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New APAP/CPAP User - Help with optimizing treatment
#11
RE: New APAP/CPAP User - Help with optimizing treatment
I tried using the c-collar for the first few nights, but it made my neck very snore. Maybe it's not sized correctly or I'm not wearing it correctly. I tried it again last night and made sure my chin did not slip into it.Not sure it helped much. My elastic straps on the nose pillows is a bit loose (I ordered the clips) and I do find myself adjusting the nose pillows quite a bit throughout the night.

   
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#12
RE: New APAP/CPAP User - Help with optimizing treatment
Your pressure is pegged at 20 all night. If you can't find a comfortable cervical collar, there is nothing more your machine can do. I would look for a different model of collar that is more comfortable, or talk to the doctor about a bilevel machine, because you still have very high obstructive apnea. Your leak rate has improved a bit. I'm certain that if you can resolve the positional apnea problem, much of the OA problem can be resolved, but otherwise, a bilevel machine like the Resmed Aircurve 10 Vauto can provide up to 25 cm of pressure.
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#13
RE: New APAP/CPAP User - Help with optimizing treatment
I found a more comfortable collar with adjustable height (from Walgreen's) as my neck is short. I'm not sure how much it is helping.

   

   

   

   
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#14
RE: New APAP/CPAP User - Help with optimizing treatment
There are still clear signs of obstruction in clusters, and your snoring may be the worst I have ever seen at maximum CPAP pressure. You are still having a lot of obstruction, moderately high obstructive apnea and your user-name seems appropriate. I honestly think you need to discuss the bilevel option with your doctor. An auto BiPAP/VPAP can deliver a bit more pressure and comfort and give us some additional tools. Your pressure requirements alone will satisfy the medical necessity aspect of insurance coverage.
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#15
RE: New APAP/CPAP User - Help with optimizing treatment
Even with the adjustable height collar, I was never very comfortable. I think I've trained myself to breathe through my nose now. I stopped wearing the collar and things have gotten better.

   

   

   
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#16
RE: New APAP/CPAP User - Help with optimizing treatment
You still have a lot of OSA. The treatment is more pressure.
It is not clear that your current machine has enough pressure but before you give up on, you should try it at full power.
When in auto, you will have unnecessary events when the min is set too low. Since we know that your pressure needs are at the upper limit, set the minimum pressure to 17.

You may then want to cut back on EPR to see if a higher EPAP helps you.
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#17
RE: New APAP/CPAP User - Help with optimizing treatment
It's looking a lot better and you only occasionally hit the upper pressure limit. I don't disagree with Ted, but I would make increases in minimum pressure fairly slowly. You will eventually find where the events are better controlled, and you are comfortable. Considering where you started, this is pretty darn good progress, and I'm surprised the collar didn't work out for you.
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#18
RE: New APAP/CPAP User - Help with optimizing treatment
I had my remote data download and review this morning. The clinician's note didn't say anything about me changing the settings, but did change it back to CPAP at 18.6 (which is higher than what she set it at a month ago -17.6). Should I try it or should I change it back to Auto? If I change back to auto, should I go back to my last settings or should I make any adjustments?
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#19
RE: New APAP/CPAP User - Help with optimizing treatment
Whether you use the suggestion or not I would call and let them know that if they are going to make changes to your machine settings, they should also call and advise you of the change. The higher pressure should help with the obstructive issues, but the principle of someone remotely changing your settings without notice is offensive. I would simply let them know you intend to be an active participant in your own therapy, and if they have a professional opinion that might be helpful, you would rather hear about it, than simply find the settings are secretly changed. As a patient you have the right to accept or decline such changes, but knowing about them seems pretty basic.
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#20
RE: New APAP/CPAP User - Help with optimizing treatment
(06-08-2018, 08:27 AM)Sleeprider Wrote: Whether you use the suggestion or not I would call and let them know that if they are going to make changes to your machine settings, they should also call and advise you of the change.   The higher pressure should help with the obstructive issues, but the principle of someone remotely changing your settings without notice is offensive.  I would simply let them know you intend to be an active participant in your own therapy, and if they have a professional opinion that might be helpful, you would rather hear about it, than simply find the settings are secretly changed.  As a patient you have the right to accept or decline such changes, but knowing about them seems pretty basic.

That's a very polite way of putting it and i think it's also the best way to handle that. 

Me, on the other hand would take it a little more coarsely. If my healthcare provider changes my medicine up and doesn't tell me about it, I would make a fuss to make sure that it NEVER happens again. That is me.
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