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Curious to get thoughts from the group
#1
Curious to get thoughts from the group
Hi All:

I have been using my Philips Respironics DreamStation Auto CPAP with Humidifier for about 1 year now.  Initially, I was set up on Auto, (min pressure 6.0, max pressure 14.0, 90% pressure 7.0) and using nasal pillows.  Things had been working well for several months, then I started developing problems with compliance.  For the last several months, I found myself ripping off the mask in my sleep on most nights after about 2-3 hours, and was winding up with an AHI of 2~3.

I went for a sleep study, where I was given nasal pillows at a constant pressure of 7.0.  I tolerated it for the entire night, and was told by my doctor that I had "better results" than what I was achieving at home, and he ordered a settings change to go from APAP to CPAP with 7.0 pressure.

I did my first night with the new settings last night.  While I kept the mask on all night (6 hours, which was amazing), I wound up with an AHI of 6.5, which was much higher than ever before.  This was comprised of 2 Clear Airway Apneas, 2 Obstructive Apneas, and 33 Hypopneas.  

While I'm thrilled that I didn't rip the mask off last night, this certainly wasn't what I had expected - any thoughts from the group here?
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#2
RE: Curious to get thoughts from the group
Welcome to the forum.  You will find the help you seek here, but you will need to help us too.  Data will help us, a copy of your sleep studies, and your daily SleepHead charts.  see "New to Apnea? Helpful tips to ensure success" in my signature, "Using SleepyHead".  You will have to add a space to the url (http:  http://www.xxxx.xxx) because we limit new users.

That said your pressure appears to be too low, close, but low.  Either raise to 8 in CPAP mode, or auto mode 7-10.  Your machine in auto mode works best with a fairly narrow range with the min value fairly close to the value that controls obstructive events.

Seeing your charts will let us view other factors and be much more accurate with our suggestions.  

Please keep your posts in this thread as it will show us history.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#3
RE: Curious to get thoughts from the group
your settings were 6 to 14 and 90% pressure was 7 on Auto APAP.  This means that the exhale pressure was 4 to 5.

when the doctor ordered the change to CPAP and 7, this meant your exhale pressure was raised from the 4-5, to new setting of 7.  at the same time, the inhale pressure remained about what it was, at 7.

it shouldn't surprise us that there are less OA at exhale pressure that is higher.

something you'll learn as time permits is that not all hypopnea are caused by obstructions.

another point is that your machine has a flex setting that is either off, or set at 1, 2, or 3.  this setting will change the level of comfort in your breathing and can really affect how well you can tolerate the machine and for how long.

read up on flex, at thread ->  http://www.apneaboard.com/forums/Thread-...#pid206250

once we see some of your recent data, we may be able to sort out some of the issues, or at least put a name on them.

meanwhile, having a good night sleep at AHI of 6.5 is probably better than 3 hours at 2.0. not to worry.  switching the settings can sometimes lead to brain body reactions that can temporarily increase (sometimes erratically) the AHI score.

QAL
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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#4
RE: Curious to get thoughts from the group
Hi CardiacCrusher,
WELCOME! to the forum.!
Hang in there for more responses to your post and good luck to you with CPAP therapy.
trish6hundred
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#5
RE: Curious to get thoughts from the group
Need to get to 4 posts before I can post my data Smile
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#6
RE: Curious to get thoughts from the group
Thanks for the help, all!  I have a lot of work to do.  Will get the sleep study results and post them here.

In the meantime, here's my data from last night.  I'm going to bump the pressure to 8 and see what happens tonight.

h ttp://imgur.com/79ypcic
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#7
RE: Curious to get thoughts from the group
Were you placed on a fixed pressure for a reason? The hypopneas would indicate too low of a pressure. Bumping it up to 8cm will allow you to see if it will help. At the same time it should be a tolerable increase.
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#8
RE: Curious to get thoughts from the group
My doctor ordered the change from auto to continuous based on my titration study in the lab (he said that I did better on CPAP than APAP, and the fact that I didn't rip the mask off at night).
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#9
RE: Curious to get thoughts from the group
OK, I'd still recommend that you up your pressure from the 7cm to 8cm. You may need a few days to see if is helping. If you don't, try sleeping on your side. When your airway relaxes during sleep. gravity is not your friend.
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#10
RE: Curious to get thoughts from the group
(06-06-2017, 05:15 PM)quiescence at last Wrote: your settings were 6 to 14 and 90% pressure was 7 on Auto APAP.  This means that the exhale pressure was 4 to 5.  

I do not understand how it was figured that his exhale pressure was 4-5. I have seen no mention of any flex settings

(06-06-2017, 05:15 PM)quiescence at last Wrote: when the doctor ordered the change to CPAP and 7, this meant your exhale pressure was raised from the 4-5, to new setting of 7.  at the same time, the inhale pressure remained about what it was, at 7.

When your 90% was 7, it does not mean that 90% of the time you were at 7. It means that 90% of the time you were **at or below 7**. it could mean that 89% of the time you were at 6 and 1% of the time you were at 7. That would make your 90% pressure 7.

(06-06-2017, 05:15 PM)quiescence at last Wrote: it shouldn't surprise us that there are less OA at exhale pressure that is higher.

something you'll learn as time permits is that not all hypopnea are caused by obstructions.

another point is that your machine has a flex setting that is either off, or set at 1, 2, or 3.  this setting will change the level of comfort in your breathing and can really affect how well you can tolerate the machine and for how long.

read up on flex, at thread ->  http://www.apneaboard.com/forums/Thread-...#pid206250

once we see some of your recent data, we may be able to sort out some of the issues, or at least put a name on them.

meanwhile, having a good night sleep at AHI of 6.5 is probably better than 3 hours at 2.0. not to worry.  switching the settings can sometimes lead to brain body reactions that can temporarily increase (sometimes erratically) the AHI score.

QAL

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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