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New Board Member - Long time CPAP user - Issues
#1
New Board Member - Long time CPAP user - Issues
Hi,
I've been searching threads on this board for the past few days and finally joined so I can get some advice.

I've been using CPAP since 2013, I used to use Sleepyhead once in a blue moon, and just downloaded OSCAR.

When I had my sleep study I was 70+AHI
After starting therapy looking at OSCAR I was under 3AHI for years.

The past few years it's crept up. Most nights 10+AHI, some 5, some 20ahi....
I just sort of learned to deal with it.
I go in yearly to see my sleep DR and he would never say the numbers look bad. I'm in a tough spot because if I tell him therapy is not working and I'm sleepy then I can not get a letter to send to the FAA (since I'm a pilot). So I need to say everything is good, and I ask theoretical questions about my therapy but he's never ordered a new sleep study from my one in 2013.

So since I've been tired at night, fall asleep watching TV, wanting to take a nap in the afternoon. I decided to make some changes.
I purchased a New Phillips Dreamstation APAP and it arrived last Friday.
When I woke up Saturday I felt like a actually wasn't tired. For the past four nights I don't fall asleep watching TV on the couch at night.

But my AHI is still around 5ish and I see people here talking about less than five so i've been playing with the settings. 

First night APAP 4-20 ( I didn't know how to change the settings yet) - AHI 5.29 pressure med 7.3 max 9.3
11/7 = APAP 4-20 -AHI 7.05 - pressure med 5.9 max 8.80
11/8 = APAP 6-15 (I looked and my script was for 6 on the CPAP) =AHI 5.74 pressure Med 6.00 Max 7,00 (so I  think the pressure settings are good. EPAP was set for Auto Flex 2)
After reading the board I changed to nonauto and Flex1 for last night)
11/9 = APAP 6-12 = AHI 9.59 Pressure Med=6.3 MAx 7 So the only major change was the EPAP last night and my AHI almost doubled (I still feel rested though) My Periodic breathing went to 6.7% vs 1% with the previous flex setting.
What did change with the EPAP change also was Clear airway events went from 10 previously to 4 with the flex1 setting.
But my Hypopneas went to 60 events for the eveing.

Tonight I'm going back to Auto EPAP and level2 and see what happens.

For the longest time (years I've been living with being tired during the day, but after not being tired during the day I want to get this dialed in so I can live my days to the fullest!

Thanks for any help.
G.
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#2
RE: New Board Member - Long time CPAP user - Issues
Lets try 6= min   12= max  and NO flex.  I think that will help with the hypopnes.  Post tomorrow I hope you have about 1/2 or less than the last one.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: New Board Member - Long time CPAP user - Issues
I'm going to disagree with the above. All of your issues in the three posted charts point to minimum pressure being too low and the Philips is a very slow machine to catch up to what you need. I'm going to recommend a minimum pressure of 8.0, maximum pressure of 14.0 and A-Flex 1. I see a lot of flow limitation in the zoomed image you showed. If you get in closer on the flow rate, I suspect you will see many periods where the inspiratory flow wave is flattened showing airway resistance. Increased pressure may help to relieve this, but the better solution for the number of hypopnea you have is the use of bilevel pressure support. The Resmed Airsense 10 Autoset CPAP can provide up to 3-cm of pressure support (difference between inhale and exhale pressure) and its EPR (exhale pressure relief) works in ways the Philips Flex cannot. Give the higher minimum pressure a try. We should be able to make some progress on your event rate, however if you ever have an opportunity to change to a Resmed, it will be more effective and comfortable for the kinds of issues we see here.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#4
RE: New Board Member - Long time CPAP user - Issues
So Last night I went back to my prescribed setting and back to Auto EPAP with flex2. I figure I will try for four nights before changing to Sleepriders advice.
Ahi went from 9+ to a little over 6 last night.

Last night I also wore my Beddr o2 sensor and it agreed with how many apneas I had. When you look at the screenshot from my phone it goes by hour of sleep in the report. So hour 2 relates to midnight hour from Oscar and that's when I had issues.

If I had so many event's I don't understand why the Dreamstation didn't up the pressure anymore than 8 for the entire night?

Thanks for the input. I keep reading all the other posts to see how this all relates......

G.
           
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#5
RE: New Board Member - Long time CPAP user - Issues
It looks like you are “chin tucking”. You are cutting of your airway. And if sleeprider gave you a suggestion I would suggest you consider it. He knows what he is doing.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#6
RE: New Board Member - Long time CPAP user - Issues
Welcome to Apnea Board. You're getting good advice on setting edits to make the Respironics give better therapy. As I see it, the Respironics has an inherent flaw of being slow to respond, and you do have to do a self titration for a few nights to get the settings on top of where your therapy needs are. In my opinion, I'd be of a mind to enact the edits now rather than wait. I have a feeling it's not getting better without your implementing the suggestion given by Sleeprider. I do realize it is your choice. I've said what I felt was needed, but I'm not here to pressure you into anything. You are in charge of your own therapy. Once we see the next OSCAR chart, we can view progress and suggest things to make it better. Sincere best to you that we can get your therapy up to par ASAP.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: New Board Member - Long time CPAP user - Issues
I rarely see anyone achieve good results at pressures this low, and after working with hundreds of people on optimizing CPAP it is rare that a pressure less that 8.0 is used. If you're reluctant to give that a try, then set the minimum pressure at 7.0 which is your current maximum, and set the maximum pressure at 14. The machine will show you if it needs to be higher, and these are very conservative settings. The clustering of hypopnea may be the result of positional apnea. These articles can help you to understand that pattern and how to resolve it.

Positional apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar
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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#8
RE: New Board Member - Long time CPAP user - Issues
A bit of update on my treatment.
Per advice on the board. I recognized that I was tucking my chin at night so I adjusted pillows and made myself aware not to place myself in that position at the start of the night and I was able to lower my AHI.

Then per sleepriders advice I increased my min pressure to 8 and was able to lower my AHI

I am feeling more awake in the mornings and during the day for this past week, and I'm encouraged that I've been able to get my AHI down under 5. Previously I was happy with anyting under 10.

On another note - my wife always falls asleep at night and was supposed to get a sleep study and with covid it never happened. Since I just got a new machine. I've taken my old machine and programed it for A-Trial settings with min 4 and max 14
(previous to using the machine she used my Beddr o2 sensor that showed she has having Apneas.
With those settings she got an AHI of 2.xx(something)
Then two nights ago we moved it to a plain CPAP  with the lowest setting of 4 to see what it would record (to verify she has sleep apnea) and it went to over AHI6.xx
Last night I moved it back to Auto and 6-14 for the settings and she went back to under 5 AHI. Her max pressure is greater than mine which I find interesting. She is now feeling more rested and not falling asleep on the couch when we watch Law & Order (That was my joke - I always ask what she wants to fall asleep to. Next post I will share her OSCAR graph.


Thank You for your input and help!

       
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#9
RE: New Board Member - Long time CPAP user - Issues
So here is my wifes graphs.
First is her first night.
Second screen shot is at a constant CPAP of 4cm
Third is with APAP 6-14 settings.

She is using my old Phillips machine with new hose, New Nasal Pillows, New Water tank, and new filters.
She is still getting used to the nasal pillows.
She no longer falls asleep in the evenings.

Thanks for any input or if we should stop her use until we get the official sleep study.

       
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#10
RE: New Board Member - Long time CPAP user - Issues
That cluster on the 15th is positional, but with a fixed pressure at 4.0 it can also be poor therapy. Her pressure needs are close to your own, and you really need to get this thing over a 8.0 minimum pressure, and with a range of 8-12 I think you will see greater comfort and efficacy. Since this is a fixed pressure machine when the A Trial runs out, you need to establish the 90% pressure that is effective, and that will become the fixed pressure until she can get her Resmed Airsense 10 Autoset for her.
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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