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Advise a New Guy [on high pressure readings]
#21
RE: Advise a New Guy [on high pressure readings]
Would you be willing to try a self-titration?  It may not be comfortable, and it will require you to get up at night and revise settings. I'm curious to see what happens if you set maximum pressure at 8, 10, 12, and 14. You will need a 2-hour trial at any pressure and it can be done over two nights whenever you can afford to disrupt your sleep by making changes.  The purpose is to rule out that this might be central in nature  Truthfully, the best thing would be to go back to your doctor and ask him to schedule a titration as soon as possible.  You can keep using your machine, but you need to be evaluated on bilevel up to 25, and  find out what these events are and why the are happening.

In this image, I see a possible FL breath at 21:55:35 and 21:56:35, but mostly looks good. Respiration tends to taper in and out, which looks more like central, with no evidence of recovery breath with possible exception at 21:55:22. The good news these are minimal length apnea at 10 seconds. For whatever reason, I think the machine mis-classifies them and increases pressure which may make it worse.  By preventing pressure from going higher, we get to see if a lower pressure reduces events.  If so, we will immediately conclude this is central and you need a different solution.  FWIW, I may be completely and utterly wrong.

[Image: v6uLAoH.png]
Sleeprider
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#22
RE: Advise a New Guy [on high pressure readings]
Sleeprider;  Much appreciate your kind assistance.  I am scheduled for a Sleep Test in ten days.  In the meantime here are some charts to peruse.  In these examples the AHI is all over the place.  Seemingly last night is an improvement.  The self-test you suggested to start at 8 cm up to 14 cm.. Already have the 14 cm.

FIXED at 14cm CPAP mode

FIRST TIME USED

LAST NIGHT
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#23
RE: Advise a New Guy [on high pressure readings]
I would like to see a brief trial at 8 cm and may need to see closeup of the resulting flow rate. That sequence of apnea at 14 cm was not obstructive, but let's not jump to conclusions. You will need clinical evaluation under CPAP. I would work on getting that referral as soon as possible. We are not going to be able to solve the scope of your problem with the current equipment, and with current clinical knowledge of what is causing the problem. I recommend you obtain a recording oximeter from your doctor (or Amazon) to add to your knowledge what the impacts of this problem are.
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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#24
RE: Advise a New Guy [on high pressure readings]
(09-24-2017, 03:09 PM)Sleeprider Wrote: I would like to see a brief trial at 8 cm and may need to see closeup of the resulting flow rate. That sequence of apnea at 14 cm was not obstructive, but let's not jump to conclusions. You will need clinical evaluation under CPAP.  I would work on getting that referral as soon as possible.  We are not going to be able to solve the scope of your problem with the current equipment, and with current clinical knowledge of what is causing the problem.  I recommend you obtain a recording oximeter from your doctor (or Amazon) to add to your knowledge what the impacts of this problem are.

Had an EKG just over a month ago and the cardiologist was happy with it. 
If my machine is run in CPAP mode at a set 8 cm and I use 20 cm+ am I going to wake up Unsure
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#25
RE: Advise a New Guy [on high pressure readings]
I would think so. You are self-treating and if CPAP was life-critical you would have been prescribed a ventilator. What we are looking for is whether we can relieve the central apnea and stresses during your sleep. This is no different than before you were using CPAP except 8 cm is a common pressure that relieves mild and moderate OA, generally with out increasing CA. Set a timer for 2-hours and let's see if you're doing better at low pressure or not. Your 14 cm pressure actually revealed a periodic breathing pattern that I was hoping not to see. So far, your AHI is something that needs professional attention given you have tried a full-range of pressures unless we get into bilevel capability.

EKG is only testing the electrical activity. It has nothing to do with cardiac efficiency. You need Echocardiogram for that.
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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#26
RE: Advise a New Guy [on high pressure readings]
Sorry, I always confuse [electro]cardiogram (EKG) with [echo]cardiogram.  Will call tomorrow to verify that it was an Echocardiogram I was referring to. 
Set to retrieve data for 8 cm CPAP tonight.  Looking into the recording oximeter on Amazon.
Thanks
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#27
RE: Advise a New Guy [on high pressure readings]
Hi zzzZorro  Welcome

I'm late to the party. Wishing you the best on getting these issues addressed. You got some guru guys working with you, so that's very positive. Later.

Dave
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#28
RE: Advise a New Guy [on high pressure readings]
(09-24-2017, 03:09 PM)Sleeprider Wrote: I would like to see a brief trial at 8 cm and may need to see closeup of the resulting flow rate. That sequence of apnea at 14 cm was not obstructive, but let's not jump to conclusions. You will need clinical evaluation under CPAP.  I would work on getting that referral as soon as possible.  We are not going to be able to solve the scope of your problem with the current equipment, and with current clinical knowledge of what is causing the problem.  I recommend you obtain a recording oximeter from your doctor (or Amazon) to add to your knowledge what the impacts of this problem are.

Ordered the Recording Oximeter from Amazon last night.

Ran the CPAP at set 8 cm for a couple hours.  Felt like I was getting restricted oxygen and like I had a towel over my head but hung in there.

..Then I eagerly switched to the APAP mode set at 16-20 cm for more air

After a couple hours of that the unit was retired for the night. Needed to breathe normally without a mask.

Charts for the session
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#29
RE: Advise a New Guy [on high pressure readings]
Thanks. That was clearly not the answer, although it showed that you reacted as expected with obstructive apnea to lower pressure. That is kind of reassuring, in spite of the ugly graph. How did things look at 16-20? So far, it has appeared you do need higher pressures than CPAP provides, and a bilevel would need to be considered to provide pressure up to 25. It would probably be best to arrange for a titration study, and let your doctor know that CPAP is limited out. I think it would be very interesting to see what higher pressure support or ASV could accomplish, and that is something we just can't do with the current equipment.
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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#30
RE: Advise a New Guy [on high pressure readings]
(09-25-2017, 10:08 AM)Sleeprider Wrote: Thanks.  That was clearly not the answer, although it showed that you reacted as expected with obstructive apnea to lower pressure.  That is kind of reassuring, in spite of the ugly graph.  How did things look at 16-20?  So far, it has appeared you do need higher pressures than CPAP provides, and a bilevel would need to be considered to provide pressure up to 25. It would probably be best to arrange for a titration study, and let your doctor know that CPAP is limited out.  I think it would be very interesting to see what higher pressure support or ASV could accomplish, and that is something we just can't do with the current equipment.

Sincerely appreciate the effort and advice.  I confirmed it was an ECHOcardiogram just over a month ago and sure it was OK (confirming that).  Here is an expanded view of the above chart (what you asked for?).  I had the feeling that depleted oxygen from the 8cm test lingered into the 16-20 cm APAP, which this was.  So had an overwhelming urge to breathe straight room air that was not manipulated when I hung it up for the night.  After I get the Oximeter I can check to be sure, but I have been using humidity on the treatments and believe that warms the air and subsequently gives the feeling of taking less oxygen in.

Will take the SD card with me when I go in for the Sleep Test in just over a week.

EXPANDED 16-20 APAP Chart
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