Back to the lab

Well I guess I get to go back to the sleep lab for the third clinical titration study after completing my third at home titration on an APAP. My current CPAP machine is set at 15 and seems to be working okay but the AHI is still around 10 on it.

My AHI is 13.3 from the APAP study and the doc is starting to wonder if I have CSA and need a Bi-PAP machine.

I think the doc is as frustrated as I am that we still don't have this settled after 1 year of therapy. I was hoping to see the light at the end of the tunnel--but I guess the light has been turned off due to budget cuts.

Thoughts? Suggestions?

tvmangum wrote:My current CPAP machine is set at 15 and seems to be working okay but the AHI is still around 10 on it.

If you're still using a ResMed S8 machine, and if the bulk of your AHI comes from a high "HI" (hypopnea index) but you have a low "AI" (apnea index), I would not worry about the AHI being around 10. I would mentally cut the HI in half, then add that to the AI and consider that new total to be your "real" AHI for all intents and purposes. That's just the way I'd look at it. I'm not a doctor.

Before writing that, and before writing what I'm going to say next, I did go back and read all your posts...yes, all of them... from the day you joined this message board to now.

"If it were me", I'd try this with the ResMed Elite:

If I were using EPR at 3, I'd set the Elite's pressure at 18.
If I were using EPR at 2, I'd set the Elite's pressure at 17.
If I were using EPR at 1, I'd set the Elite's pressure at 16.
If I turned EPR off, I'd leave the Elite's pressure at 15.

Whatever results I got at any of those settings, I'd still cut the HI number in half -- every time -- before adding the HI and AI together to get a new AHI.

tvmangum wrote:My AHI is 13.3 from the APAP study and the doc is starting to wonder if I have CSA and need a Bi-PAP machine.

I'd exhaust (no pun intended!! ) a few more things that have been suggested to you in previous topics before I'd go back for yet another titration in the sleep lab. I don't think ANY of your "APAP studies" at home were set up right at all. The minimum pressure was set wayyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy too low, imho. I don't think the AHI of "13.3 from the APAP study" is meaningful at all, given the low minimum pressure ( 5 ) the autopap was set for each time they did an APAP study at home on you.

tvmangum wrote:I think the doc is as frustrated as I am that we still don't have this settled after 1 year of therapy. I was hoping to see the light at the end of the tunnel--but I guess the light has been turned off due to budget cuts.

I doubt if budget cuts have anything at all to do with it.

I personally think the doctor and DME have missed the boat all along with the setting for your CPAP (if you would be using EPR) and APAP settings (minimum pressure set too low) for your first two APAP trials at home. Just my opinion. As I said, I'm not a doctor. Nor am I anything at all in the health care field. Nothing. Nada. What was the APAP minimum set for in your third APAP trial at home? I think I missed seeing a post about a third APAP trial at home?

Another thought -- CPAP can be doing its part of the job fine -- keeping the airway open. Yet a person can still feel wornout, fatigued, sleepy, lousy, etc. for other reasons. Possible other reasons for still not feeling good -- med side effects, poor sleep hygiene, not being able to use CPAP all night/every night, other health conditions, hormone imbalances, lack of good vitamins/minerals, pain (like arthritis) causing sleep fragmentation. Bed getting jostled every time the bed partner moves. Saggy mattress that's seen better days...well, "nights". The list could go on and on.

All of that is not to say that you might not do better with a different machine, tv. But I really don't think the APAP trials were worth doing -- the way they set the minimum pressure. And it may very well be that adjusting your Elite's pressure to compensate for wherever you have the EPR set could make a difference. I'd at least try changing the pressure according to where you have your EPR set.

But mainly I'd quit worrying about a ResMed AHI that is higher than five, if most of that AHI is made up of the hypopnea index. If the AI (apnea index) is low, and if the overall AHI is below 5.0 when I mentally cut the HI in half, I'd consider my CPAP treatment to be doing exactly what it's supposed to be doing. I'd look for other reasons for still being tired, or not feeling well.

I'd start doing a good bit of tweaking on my own. But that's just me. And I don't have your cardiac problems.

I echo what Den said to you once, here:
viewtopic.php?p=362251#p362251

Wulfman wrote: "Man, you've got more patience than I would have in your position.......

Good luck!!!

My edit in 2011: Edited to add "S8" after the word "ResMed" in my first sentence. The later S9 that came out uses a different definition from the older S8 -- for when to mark a flow limitation as a "hypopnea." I wouldn't cut the HI index in half with an S9.

LOL, RG

tvmangum,

Maybe you need to try a different BRAND (manufacturer's equipment)......like a Respironics (APAP or Bi-PAP)......and a different DOCTOR. This one is either greedy or plumb stupid.
If you could try a REMstar Auto M w/A-Flex at a narrow range, you'd be able to see (with the software, of course) what was the makeup of your AHIs. If you have a lot of Flow Limitations (which ResMeds count into the AHI), and a lower number of apneas, that would be worth knowing.


Den