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[Diagnosis] Sometimes extremly high AHI withe new CPAP
#11
RE: Sometimes extremly high AHI withe new CPAP
force yourself to try the soft cervical collar for a week or two. I don't much like it either but it's a necessity for me to reduce clusters of positional events and mouth / lip leaks. then you'll know whether it helps or not. it it does, you'll be able to make an informed decision about the trade-off between a little discomfort (we can adapt to a lot) and a bunch of clustered events.
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#12
RE: Sometimes extremly high AHI withe new CPAP
Hey here we go again, 
unfortunately I made two mistakes which might have destroyed the result.  First the max pressure value, I had set it to 17 before I saw your replies and for some reason forgot to change it to 20 (It is 20 now), second one I did not open my braid which probably forced my head to the side idependently of my body position.

Sorry for mistakes , I was quite tired last night.


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#13
RE: Sometimes extremly high AHI withe new CPAP
In spite of any errors, this is progress and shows some benefits of what you did. The persistent flow limitation at times where apnea was quiet shows you are a candidate for bilevel therapy which would offer both higher pressure and pressure support that should reduce that problem.
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#14
RE: Sometimes extremly high AHI withe new CPAP
Thanks. So what is the program for tonight. And any tips how to push my doctor in the right direction?

I have my first appointment with him end of next week. The guys from the sleep clinic seemed pretty clueless and uncooperative.
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#15
RE: Sometimes extremly high AHI withe new CPAP
The best approach is going to be to go ahead and set the maximum pressure to 20. That is the most your machine will produce, and the only device capable of higher maximum pressure is the bilevel.  In your case, pressure support (the difference between IPAP and EPAP) is what is needed to relieve the flow limitation.  OA was substantially relieved when pressure rose near 17/14 last night, but flow limitation remained. Pressure does apparently work for you.  With bilevel, you could increase the pressure support and probably see very excellent results in the range of 20/15 - 23/18 (PS 5.0), and the pressure support would be both therapeutic and comfortable.

There are many resources that might convince your doctors of the benefits of bilevel therapy. The simplest approach is to point to the standard recommended titration protocols normally used to set the optimum pressure for a patient. Here is a copy of the Resmed titration guide https://www.resmed.com/us/dam/documents/...er_eng.pdf,

This document should be available in German if you search.  The therapy intentions for the Resmed Aircurve 10 Vauto are described on page 24. They describe you well.  The titration protocol is on page 26.  Where the patient is experiencing obstructive apnea like you, the recommendation is to increase EPAP pressure.  If there is hypopnea or snoring, increase IPAP. When IPAP is increased this is the same as increasing PS on the Vauto.  We can see that on your last posted chart, you have obstructive apnea, so you need higher EPAP pressure. You also have hypopnea, so you need more IPAP (PS).  Your CPAP machine has nearly reached the limits of its capability.  If these events continue after you increase the maximum pressure to 20 cm, then the only logical progression is to prescribe bilevel.

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#16
RE: Sometimes extremly high AHI withe new CPAP
That first cluster still looks positional and would benefit from a collar, but I'm going to suggest not using the collar until after you see your doctor.

Let's raise your min pressure to 14, and I'm anticipating going higher, with 15 likely the next night. Looking to try and defeat the flow limitations with pressure, rather than pressure support which you cannot get any more out of your machine than you are already getting, also 15 is a pressure where titration protocol says to consider a BiLevel such as the VAuto.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#17
RE: Sometimes extremly high AHI withe new CPAP
Hey here we go again, this time without braid.
Looks a lot better to me, thank you all. 
Good news is I got an earlier appointment with my Sleep Doctor (in a few minutes) wish me luck.


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#18
RE: Sometimes extremly high AHI withe new CPAP
Ok, the doc was Not very happy with the fact that I changed settings myself. Anyway he wants to try our Settings for 3 weeks, with the minimal change that max will be set to 19.

He doesn’t seem to see a Bipap in my future, at least not as long as my values stay below 10 with actual settings.

What do you think?
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#19
RE: Sometimes extremly high AHI withe new CPAP
Hey all, today was the second apointment at the Sleep Doctor.

End of Next Week they will try to set me up with BiPAP. Finally. He came up with the same values as you Sleeprider.

Thank you all for your help. If you want I can keep you updated.
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