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padawan wrote:Here are two very recent graphs.

Padawan,

Maybe you should see another sleep doctor. I suspect that there is a bit more to the story, and your current doctor has given up on trying to get to a solution.

In looking at your plots as a series of numbers, I see that your events are clustered (lots of them at times, none at other times), and occur without a pattern (some early one night, late the other night). That seems to suggest that your events are based on something that is happening when you are sleeping. Sometimes that is correlated with your sleep stage, but in this case, I don't think that is the connection. Rather, I suspect it is your sleeping position. Some people are really sensitive to their sleep position. If this were my data, I'd try sleeping exclusively on my side for a few nights and see what happens. If you cannot do that, then pressure might be the solution. You might need to crank up the pressure. Try 15, 18, 21, and 24. Stop going higher when the number of events tail off. If you cannot sleep on your side, and cannot tolerate the pressure, then you might have to consider a trache. You really should have a MD in the loop on this--doing the stuff that I suggest might cause issues if you do it unsupervised.

-john-

ozij wrote:jnk asked, rightly about the AI, not the AHI.

Have you had any repeat sleep studies in all those years? What did they show?

Problems:

• You're using a machine that is intentionally built not to raise pressure in response to apneas occurring above 10. The reason is that for the majority of people, those apneas are not caused by obstructions, and therefore additional pressure won't help. The machine does respond to flow limitations and snores above 10. Works great for many, doesn't work at all for some.
• The ResMed algorithm also assumes hypopneas are not obstruction induced, and will not respond to them. That too works fine for many people, but not so well for some.
• You're driven to use higher pressure, and that causes aerophagia.
• You suffer from congestion

Possible solutions:

• Have a gastroenterologist examine your lower esophageal sphincter -- it is this that is letting air into you stomach, and sometimes it needs medical or surgical intervention. Silent Gastroesophageal Reflux Disease (GERD) (a return of acid for you stomach to you nasal cavity that you don't even feel) is a known cause of congestion and sleep disruption, and having it properly treated helps in improving your sleep quality -- including a reduction of AHI.
• Add nasal irrigation -- flushing your nose with salt water -- to your daily nasal treatment regime. See http://www.neilmed.com for an example, and links to studies.
• Use the Autoset's EPR - Exhale Pressure Relief. Its maximum is 3, and for some people the gives relief for aerophagia.
• Try another machine's automatic algorithm - you may do better on a Respironics, a Covidien Sandman or a Fisher & Paykel machine. Each of those has another approach to a. identifying breathing patterns b. responding to the events identified, and may therefore give you better therapy.
• Some people with aerophagia are helped by using a bi-level machine. You need an Rx to buy that. If your PCP (or ENT?) will give you an Rx for a bi-level, you can buy one online -- however I think it would be better you for to have a bi-level titration first.

If you haven't had a PSG in the last years then by all means, change doctors. If you have had one, post it.

Good luck.
O.

Whoops...missed the AI vs AHI question. AI is running 1.5-2.0 most nights. I did have a study last year. I'll have to dig it out tonight an post the info. I am doing the saline nasal rinse, and it does help. Is an Rx for APAP specific to a machine or just the fact that you need APAP? I cringe at the thought of having to explain why I want something different than they recommended. I would prefer to just go online.

padawan wrote:Is an Rx for APAP specific to a machine or just the fact that you need APAP? I cringe at the thought of having to explain why I want something different than they recommended. I would prefer to just go online.

You can buy any brand of autopap if your prescription says "APAP." The letters "APAP" are not specific to a particular brand of autopap.

For that matter, you could buy any brand of autopap if your prescription had said "CPAP" on it, since an autopap is, first and foremost, a "CPAP" machine. It's an "autotitrating CPAP" machine.