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[Diagnosis] New to APAP DreamStation recommended settings
#1
Hi, this is my 1st post. I'm from Spain, so my english could be a little "buggy"
I've diagnosed with a severe Apnea. AHI: 84,6 !!!. I want to share my experience with you, and get some hints to get started with my new APAP DreamStation machine.


Sleep study at home using a RESMED sleepstudy machine. Results:

Duration: 7h 54min
Age:46 Weight: 251 lbs Height: 5,74 feet
SPO2 desaturation index: 75,3
Lowest desaturation: 63
Average O2 saturation: 89, min:64
Pulse rate min:40, max:121, average: 84
AHI: 84,6
OA: 51,6
CA:8,1
Hypo: 8,6
Mixed: 6,3
CSR: 0

I began with a fiexed CPAP machine with a fullface mask, at pressure 8 with ramp. Prescribed by MD via Insurance.
I've used it very few days, because at 8 pressure I still snore, and when the pressure reached 8 I felt uncomfortable and woke up.
Also had difficulties to exhale, at these low pressures, this machine have no  *Flex features.

Now I've purchased a DreamStation APAP machine with Humidificator.


I've started at 
MIN PRESSURE: 4
MAX PRESSURE: 12
Aflex: 3

Nasal mask: Respironics Comfort Classic

Here are the graph of SH, I would appreciate if you offer me advice to adjust the pressure and other parameters, because I guess it's low due to flattened waveform of pressure.

Attached my sleepyhead graph, this is my 1st post, and cannot attach images until I reach 4 posts.


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#2
Both your diagnostic test and Sleepyhead results using CPAP show some mixed or complex apnea with both obstructive and central events. This is going to make it more difficult to find an ideal therapy pressure due to your need for higher pressure to resolve obstructive apnea, and the fact you have more treatment emergent central apnea and hypopnea when higher pressures are reached. Your current settings are 4.0 minimum and 14.0 maximum, and it appears you are using AFlex at 1 (unsure about flex setting).

I think your minimum pressure is ineffective and recommend you move it up to 8.0. If that pressure is too high to tolerate, then use the smart ramp feature to gradually increase pressure to the minimum therapy pressure of 8.0. Due to higher central apnea at higher pressures, I would suggest you reduce maximum pressure to 12.0.

You may want to consider using a soft cervical collar to prevent obstruction that results from tucking your chin toward your chest as you sleep. Keeping the airway unobstructed by using this aid can make lower pressures more effective. There are some other tricks we can try if your AHI remains high, but this is still early in your therapy, so the first step is to narrow the therapy range, and deal with any positional apnea issues, then we can try to address what is left-over.

Good luck and welcome to the Apnea Board.
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#3
Thanks for your feedback, I’m starting to lose weight, maybe weightloss and positional changes will reduce my complexity?
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#4
Could you recommend a cervical collar? I’m not sure about  which type to choose.
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#5
(07-12-2018, 09:33 AM)dgranero Wrote: Could you recommend a cervical collar? I’m not sure about  which type to choose.

Hi dgranero, I'm Spaniard and newbie in the forum like you, mate. 

I might help you with the cervical collars. The recommended options are these: Caldera Releaf, Dr Dakota and The Eliminator, but these are only available in Amazon US. The only one that admits shipping into Spain is The Eliminator; I placed order a few days ago and expect to receive it over the 20th of July.

In the meantime, I'm using a nice one that you can buy from Amazon Spain. It's very comfortable and does the trick of avoiding your chin to fall down to your chest and keeps the mouth reasonably shut. Search "Collarín cervical blando Emo color gris" (sorry, I think it is not allowed to insert commercial links in the forum).

The size I selected is Large (48 centimeters). Price is 8.14 EUR + 3.99 shipping costs. Vendor is Farmacias Trebol. I received it at home in a few days.

Hope this helps.

Mucha suerte,

Rumble.
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#6
Bien hecho, gracias Rumble.
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#7
Thanks Rumble, I'll try this collar.
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#8
After following your suggestions, I've set pressure to 8min, 12max, and turned Aflex from 3 to 1.

I've not noticed barelly any change in my exhalation relief after changing aflex from 3 to 1 (good). What changes increasing or decreasing AFLEX? (DreamStation).

Also tried to sleep in my side, avoiding supine.

Today my AHI is 8.12 , and I've noticed that position is very important.
I'm recording my sleep with a Camera with motion detection, Is very helpfull to record when I woke up, potty times, and of course sleep position.
I create bookmarks and notes on SleepyHead, and taked some conclusions that confirms your suggestions:

- When I change to supine as showed in SH graph  I begin to snore, and also increases Apnea events Overall, exact time matches recorded video.
- Sleeping on my side significally lowers these numbers.
 
Maybe could be so obvious for you, but Another metric I noticed is Potty frequency, before using CPAP, with AHI of 84, I woke up every 3 hours (exactly), to go to potty.
Now with APAP still in adaptation with AHI 28 - 8, only one time. I guess that you, more experienced CPAP users could confirm it.
I guess that potty freq could be directly related to treatment effectiveness.





Also I bought an Oximeter, CMS50i, I hope that its internal clock be accurate.

thanks for your help


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#9
Another question is, top flat Pressure waveform could indicate that a max pressure is needed?
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#10
Yes you are maxing out your upper pressure of 12 the machine wants to go higher maybe raise the maximum so it has more upper range
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