RX changes by new pulmonologist (long)

I asked to be referred to a Board Certified Pulmonary doctor more in tune with current medical advances in OSA: read a younger, very knowledgeable sleep doctor.

Just spent 50 minutes with him, reviewing my past sleep studies and titration reports, a previous PFT (pulmonary function test) results, a through medical history including recent blood test results, discussing my current lifestyle, viewing today's chest xray, and what I expected from OSA treatment. This was after spending 20 minutes with his RN collecting medical and personal data.

BTW, Mr. Goodman, this younger Board Certified doctor reads this message board, but at times it "gets too silly". I agreed.

I am an exceedingly handsome, personable, and friendly male of 70, who is 6 ft 2 inches tall and weights 260 lbs (not all muscle, but a little teensy bit).

I was originally on a CPAP with pressure of 13, but having trouble exhaling, was put on a Respironic BiPap Pro 2 with Bi-Flex at a pressure of 13/9 with a Remstar heated humidifier and heated hose. Settings were changed a few weeks later by my first Pulmonologist, who was good, but not really current in the newer OSA studies. He changed the pressure to 13/6.

My second DME sent an RT to visit me (as a standard part of their treatment) 10 days after I began using her. The RT gave his own opinion that 13/6 was too low a setting. The RT said if 13 is the cpap tritated setting, then my EPAP (lower bipap exhallation setting) should be much closer to 13, and to compensate for breathing against 13, the IPAP (inhallation) setting should be raised a bit higher than 13.

At 13/6 I was averaging (estimate) an AHI over 11 and a snore index ranging from 55 to 105 per hour. My first pulmonologist did not want to change settings until I had another sleep study at *his* location in 6 to 8 weeks.

On my own, I changed the settings to the original 13/9 and my AHI went down to 2.5 and snore index to 8 per hour. I did not raise the 13 any higher because I had read (on this board and other places) that too high a pressure can induce Central Apneas.

As a result of the total 70 minutes I spent in his office today, my new Board Certified pulmonary doctor said:

1. Raise the settings, today, to 16/11. Stay with the heated humidifier and heated hose.

2. After I mentioned that my sleep study showed I had a central at a pressure of 14, the doctor said, and I quote as closely as I remember: "Higher pressure does NOT induce central apneas. There are no valid studies of which he is aware that high pressure can cause central apneas. Possibly it may be a slight contributing factor if a number of *other, more meaningful contitions*, are first present. On its own, high pressure doesn't cause centrals."

3. With what he knows about me at present, it is NOT likely that I will need another sleep study.

4. The *main* thing, at least in my case, is to be certain that the destat Oxygen level is good enough at night to continue healing your body. He implied that is where a lot of people fall short in OSA - namely, not *knowing exactly how low their destat O2 drops* during the night. He said no matter how low your AHI *apparently is* according to your software, if you don't know how low the O2 level drops, you are not *sure* you're as good a treatment as is possible for you to get.

5. I kept interjecting how good I feel after a three weeks at 13/9 and an AHI of 2.5, and snores of 8 per hour.

The good doctor simply smiled and said: "Andy, you *think* your AHI is 2.5. If your O2 drops to 69 as it did during your titration, your AHI could be higher than you think. Not all your apneas and hypopneas may be recorded at your current pressure settings if your O2 levels drop too low.

As far as feeling good, he smiled again and said that "I do not know what feeling good really means". He said I have had (according to my wife) apneas and breathing interrptions for 30 to 40 years without treatment. For half my life I never realized what "feeling good" truly means. My current "good" feeling is only compared to my almost dead body at a destat of 69 percent. He said I have had too little oxygen for probably half my life. He said if my brain isn't functioning properly due to low O2 during nightime, how many "events' did any sleep study miss?

At least I have a reason now for screwing up all my life.

so, guys, whatcha think?
Andy, tired from typing for so long. sorry.

I found out what it means to be "guested".

I am absolutely CERTAIN I logged in when I typed the post.

Andy

Just in case your new sleep doctor is reading this right now, Andy...I think he's telling you right! For whatever this layperson's opinion counts.

Feeling "better", if a person has never known what feeling "good" is really like -- yep.

I hope the day will come when every cpap, autopap, bi-level machine includes recording pulse oximetry with the machines. It boggles the mind that something that important in the many pieces of the OSA puzzle is not just a standard part of all top of the line OSA treatment machines.

ResMed's ResLink add-on is an expensive way to get oximetry results included in the overnight data.

With a borrowed recording pulse oximeter, I was able to check myself with a night not using my autopap and several nights using the autopap. Most interesting. Without going into all the details of how many minutes here and there:

Sleeping without the machine:
SPO2 dropped to 83%
Average SPO2 during 6 hours of sleep: 93%

Sleeping with the machine:
SPO2 never dropped below 92%
Average SPO2 (several nights) : 95% - 97%

Glad you've found a savvy doctor, Andy!

Is he good looking? Rich? Single?

Whoops! I didn't mean to get silly.

I just wanted to interject something about checking O2 sats at night... if you're wanting to know your sats on any given night without purchasing an addition to your machine, check with a local DME company. I know ours does them for free- we would just need a little information from you and an order from the doctor. But there is absolutely no charge and we get the results immediately.

Just a plug from your friendly DME-er.

Excellent, Christine. Thanks for the info. That would be a good thing for every cpap user to inquire about if they use a local DME. That kind of easy "check up" at home at least once or twice, especially in the first few months of getting on cpap (and later if cpap doesn't seem to be giving as good results as expected) wouldn't be a bad idea at all.