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[CPAP] New and need some help lowering AHI
#81
I like your results and where you are going with this. Keep up the good work.
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#82
(12-09-2016, 08:52 PM)richb Wrote: I like your results and where you are going with this. Keep up the good work.

Thanks a lot, Rich! Going with 6.8 cm tonight. 82F hose and humidifier 2. I'm extremely curious about that mask liner that SR mentioned.

~Casey
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#83
Last night...

Pulse Oximeter dies so there isn't much in the way of data for that, but it was a fairly decent night. The water in the mask was almost non-existent which was nice and leak rate was near perfect. AHI was 2.86 still with a great majority CAs. Thinking of going down another 0.2CM tonight as I slowly fine tune the correct pressure for me. Screenshots below.

Settings:
CPAP 6.8CM
EPR Off
Humidity 2
Hose Temp 82

Whole Night - http://imgur.com/w57Wtfn
5 min - http://imgur.com/EWeeZ6L
5 min - http://imgur.com/RIp9fSz
5 min - http://imgur.com/cSgdemt

~Casey
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#84
Update: Data from 12/10 and 12/11 below.

So as I begin to eliminate the CA events (only 8 last night which is amazing) I'm seeing lots more RERA events pop up. I'm now looking for some advice regarding those as I feel like I have a pretty good grip on my CA's. Last night's AHI was 1.36 which I feel great about.

My current settings are CPAP 6CM, EPR Off, Tube Temp 74, Humidity 3, Ambient Room Temp 60. I was finally able to find settings / room temp that eliminated the condensation in the mask. 5 degree room temp increase made a big difference.

It's my understanding that RERA events are an equal problem to hypopneas as far as how you'll feel the next morning. It's also my understanding that they don't count towards AHI making it very hard to get treatment approval from insurance for them. I noticed that as I go lower on my CPAP setting that RERAs are more more and more present. This is essentially what Rich said would happen except I'm getting RERAs and not Hypopneas, but again if what I'm reading is correct a RERA is a every so slightly less intense version of a hypopnea.

What do y'all think? Charts below.

12/10:
Whole Night - http://imgur.com/xdbrAPX
15 min point of interest - http://imgur.com/G6xJnj0

12/11:
Whole Night - http://imgur.com/9Djtn1X
10 min point of interest - http://imgur.com/uZrYVoL

~Casey
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#85
You have a couple options. I think you've reached your limit in reducing pressure as shown by an increasing obstructive component (RERA). If you feel good you can hold where you are. You could re-introduce another 1/2 cm additional pressure. You could also try a little EPR and see what happens. As you know, this is trial and error, and your instincts have been pretty good so far. There is no 'right way' to do this.
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#86
Hi Casey. It looks like you have gone about as far as you can go with your present machine. Your 10 and 15 minute screenshots show lots of periodic breathing (central in nature) that can interrupt your sleep. Highlight some more of those RERA events to see what the flow pattern looks like. I bet you have Hypopnea like events throughout the night with only some of them being scored. If this is the case you are going to need to build a case for an ASV machine.

Rich
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#87
Getting an insurance funded ASV with a treated AHI of 2.0 is going to be a tall order, and I still haven't heard his doctor buys into the whole complex apnea thing. On top of that, Casey has built a strong case that his health and even oxygenation are good with CPAP. His next doctor's appointment is going to have a predictable outcome where it can only be concluded he is both compliant and doing well on CPAP, and is recommended to continue. This is only possible because he is motivated and has become knowledgeable in optimizing his treatment with what he has. I actually look forward to him becoming an Advisory member himself shortly. The part of the conversation where Casey tells his doctor he is using a CPAP pressure of 6, and this is needed to prevent prolific central apnea will be interesting. Maybe his doctor can scold him and reset his pressure back to 16. Oh-jeez

Unless he is self-financing ASV or his good results turn around for some reason, this is it. You've arrived, and may continue making small changes, but you have graduated. You now know what you're doing and why you're doing it. With regard to your doctor, I think it would be beneficial if he finally acknowledged for the record you have complex apnea in case this issue has to be revisited in the future. It will save a lot of time if the problem re-emerges and CPAP is no longer a viable solution.
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#88
SR/Rich,

I'm honestly considering going back up to 7.0CM as a sweet spot. When I compare my breathing patterns in the 6.6CM from the 10th and the 6.0CM from the 11th back to my initial positive results of 7.0CM on the 7th and 8th, I feel like I was in better shape with over all RDI vs AHI. I had very low obstructive events if any, barely any hypopnea events and low RERA while the CAs remained at 10-20. These results definitely make me feel like 6.0CM is a little too low so I will likely go up a little bit.

As for my doctor I have two more nights of sleep before I see my doctor. I'll see him on the 14th and will need to be ready to build a case to move forward. While I'm glad I'm able to get to the results I've achieved thus far I'm still shooting for 0.00...

Rich as you suspected there are many unregistered hypopneas at this low setting, but I don't see nearly as many of them back up at 7.0CM. I definitely feel like I've really honed in on the best possible settings for me with regard to my current machine.

I'm thinking my plan right now is going to be to go back to 7.0CM, but turn EPR on 1 as I haven't tried 7.0CM w/EPR yet. Last time I had EPR I was 7-8 APAP. I think I'll try that for tonight and tomorrow night prior to seeing my doctor. **Ideas?**

I'm wicked nervous about seeing the doctor. They just told me that I'll be seeing my doctor's trusted physician's assistant.... I let them know that I'm adamant about seeing someone competent in Complex Central Sleep Apnea and that the person I see needs to have authority and have reviewed my data prior to my visit. They assured me I'll have all that and more so we'll see.

~Casey
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#89
I agree with your plan to move up pressure and try some EPR...as always, good idea.

Sometimes a PA can be very approachable, and will take more interest in you than the doctor. I used to prefer seeing a PA at one point. You might start with a question, rather than trying to explain. For example, "How would I recognize complex apnea?" If he balks at that, give him some history on your situation, but persist with the original question, because it's pointless if he is clueless. Hopefully you will have a productive conversation. There is nothing to be anxious about. If they are not helpful, you need to find a different practice to work with, and you have a perfect excuse; in spite of your serious concerns they shuffled you off to the PA.
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#90
(12-12-2016, 03:02 PM)Sleeprider Wrote: I agree with your plan to move up pressure and try some EPR...as always, good idea.

Sometimes a PA can be very approachable, and will take more interest in you than the doctor. I used to prefer seeing a PA at one point. You might start with a question, rather than trying to explain. For example, "How would I recognize complex apnea?" If he balks at that, give him some history on your situation, but persist with the original question, because it's pointless if he is clueless. Hopefully you will have a productive conversation. There is nothing to be anxious about. If they are not helpful, you need to find a different practice to work with, and you have a perfect excuse; in spite of your serious concerns they shuffled you off to the PA.

SR,

Yeah that's a really good point. I'm going to write out my thoughts on a work document and make sure that they make sense and I'll bring them with me for notes as talking points. Once I have those notes, I'll post them and see what you guys think.

As far as me becoming an advisory member, I think I'd like that. I genuinely do feel like I have a very strong understanding of this condition at this point and how different it can be from one patient to the next. If there becomes a time when I transition to that I would probably just need some assistance on how to go about searching topics to help others and what not.

~Casey
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