Newbie still has AHI in the teens on CPAP

zoocrewphoto wrote:
I've seen this mentioned several times. Does this machine really not give a one night result for that night? I

Yep, that is what it means. Respironics has always done the 7/30 averages. There is a workaround for it to get a single night but with the availability of the software it is silly to do the workaround it for a lone single number.

zoocrewphoto wrote:What good is a 7 day average on the screen?

zoocrewphoto wrote:A useless average of the last 7 days? It seems like it does more to confuse people than to offer useful data

That pretty much describes how I feel about it myself. It's not entirely useless I suppose. It is better than nothing from a machine that offers only that I slept 6 hours last night.

Respironics has never done anything based on what we want. They won't tell us an exact large leak number either.
That's okay. We manage just fine one way or another.

The whole idea behind the 7/30 day thing is for trends...not nightly data anyway. We are the ones that want the nightly data.
Most DMEs never look past the summary pages unless they are pushed.
"Gosh, you are doing great, you are averaging 5 hours a night"....and they leave it at that.
We aren't supposed to be able to understand all this stuff and aren't supposed to obsess over it.

That's a real bummer. I can see how doctors look at trends, and they don't expect patients to look at daily info. But you would think that companies that make these would realize that compliance (and thus sales) would be higher if people could see their data and use it to either confirm that it is going well or adjust when it is not.

You would also think that they put the screen info for the express purpose of letting the patient see it, so they should put information that is useful for the patient. Perhaps they need to use their own machines so they can get some sleep and regain some logic

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Oh, there's my cat typing again. I usually delete it since it tends to be in the middle of the words. But she was better about it this time.

Well I didn't like the Fit Life mask, to get it to stop leaking I had to tighten it down to where it was to uncomfortable especially around my jaw. I guess back the mirage quattro tonight, I can't wait to get my padacheek stuff I ordered.

Ok, I finally figured out how to post an image...can someone comment on this nights sleep?? I felt like I slept good this night.

Looks like you have a lot of events per hour. Is that mask leak rate intentional or unintentional? If it's unintentional, it might be a bit high.

Your pressure is 15 cm per your comments line.

Your leak line is superb. The Respironics machines report total leak so you have vent rate plus any excess leak. At your pressures with your mask your leak is minimal to none.

Don't let the FL 0.0 fool you. The PR S1 Pro doesn't flag flow limitations.

The abundance of snores, hyponeas and obstructive apneas point to less than optimal pressure. Can't blame it on leaks. That leaves the 15 cm pressure as the culprit.
When is your follow up with your DME or doctor scheduled? If this is what you are seeing for each night then they need to be aware of this. It appears that the pressure is not sufficient enough to do a good job preventing.

We would like to see the AHI less than 5. You aren't even close if this is what your other reports also show.
I know you just started therapy and we might say give it time if your AHI was 6 or 7 but this one here screams "I need more pressure" IMHO.

Need to talk to your DME or doctor about an increase in pressure. You are real close to maybe needing or wanting a bilevel machine. Higher pressures are likely going to be a challenge to get comfortable with.

If your follow up is fairly soon that is okay. If it is 3 months away that is not okay unless you see some drastic changes here.

This is how I started out... Notice the high AHIs in the beginning. It took me almost a month for them to come down.

Now I have a major conundrum because my doctor is just a regular MD, my sleep center I took the test uses doctors in another state and they told me to go to my DME and they will send the data to my regular MD as I don't have a sleep doctor. On top of that my insurance deductible changed the day after I got my machine, so I still fall into my 30 day window now (until Sept 1) then I will have to pay for a new machine I think...I don't know (this one was covered as I met last years deductible).

So I think my question now is should I have the DME send the data to my reg doctor or should I hurry up and try to find a new sleep doctor and then would the DME even send the data to a new doctor....oyyyyyy!

Start with what you have available right now.
Get with your DME and express your concerns. They may have a RT on staff that can help your doctor out if he doesn't understand the fine points. It isn't rocket science.

While the DME can't really change anything without a doctors say so there is nothing to prevent them from making suggestions and say "we think this is needed and just need your okay".

There are people using straight cpap at pressures much higher than yours...so a new machine is not a forgone certainty. I just mention it in case you start having a lot of problem exhaling if your pressures need to be increased much more than what you are using now.
We also don't know how much more pressure you may need. Might just be one more cm...might be more and there is no way to know until it is tried.

There is also some truth to "give it time"...I don't know that there is enough time in your situation but it is not an impossible thing to hope for.

Did you have a full night of titration or a split night study? Did you have trouble sleeping during the titration study?
Have you seen the reports? I wonder if there is a mention of maybe not being able to find the optimal pressure for some reason like limited sleep or running out of time or something.
I know that sometimes the titration studies don't always get it right but there is usually some reason why they miss the mark a bit.

Do you have copies of your sleep studies? If not you need to get them.

We could tell you how to change the pressure yourself but I don't know if you would be comfortable with that option and it is always preferable to have your care managed by your health care providers if at all possible.

It was a 2 night study (not a split). Spaced by about 1 week. I did get a copy of the final which showed a chart of something like what happened at each pressure, but I do remember the tech the next morning said he was able to get 45 minutes of my REM sleep which was right before he woke me up. And yes I slept horrible, matter of fact I didn't think I slept at all, that is when he told me he got 45 minutes of REM. I don't have that data with me right now as I am at work. I think my main concern right now is if they want me to change machines, that I do it in the 30 day window. Other than that I don't mind waiting the 30 days (which is when my DME says they will ask for the data, for compliance purposes I think).

Pugsy wrote:
Did you have a full night of titration or a split night study? Did you have trouble sleeping during the titration study?
Have you seen the reports? I wonder if there is a mention of maybe not being able to find the optimal pressure for some reason like limited sleep or running out of time or something.
I know that sometimes the titration studies don't always get it right but there is usually some reason why they miss the mark a bit.

Do you have copies of your sleep studies? If not you need to get them.

We could tell you how to change the pressure yourself but I don't know if you would be comfortable with that option and it is always preferable to have your care managed by your health care providers if at all possible.

Call your DME now and explain situation about the new insurance thing and that you can't wait for the 30 day follow up. Tell him you have software that shows you having way too many events. If he raises an eyebrow...just tell him that Respironics sells a patient version of the software called EncoreViewer easily found on the internet...this isn't a lie..they do..just not for your machine right now but I doubt he will know that

Tell him it appears that the pressure may not be sufficient and you are concerned that since you already have to use the ramp so much that higher pressures may be even harder to manage.

Main thing is get him to see the reports and get you an okay to increase the pressure.. See how you tolerate it.
Tell him you are under the gun because of the change in insurance and don't want to have to satisfy a new deductible so soon.

I found another sleep center that has a sleep doctor on staff and made an appointment with him for Tuesday, which is what I would have done eventually anyway...just sooner than I expected.

That's great.

Print off copies of all your software reports and take them with you. All pages, daily details and summary.
Probably take your SD card with you in case they want to run their software if they have Encore.
They may or may not have the Encore software that works with your machine. Take your own reports just in case.
Of course the copies of whatever you have regarding your prior studies.

My doc looked at my data and said I am doing everything right, he was shocked I clocked at least 9 hours on the machine every night. I told him it is taking me hours to fall asleep with the machine. He said he want's me only sleeping 7 hours, don't lay in bed with the mask for more than 20 minutes, if not asleep then get up. He said first get this down, then he will address the other issues.

At this point once I fall asleep I am fine on the machine, but it takes hours to fall asleep and I wake up exhausted.

jjlady wrote:At this point once I fall asleep I am fine on the machine, but it takes hours to fall asleep and I wake up exhausted.

Your first reaction might be to reach for a sleep aid, but what I'm finding for me is that, yes, a sleep aid does help me get to sleep, but it makes me feel worse (more exhausted, groggy) during the next day. What I'm finding, and it may be hard starting out when you feel so tired, is I pick up the pace during the day so that when bed-time rolls around, I feel like zonking out. I make that bed-time consistent so my body knows that it's about bed time and starts getting sleepy.