sleeptech

It is safe to say that, regardless of your style of treatment, the best approach is always to work as a team. The patient should educate themselves in order to play an active and constructive part in their therapy, most particularly so that they can provide useful and meaningful feedback on their situation. The doctors and technicians involved should be attentive, cooperative and provide the benefit of their specialised knowledge and experience. Your various medical professionals (should) have a wealth of knowledge, which has taken years to acquire, that they can place at your disposal. On the other hand, only you know what is happening for you as you use your treatment. Only by working together can the best outcome be achieved. Unfortunately, in our neo-conservative western world, money is the primary determining factor in almost everything. For medical professionals to invest more time in their patients may yield better outcomes but also costs more money (in the short term at least) and the health care industry is no different to any other in that money will win out 9 times out of 10. This leads to a set-and-forget approach being all too common in all areas of health care. Work with your doctors, techs, whoever and encourage them to work with you. When you find medical professionals who actually care about you, or at least helping you to get the best outcome, value them.

The machine is behaving as it is deigned to do and your response in restarting it is exactly what is recommended. What exactly is waking you? Do you have mask or mouth leaks? What kind of mask do you wear? Do you have access to your download data? That may shed some light on the situation.

It's great to hear that all is going well. What you describe are the potential benefits of auto CPAP - lower pressure for most of the night leading to fewer leaks, mask being less tight and increase in overall comfort. I am also glad that you have been monitoring your own progress to enure that everything is working properly. It is a shame that, where I am from, an auto costs so much more than fixed pressure, or it could be useful for more people. As an aside, a good doctor should be happy to work with you through this process. Either that or they should be able to explain very clearly why they think it's a bad idea. If you find a good doctor, hang on to them.

Hi there Daryl

If you have been diagnosed with OBSTRUCTIVE sleep apnoea you don't need BiPAP, you need CPAP. This is good news because a BiPAP machine is about 4 times the price of a CPAP machine. I can suggest one online service where you can get either at a very good price. But before that perhaps we should clear some things up. What exactly was your diagnosis? Have you actually seen the results? If not, I suggest that you try to do so, because it is important to be clear about exactly what you problem is and, therefore, exactly what the appropriate treatment is. Be of good heart. If you need CPAP or BiPAP treatment there are ways of getting one without it costing the earth.

Certain machines and software refer to central apnoeas as "clear airway" apnoeas. It just means that your breathing is irregular but your airway is open (rather than obstructed). AHI is then a sum of your central or clear airway apnoeas, obstructive apnoeas and hypopnoeas. Your machine is saying that it is picking up some irregularity in your breathing but that your airway is not collapsing. If your AHI is the same as your clear airway number that means that nothing else is happening. Don't worry, that level is within normal range.

Paediatrics is not my field but, in adults at least, high CO2 suggests that he needs to get more air in and out, which would require BiPAP. I know it is used for kids that age. It should also address any central apnoea. Depending upon the cause, I surgical intervention can be successful in children and in some instances.

A very brief summary of the data you have posted: you have severe OSA but, on the up side, your lungs work well. To address some of your questions:

1) In short, no. Restlessness and discomfort do not cause OSA. The OSA recorded on your study is a chronic condition and happens whenever you sleep. There is a small but significant proportion of people who have OSA but are asymptomatic. That is to say that they subjectively rate their sleep as good and they don't feel tired during the day. No one knows why this happens, but it it is well described. Unfortunately, it also doesn't change the fact that severe OSA is causing damage to your body every day (or, rather, night).

2) 10 days is still very early. It often takes a while to get everything sorted and to begin settling in to treatment. WiredGeorge is right about making sure you have the best mask. If nasal has been an improvement how about intra-nasal (up the nose)? Investigate the options.

3) It is quite possible that OSA could exacerbate your muscular degeneration. It certainbly won't help.

4) Err... CPAP *is * the treatment. In fact, it's the only reliably effective treatment for the vast majority of people. It is not a CURE as the OSA is still there if you stop using it, but it certainly is a treatment.

It may not be glamorous, and it may take some time and work before you are sleeping well with it, but CPAP will definitely have a positive impact on your health, especially given the severity of your OSA and your muscular condition. It is worth the effort, so keep working at it.

I would not say that I am annoyed by any of the previous posts, rather concerned for you health. Random tinkering with machine settings (as some people certainly do) can cause all sorts of problems. It sounds like your approach is considered and systematic which is excellent. The complexity of Bi-level therapy requires a careful and thoughtful approach. I'm also really glad that you have a doctor you can trust - stick to them like glue. It may also be encouraging for you to know that, once on BiPAP, people with complex respiratory failure can improve, sometimes a lot. So hang in there, things can get better, and keep working on your treatment. It is a process, and sometimes a long one, but it will be to your great benefit in the long run.

As one of the idiots who makes the adjustments for the doctor, I feel that I should point out that CPAP pressure is prescribed by that doctor. We have to set the CPAP/BiPAP exactly according to what the prescription says. If the pressure is to be changed for any reason, this requires a new prescription, in writing, from the doctor. It is illegal for us to change the pressure without a prescription, no matter how much a patient may want us to and no matter how much we may agree with them. This is of course in Australia, but I would think the same is true of the US.

There are internationally standardised rules for the scoring of, well, everything that is scored in a sleep study. There are lots more of them. They are all very boring and no one except a sleep tech needs to know them.