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Permalink Reply by Duane McDade on September 12, 2009 at 4:05am

Reduce The gap there Peter? 7-15 is too much. You need no more than a 2-4 difference. APAP is not the best way to find a pressure that works best for you. You need a sleep study to find your exact CPAP level. Then set the APAP to that level. Let's say your "pressure is 12cm/h20.....you APAP should be set to 10-14 or 11-14 that might reduce your AHI to 0. I've only been doing this stuff for 7 years now, but this kind of adjustment has worked very well for the Patients I have titrated. If you can't get to a sleep lab like you state, I would start by going to maybe 10-15 and seeing if that works ......reduce the difference, and you WILL get better AHI results.

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Permalink Reply by Peter Hollard on September 12, 2009 at 5:58am

Many thanks for the advice.. I will try tightening the range and see what impact that has..

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Permalink Reply by Peter Hollard on September 13, 2009 at 1:50am

Thanks Duane... I tightened my range last night to 8.5 -13 and this brought my AHI down to 3 from 6... will tighten a little more tonight by decreasing the top of range from 13 to 12 ... great advice

Duane McDade said:

Reduce The gap there Peter? 7-15 is too much. You need no more than a 2-4 difference. APAP is not the best way to find a pressure that works best for you. You need a sleep study to find your exact CPAP level. Then set the APAP to that level. Let's say your "pressure is 12cm/h20.....you APAP should be set to 10-14 or 11-14 that might reduce your AHI to 0. I've only been doing this stuff for 7 years now, but this kind of adjustment has worked very well for the Patients I have titrated. If you can't get to a sleep lab like you state, I would start by going to maybe 10-15 and seeing if that works ......reduce the difference, and you WILL get better AHI results.

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Permalink Reply by D. W. Conn on September 13, 2009 at 7:48am

I take it you are doing self titration with autopap.... you mentioned a leak value of 0. That does concern me. Contact your mask provider and ask what the normal leak value should be. Some mask should have a leak value of 20 to 40%.

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Permalink Reply by Todd Morgan, DMD on September 14, 2009 at 12:47am

The latest research on the effects of sleep apnea on mortality show that folks adapt differently to the oxidative stress at night and some may have little/no imact on their logevity despite severity level. New rports on long term data (10-18yrs) of patients with severe apnea died much sooner than normals from all causes (heart attack, car crash). However, treated vs non-treated or not adhearent survive the same if AHI is <15. So, I think you're OK based on these srtudies.

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Permalink Reply by Peter Hollard on September 14, 2009 at 1:10am

My mask manufacturer defines leak time as the percentage of time where leak was above 95 liters per minute... so my leak flow is never above this... is this good or meaningless?

D. W. Conn said:

I take it you are doing self titration with autopap.... you mentioned a leak value of 0. That does concern me. Contact your mask provider and ask what the normal leak value should be. Some mask should have a leak value of 20 to 40%.

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Permalink Reply by Peter Hollard on September 14, 2009 at 1:23am

Before I was diagnosed with sleep apnea the diagnosis was polythythemia and I spent months having blood tests and teatment before having a JAK2 test come back negative. My heart specialist (I had two stents inserted 5 years ago) then insisted I be tested for sleep apnea as he believed it could be the root cause of my trouble. Is this misdiagnosis common? why do GP's not test for sleep apnea at an earlier stage?

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Permalink Reply by D. W. Conn on September 14, 2009 at 8:35am

Peter I wouldn’t say it was a misdiagnosis as it may have been a missed diagnosis. Polythythemia is a diagnosis many apnea patients receive.
When we have sleep apnea our blood oxygen level can go down. The body reacts to get more oxygen to tissue and so the body increases production of red blood cells. PCP’s have to quickly rule out cancers such as leukemia, hyper K production etc. Sleep Apnea just gets bypassed. Thought I have worked in Sleep Disorders since the 1980s, I have seen most healthcare pros over-look apnea and other sleep disorders.

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Permalink Reply by Rock Conner RRT on September 15, 2009 at 2:41pm

Peter I'd leave well enough alone on your AHI, & with respect I disagree with Duane about the permissive pressure range. You don't want to overtitrate, your 6-7 AHI is already the envy of many. You need to allow for the night-to-night variances of head colds, decongestants, big meals, too many adult beverages, etc. Duane's position regarding optimal titration & then ongoing CPAP is the high road & is based on the science, but I like the adaptability of APAP & how it doesn't lock you in to the slice-of-life results of a conventional PSG PAP titration. We have cool new toys like APAP -- let's use them!

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Permalink Reply by Peter Hollard on September 15, 2009 at 3:06pm

Thanks for that input... I seem to have the AHI down to 3-4 now with the pressure set to the range 8.5 - 13 I think I will leave it at that for a while and not be more aggressive ...

Rock Conner RRT said:

Peter I'd leave well enough alone on your AHI, & with respect I disagree with Duane about the permissive pressure range. You don't want to overtitrate, your 6-7 AHI is already the envy of many. You need to allow for the night-to-night variances of head colds, decongestants, big meals, too many adult beverages, etc. Duane's position regarding optimal titration & then ongoing CPAP is the high road & is based on the science, but I like the adaptability of APAP & how it doesn't lock you in to the slice-of-life results of a conventional PSG PAP titration. We have cool new toys like APAP -- let's use them!

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