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Need help titrating new APAP
#1
Need help titrating new APAP i've had for a few weeks
            So i've been having trouble over the past half year with brain fog, bad fatigue, headaches, blurry vision (unable to focus eyes and light sensistivity), memory problems, bad concentration, taking a long time for muscles to heal after working out, etc... All of this started overnight and hit me like a ton of bricks. I have no idea why this was so sudden.

I tried antidepressants for around this time, but they didn't do much. Didn't help even a little bit over the first 5 months of usage. I am now coming off of my current antidepressants as they aren't helping.

I figured that sleep apnea was a possible cause, as I tended to sleep 9-11 hours a day and have been reported to snore/choke in my sleep. Tried to get a sleep study but everything got cancelled as a result of the coronavirus epidemic.

I got a machine online (the dreamstation apap with a full mask and humidifier), and the day after i used it I felt my headaches and joint stiffness disappear. However, many of my symptoms are still present weeks after I used it and I'm having trouble consistently keeping my AHI below 5, since I have no doctor to help titrate this machine. I felt best on April 18th, when my AHI was as low as 1. I have OSCAR data I have been using to track my progress.

Additionally, I have ordered a mouth mask instead as the full face mask caused a welt on my nose that would not heal as I kept using the machine, even when I shielded my nose with bandaids/cottonballs/etc. It should come in the coming days and help a bit because I am naturally a mouth breather.


I have included OSCAR data with this post in hopes you guys can help me properly titrate this machine. There is a mix of obstructive, hypopnea, and reras that are around the same each night. Please help me properly fix the pressure on this machine so I can heal from the state I'm currently in.
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#2
RE: Need help titrating new APAP i've had for a few weeks
Welcome! You are off to a good start: using the machine all night, joining this forum, using Oscar, and even seeing some improvement right away. You also have the right attitude: practical and problem-solving.

Philips Respironics machines are good machines, but they have a reputation for being slow to respond to obstructive events. You can see several places where the machine sits at the minimum after you've had obstructive events, allowing more of them to occur.

So a higher minimum would be a good idea, to head obstructive events off at the pass. I don't have the expertise to give you a confident recommendation, and I hope an expert will swing by to take a look. But if that doesn't happen today, you can't harm yourself by raising your minimum to 10 to see what happens. You may need to raise it more in the future, but additional increases would be determined by new data.

About change: improvement can come quickly for some, but many of us find that it is gradual, unfolding over time. So patience will be your friend.

When you can, I would suggest you have your eyes checked, if you haven't already. The eye problems may be unrelated to the apnea.

Keep us posted, would you?
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#3
RE: Need help titrating new APAP i've had for a few weeks
I did get my eyes checked, as well as my blood tested for lyme, hypothyroid, etc. 

I appreciate the advice, I'll try raising it to 10 to see if that helps
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#4
RE: Need help titrating new APAP i've had for a few weeks
You definitely need higher minimum pressure. Dormeo's advice is very good, and I think you are going to need a minimum pressure of 10.5 to move the hypopnea and OA. It looks like AFlex at 1 is your better setting from the past machine settings. Some people just respond better to a Resmed Airsense 10 Autoset, and you certainly look like one of them from what I see here. Lots of obstructive events and the Philips Auto just sits there like a lump. If you ever get a chance to change, don't turn it down. The Resmed works so well because its EPR (exhale pressure relief) is actually bilevel pressure, and treats the hypopnea and flow limitation that are prevalent in your charts. Another possibility is positional apnea. Your events are not clustered, but if they don't respond to higher pressure you will want to read up.
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#5
RE: Need help titrating new APAP i've had for a few weeks
Hi! Thanks for the advice. In the long term I may consider changing machines, or when things open up again I can get a proper sleep study done and get a better machine through my insurance. In the short term, I'll raise the minimum pressure to something like 10.5 or 11 in order to see some changes. Thank you
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#6
RE: Need help titrating new APAP i've had for a few weeks
A "proper" sleep study is a complete waste of time if you have a doctor that recognizes the problems and just prescribes based on his knowledge of your health, conditions and the data you can show. How can anyone look at the charts you just posted not not know you have obstructive sleep apnea? This is a huge problem with our medical system. Your primary doctor may be aware, and willing to deal with sleep disordered breathing based on your CPAP results. Just the fact you thought this was important to treat at your own expense speaks volumes. Just saying, there may be support where you least expect it. If you had come here before buying a machine, you would not have gotten "second best". There is a big difference. I wish Philips was as good as their reputation, and I live in the town where they are designed and manufactured. They are way behind the curve. Recently we have learned the same hardware Resmed produces as the Autoset is the identical hardware that makes Adaptive Servo Ventilation and intelligent Volume Assured Pressure Support ventilators (iVAPS) sold for $3500 to $5000. Only the firmware is different. Like I said, if you can buy the Autoset or Aircurve 10 Vauto and sell your Philips, you will be much better off, and the next person can come here and find out why things don't work well.
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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#7
Need help titrating new APAP
So i took the suggestions of people on the site of increasing the pressure over the past couple weeks on my apap machine, and it seems to have lowered the ahi by a few points. I am now consistently below 5 ahi, and am hovering around 3.5-4. I have yet to notice any real difference in my condition, but at the very least it seems I may be on the road to recovery.

I have pics of my recent nights, and would appreciate if you guys can give more suggestions, like if I need to raise the pressure more or something.


Attached Files Thumbnail(s)
       
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#8
RE: Need help titrating new APAP
Hello again, Chris! Just for the future, it's a good idea to keep all your therapy adjustment questions in one thread. I took a look at the earlier thread here:

http://www.apneaboard.com/forums/Thread-...-few-weeks

and see that you have gone way up on your minimum pressure, to good effect. Do you think you could hack opening up the maximum to 20? If so, that might be worth trying, just to see what happens. Right now, when you have obstructive events, the machine tries to respond to head off more of same, but it immediately hits the max, since you have such a tight range.

Do you think you were asleep during that cluster of OAs right near the beginning of the night? They might be SWJ (sleep-wake junk). On the other hand, they might be a cluster caused by your sleep posture. Might you have been on your back? Or in a position where you were tucking your chin toward your chest?

I see you are having flow limitations and hypopneas. They are probably being treated about as well as possible on your machine, but I'd be curious what would happen to them if you raised your minimum a little bit more (if you can hack it).

I think you are on the road, and I'm especially impressed by the way you're taking your treatment into your own hands. I hope that before long you'll restart your earlier trend of feeling better during the day.
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#9
RE: Need help titrating new APAP
chris0504,
Your two threads have been merged, as this makes it a little easier for folk to see what has already been tried before advising.
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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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#10
RE: Need help titrating new APAP
Again, Dormeo is offering good advice. It will help if you minimize the monthly calendar in the left margin of the charts so more statistics can show. Just click on the triangle in the date line. Your pressure is high enough now that it may be worth discussing bilevel with your doctor. The use of bilevel is much more comfortable at higher pressure, and it would probably result in significant improvement in hypopnea, flow limitation and comfort (better rest). Here is a thread where a member had results similar to you and just switched to bilevel. http://www.apneaboard.com/forums/Thread-...it-of-help
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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