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Events way too high!
#11
Great job posting the charts, sorry I missed them in the last reply. On the positive side, the leak rate is very good. The clusters do seem to correlate with snores. It might be helpful to zoom in on the respiratory flow rate on the day when AHI was 14 and look at a period that was relatively free of events and one that is in a cluster of OA. Also, are there any medications or health issues aside from apnea that might be affecting things?
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#12
The mask pressure graph is too ragged on IPAP. Something seems wrong here.
A zero in of the flow and pressure is warranted.

When he set the IPAP from 14 to 15, it did not increase mask pressure to 15.
Maybe the rise time or trigger or Timin are messed up.
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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#13
When an obstructive apnea occurs, the machine does not resume IPAP pressure until it is over. So those dips in mask pressure are to be expected with the number of events. I did notice these are very different times, with the session onf 10/20 going from 10:00 PM to 5:30 Am, and the session on 10/19 going from 5:00 AM to 8:15 AM. Hard to know why. Also seeing that 2-second inspiration and 1-second espiration, which suggests some irregulariteis in teh breathing that the machine usually misinterprets. Also, respiration rate is pretty high...again machines tend to over-count when exhale has irregularities.
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#14
On the first chart at IPAP 14, EPAP 10, the most of the OAs look like they are from times when your wife was slowly waking up. It is normal to have apneic events as you are awakening.Even people with no sleep apnea have this type of breathing during awakening. If it were me, I would ignore those 2 clusters. The rest of the chart looks fairly good. I did a quick calculation and leaving out what I am considering what we call sleep/wake junk, I get an AHI of around 4.6.

There might also be some positional situation making the sleep/wake junk worse. If your wife was lying on her back during these two periods, it may make the OAs worse. If this is or might be the case, you and your wife might want to try some things to keep her sleeping on her side. Things that meke it uncomfortable to be on ones back, like tennis balls sewn into the back of a Tshirt or wearing a back pack with light but angular things in the back pack or pillow arrangements, et cetera.

Best Regards,

PaytonA
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#15
How about we suggest ResScan in case Sleepyhead has a bug for the VPAP S?
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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#16
Hi sfrasher,
WELCOME! to the forum.!
Your wife is fortunate to have you looking out for her and I wish her good luck with her CPAP therapy.
Hang in there for more responses to your post.
trish6hundred
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#17
Phew! That was a lot to catch up on.

Drugs: she is severely diabetic and takes 200 times the insulin that most type II diabetics take. But that is an old problem that has been constant since day one. She also takes 11 other meds for various things. We have tried to narrow down to something that might have changed at about the time her AHI went up to drastically. There are two that I can think of that are fairly recent...Irbesartan and Montelukast.

She is on oxygen at 3 liters. That feeds into the CPAP machine. That hasn't changed.

The large dips and cutoffs are when she gets up to go to the bathroom. Usually around 5 AM. A normal night for her is roughly 10:00PM to 8:00AM.

She normally sleeps on her side but occasionally rolls onto her back.

Thanks for all the help! I wish her doctors cared so much!
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#18
that is a lot of stuff going on. Going back to your original post:
Quote: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!

Something changed at 3-months. Her medications, and particularly montelukast, or the underlying asthma, are possible suspects. Getting your doctor to respond again seems to be the priority. The complications of this case may exceed what the forum can advise on, and I'm more comfortable with a supportive, rather than advisory role. Meanwhile, I continue to believe keeping things fairly close to the original prescription is a good idea until you have professional support. We can only hope that is sooner than later.
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#19
Update:
Friday, at 16/11, AHI was 59.3
Saturday, at 14/10, the prescribed settings, AHI was 21.7
Sunday, at 14/10, AHI was 8.5
Monday at 13/10. AHI was 14.3, which, for her, is not bad.
Tuesday, no change (13/10). AHI was 33.3
Wednesday, today, changed to 13/9 to get back to the 4 point span mentioned before.

SleepyHead is amazing! I was able to go back and figure out that it all started around June 16. On the 15th, AHI was 2.46. On the 16th, it was 41.96. We cannot figure out what happened on June 16th! Of course the calendar pages are gone so I can't look at that day. I have learned to not throw away the calendar page for the next year!

Her second sleep study was on the 19th, 7 days ago. She called them to get the results and recommend changes, and they say they have not gotten the results yet!!!

So, my latest change (this morning) was to change to 13/9, to get back to the 4 point span, and I will try to increase her oxygen by 1L tonight if I can remember. We leave for Arizona in 5 days, so that will eliminate the oxygen variable altogether. We are currently in Colorado, land of no oxygen!
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#20
What's your altitude?
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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