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APAP Tuning Start Over?
#1
APAP Tuning Start Over?
I previously posted 3 nights each of two different CPAP settings.  I was thinking my new knowledge of my Airsesnse 10 Autosense APAP capability and new Board membership  using Oscar would work better for me using the APAP mode.  I was a longtime user at a fixed pressure of 11 with an EPR of 3 who looked for a CPAP solution to a possible medical problem with daytime dizziness.  I am going in tomorrow to my family doctor to rule out any other medical condition and intend to ask for a referral to an ENT if that looks OK

Now my issue is I was completely surprised by the results of my titrations last step.  I posted 3 nights at APAP 11-16 EPR 3 which showed better results than the 3 nights of fixed CPAP.  I only had 1 night with about 20 minutes of dense pressure limits and high density of OA and H tags.  The APAP pressure tracked potential problems each night and maxed out at 16 before coming back down again.  Bonjour asked me how I felt and I said I felt rested in the morning but felt a little groggy the one night that I had the cluster,.  Sleeprider gave me a good explanation of the value of pressure support using higher levels that BPAP can support.  I also got the paper by Dr. Barry Krackow wrote about Flow limitation/UARS and BiPap.  Great article and it caught my attention for some of the anxiety that some individuals feel in their sleep.

Since I was maxing out on the APAP setting of 16 and still not fully controlling the one significant apnea cluster in the 3 nights,  BTW the soft neck collar was on all the time now so no chin tuck.  I was recommended to take the upper limit to 18, still with EPR of 3.  The 3 nights at 11-18 were almost without an episode and didn't max out the upper limit of the APAP setting even though it was tracking something each night.  I was ready to declare victory.  I felt rested in the morning.  Then the anxiety episodes hit me.  At first it started a couple of hours after waking up and lasted all mornining.  Then it lasted all day starting a couple of hours after waking up.  It was very uncomfortable and added to that my BP also went up.

Last night I thought about what could be causing this.  I figured it must be the large expiratory pressure what much more that what I was used to and it was catching up with me.  Last night I lowered the APAP setting to 11-14.  Another surprise.  APAP didn't max out, my numbers were good, but I only got 3.5 hours of sleep and had high anxiety for most of the day.  Just coming out of it now.

I posted here the one night with the 11-16 episode.  One night with 11-18 (out of 3) and last nights 11-14.  All at EPR 3.  Does anyone think I need to start over with titration at a lower level?  I do have nasal breathing problems, deviated septum and long time ago got turbinate reduction surgery --not too effective.  I stopped using Flonase but started in again last night.  I was thinking 9-14 EPR 3.  Also I was a very heavy snorer before my first CPAP about 12 years ago so I do need inhale pressure to open me up.


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#2
RE: APAP Tuning Start Over?
The results look fine, with the December 3 looking best of the examples above. November 27 shows an obstructive cluster, but it seems to be resolved more recently. Flow limitation is a significant feature of your therapy, and I think you will be much more comfortable with additional pressure support from bilevel, but with very good AHI, it's unlikely your doctor will prescribe unless he is very open minded, and insurance is unlikely to pay. Good used bilevel machines are widely available through resale channels.

I have not seen anxiety as a consequence of therapy, whether it is good or bad. I would look at other factors than CPAP use. For some reason, it seems once people start using CPAP, the therapy becomes the solution or gets blamed for everything in their life. It's just a matter of getting better sleep with fewer arousals.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: APAP Tuning Start Over?
Do you find it difficult to exhale against the pressure? You might have done better on Max 14 because it was easier to exhale, your flow limitations are also lower on Max 14.
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#4
RE: APAP Tuning Start Over?
My thoughts as well Sleeprider on the anxienty as well as the dizziness issue.  I was just hoping the anxiety reference in Dr. Krackow's paper might also apply during the day.  It would be nice to get a universal solution as sometimes things have more than one cause and are related.  Thanks.
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#5
RE: APAP Tuning Start Over?
(12-04-2019, 03:59 PM)JoeyWallaby Wrote: Do you find it difficult to exhale against the pressure? You might have done better on Max 14 because it was easier to exhale, your flow limitations are also lower on Max 14.

I seemed to have settled in to all the pressures and didn't feel uncomfortable until after waking up.  I wasn't sleeping long that night and assumed I was still recovering from 3 nights at 11-18.
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