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Chart Envy
#1
Chart Envy
Hello all,

was diagnosed just over a month ago at 49 AHI and started CPAP then 

I have a Dreamstation set at 10-16 with a ramp from 9.

I travel a lot and across major timezones, I'm 4 days back from a 12 hr timezone difference and as you can see from the charts struggling to get down.

While I was away two weeks ago I seemed to be able to get down to below 10 but seem to be hovering around 30 now as I get back into this timezone - this seems to have a massive impact on my apnea.

My sleep doc is suggesting I up the max to 18 and min to 11 and is trying to find a spot to stabilize and set onto manual. She was adamant that leakage is a major concern, I tried a nasal pillow last night for the first time but when it ramped up it just felt like it was blowing straight out the nose vent - it woke me.... is this normal ? second part of last night was on the Pico mask.

I got another new nose mask yesterday which I used for the 2nd half of the night and it seems less susceptible to leaks through movement. I have a chin strap and seem to be controlling mouth breathing now but would appreciate thoughts. I have a Philips Pico nose mask and Dreamwear Nasal Pillow currently.

It feels like anything above 14 just blows straight out of the mask and wakens me - want to get this down but struggling with advice just now as for me looking at this from a trends perspective I've been down below 10 and when I was it seemed 13-14 would be the correct setting but maybe there were too many leaks then ? When it wakens me it just seems to be blowing straight out of the vent or from flexible connection in the nose mask.

Thoughts on the graphs please, I really want to crack this and feel much better overall but want to get it down and under control. I wont be traveling for 2 months so have time to try things but not sure what - I'm probably 2-3 nights from being properly back in timezone now

Thanks in advance

Rob
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#2
RE: Chart Envy
I think you need a new Doctor. Raising your pressure isn't going to fix your problem. You look like you have complex apnea.
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#3
RE: Chart Envy
To some doctors, all apnea requires more pressure, but you have complex apnea with both obstructive and central events. What you probably need is ASV. Your charts go back a month and demonstrate a pretty convincing case. You will have inconsistent results, but if you want to really reduce this AHI including centrals, I recommend you go straight pressure at 8.0 to 9.0 cm with no Flex. Straight pressure is most likely to give you the best results. I think you ultimately need to discuss the complex apnea issues with your doctor or one with expertise that recognizes this pattern. I'll be honest that being in Canada does not help you. Doctors seem very reluctant to diagnose and treat complex and central apnea.
Sleeprider
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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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#4
RE: Chart Envy
I don't know how to read charts but the comments above sound legit to me. My only recommendation is you try the Airfit P10 mask. I've tried 6 or 7 different masks and this one is the best for me. The vent on this mask is diffused so the air doesn't shoot out from it the same way many masks do.
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#5
RE: Chart Envy
Walla Walla / Sleeprider - many thanks for the responses, would appreciate a little more info if you don't mind.

The last trend from the 22nd showed no CA and I was hoping that this would return once I got fully into timezone so I wondered if this was possible all the time once I got it 'dialed in' so to speak.

Is the seriousness of sleep apnea jet lag related, i.e. can it change considerably ? This really is my main question as f so I can't see why
i.e. - will it likely settle back to where it was last month (these graphs) or is this just wishful thinking ?
How does my leaks look in recent nights ? (first graphs)
Should I be reading the total leaks or the leak rate ?
Are the charts below valid - is the leak rate too much etc ?
Is the air whooshing normal for higher pressures out of the vent ?

Here are a couple more graphs from when it was below 10, I was thinking of trying it around 12 or 13 seemed to take care of the apneas at the previous best trends

Does setting it too high have any adverse effects ? IE can this make things worse ?

Sorry for the quick follow ups but am worried and conflicted and would just like to understand more before I do any setting changes - worried about what Central means as the way it was described to me this was typically brain stem injuries so kind of crapping myself at the thought.

Overall I'm really happy I finally did something about this and am telling myself I'm on the road to success but every other chart I've seen from everyone else looks so stable and low that it just scares me - I'm not the best at dealing with health related stuff and honestly tend to bury my head....as I had done with this for a few years

Mr Zennie - many thanks will look into that mask

Thanks again in advance

Rob
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#6
RE: Chart Envy
In large part, my suggestions for fixed, lower pressure was based on the Overview charts, where from June 14 to 23 you had a lower event rate that corresponded to a pressure somewhere around 9, with relatively little increase. I think high pressures make your apnea worse and may even cause a higher event rate. You wouldn't be the first person I encountered with this phenomenon. A closer view of your flow rate line might tell us more, but I'm pretty certain you are one of those individuals that needs a lower fixed pressure. To be honest, I only see five or six days with an AHI that is even remotely acceptable, and even your best results to date does not convince me you are on the right therapy. I bet you never had a titration study, right?
Sleeprider
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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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#7
Sad 
RE: Chart Envy
Sleep rider / Walla Walla,

Well that felt like the best night's sleep for a while but the numbers say otherwise  Thinking-about The dreamwear nasal pillow was so much more comfortable at this lower pressure and leak rate seems much better so I woke less with it so thats something at least but this pressure didn't work (last night at least) as worst numbers yet

I was thinking try to bump it to fixed at 11 tonight and see if it brings it down or should I bump it 1 at a time ?

Others - help on my other questions appreciated too please

Rob
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#8
RE: Chart Envy
You my friend are in need of an adaptive servo ventilator (ASV) very very soon. Have you discussed these results with your doctor yet? I have seen many cases of "Treatment Emergent Central Apnea" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721000/ , but you have one of the highest rates of apnea I have ever seen with CPAP. If your untreated AHI is lower than the 68 you are currently showing, I think you might be advised to stop therapy until ASV can be approved. Please contact your doctor sooner than later, and if possible send these images so he understands the problem. Based on all the charts above, your best results occur with lower pressure, and events significantly increase at pressures above 9.0. As counter-intuitive as it may seem, I think the temporary solution pending ASV is to LOWER pressure, not raise it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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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#9
RE: Chart Envy
Unfortunately I agree with Sleeprider concerning your mode of therapy. This route of therapy is not working and there are machines that will help you. I think you should start contacting your doctor and begin discussions about changing approach.

The machine you are using has no effect on your therapeutic outcome and with changes in pressure settings there is no pattern that indicates that plain ole CPAP therapy is going to work.

You need an advanced bilevel CPAP machine that provides a backup rate. The ASV (adaptive servo ventilator) is your best option at getting results. The ASV is intended to treat exactly the symptoms you suffer.
Jesse


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#10
RE: Chart Envy
Really appreciate views and advice I've got so far, and I take experience over qualification every time. I have left a request with my sleep doc for a cancellation, not sure what to do in the meantime because

- sleep technician suggest upping max to 17 on variable but it just blows the mask off and wakes me up
- you guys suggest lower than 9 but don't want to make it worse again - last night being worse than untreated really scared me though, didn't realize I could make things worse through treatment 
- my less than trained eye thinks that 11-12 seemed to get the lowest AHI numbers


I fully understand I have got the wrong machine and need an ASV, will progress that soonest, left a message with sleep doc and worse case have an appointment next Friday - think I'll try each suggestion for a few days and see what works best ?

Appreciate others views too please - was just responding to those who took the time to help and would really appreciate other thoughts too - ideas on strategy for next 8 nights is really what matters most right now

Rob
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