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Anyone on a fixed 20cms CPAP?
#1
Anyone on a fixed 20cms CPAP?
My sleep docs just suggested it was my next option.

Your thoughts?
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#2
RE: Anyone on a fixed 20cms CPAP?
Well we can agree with you, or look at some history. Le't see what led to this. Post up a chart and maybe we can figure out why high pressure is your current best or worst choice.
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#3
RE: Anyone on a fixed 20cms CPAP?
Female, 5'8, 190lb (BMI just under 30)  No problem with sinus restrictions, adenoids or tonsils.  No allergies.

Was diagnosed with OSA in 2009, titrated at 13cms.

Later sleep study titrated at 15cms.  Asked for an APAP and was told no, so I took a vacation from CPAP for 5 years.

Just came back to it this year, having recognized that I was having morning headaches and daytime sleepiness.  My PCP ordered me an APAP.  

I was using sleepyhead to look at my pressures.  Machine was maxing out at 20cms most nights, so I asked for a sleep study.  PCP ordered a retitration CPAP/BiPAP. 
   
One night the machine (ResMed 10 autoset) hit 20cm on a night when I had asked for 15-18cms, and then stopped recording data, even though it continued to run for the rest of the night.

I returned the machine to the DME, and got a replacement.

Sleep study titrated at 16cms, with the note that they did not see any supine REM.

I saw the Sleep clinic for a follow up appointment.  I had been using a setting of 17-20cms, EPR 3.  I said that I felt like I wanted to go above 20cms.  I was told to go to straight 20cms.  I asked about Bilevel, and she said I would need more tests.

I am expecting to see my sleep test results this week - they are mailing them to me, but when I look at the titration guidelines, I think that they should have switched me to Bilevel at 15cms of pressure.

   

This is a recent night.

Does anyone else use a fixed 20cms CPAP?
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#4
RE: Anyone on a fixed 20cms CPAP?
Many years ago I started with an Rx of 19 fixed on a CPAP Brick,  they could only get it up to 17 but "it was good enough" or so they said.  2 Years ago with my self purchased APAP I was hitting 20 and frequently exceeding 15 and after a failed titration on BiPap I got an Rx for a BiLevel .  My pressures were not as bad as yours.

Your recent chart shows persistent Flow Limitations.  The fact that they diminished from without EPR shows that increased PS is an effective tool for you to treat them with.  Increasing Pressure support beyond the 3 (EPR) that you are using should help you.  Looking at the flow detail may show frequent RERAs, which by definition end with arousal.  Since Higher PS is used to treat these (Flow Limits and RERAs) you have a physical reason for getting a BiLevel (ResMed AirCurve 10 VAuto recommended).  I assume these are disrupting your sleep, another argument/symptom.

You are not having that Flow Limit Flag that says to look here, but the chart below shows you what to look for.
Optimizing_therapy#RERA
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
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Dealing with a DME
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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: Anyone on a fixed 20cms CPAP?
Thanks.

I was not sure if I should be pushing back or submitting unwillingly.
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#6
RE: Anyone on a fixed 20cms CPAP?
A possible question for your doctor,

"then why do these decrease when the difference between my EPAP and IPAP goes up? "
a follow up

"How can I get a greater difference on my APAP?"

And don't forget

"I'm going to be using this machine for the next 5+ years, I want one that will not require me to get another new machine if this doesn't work." (it's not working now at 20 it won't work later at 20)
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: Anyone on a fixed 20cms CPAP?
I'm in agreement with Fred. You actually have two things going on. Your flow limitations are absolutely prodigious, and you have all the signs of positional apnea that can be resolved with a soft cervical collar rather than increased pressure. Let's start with your high pressure.

Your very high pressure and high AHI will qualify you for insured coverage to get a Resmed Aircurve 10 Vauto bilevel machine. You should simply ask for it. While I think we can resolve your AHI with lower pressure, the Aircurve 10 will let us more directly treat flow limitations and hypopnea, which is the root cause of all that RERA.

You need a soft cervical collar! All of this apnea is caused by a chin-tucking habit that can be easily fixed. Please read the positional apnea sections of the Wikis in Flow Limitation http://www.apneaboard.com/wiki/index.php...Limitation and Optimizing Therapy http://www.apneaboard.com/wiki/index.php...onal_Apnea

You are going to see that you are not alone and we have helped many people achieve excellent results at lower pressure by using a soft cervical collar.
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#8
RE: Anyone on a fixed 20cms CPAP?
I hated the cervical collar - it made me too hot.  I already struggle with heat intolerance, and having padding round my neck was just miserable.  Is there anyway to achieve the same thing without having to wear a scarf?


I did ask for a bilevel.  I'm going to need to ask again and repeatedly.  She did suggest a dental device too.
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#9
RE: Anyone on a fixed 20cms CPAP?
Look at the wedges like the Dr. Dakota Anti Snoring Stop. It maintains chin position without the "scarf".

The bilevel under insurance is contingent on pressure and comfort. You clearly use the entire capacity of your CPAP, so I have no idea why you would not qualify for bilevel. The unstated recommendation is to turn on EPR, Full time at 3. This is in your Comfort Settings, and will give you up to 3-cm of real pressure support (20/17) at maximum pressure. You will find it more comfortable, it will treat flow limitations, but I think in your case, the wedge is needed.
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#10
RE: Anyone on a fixed 20cms CPAP?
i'll try a wedge.  

Thank you
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