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New diagnosis, 3 weeks with CPAP
#11
RE: New diagnosis, 3 weeks with CPAP
Thank you, bonjour. I'll keep an eye on it. I think my clinician's done a nice job in bringing me to this point. He's indicated that he too has sleep apnea and uses a CPAP machine.
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#12
RE: New diagnosis, 3 weeks with CPAP
encourage _cpap_adjustment "turned off flex on trial dreamstation per #2"

Using this tag so that I can search for and track all changes in my therapy.
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#13
RE: New diagnosis, 3 weeks with CPAP
You have a diagnosed co-morbidity of COPD and over 12 AHI based on your chart and results from the Dreamstation Auto. At 8.0 fixed pressure, you have an AHI of 12.61 with predominately H and CA events. Looking at the zoomed in events I see a very flow-limited expiration, and some flow-limited inspiration. My impression is you need bilevel so that we can preserve expiration time to allow your lungs to more easily expire air, allowing the next inhale. You are on perhaps the worst machine (Philips Auto CPAP) to facilitate your needs.

With your lack of efficacy, you should contact your doctor to discuss the use of a bilevel machine that has a higher inhale pressure, and lower exhale pressure. The ideal machine would be the one I use, a Resmed Aircurve 10 Vauto. We really need to get your pressure a bit higher to avoid obstructive apnea, but more importantly, we need pressure support to allow you to exhale fully on each breath. Without pressure support, you don't fully exhale, and there is no place for the next inhale to go.
Sleeprider
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#14
RE: New diagnosis, 3 weeks with CPAP
Hello Sleeprider, you have my attention. I’m seeing my clinician this coming week. Would you stay on the current course, with the Dreamstation, until then, if it were you?
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#15
RE: New diagnosis, 3 weeks with CPAP
My results from last night, with flex turned off, are attached. I noticed that it took more effort to exhale.

   
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#16
RE: New diagnosis, 3 weeks with CPAP
At this point, your CPAP is probably good to continue to demonstrate a commitment to making therapy work, but your AHI suggests it is not having much benefit. With CPAP therapy you have developed at least twice the frequency of central apnea as obstructive, along with a considerable hypopnea. You appear to need pressure support to overcome the hypopnea, and may need a backup rate to deal with the centrals. In the long run, this might respond best to ASV, which provides adaptive pressure support to cause a breath when you don't initiate one, and to augment breaths that lack volume and are flagged as hypopnea. I think the best approach to take with your doctor is to consider a sleep study that evaluates bilevel pressure support, and the possible need for a backup rate to better understand the problem.

The central apnea and hypopnea may be a treatment onset condition that most people don't experience, but it is common enough that your doctor and sleep clinic should be aware of it. In some cases it does spontaneously resolve as you adapt to CPAP therapy. You have shown some improvement, but are yet to experience acceptable results, so it might be time to investigate the alternatives to CPAP.
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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#17
RE: New diagnosis, 3 weeks with CPAP
When I disabled Flex on my Dreamstation, last night, I didn't take notice of whether it had been set to A-Flex or C-Flex. I'd like to enable flex again, but I don't know which setting will be best for my situation. From the reading I've done I'd say C-Flex would be better than A-Flex. Does anyone have an informed opinion?

I awoke this morning with much congestion and some difficulty in breathing. I pretty much felt the worst I have over the past three weeks. I also had a fullness in my chest and side that made it painful to bend or sit upright. This has all subsided now. I notice that my pressure and EPAP was a steady 8.0 for the duration of my CPAP time. Is this normal for some, when flex is disabled?
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#18
RE: New diagnosis, 3 weeks with CPAP
Thank you, Sleeprider. I have an appointment with my clinician this coming Tuesday and an appointment with my doctor the following Saturday. I'll keep using the machine for now. I hope some light will be shed on this over the next few weeks.
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#19
RE: New diagnosis, 3 weeks with CPAP
I'm going to return the trial Dreamstation to the DME on Tuesday and ask my doctor for a referral for a proper level 1 sleep study at a local well-respected sleep clinic. I'm not sure how long it'll take to obtain an appointment, but I'll continue to hang out here and read and ask questions. Reading through other's posts, reading the supportive responses based on the OPs charts, and the frequent success stories is very encouraging and heartwarming. I hope to one day be able to contribute to others. Thank you all.
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#20
RE: New diagnosis, 3 weeks with CPAP
I've continued to use the Dreamstation APAP, set at a constant pressure of 8.0. I tried a soft cervical collar last night. Not nearly as many events and a lower AHI. Although I slept only 5.5 hours, I feel rested and clear minded.

On another note, I do notice that I breathe much much easier when I take the nasal mask off. Is this normal?

Will see the clinical technician at the DME tomorrow.

   
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