(07-11-2014 10:21 PM)seamad Wrote: I can't understand why I still have apnea if I use an APAP, Are those the ones the device cannot solve?
What is the Central Apnea Index and the obstructive Apnea Index which your machine is reporting? (In the Italian language I am not sure what IAI and AI would signify in the ResScan summary statistics.)
If more than half of your apneas are central, it may be helpful to lower your Max Pressure setting a little, even though this would likely increase the number of obstructive apneas.
On the other hand, having a few central apneas is usually no big deal. In the beginning weeks of therapy, patients sometimes have more central apneas than obstructive apneas, but these often gradually go away after a few weeks or months, as the body becomes accustomed to breathing under pressure.
I suggest lowering the max pressure may be helpful if it reduces the overall AHI (average number per hour of all apneas plus hypopneas), or if it reduces to bearable levels other symptoms like aerophagia (air swallowing) or eliminates problems with balance or vertigo or hearing loss or discharges from the tear ducts.
Regarding the setting for Minimum Pressure, your machine is spending at least half its time above 14. If I had pressure data similar to yours and was using your machine, I would probably jump the Min Pressure to about half the highest pressure the machine is reaching each night, and then I would walk the Min Pressure higher by 1cm H2O every night, until the Min Pressure is at least within 5 cm H2O from the highest pressure which the machine is actually using each night.
On ResMed machines, the Min Pressure is treated as a target which the machine is slowly trying to return to (between obstructive events). So. if the Min Pressure is much lower than the needed therapeutic pressure, having the Min Pressure so low will significantly decrease the average pressure the machine uses, which would likely increase the number of obstructive events.
What setting for EPR are you using? Using EPR (Exhalation Pressure Relief) may influence how many central apneas we will have. Often, lowering or turning off EPR may lower the central apnea index, but may also be less comfortable and may also increase the hypopnea index.
By the time of your in-hospital titration, if the Central Apnea Index is not lower than about 5 then you may need a more expensive ASV (Adaptive Servo Ventilator) type of CPAP machine, which is able to treat central apneas as well as obstructive apneas.
In any case, before the titration starts, I suggest you ask that, if the needed therapeutic pressure turns out to be higher than 15, that you will be switched to bi-level therapy.
Here is a link to a good article which discusses why some patients need bi-level therapy. Explains UARS and Respiratory Effort Related Arousal (RERA) events, and why some patients continue to suffer excessive daytime sleepiness even though they are using PAP treatment and have low AHI numbers, and how bi-level treatment may be able to solve this:
However, sometimes bi-level therapy will increase the number of central apneas we have. In that is true in your case, perhaps ASV therapy can be used, or perhaps bi-level therapy can be used if the number of central apneas it causes are small enough to ignore.
With your pressure maxing out night after night, I suggest taking precautions to guarantee you are never sleeping on your back. For example, I wear a teeshirt with one or two tennis balls in pockets sewn on the back along my spine, between the shoulder blades and higher, so that WHEN I roll onto my back I awaken enough to keep rolling until I am on my other side.
When the needed pressure is 15 or higher, it is common to prescribe bi-level machines, so that the exhale pressure (EPAP) can be lower, which is usually much more comfortable. Also, bi-level machines (including ASV machines) usually allow the pressure to go as high as 25 cm H2O if needed. (Which you may need.)
If getting a bi-level machine, I recommend an Auto model, such as the S9 VPAP Auto or the Philips Respironics System One BiPAP Auto with Heated Hose. The S9 VPAP Auto would be able to share the same power adapter and humidifier and air filters (and hose and mask, etc) as your S9 AutoSet.
(If you didn't already own an S9 machine, I would suggest a preference for the PRS1 BiPAP Auto, because it has a couple nice features which the "equivalent" ResMed machine does not have -- namely, the Pressure Support will slowly auto-adjust itself to minimize obstructive events, plus PRS1 bi-level machines have a second type of exhalation pressure relief called BiFlex which can provide additional pressure relief during exhalation without increasing the AHI.)
For now, look at the detailed data in ResScan to see how long your apnea events are lasting. By the way, personally, I would be less concerned about a central apnea event which lasted fairly long (like 30 or 40 seconds) than I would be concerned about an obstructive apnea which lasted the same amount of time, because with a central apnea as soon as I tried to breathe, I would start breathing again. But with an obstructive apnea, there would a struggle to breathe, and I think the stress on the body would end up being greater. (Just my opinion.)
Good luck, and take care,