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My Therapy Thread: [reports+updates]
#1
My Therapy Thread: [reports+updates]
Hello!

This will be a continuously updated thread. Here I'll maintain all my reports and requests for advice and would appreciate all the interaction and help I would get.

So I finally got my diagnosis & sleep report & machine & have a couple cpap nights under my belt! Let's first share the Dx & sleep report details:

Dx: Severe OSA

Doc summary included the following: [...] At CPAP pressure of 7 cmH2O respiratory events were eliminated during lateral REM & NREM sleep. However, some respiratory events persisted with CPAP pressure of 10 during supine sleep. [...]

Sleep report data:
Off CPAP
  • Total sleep 136min, N1 4.8%, N2 76.5%, N3 18.8%, R 0%, 0 REM cycles
  • AHI: 64
  • CA Index: 0
  • OA Index: 0.9
  • Hypopnea Index: 63.5
  • Desaturation: % Time O2 < 90%: 0
  • Arousal Index: 56
  • Snoring % 61
  • LM: 0
ON CPAP
  • Total sleep 144min, N1 2.8%, N2 74.7%, N3 0%, R 22.5%, 3 REM cycles
  • AHI: 12.5
  • CA Index: 1.2
  • OA Index: 0
  • Hypopnea Index: 11.2
  • Desaturation: % Time O2 < 90%: 0
  • Arousal Index: 11.6
  • Snoring % 3.3
  • LM: 0
Study report attached...
   


Rx was:
6-11cmH2O
4 ramp pressure
40min ramp time



On to OSCAR reports for my 1st 2 nights:

1st night I had A Flex ON @3 and was my 1st night ever with a CPAP, awful night
   


2nd nigh I turned all flex OFF and it was an OK night, but not a great one because I like to cover my face while sleeping and the mask was in the way moving & jamming so I kept waking up especially during the last 3-4 hours of sleep. Any tips/recommendations?
   
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#2
RE: My Therapy Thread: reports+updates
The Philips Auto algorithm is not known for getting ahead of hypopnea, and I think you are going to ultimately need a minimum pressure of 8.0. If you are more comfortable with gradual changes, then changing the minimum pressure in 1-cm increments and observing the results will get you there. I think you did much better with the Flex Off, but don't hesitate to try some settings in-between. A C-flex+ setting 1 may be just the thing.
Sleeprider
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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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#3
RE: My Therapy Thread: reports+updates
(12-23-2020, 09:54 AM)Sleeprider Wrote: I think you are going to ultimately need a minimum pressure of 8.0

Thanks for reviewing my thread. I'm new to all of this so sharing your insight would be helpful. When I look at the Dec 22 (no flex) chart, I see that for half the time I have no events and the pressure was on 6. When events happen, it seems the machine reacts by increasing the pressure but events continue to happen nonetheless!

Can you share why you think 8 is what's needed when there are long periods of time @ 6 with no events, while there were events even with pressure @ 8?
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#4
RE: My Therapy Thread: reports+updates
The rationale is that your Philips Dreamstation is always 'behind the ball'. It only gets up to an effective pressure late in the sequence of events which is typical for this machine's algorithm. If you were using a Resmed Autoset, you would certainly not be stranded at a pressure of 6.0 as hypopnea or OA begins, and then waiting for multiple events for the effective pressure to be reached. It's clear to me you are not effectively treated at 6.0 and I don't think you are going to head off these events at a lower pressure than 8.0. In addition to that visual logic, I just don't see many individuals fully treated at a lower pressure than 8.0. Having looked at thousands of CPAP users, I really need a compelling argument to consider a pressure lower than 8.0 and likely to succeed, particularly on the slow response Philips. I find the ideal minimum pressure with Philips is at about the 90th percentile of pressure (pressure exceeded 10% of the time). Guess where that puts you? This 90th percentile rule-of-thumb is widely used by clinicians for CPAP therapy. Unfortunately the Philips Dreamstation simply won't get ahead of events on its own, so we have to do it with a higher minimum pressure. Finally, fewer pressure swings, results in less sleep disruption. Starting at a higher pressure within your effective range will limit the pressure changes you experience, and result in less over-shooting by the machine. So you get the benefit of fewer events, and less sleep disruption hopefully resulting in better sleep quality.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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How To Deal With Equipment Supplier


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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#5
RE: My Therapy Thread: reports+updates
Thanks for elaborating on the rational behind your recommendation!

The titration was done on some kind of Philips machine. I wonder why the doctor prescribed 6-11 when his summary stated that a 7 eliminated events during lateral sleep?
I'm even more confused why his summary stated that events persisted with a CPAP pressure of 10 during supine sleep, but with no further comment on how these should be treated! Is that normal for sleep docs to do with a 1st-time diagnosed OSA patient? Just say events weren't resolved and stop at that?! Very confusing  Dont-know
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#6
RE: My Therapy Thread: reports+updates
Doctors take a lot of different approaches, and probably each has his own reasons. Yours appears to have relied on the auto CPAP to get you to an effective pressure as needed, while others will prescribe a higher fixed CPAP pressure. Both are common approaches, and the doctor only gets to see how you respond during a very limited period of time in a clinic. We have the advantage of being able to use the machine's data to see not only events, but trends and tendencies, and we should continue to see what happens and look for opportunities for improvement as you use a higher minimum pressure and move closer to optimized therapy. Once you have done this, you will be empowered to continue to make the therapy your own and work on comfort issues if and when they arise. No doctor can hope to do better than you can do for yourself with the right information.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#7
RE: My Therapy Thread: reports+updates
Appreciate your interest and help, Sleeprider. It's been only 3 nights for me on CPAP and for each night I changed something. I'm probably too eager to get this daily headache/tiredness over with and I'm not exercising enough patience with the treatment. I'm thinking maybe I should be patient and stick with the doctor prescription for a few days before changing stuff. Then, I'll come back with reports after getting used to this new friend I have. Thanks again, man.
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#8
Jan 8, '21: Do I have RERA/UARS?
Jan 8, '21 Update & Questions

Status Update: so I stayed on the doc's rx of APAP 6-11 for 2 weeks, averaging about 4.5 AHI, then increased minimum to 8 (APAP 8-12) for 1 night & got AHI 2.5, then increased again the next night to a APAP 9-12 and got AHI 1.18 with more than 10 hours of sleep.

Question: Do my charts show flow limitations/RERAs/UARS or anything else that the machine didn't flag? detailed charts below

I still have some (less) headache and feel like 50% more rested than before starting any PAP therapy. Didn't yet notice much difference in how I feel between 6-11 & other pressures.

10 x 2-minute snapshots of last night (10+ hours of sleep, AHI 1.18, APAP 8-12 no flex)

   



10 x 5-minute snapshots of last night

   



Finally, this is how the whole night looked:

   
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#9
RE: My Therapy Thread: reports+updates
What a great improvement! in your flow rate charts of 8-12, there were occasional flow-limited breaths, but it looked okay overall. The Jan 7 charts are free of flow limitation except at 8:59. Nice job self-titrating and optimizing pressure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#10
RE: My Therapy Thread: reports+updates
Argh, I screwed. The post had typos, all the charts on my last post were from Jan 7, settings for all the charts above were APAP 9-12, no flex, F20 AirTouch, no supine. Wish I could edit the last post to correct.

Anyway, my concern is that the machine is not flagging possible flow limits and I have no way to identify an underlaying UARS/RERA. I know my sleep is only half improved since starting cpap.
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