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#1
New User
Hi Folks,

A few years ago I did a sleep test, but the experience was very poor. The clinic was stifling hot, with too many blankets (which were drum tight). Consequently I couldn't get to sleep. Later when I visited the sleep doctor, I found him an arrogant jerk and totally unhelpful.
I have a deviated septum (I think), and when he looked up my nose his reaction was "Jesus, what a mess" (literally!).

So I gave up on the Sleep Clinic.

But time passed and my sleep apnea was getting desperate. Couldn't use my computer or try to read without going to sleep.
Was terrified to drive.

So after many inquiries I purchased a new Resmed Airsense 10 Autoset, plus Airfit F20 mask.

I've had it for a week now, and found little difficulty with the mask, or in getting to sleep.
Am still getting used to it, so results are all over the pace.

I've attached a Screen print of a typical night.

I have many questions, but the first is about my high AHI figures (is around 19).

I get conflicting messages in reading the forums.
Should the figure be trending downwards if I'm using an automatic machine?

One last note: I just discovered that the machine was set for "Nasal Pillow" instead of "Full Face" mask.
Have now corrected that.

Thanks in advance for any help.


Thanks ..... Zim


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#2
RE: New User
Welcome to the forum
I know it's unbelievable but therapy must be optimized for everyone and yours is not.

Several things
  • At 4-20 your machine is running wide open, good to get a good Idea about what you need but bad for optimization.
  • Your obstructive apnea is clustered which typically means a positional apnea coming from a chin tuck.  It may be but in this case it is always as you are starting therapy.
  • You have a really high number of hypopneas
  • finally, with a CAI of over 3 we are going to watch your centrals closely, but not do anything for them just yet

First set you min pressure to 14, likely it will need to be raised but I want to eliminate that very large jump at the beginning of each therapy session and hopefully shrink that cluster of Obstructive Apnea events at the start.

Even though you are on a CPAP machine you need to think of having 2 different pressures.  IPAP or inhale pressure is the same as pressure on a CPAP machine such as what you are using.  EPAP or exhale pressure is what splints your airway open for Obstructive Apneas.  On a straight CPAP pressure = IPAP = EPAP.  On the next level up there are 2 separate pressures EPAP and IPAP with the difference being called PS or Pressure Support.

The best way to treat Hypopneas and Flow Limitations (you have plenty) is with a difference in pressure between EPAP and IPAP or PS.  We are going to start with a 2 cmw PS or difference between EPAP and IPAP by setting EPR to Fulltime and a value of 2.  This means your initial pressures will be EPAP = 12 (pressure or IPAP -2) and your initial IPAP will be 14.  This change could cause an increase in Central Apneas so we will watch for that and reevaluate to see what additional changes are needed.

So here is what you need to set
EPR: Fulltime value = 2
Min Pressure 14
Max Pressure 20 (unchanged)

I expect to see your Obstructive Apneas drop, your hypopneas drop, and your Flow Limitations also drop.

Fred
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#3
RE: New User
Welcome to the forum. I was about to make the same recommendations as Fred but I guess he types faster. You have gotten  excellent advice. The only thing I would add is that you post results soon so we can see what additional adjustments may be required. Also, consider a soft cervical collar to prevent the chin tucking. I and many others on the forum use them for the same issue.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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 User
Hello Fred,

Thanks for your very quick reply!

I've set the machine as requested:

EPR: Fulltime value = 2
Min Pressure 14
Max Pressure 20 (unchanged)

Will report back tomorrow.

One question: We are asked to post stats for a single day.
Given that there is a fair variation from day to day, would not longer term stats be more useful?

Thanks again.

P.S. Will buy a soft cervical collar today (thanks Melman)

.......Zim
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#5
RE: New User
Hold on the collar until tomorrow.  I think in this case you may not need it, tomorrow should give us a better idea.
I expect to see variation in days, if they are typical it shouldn't matter.  See the organization link in my signature.  That said, more info is always better than less.
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#6
RE: New User
Hi,

I bought a soft cervical collar today. Results were mixed last night.
Of three sessions, the AHI was 22, 2 and 22.

Something odd with the middle session, I think I was trying to lie on my back.
(I usually sleep on one side).

see attached

I found the collar very uncomfortable. If it's tight enough to work, it pushes up the mask causing a leak around the eyes.
Might have a look at other types of collar.

Also I have ordered a nasal pillow mask.


Thanks in advance...

edit: Fred, you said "See the organization link in my signature"
Is there something wrong with my printout format?


.........Zim


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#7
RE: New User
(05-27-2019, 04:41 PM)gzimmer Wrote: edit: Fred, you said "See the organization link in my signature"
Is there something wrong with my printout format?
.........Zim
no you are good.
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#8
RE: New User
Thanks Fred,

Originally I couldn't find the "Snore" panel.

I've managed to make it appear.

see attached


Thanks ..........Zim


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#9
RE: New User
About the collar: some people (including me) prefer the Dr Dakota collar. It is a firm half-collar with a strap in back, and by wearing it a little loosely, you can adjust it so that it supports just the chin-end of your lower jaw.  If you try it and like it, but have trouble fastening the strap, let me know. There’s a little fix I could try to describe.
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#10
RE: New User
Hi folks,

Reading in the forum, I occasionally see reference to a machine "running wide open".

I'd be grateful if someone can explain what this means.

Although I have an engineering background, I'm having trouble finding background information on setting up a machine.
Any pointers to documents or technical manuals would be very helpful.


Thanks ....... Zim
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