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APAP behavior puzzling to me
#11
Vaughn makes a good point.

Also, the only way to begin to tell if the behavior is normal is to look at the AHI numbers.

Did your numbers change when you went APAP?

But I think we are down to two possibilities:

1) the machine correctly thinks you need a pressure somewhere north of 12

2) the machine incorrectly thinks you need a pressure somewhere north of 12

Tracking AHI might help us suss that out.
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#12
Thanks Guys!

I mis-typed; I meant to say I changed my Autoset from a fixed setting of 10cmH2O to a variable setting of 8-12cmH2O. I went from an AHI of 3.18@10cmH2O to an AHI 7.83 using the variable setting. The majority of the increase of AHI are CA's. I tried setting the max to a 10.6 setting and the AHI was reduced. My machine starts at the low setting for about 30 seconds then climbs to the maximum pressure that is set. I am enabling the ramp feature for 30 minutes to see if it can get the hint to stay away from the maximum unless it's really needed. My intent was to see if I could get away with a lower pressure for most of the night and have a "backup" pressure for the occasional OA's. So much for good intentions.

This is one of those "side thoughts"; I am wondering if the S9 has the capability to read the old sleep data on the SD to develop profile model of pressures. I say this thinking that if you change the parameters using ResScan, it wants to erase all the old data on the card. . . I know, I need to get some better wine or drugs. Oh-jeez
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#13
(12-26-2014, 06:43 PM)sgearhart Wrote: I meant to say I changed my Autoset from a fixed setting of 10cmH2O to a variable setting of 8-12cmH2O. I went from an AHI of 3.18@10cmH2O to an AHI 7.83 using the variable setting. The majority of the increase of AHI are CA's. I tried setting the max to a 10.6 setting and the AHI was reduced. ...

This is one of those "side thoughts"; I am wondering if the S9 has the capability to read the old sleep data on the SD to develop profile model of pressures.

Sometimes people are very sensitive to pressure, with a pressure above which CA events increase rapidly.

Another thing which often reduces the number of CA events is turning EPR down or off except during the Ramp.

Obstructive events (or partially obstructive conditions like Flow Limitation) cause the pressure to rise, so avoiding sleeping on your back may be important in allowing the therapy pressure to stay low enough to avoid causing many CA events.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#14
So if your AHI went up, mostly due to higher pressure causing CAs (many of which may be false positives) it does not clear up the issue of why your S9 wants the pressure higher, now that it has the ability to change pressure, supposedly in your best interests.

Was this a change you made that was recommended by your sleep doc? If you were given an Autoset, it probably takes a sleep doc to decide to set this (an APAP) at straight 10 (bricking it to CPAP mode), but that may be a first or second step after the sleep test.

For instance, I had a home study with an untreated AHI of 55.7. The original setting from that was 5-20. I then had a full study with titration months later, and was recommended a straight 8 after that. The original no-CPAP home test was mostly OA, no CA at all, and a few hypopneas, indicating that OA was my primary issue. I get CAs twice what I get for OAs now in therapy, and total AHI is regularly below 3. So it appears that the XPAP itself is invoking the CAs for the most part.

It is only a guess, but I think restricting the XPAP to CPAP is an attempt to lower the CA numbers, which as Vaughn says, can increase as pressure goes up, and/or if EPR is set too low. There are two problems with that, however, which is that CPAP may not be as comfortable or as easy to comply with, and it will never titrate you and find your optimum pressure while restricted to just operating as a CPAP.

If you had a home study or a full sleep study that diagnosed you originally, (no XPAP at the time) what range did you fall in?

Going from a straight pressure to an APAP range seems to be done for one or both of two reasons; find a more-comfortable pressure, or find a more-optimum pressure via the inherent titration this provides.

If you made the recent change of your own volition I think few of us would have a problem with that, and many think the informed patient is a bit more invested in trying to adjust to improve numbers (or comfort/compliance) than most sleep docs are; they seem to be motivated to collect copays and insurance reimbursements for sleep studies and office visits, while we are more motivated to get the best treatment by titrating our own pressures.

But were this my experience, I would have a lot of questions for the sleep doc regarding why the machine is doing this.
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#15
All my exploits are approved by my doctor. All my sleep studies where in a sleep lab(quite nice actually). The initial study produced an AHI of 86.2 without any REM sleep. The Sleep Tech told me after my titration study that the best setting he found was at 8cmH2O. He said I started throwing CA's if he raised it any higher. My doctor wanted my S9 set to 10cmH2O without EPR initially. Now that I have some data under my belt with the initial setting my doctor approved me adjusting it. I have been furnishing him weekly sleep reports. I just wanted to see what life was like at 8cmH2O and have the additional kick if needed. Also, to answer another question; I am a side sleeper.
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#16
Sounds like you have created the proper framework to get his info regarding the results of this change.

It also seems like the titration revealed why higher pressure is not recommended and why you are getting more CAs, which is somewhat typical, and apparently a factor in your individual case.

We probably should not minimize that from 86 to 3 is a pretty good result for the therapy.

It will be interesting to see how he answers these questions.

How are you "furnishing weekly sleep reports"?
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#17
(12-26-2014, 08:36 PM)TyroneShoes Wrote: How are you "furnishing weekly sleep reports"?

I provide him a pdf file comprised of the Stat page from Sleepyhead, weekly overview. daily printouts, and an Excel spread sheet listing daily BP, pulse, and O2 levels taken at bedtime and when I awake. Additionally, I provide information such as mask/equipment changes, any problems encountered (insomnia), and how I feel. I've recently added pulse oximeter readings to the normal nightly data.
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#18
(12-26-2014, 08:25 PM)sgearhart Wrote: The Sleep Tech told me after my titration study that the best setting he found was at 8cmH2O. He said I started throwing CA's if he raised it any higher. My doctor wanted my S9 set to 10cmH2O without EPR initially. Now that I have some data under my belt with the initial setting my doctor approved me adjusting it.

Hi sgearhart,

Were you using ERP?

Turning EPR lower or off sometimes helps to lower number of CA events.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#19
(12-26-2014, 09:51 PM)vsheline Wrote: Hi sgearhart,

We're you using ERP?

Turning EPR lower or off sometimes helps to lower number of CA events.

I don't use the EPR. I found early on that it caused problems. I setup the S9 last night with an 8-12 setting and a ramp of 8cmH2O for 30 minutes. I had no events until it ramped up to 10.8, on its way to 12. I believe my machine has a bug (undocumented feature). Looks like I going to have to constrain it until I talk with the doc.

Thanks for the help!
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#20
(12-27-2014, 10:30 AM)sgearhart Wrote: Looks like I going to have to constrain it ...

you mean like 8 to 10.5 with ramp of 30 minutes?
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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