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sleep nasendoscopy
Hi,
I have mild osa and have been using an a/pap for 2 years now.
I went to the hospital yesterday and and showed them my printouts from my machine and the results from using my Oximeter.
I have tried 1 night of sleeping with no a/pap and the Oximeter showed very clearly that the a/pap does a good job.
I told the doctor that although the a/pap does a good job I am still having apnea's and I would like to have a sleep nasendoscopy and if it showed clearly what is causing the apnea's I would like to have surgery for that.
He said this hospital does not do that because surgery has a high failure rate and think's i should look at using a c/pap as the a/pap is failing me.
he is talking about setting the pressure to 20! I said isn't that an overkill and he said we will start at that and see if apnea's stop and then monitor it.
I do not look forward to a set pressure of 20 and feel i should be going down the sleep nasendoscopy route.
i would be very interested to hear your thoughts on this.
Regards Joe
I have mild osa and have been using an a/pap for 2 years now.
I went to the hospital yesterday and and showed them my printouts from my machine and the results from using my Oximeter.
I have tried 1 night of sleeping with no a/pap and the Oximeter showed very clearly that the a/pap does a good job.
I told the doctor that although the a/pap does a good job I am still having apnea's and I would like to have a sleep nasendoscopy and if it showed clearly what is causing the apnea's I would like to have surgery for that.
He said this hospital does not do that because surgery has a high failure rate and think's i should look at using a c/pap as the a/pap is failing me.
he is talking about setting the pressure to 20! I said isn't that an overkill and he said we will start at that and see if apnea's stop and then monitor it.
I do not look forward to a set pressure of 20 and feel i should be going down the sleep nasendoscopy route.
i would be very interested to hear your thoughts on this.
Regards Joe
Views: 319
Replies to This Discussion
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Permalink Reply by Tigers Fan on
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Why on earth are you so decided that you want lumps cut out of your throat, especially as your APAP is doing a "good job"?
As for the CPAP: makes a lot of sense to me because that is what I have done except I did it by increasing from a lower pressure rather than decreasing from the maximum pressure a machine will give.
"Does a good job" does not tell us a great deal technically. What is your AHI on APAP? What is your 90% pressure? How much leakage do you record? How many times do you wake per night? Are you well hydrated? Use a humidifier?
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Permalink Reply by Kath Hope on
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Joe, I can understand you wanting to try to fix your OSA with operations, as I know how hard CPAP is for you with your ear problems. However, I would be very hesitant in having surgery with the hope of fixing it. Like Mary indicated, not many people can say they've cured their OSA with surgery. There are lots of instances where people 'seem' to be cured at first, but the symptoms usually return soon after. As you know, I've had 2 lots of nasal surgery (due to the 1st one failing), but I never expected it to cure my OSA - only help it, which it has! Now that I can breathe through my nose my therapy is much more comfortable and my AHI has decreased (most of the time) due to less hypopnoeas linked to the nasal issues. However, the obstructive apnoeas are still there, and if the pressure's wrong a few centrals creep in too..
Whilst I'm no medic, I actually think that your doc should be looking at changing your minimum + maximum pressures on the APAP so they're closer together, rather than just opting straight into a pressure of 20 on CPAP. I'm with Tigers Fan on this. It would be interesting to see what your results came out at say a pressure of 14 first + then gradually increasing it if this didn't sort it. I suppose there's no harm in going for a pressure of 20 though and seeing what the results are, and if they're good, they could be gradually lowered until you find the correct one. Like Mary said, if you really want the nasendoscopy then you need to be seen to be working with your doc. It would be interesting to have the procedure to see if you can find out why you actually have OSA. As for me, I'm stuck with it for life......large tongue base, large soft palate, receding jaw etc., and there's no way I'm going under the knife anymore!
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Permalink Reply by RockRpsgt on
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What pressures are you on now? Is your APAP set to an open wide range of 4-20cm?
Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients
with Obstructive Sleep Apnea: AASM Guidelines:
http://www.aasmnet.org/Resources/clinicalguidelines/040210.pdf
4.3.1.1 If the patient is uncomfortable or intolerant of high
pressures on CPAP, the patient may be tried on BPAP. If there are
continued obstructive respiratory events at 15 cm H
during the titration study, the patient may be switched to BPAP
2O of CPAP
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Permalink Reply by Joe barnes on
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Firstly thank you all for your help.
I had been using a/pap for around 4 months.Then had polygram january 2000 and they it was set 4-20 and by the time it caught the a's it was to slow.
So they set it 10-20
I have tweaked it many times and have been using at 9--15
I changed it last night to 12-17 .
My a/pap software is not working again and so will have to wait till Monday to resolve this but the Oximeter figures look encouraging.
I understand that there are several things that can cause ap's and so they had to do many procedures to cover all of them to make it work.
Having found out about sleep nasendoscopy I felt they could find out what is causing the a'p and correct just that on it's own.
Why would I want to do this?
well 3 months after i started using my a/pap I would wake to tinnitus sound that was similar to the sound of the a/pap.
This would go after several hours and return when I woke up.
Then my hearing started to deteriorate to the point now 20 months on that i am classed as severely deaf .
The experts say they have not heard of a/pap doing this but can't offer any reason why this has happened so quickly.
I am grasping at straws but I have to try to stop it getting any worse,
Regards Joe
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First of all Joe I believe that your range is to wide. In my opnion anything above a range of 3 is for exploratory purposes. You my friend are past exploration. I would love to see a more up to date or specific report to better identify your trends. According to the one you posted your 90th% pressure is 12.7. Meaning that this is where your treatment is the majority of the time. You average peak pressure is 13.2 with a mean pressure of 10.1. I can't tell you to change your pressure as it could put my license in jeopardy. If this were my treatment I would set my range to 10-14 or 11-14. If I were to do a straight PAP pressure I would think about 14cm.
Without knowing the cause of your inner ear problems 20cm sounds like a lawsuit waiting to happen for your doc. The pressure from PAP therapy can and will cause ear problems in a small amount of users. PAP therapy changes the atmospheric pressure in your nasal/sinus passages and at the back of the throat and airway. The eustachian tubes are connected. Most of the studies out say otherwise. My problem with this research is that most of them are on new users with 1-6 months use. I think that the results would be different if they did these studies on long term users. You are the 3rd person within a year that has epressed ear problems after therapy.
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Hi Rock,
Thanks for your help.
I will reset it to 11-14
my encore viewer software has lost me the resent info , so will get on to them Monday and get it sorted.
if you had this apap what would you set the a flex on?
I am convinced that it is a middle ear problem but when they do an ear test on the bone and then in the ear they are the same so they say this proves it is inner ear.
Some months ago the top audiologist at my hospital said he had 3 resent cases from people using pap's
he then referred me to a Consultant Otolaryngologist who said that some people keep there hearing and some loose it, you are one of them that loose it.Nothing can be done to help me.
I also have pulsating tinnitus and although they cannot help me with this they say it is quite rare and have ask me to take part in research they are doing on this.
Regards Joe
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Kath said, "However, the obstructive apnoeas are still there, and if the pressure's wrong a few centrals creep in too.."
Can you expand on that, please, Kath. How do you know they are central apnoeas and not just obstructive apnoeas? I ask because I don't understand and because it might be happening with me as well.
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....because my Respironics software tells me. I have the System One APAP + it's amazing how much detail I get now. I shall be having another sleep test soon to check this out, but am hoping it's when the pressures have been too high. Why do you think you might be having them TF?
Tigers Fan said:
Kath said, "However, the obstructive apnoeas are still there, and if the pressure's wrong a few centrals creep in too.."
Can you expand on that, please, Kath. How do you know they are central apnoeas and not just obstructive apnoeas? I ask because I don't understand and because it might be happening with me as well.
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Aha! Should have thought of that! The machine tells you so! Not magical intuition, after all. I had thought the centrals may wake you differently somehow. Anyway, in my limited understanding of centrals, pressure will have little or nothing to do with them if you are within a gnat's crotchet or two of your optimum.
Brain function is the answer! Alzheimer's would have to be very severe for you to forget to breathe and as your run your life well, I don't suppose that is the cause. CJD is unlikely. Pehaps we'd best wait to see what the medics have to say?
Oh! Why do I think I might be having centrals? Alzeimer's for sure! Seriously - just a maybe becaise I cannot get my AHI down to anything approaching zero - I'd like to be less than 1 consistently. Plus, my duvet suggests my legs are active through the night.
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LOL...no I'm not that clever, but the software is! The strange thing is that I feel worse when the centrals are up. Of course, it could just be higher pressure causing the centrals. The re-test will tell.....
Tigers Fan said:
Aha! Should have thought of that! The machine tells you so! Not magical intuition, after all. I had thought the centrals may wake you differently somehow. Anyway, in my limited understanding of centrals, pressure will have little or nothing to do with them if you are within a gnat's crotchet or two of your optimum.
Brain function is the answer! Alzheimer's would have to be very severe for you to forget to breathe and as your run your life well, I don't suppose that is the cause. CJD is unlikely. Pehaps we'd best wait to see what the medics have to say?
Oh! Why do I think I might be having centrals? Alzeimer's for sure! Seriously - just a maybe becaise I cannot get my AHI down to anything approaching zero - I'd like to be less than 1 consistently. Plus, my duvet suggests my legs are active through the night.
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Yeah! See! Higher pressure causing centrals. I'm on 18 cm.
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