When nothing seems to be working, what do you do??  My dh has been on the Resmed Adapt sv vpap for a month now and he's still not waking up in the morning feeling rested.  He's had 2 sleep studies done recently (one as a baseline, and one as a titration study w/vpap) and he didn't go into anything but sleep stages 1 and 2 in either of them.  His pulmo said that there were a couple of meds out there that could help him get into a deeper sleep, but that she didn't feel good about him using them because they could also cause him to stop breathing.  She is a diplomate of the American board of sleep medicine and she seems to really know her stuff.  The vpap dropped his AHI down to 12.8 (from 89) and took away the centrals all together....  I don't want to give up on him and I don't want to believe that this is the best we can do, but I can't seem to find anything else to try....??  Any thoughts??  Thanks!!



Last edited by shelee on Thu Jul 24, 2008 11:24 pm; edited 1 time in total

From my layman mind...you will have to keep working on it with the VPAP along with continuing to find out why he is haivng the problems that he is..  Is your Sleep Dr Pulmonary or Neurological?  Maybe go for a second opinion to a Neurologist who specializes in sleep medicne.  He could have other things going on...he may need to have an MSLT study also (Primary CNS hypersomnia)...his pressure may need to be increased, he may have leg movement, may need O2, several things.

Going through 2 sleep studies is what everyone does...unless for some reason ($$, Insurance, Severity) they are given a split study.  So, 2 sleep studies is the typical and nothing odd.


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Is your Sleep Dr Pulmonary or Neurological?
Maybe go for a second opinion to a Neurologist who specializes in sleep medicne. He could have other things going on...he may need to have an MSLT study also (Primary CNS hypersomnia)...his pressure may need to be increased, he may have leg movement, may need O2, several things.

Our family's sleep doctor is a Pulmonologist and dh has already been seen by a neurologist who specializes in sleep medicine (or so we thought....).  He said that dh was out of his league....   and that we'd need to go for a pulm consult.  What is an MSLT study??  (if you don't mind me asking...)  His pressure was initially set higher but his stomach was filling up with air, so they lowered it.  Maybe that can be changed again since he's more used to the machine now.  He does have leg movements....the summary says "episodic leg movements; cannot exclude the possibility of PLM.  In what cases is O2 helpful??  So many questions....

Thank you so much for all of your help!!

shelee
When your husband had his sleep studies how low was was his O2 saturations, was it in the 90's or 80's or was it lower. Does his mask fit properly?, is he having any leakage around his mask?  His AHI still seems a little high for being on the VPAP Adapt SV. Do you have his sleep study results? There are several people here that are really good at all this, and should be able to help you! RAM_Sleep, would probably be able to advise you best, but it would help to have the  sleep study results.
  Anyway it can take awhile to see results, so don't get to discouraged just yet, I have been on XPAP since Jan 07 but I have only  been on my VPAP Adapt SV since May, and I still have good and bad days.  So it can take some time. I am sure you will be getting allot of good advice shortly! Good Luck to You.


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White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

When your husband had his sleep studies how low was was his O2 saturations, was it in the 90's or 80's or was it lower. Does his mask fit properly?, is he having any leakage around his mask? His AHI still seems a little high for being on the VPAP Adapt SV. Do you have his sleep study results? There are several people here that are really good at all this, and should be able to help you! RAM_Sleep, would probably be able to advise you best, but it would help to have the sleep study results.

During the first study his lowest level (O2 sats) was 81%, average was 91% and 24% of the time was spent under 90%.....  During the 2nd study (w/vpap) the average was 96%, lowest was 83 and only 2.5% of the time was spent under 90%.  (big improvement).  

His mask fits properly (according the the DME guy).  I think it's the Resmed quattro (??)....  No leaks that we know of.  Excerpts from his last sleep study (w/vpap).....
*Evidence of severe sleep-disordered breathing with both obstructive and central events (not sure if that is more case history since there didn't seem to be any centrals when he was on the vpap...??)
*Adequate sleep efficiency of 89.9%
*Markedly prolonged sleep onset latency of 120 minutes (because he had a hard time getting used to the vpap and went into a panic attack)
*Markedly abnormal sleep architecture w/no REM sleep observed
*No clear evidence of PLMD
*Sleep stage summary:  Stage 1, 6.2%   Stage 2, 83.7%  No slow wave sleep observed.  10.1% spent awake.  Episodic awakenings, frequent arousals (113-index of 27.2), 7 awakenings.  *SNORING WAS ELIMINATED!!!  
*Cardiac summary:  Underlying heart rate of 59....no sustained atrial or ventrical dysrhythmias.

I don't know if there's anything else that's pertinent...  I only have the 2 page summary, not the full report, but I will get a copy of that when we go in next.

IMHO...it takes time...check the leak rate on the VPAP to see how much the mask is leaking compared to the acceptable leak rate for the mask.....The lower pressure due to the aerophagia may not be adequetly treating the apneas.

O2 seems ok..but I am no expert.

MSLT...Multiple Sleep Latency Test..aka Nap test...checks for Narcoplepsy & Hypersomnia.  However, most likely IMHO it is mask leaks and pressure too low...plus time.  He also needs to be 100% 'compliant'...using the mask everytime he sleeps and not removing it until he is out of bed or up from the nap.


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.