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1 month in.. I think I'm doing good?
#1
1 month in.. I think I'm doing good?
Hi everyone,

So I'm a month into treatment. I was diagnosed in May with an AHI of 152.2 which scared the crap out of me. I think I've had SA for years. I took some screens of SleepyHead and it all looks pretty decent to me but I'm new to this so who knows. Since starting treatment I've felt awesome minus the crazy vivid dreams, my restless legs syndrome has pretty much gone away (not sure if that's normal), and oddly my allergies/congestion has improved.

Anyhow, thanks for taking a look in advance! Smile

Matt
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#2
RE: 1 month in.. I think I'm doing good?
Looks good overall. You could probably set your minimum EPAP to 15cm if you'd like to lower your AHI.
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#3
RE: 1 month in.. I think I'm doing good?
(07-07-2018, 08:41 AM)Walla Walla Wrote: Looks good overall. You could probably set your minimum EPAP to 15cm if you'd like to lower your AHI.

Thank you! I will look into how to set that as I'd like my AHI to be as low as possible Smile

Thanks
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#4
RE: 1 month in.. I think I'm doing good?
You've come a long way, and your hours of therapy are trending to increase.  With EPAP min 14, IPAP max 22 and PS 5 your obstructive apnea is completely resolved, so I disagree with Walla you need to increase minimum EPAP.  You might try small increases in pressure support between 5 and 6 to see if you can further lower hypopnea.  Excellent results overall. The recommendation for increasing PS rather than EPAP is based on basic titration protocol principles.  In the chart below, the recommendation for hypopnea is to increase IPAP pressure (in your case with Vauto, PS), until resolved.

[Image: attachment.php?aid=4203]
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: 1 month in.. I think I'm doing good?
(07-07-2018, 09:11 AM)Sleeprider Wrote: You've come a long way, and your hours of therapy are trending to increase.  With EPAP min 14, IPAP max 22 and PS 5 your obstructive apnea is completely resolved, so I disagree with Walla you need to increase minimum EPAP.  You might try small increases in pressure support between 5 and 6 to see if you can further lower hypopnea.  Excellent results overall. The recommendation for increasing PS rather than EPAP is based on basic titration protocol principles.  In the chart below, the recommendation for hypopnea is to increase IPAP pressure (in your case with Vauto, PS), until resolved.

Wow, I have so much to learn! I see my doctor soon for a follow up, he's going to hate me with all these notes I'm taking, haha.

Question though, if I change any settings will that mess with insurance compliance? From what my doc told me, as long as I use the machine 4 hours per night 5 days a week I'm within compliance but I'm not sure if that was just some kind of oversimplification.
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#6
RE: 1 month in.. I think I'm doing good?
Insurance is concerned mostly about your time of use, and it appears you don't have a problem there. If you want to try the changes I suggested, just enter the clinical settings and try setting PS to 5.4. This won't be a problem with your doctor, and you can always use the protocol chart to explain why you tested the slight increase in pressure support. Your initial pressure settings were better than most that I see here in getting it right from the start. It will be interesting to hear what your doctor says in follow-up.

I think the summary information you provided is useful, but a detail daily chart would tell the story better so we know how the remaining events occur in relation to time and pressure.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: 1 month in.. I think I'm doing good?
(07-07-2018, 09:33 AM)Sleeprider Wrote: Insurance is concerned mostly about your time of use, and it appears you don't have a problem there.  If you want to try the changes I suggested, just enter the clinical settings and try setting PS to 5.4.  This won't be a problem with your doctor, and you can always use the protocol chart to explain why you tested the slight increase in pressure support.  Your initial pressure settings were better than most that I see here in getting it right from the start.  It will be interesting to hear what your doctor says in follow-up.

I think the summary information you provided is useful, but a detail daily chart would tell the story better so we know how the remaining events occur in relation to time and pressure.

Good to know, the whole insurance compliance thing worried me at first but not anymore with how much I've been sleeping with this machine. Love it!

Here's my last 5 daily charts, I think I set it up right.
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#8
RE: 1 month in.. I think I'm doing good?
Charts are good. The presence of snores, flow limits and hypopnea point to pressure support rather than higher pressure as a solution. I encourage you to give it a try. Your pressure is moving with snores and possibly flow limits that we can't see, so you hit your maximums without obstructive apnea.

Your respiration rate is a bit high with a short inspiration time. If your TiMax is less than 1.4 I think we need to look at that, or consider moving it to 1.8. This won't change your respiration rate, but will give you more time on IPAP if you demand it through your own respiratory effort. Tidal volume is good. A high respiration rate (20-30 BPM) while sleeping is not necessarily a concern, but may be something to add to your notes to discuss for your own peace of mind. This machine cannot pace your breathing, so that is not something we would deal with in therapy settings anyway.
Sleeprider
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____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: 1 month in.. I think I'm doing good?
(07-07-2018, 10:53 AM)Sleeprider Wrote: Charts are good. The presence of snores, flow limits and hypopnea point to pressure support rather than higher pressure as a solution.  I encourage you to give it a try.  Your pressure is moving with snores and possibly flow limits that we can't see, so you hit your maximums without obstructive apnea.  

Your respiration rate is a bit high with a short inspiration time.  If your TiMax is less than 1.4 I think we need to look at that, or consider moving it to 1.8.  This won't change your respiration rate, but will give you more time on IPAP if you demand it through your own respiratory effort. Tidal volume is good.  A high respiration rate (20-30 BPM) while sleeping is not necessarily a concern, but may be something to add to your notes to discuss for your own peace of mind. This machine cannot pace your breathing, so that is not something we would deal with in therapy settings anyway.

I wonder if that has anything to do with being an ex-smoker and being overweight. My pulmonary function test was good, no idea if that even has anything to do with respiration rate. Uhg, wish I never smoked but glad I quit 5 years ago. The weight issue is hopefully being taken care of via gastric bypass in August Smile
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#10
RE: 1 month in.. I think I'm doing good?
When flow limitation is present, it can occur in the upper airway or in the lungs themselves, as in COPD. Without a medical workup I would not speculate on that, however the use of pressure support applies to either case. I actually think you might tolerate lower overall pressure based on the lack of obstructive events. Your AHI is pretty darn good, and most of the events should respond to pressure support, even if we limit how high EPAP is allowed to move. That would take some experimentation to prove, but your current PS at 5.0 is not excessive. If you move above 6.0 PS then you will notice the machine is unloading more of your own respiratory effort.

If you want to know more, then it is pretty easy to request a pulmonary function test during any annual exam. The FEV1 (forced expiratory volume) and FVC (forced vital capacity) tests are very simple to conduct and provides a lot of good information on lung function and performance. Here is some good information https://lunginstitute.com/blog/fev1-and-fvc/ It's always good to have the test as a baseline against which future changes can be compared, and are often performed pre-surgery for the anesthesiologist anyway. These tests used to be mandatory for me using safety respirators, and I did the test again two years ago with good results. Judging from your tidal volume, I doubt you have a significant lung problem, and it's more likely restriction is in the upper airway...just guessing. I still think you could do FEV1 and FVC tests and discuss the respiration rate and come away with a good understanding of your health. FWIW, your therapy looks great.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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