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30 Days in - May I ask for some guidance and advice?
#1
30 Days in - May I ask for some guidance and advice?
I feel like CPAP treatment has been a good choice and have been using my new travel dreamstation auto for about a month now.  I've attached my sleep study, titration study and todays OSCAR data, which has been my best result so far, in hopes that the experienced folks here might point me in the right direction towards thosse sub 1.00 AHI numbers.

Thank you for any help - I love what this community has done to let individuals learn what works for them!

   

giff


Attached Files
.pdf   mark-sleep.pdf (Size: 689.54 KB / Downloads: 18)
.pdf   titration-min-2.pdf (Size: 903 KB / Downloads: 19)
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#2
RE: 30 Days in - May I ask for some guidance and advice?
You have had mixed or complex apnea in both your diagnostic and titration tests. Your doctor noted the possibility of moving to ASV if excessive central apnea remained in therapy. In your case, PLM is a complicating factor and can increase flagging of events. Based on your titration test, the best result was obtained at 8.0 cm-H2O.

If you want to optimize your CPAP results, I will recommend you turn off Flex or set it to CFlex at 1. I think you should go to a fixed pressure of 8.0, and you can do that in CPAP mode or in Auto mode by changing the minimum and maximum pressure to the same value. The reason I want to see fixed pressure is to eliminate the possibility that variable pressure is causing the CA and hypopnea events. If I was looking into my crystal ball, I see ASV in your future.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: 30 Days in - May I ask for some guidance and advice?
a caution re periodic limb movement and asv: I have mixed apnea which asv admirably resolved. ahi of about 0.3. however, the asv's ineffective response to the non-passive flow limitations (grunts, moans) between my periodic limb movements were huge repetitive swings in pressure support that cannot be capped or stopped. I was unaware of it at the time but since I continued to feel unrested I'm now using a more constant pressure with bilevel vauto and I now realize how exhausting those pressure swings were. if/as/when I ever get adequate treatment for plm, I will try asv again. in fact I did use asv the other night since my plm has improved somewhat (but not enough) with a low dose of ropinirole but I didn't feel so great the next day so back to vauto for now. even though ahi is higher I feel better with the restricted max pressure support.

I was initially diagnosed 30+ years ago with central apnea. over the years it evolved into mixed obstructive and central apnea. it appears many of my events are associated with plm. lately I've been wondering if maybe my initial ca diagnosis was really because of plm.
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#4
RE: 30 Days in - May I ask for some guidance and advice?
Thanks, both. Will start by switching to CPAP mode and Flex off. Will gather some data and share again in a few days.
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#5
RE: 30 Days in - May I ask for some guidance and advice?
I have been seeing somewhat similar results since setting the machine to fixed CPAP at 8 - Reasonable AHI for a few hours and then hypopnea events increasing.  I'm new to CPAP and wondering why I'm not getting similar result to my titration study attached above.  I'm not sure what to do next, and would appreciate any advice.

   
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#6
RE: 30 Days in - May I ask for some guidance and advice?
Your diagnostic and titration tests both indicate a significant central component to your AHI. The titration test found that you had a "successful" titration at pressures of 7.0 (99 minutes, AHI 4.9) and 8.0 (80 minutes AHI 2.7). The titration results are far from stellar and each included an obstructive apnea and up to 4 CA and 3 H events. Your titration shows high levels of complex AHI on either side of your successful titration, which shows the results are not linear with pressure, in fact both obstructive and central events increased with higher or lower pressure.

As I said before, you are not trying to treat obstructive sleep apnea, which would be easy with a CPAP, but instead you are trying to treat complex sleep apnea with CPAP, and as a result, your therapy results will be consistently inconsistent. With AHI of 21, you should advise your doctor of the problem, and remind him you have a significant central apnea and hypopnea component in both your diagnostic and titration tests. You will ultimately be moved to a different level of machine, probably BiPAP first, then eventually ASV. Normally with the levels of hypopnea and OA we see in your latest chart, we would suggest turning off all Flex comfort options and trying higher or automatic pressure, however, I think you may actually be at the pressure that best treats your obstructive sleep apnea without aggravating your complex apnea. Thie is the prescribed pressure for you, and I don't think tweaking settings is going to improve your results. You must contact your doctor and have him test you for ASV therapy which will solve all of this.
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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#7
RE: 30 Days in - May I ask for some guidance and advice?
That result is radically different from your previous one. That I believe has a strong chin tucking component. I am hesitant to add a soft cervical collar to your night based on one night but if the obstructive element, ignoring the CA looks like that again or frequently you should add a cervical collar.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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