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Events way too high!
#1
My wife has been on biPAP for almost a year. She had the sleep study and they finally got her a machine after about 6 months! Overnight, she went from sleeping 20 hours a day to getting a good night's rest in 8 hours and actually staying awake all day!! Overnight!

So everything was going great and all of a sudden about 3 months ago, her events per hour went up to 30-45 for no apparent reason. I just read a thread here that someone was freaking out over a high of 9! I mentioned it to her doctor and she finally set up a second sleep study. Great! Finally someone is doing something about it!

So she did the second sleep study around 2 months after the problem started. She said that she slept well, but the pressure seemed a lot higher than what she has at home. So I'm thinking that I/we/they need to increase her pressure. That was a week ago and we haven't heard one word about what to do about it!

That's what led me here. I Googled something about increasing her pressure.
Her IPAP was 14 and EPAP was 10. Her events (AHI?) was 52.
I increased it to 15/10. AHI of 56.
I increased it to 16/11. AHI of 59.
I put it back to 14/10 last night. AHI of 8!

I almost feel like I'm doing something illegal by changing it myself, but nobody else seems to care enough! And what I thought would help actually made it worse.

Any ideas? What should I do? Huh

Oh...my next step is to get this SleepyHead thing and see what I can do with it. I am currently using the "myAir" website from ResMed.
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#2
Pressure is not the solution to all AHI problems. We need to know the kind of apnea that is ocurring (obstructive OA, clear or central CA or hypopnea H). We can get those answers from a free program called SleepyHead. Please download from that link and install it. You can then take the SD card from the front, left side of her machine and upload the data into Sleepyhead. I think a lot of our answers will be there.

To learn how to organize the data charts for the best help, read https://sleep.tnet.com/resources/sleepyhead/shorganize
To learn how to post the data charst on the forum read: https://sleep.tnet.com/reference/tips/imgur

You will need 4-posts to link to images, so feel free to reply. My guess without seeing any data is that the big increase in events are central. You should back the pressures to the original prescription right away, but subtract one cm from pressure support. So, try 13/10. As you can see from your experiments, more pressure is frequently not the answer, but I'm sure we can sort it out. Also, is this an Aircurve 10 Auto, or S (fixed pressure) model? The prescription suggests this is an S.
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#3
(10-24-2016, 11:06 AM)sfrasher Wrote: So everything was going great and all of a sudden about 3 months ago, her events per hour went up to 30-45 for no apparent reason.
...
So she did the second sleep study around 2 months after the problem started. She said that she slept well, but the pressure seemed a lot higher than what she has at home. So I'm thinking that I/we/they need to increase her pressure. That was a week ago and we haven't heard one word about what to do about it!

That's what led me here. I Googled something about increasing her pressure.
Her IPAP was 14 and EPAP was 10. Her events (AHI?) as 52.
I increased it to 15/10. AHI of 56.
I increased it to 16/11. AHI of 59.
I put it back to 14/10 last night. AHI of 8!
Without knowing what the breakdown of the AHI into its component parts (CAI, OAI, HI) we're flying blind in trying to help you.

Unfortunately since you are pulling the data off the MyAir web site, that breakdown into component parts is most likely not available. So get SleepyHead downloaded and start looking at all the detailed data that's available. Let us know what her CAI and OAI and HAI are on the nights where they were super high.


Quote:I almost feel like I'm doing something illegal by changing it myself, but nobody else seems to care enough! And what I thought would help actually made it worse.
You're not doing anything illegal. But if you don't know the break down of the AHI into the OAI, CAI, and HI, the "obvious" change to make can be counterproductive.

Quote:Any ideas? What should I do? Huh
Download SleepyHead and look at the detailed data. Tell us what your wife's CAI, OAI, and HI is. Then we may be able to help you help your wife.

Questions about SleepyHead?
See my Guide to SleepyHead
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#4
I would highly recommend that you install SleepyHead and post its data. An AHI doesn't help without the type of apneas or hypopneas and duration times that make up its value. This is a wild guess based on the AHI increase with a pressure change, it sounds like she may be having CA's.
______________________
Useful Links -or- When All Else Fails:
Posting SleepyHead Charts in 5 Easy Steps
Robysue's Beginner's Guide to Sleepyhead
Apnea Helpful Tips
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#5
Try to get copies of those sleep studies. They should give them to you.
It would be interesting to see what type of apnea they listed as "impressions."

I find it a good practice to get copies of all medical tests; and keep them.
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#6
Wow! I didn't expect any answers so soon!

I got SleepyHead and I'm trying to sort it out! That's a lot of info!

I did back her down to her original settings (14/10) last night and she came back down to what we consider awesome (AHI of 8). She doesn't feel as sleepy this morning. She tends to be high, then low, then high, then low, etc.

The day before I made the first change, her AHI was 14.47.
Obstructive Index (OAI?) was 10.23
Clear Airway Index (CAI?) was 0.00
Hypopnea Index (HI?) 4.23

The first day that I made a change, her AHI was 52.69.
OAI = 43.81
CAI = 0.00
HI = 8.64

So it looks like OAI is the big hitter.

The ResMed AirCurve 10 is an "S" model. I will fix my profile now.

And this makes 3 posts! Cool
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#7
I am going to decrease her to 13 for tonight and see what happens.
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#8
Here is the chart from 2 days before I made any change. 14/10.
http://imgur.com/a/X8VKw

Here is the chart from the day I changed it to 15/10.
http://imgur.com/a/5dtie

Edited: If you have already looked, the original screenshot said that she only slept for 2:50, which is not right! So I changed the first line to a day earlier. The results are still pretty close to the same.
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#9
(10-24-2016, 12:55 PM)sfrasher Wrote: I am going to decrease her to 13 for tonight and see what happens.

My assumption was that the newly increased apnea would be CAI. Since the machine is reporting OAI, that is interesting, and an EPAP pressure reduction would not normally be the correct response. It's curious that her response to pressure increases and decreases are the opposite of what I'd expect for OA. Normally obstructive events respond to increased pressure. Exactly the opposite happened, and when you brought her back to the original prescription, the OA was reduced.

This is a bit counter-intuitive, but I'm going to stick with that suggestion to reduce pressure support, but I'd like to reduce IPAP to 13 and leave EPAP at 10 to see where that takes us. The rationale for my suggestion (and it is a suggestion, not based on complete information), is that lower pressures seem to be correlated with reduced AHI, and I think the pressure support (difference between IPAP and EPAP) may be contributing; and it is possible the machine is incorrectly reporting CAI as OAI. It's a stretch, but we're at least keeping the original prescription EPAP, while only reducing IPAP by 1-cm.

We still could benefit from seeing the data once you are able. Also, you should continue to press your doctor for a copy of the titration results, even if he does not currently have time for an appointment. You can certainly make any changes recommended by the doctor, then follow up at an appointment on the efficacy.
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#10
In S mode, you have two pressures to set. IPAP and EPAP. Usually, one should attempt to keep the same split.
PS = IPAP - EPAP. You have been moving the IPAP, but not the EPAP.
You need to get back to a baseline -- like the original Rx, then tweak from there.
As you lessen the PS, her breathing becomes more shallow as indicated by Tidal Volume.

for http://imgur.com/a/5dtie the IPAP indicated under the pie chart (14) does not correlate with the set IPAP listed under PAP mode (15)... something is amiss???


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