Third Sleep Study in 9 Months

My sleep doc cannot seem to figure out why my AHI is so high still and wants to do a THIRD sleep study. Had a CPAP titration in Dec. that was inconclusive. Then, a BIPAP study with back up rate in January, which determined a pressure of 17. The pressure of 17 seemed a bit much to tolerate without mask leaking so we dropped it to 16, which I can handle well. A switch to Amara mask has helped. But AHI is all over the place, from night to night. Have no idea why. Mask is not leaking. I do sleep on my back. I find sleeping on my side tends to pull on the mask and cause leaks. What would a third sleep study accomplish that we don't already know? That I need a higher pressure? I cannot go beyond 16. It's just too much air blowing on my face. An ASV machine? I'm still paying on the BIPAP. This would be my 7th sleep study since being diagnosed in 2003. Even though most nights, I can only handle the mask for about 4 hours, I don't feel tired in the morning. Sometimes I need to nap but it's only for 15 mins. or so. Could this be a shallowing breathing thing?

Have you not yet downloaded Sleepyhead to see what might be going on (for a few nights in a row)? I thought you would have by now.

I'm sorry that I don't remember everything about your prior posts, but have you already been posting your machine data? To be honest, I don't think I'd want another study until someone knowledgeable here tells you they are out of ideas for you to try. If they do another test, it will probably be either without the machine or as another titration. It sounds like you've had more than your share of those. Have they done a study yet with you using the machine all night at the prescribed pressure, or at the very least not starting a titration at the beginning but near the current level? Hopefully the data gurus here will come along and offer some insight, but they'll need your data to be of much help. Good luck with things.

Thanks kt. I posted my Sleepyhead data for Pugsy to analyze a few weeks ago. It was difficult for her to come to a conclusion for a couple of reasons. Maybe she'll post and explain.

I think the main problem is the higher the pressure, the worse my aerophagia is. Once we drop the pressure even by 1, aerophagia is significant less and much more tolerable.

She's using the AirCurve 10 ST machine. It has a back up rate and will breathe for her if a central happens...it pretty much forces a breath. I have this machine but have been using it in S mode since I don't need a back up rate. I don't have a problem with centrals. I switched it over to the Timed mode so I could see what happens if a central happens and I held my breath.
The machine will increase the pressure anyway and pretty much right away and not wait like S mode does to stay in sync with my breathing.
It won't auto adjust though. It's a fixed pressure bilevel (with some other little settings that aren't the main feature) but will force a breath if a central causes a pause in breathing.

The problem with it is that it's like any other machine when it comes to the obstructive stuff...it has to be able to hold the airway open well enough to prevent the airway collapse with X amount of pressure and that would work fine if OP could tolerate more pressure but she can't. She needs more pressure for the obstructive stuff but either has aerophagia or leak issues with more pressure. That's why her AHI is high...she needs more pressure to prevent the obstructive stuff but she's not using what is needed because using it creates problems. She needs higher pressures...maybe impacted partially by sleeping on her back.

Would the ASV model do a better job at dealing with both the obstructive stuff and the central stuff and do it without the same problems popping up with leaks and aerophagia.....I don't know. It might and it might not. It will auto adjust and there's a chance that less pressure for some of the time would offset the aerophagia issues. Since it can respond quite quickly the time spent at the higher pressures might mean less problems with aerophagia. Right now she is having to use higher pressures all the time. With ASV it might be that she could use higher pressures just some of the time.
I know ASV will treat both quite well but will it do it without the aerophagia monster or the leak monster paying a visit...dunno that one.

I don't know why she wasn't tried on ASV to start with. I don't know if there is some history there that makes it a contraindication. I don't know what the doctor was thinking...or if he was thinking. There's a lot of behind the scenes stuff that I don't know that could maybe impact the decision to try the ST instead of the ASV.

Here's the deal...if she gets leak issues with the IPAP at 16 or 17 now...with ASV and IPAP going to 23 to breathe for someone having a central...and it gets there in about 15 seconds...is likely to cause leak issues also.

The ASV would auto adjust where the current machine can't do that. If she tied the ASV machine's little hands to avoid the leak or aerophagia monster ...she would end up pretty much in the same boat as she is in now with the ST machine.
BUT...and that's a big BUT...there is a chance that she would not have the aerophagia issues with ASV IF (and that's a really big IF) the machine could spend enough time at lower pressures to help offset the higher pressure feeding the aerophagia monster.
And the other thing is ....IF the doc would do the ASV to even try...and it is expensive but the DME would/should take the ST back and start all over with insurance with ASV...that is IF the doc will do it and there's no contraindications for doing ASV.

Lots of IFs and BUTs and some pretty big ones. No guarantees though. If she has no contraindications for ASV...I wish she had been given ASV to at least try instead of the ST. In her situation I always felt it was the best option to at least try.
I have followed her since her struggles with apap machine and high AHI and the centrals that came with the pressure.
I don't know that it would have kept the aerophagia monster away because her pressure needs for the obstructive stuff are up in the high teens....but I have always felt that ASV stood a better chance because it could go lower at least some of the time if not much was going on.
Right now with ST she has to use higher pressures all the time instead of just some of the time and what she needs to deal with the obstructive stuff she can't tolerate so she is getting sub optimal therapy.

The only way I would agree to another sleep study if it was solely for the purpose of ASV titration...and even then I would do it dragging my feet because in this situation we already have a good idea what the settings need to be. Shouldn't take much work figuring out the rest.

Thanks, Pugsy.

I bought a wedge pillow to try. Also bought some chin strips to try keeping my mouth closed. I need to find a solid way to keep my chin up off my chest while sleeping. Cervical collar was too uncomfortable. All of those things should contribute to less aerophagia I would think.

lwieland11 wrote:I bought a wedge pillow to try. Also bought some chin strips to try keeping my mouth closed. I need to find a solid way to keep my chin up off my chest while sleeping. Cervical collar was too uncomfortable. All of those things should contribute to less aerophagia I would think.

What size cervical collar did you try? My wife tried the 3 1/2 in collar and it was too tall for her. She is using a 3 inch collar and doing fine with it. The one she is currently using is the soft foam collar, not the stiff foam collar.