sleeptech

I have had patients with the same experience as your dad, and the first response is a humidifier. Does he have one and, if so, is he using it correctly? Also, what sort of mask does he have and what leak numbers is he getting from his machine? Mask leaks can also cause this problem.

Sounds like it couldn't hurt to increase your pressure. I'm not sure why your doctor would be against it as it's fairly harmless. Usually the only down side is decrease in comfort as pressure increases, but if you do it slowly and sensibly that should no be a major problem. What exactly is your AHI and how has it changed?

I can tell you that heaps of people feel that they don't sleep very well during their study but almost all of them get plenty of sleep for analysis, so don't be too put off by that. Also, we'd rather see a bad sleep because the idea is to see a problem if there is one. Just reading between the lines, and please remember that I don not wish to contradict your medical professionals who have all of the data to look at first hand, I THINK what might be happening is that there was evidence of significant central apnoea in your study (hence the tech's comment). Your doctor wants to be thorough so they want to rule out under-treated obstruction by increasing your pressure to see if your AHI reduces. If it does this would suggest that there was still some obstruction that needed clearing up. However, if your AHI stays the same or gets worse, that suggests central apnoea. The doc's comment about "advanced modality therapy that is a bi-level with a backup rate structure" is just along winded way of saying BiPAP and, at risk of sounding rude, it sounds a bit like he doesn't really know too much about it. What he is saying is BiPAP in S/T mode rather than S mode, which is quite common and no one who uses it much would use such a wordy way of saying it. Still, it's far more to do with the tech who has to titrate it for you. I noticed that you have EPR on full time at 3. That can cause central apnoeas by hyperventilating you. Have you tried CPAP without EPR? If you are quite attached to it for comfort reasons, you can set EPR to ramp only, so that once you are asleep it stops. EPR is only a comfort feature, and I have seen it cause problems for many people, so if you are not completely wedded to it I would suggest trying without. If any of the jargon I have used (or anyone else has used) confuses you, please let me know and I shall try to decipher it. That's my job after all. Hang in there buddy. It sounds like the plan your doctor has for you is a sensible one. You should be working your way towards some answers.

I don't want to rain on your parade, but the success rate your quoted for the procedure seems strangely high. All of the latest from the World Sleep Conference and all my other sources of professional info are that there is no surgery considered a reliable "cure" for sleep apnoea. Also, I've had patients who had similar procedures and not only was it unsuccessful but it was incredibly painful with a long recovery. Every doctor I've ever met says to avoid surgery like the plague.

I hope that all of this does not apply to you. I'm just a little concerned that you may not have been given all of the info and I don't want your health to be put at risk or for you to suffer unnecessarily.

You AHI is only very slightly elevated. Normally we would say that if your last sleep study suggested that treatment is doing its job, you feel OK and other medical indicators are OK (blood pressure for example) then you probably don't need to worry. Nothing much seems to have changed since your last titration study, so if that was OK you should be OK.

A CPAP can count a cough as an event. Also, as your settle down after the cough your respiration may be a little irregular for a minute or 2, which can also increase the AHI reported by your machine. It is very possible that your coughing is causing a rise in the AHI reported by your CPAP. A humidifier can help with the cough.

The reps always tell me that if a doctor or (as in my case) a technician wants to review the data they can get all of the same data they would get from downloading your SD card. I have never actually put this to the test because we don't have the appropriate software where I work, so I can't verify this. All recent machines that I know of will report obstructive and central apnoeas separately, but I don't have great faith in their ability to differentiate based studies I have performed compared with downloads.

Herbertoliviera, what you are describing sounds a lot like you are having central onset events. A series of central events that occur just when you are falling asleep and disappear quickly once you get to sleep properly. They are not unusual, and often CPAP will make the more pronounced. Also, if you had a sleep study with CPAP on they would have seen if you had central events that extended beyond sleep onset and done something about it, so it seems very likely that they are just onset events. If your overall AHI is OK then they should not be a source of great concern. The main issue is that they stop you falling asleep, and the best way to overcome that is with a bit of practice. It may be worth a call to your Dr or CPAP supplier to see if they can check the data and tell you if your AHI is significantly elevated, mainly for your piece of mind. As I said, if you had a sleep study with your CPAP on, you can rest assured that you were breathing OK with it.

I can answer a few of your questions.

Until you get a CPAP machine, sleeping in a recliner (obviously sitting up to some extent rather than dead flat) can reduce OSA for some people so it's worth a try.

Over the counter aids are useless - don't waste your time. They are legion, often quite expensive, and I have yet to hear of one that is in any way effective.

Any medication that is a muscle relaxant has a good chance of exacerbating your OSA, so I wouldn't recommend it, especially without consulting with a doctor. Also, medications for anxiety are many and using them appropriately should be a process which is carefully managed and monitored by your doctor, so it seems very unwise to me.

In order to get some treatment as quickly as possible, you could look at getting an auto CPAP, at least short term until you can have a study and the full works. In Australia they are easy to rent, although they can be expensive. It should offer some relief and piece of mind, especially if you have to wait a while before getting a sleep study. I would imagine your doctor should be willing to OK it as an urgent matter without too much rigmarole. Perhaps a phone call would be enough.

I, too, suffer from an anxiety disorder, so I really feel for you. Hang in there. I can offer you the comfort that it's not OSA that kills people, but the problems that result from it which develop over the long term. Any one particular instance of apnoea may be scary but it is not, in itself, a threat.

It would be very wise to talk to your doctor about this. Oxygen can be dangerous in some cases.

Yeah, most devices to prevent you lying on your back don't work.