess that a pressure range would work OK for you since it wouldn't be chasing snores.

Let us know how it's going.

Den

Thanks Wulfman, I will change my settings. If you have some time, I would appreciate if you can look at last nights chart and let me know what you think.

http://www.freefilehosting.org/pupload/view/14399

Thanks

I SECOND THE OPINION THAT YOU NEEDTO SEE A CARDIOLOGIST. I NEVER HAD CHEST PAIN OR SHORTNESS OF BREATH BUT I HAD A BURNING SENSATION IN MY RIGHT NECK AREA. TURNS OUT I NEEDED AN ANGIOPLASTY AS MY RIGHT CORONARY ARTERY WAS TOTALLY SHUT.

Justin_Case wrote:Thanks Wulfman, I will change my settings. If you have some time, I would appreciate if you can look at last nights chart and let me know what you think.

http://www.freefilehosting.org/pupload/view/14399

Thanks

Justin,

I've looked at your chart.
One of the things that I see is that the apneas and hypopneas don't seem to be supressed by higher pressures (like between the second and third hour (hypopneas) and the last hour (apneas). In fact, they seem to go up as the pressure rises. I'm not sure whether that may imply induced centrals or it's not responding as quickly as it could to the events. That last hour bothers me. Some of them do and some of them don't seem to be associated with snores.....but you have a low snore index. There seem to be fewer of them at around 9 cm. SO......in retrospect, I think I would recommend a range of 9 to 12 for a few nights OR.....set it to a fixed pressure starting with 9 or 10 and work up in 1 cm increments after several nights at each pressure.

If anybody else has any other ideas, please feel free to jump in here with them......

Keep us informed.

Den

Last night was not a good night. I tried the pressure of 10-15. In the late am, which has recently been an issue my OA's went way up. Pressure did too. I was awaken by the pressure changes and swallowing of air. I switched to CPAP @11 for the remainder where the values jumped up even higher.

The HI seems to be around the same, 35 (HI: 3.51) and OA: 115 (OAI: 11.52). Overal AHI: 15.13. Total apnea time skyrocketed to 1728 sec(highest ever). SI: 3.01 (median 648).

Does anyone think that it is plausable that something with my neurological system is messing things up? Either Central apneas or something paralysing the nerves causing me not to breathe?

CPAP @11 yielded really bad results during the 4 hour period: OA: 16 and HI: 5.7.

Justin,

It's possible.
Something's (apparently/obviously) got your system messed up.
Please refer back to my 3rd post on this thread......
I believe you need to see your doctor(s).

Please keep us informed.

Best wishes,

Den

That's what I suspected all along.

My doc is out of town and the walk-in clinic nearby was closed early this evening. I will be going tomorrow with some print-outs for the doc; however, i suspect he won't know much about it. If I get no luck tomorrow, I'll be dropping into Emergency since sometimes that's the only way to get to see a specialist and fast.

It sucks to be me.

Justin,

Depending on what kind of relationship you had/have with your sleep doctor.....if he's nearby, you might need to contact him......especially if he's a pulmonologist......he might have some ideas, too. They may also want to do another sleep study to see what's happening while you're asleep. All of those attached wires will ultimately tell them more than a CPAP report will.

Good luck.

Den

Maybe Mixed Apnea and Complex Apnea?: http://en.wikipedia.org/wiki/Sleep_apnea

Mixed Apnea and Complex Sleep Apnea

Some people with sleep apnea have a combination of both types. When obstructive sleep apnea syndrome is severe and longstanding, episodes of central apnea commonly develop. The exact mechanism of the loss of central respiratory drive during sleep in OSA is unknown, but Mixed Apnea is most often a consequence long-term Obstructive Sleep Apnea.

In September 2006, the Mayo Clinic announced it had recognized Complex Sleep Apnea as a separate type of sleep apnea. Patients with complex sleep apnea exhibit all the symptoms of OSA but the use of a CPAP machine is not effective treatment for them. At best, even with the use of a CPAP machine, these patients still suffer from moderate to severe OSA. Further, when the use of a CPAP machine does alleviate the OSA symptoms, patients started exhibiting central apnea symptoms.

Though mixed apnea or complex sleep apnea symptoms have been observed for years, no effective treatment for it has been found. Mayo Clinic researchers are developing a CPAP-type machine for complex sleep apnea patients.

Wulfman, I have an appointment with my sleep doc on Oct 5. I will try to get a referral to a cardiologist or pulmonary specialst on Tuesday from the walk-in clinic. I will show my sleep doc these results, but he likely won't put any faith into them since he doesnt believe in APAP in general, nevermind the data they provide. The good thing is that he is an internal medicince specialist too. I will insist on an at least 8 hour sleep study instead of the usual 4 or 5 hour one.