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New to APAP. Very, very interesting!
#1
Hi All. I practice cardiac anesthesia and post-cardiac surgery intensive care. I am very familiar with PPV and NIPPV (primarily BiPaP) in my patients.

Recently diagnosed with OSA; got my Airsense 10 autoset on Wednesday, 2/10. My prescription was for straight CPAP 8 cmH2O, ramp at auto, starting pressure 4 cm H2O, and EPR 3 using an F10 FFM. First 3 nights were horrible, average 1.25 hours use per night and then DONE!

Found this board on Saturday, 2/13 and I reset the A10 parameters per the clinical manual. Now I am at: APAP, min 6 cmH2O and max 12 cmH2O, ramp at auto, starting pressure 6 cm H2O, and EPR set at 3 using a Quattro FX face mask (had a reaction to the F10).

I am sleeping better than ever! My average usage over the past 3 nights has been just a tad over 7 hours. My AHI is still hovering at over 8.5 with my OI at 0.53, HI at 1.87, and my CAI at 6.53! RERA index is 0.13.

Obviously, my primary issue is the CAI of 6.53. I am sure that this is a form of CPAP induced sleep apnea. My average MV is 9 plus liters and my average VT is 600 ml. The CA is probably due to low PaCO2 due to more efficient ventilation and decreased respiratory drive due to the low PaCO2. Theoretically, CAI is nothing to be concerned with and should not have an effect on sleep; this is a normal, natural reaction to efficient ventilation and low arterial PaCO2. Am I thinking correctly or do I need an ASV vs. APAP? Next appointment with my cardiologist is at the end of April.

I would appreciate any and all thoughts on the above. This is my first time as a patient and, I do not usually deal with these parameters in my patients (thank God for respiratory therapists!).
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#2
Did you have CA on your sleep study? and if so, what was the CAI?
If it is pressure induced, you may be better served with fewer pressure variations. I would begin by turning down, or off EPR, That alone may do the trick, but if not I would narrow the range a little at a time, stopping if CA disappears but possibly all the way to a straight therapeutic pressure. Also, check the pressure at which CA occurs, it could also be that a lower max will trade OSA for CA.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#3
(02-16-2016, 03:05 PM)DariaVader Wrote: Did you have CA on your sleep study? and if so, what was the CAI?
If it is pressure induced, you may be better served with fewer pressure variations. I would begin by turning down, or off EPR, That alone may do the trick, but if not I would narrow the range a little at a time, stopping if CA disappears but possibly all the way to a straight therapeutic pressure. Also, check the pressure at which CA occurs, it could also be that a lower max will trade OSA for CA.

Agreed

Less EPR will lessen CO2 washout.

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~ Rest in Peace ~
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#4
No CA on my sleep study. AHI was 20.1 with 10% obstructive and 90% hypopnea. Lots of RERAs.

Seem to be following this pattern on the "sleepyhead" reports except for the addition of the central apneas and no RERAs. Physiologically, the CAs are an appropriate response to hypocapnea. I do not think that CAs should adversely effect sleep as this is "normal" and when my PaCO2 rises appropriately, I will take a breath. It does bother me "slightly" when I am falling asleep. I have no problem with continuing my current therapy as it seems to be doing the job. Just wondering if my thinking is correct or if the CAs represent a real problem?
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#5
Also keep in mind that CA's are often flagged while still awake or transitioning to sleep. Those can be ignored, especially if you are feeling well rested or as you put it "sleeping better than ever." I wouldn't make any changes for a while, those CA's may disappear on their own in due time.

Dude
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#6
Thanks Dude! I do think that some of the CAs are actually transitional apneas. I plan to keep my current settings until Friday, 2/26 and re-evaluate after a data download.
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#7
Agreed Sleep-well
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#8
Aether087, this post is interesting from several perspectives. Here we have a medical professional using auto CPAP prescribed at a fixed pressure, presumably by a sleep professional, and within days changing his pressure to provide more comfort and avoid the hypoxia inducing pressure of 4.0 cm. Please provide your colleague with some feedback on this. Your experience is far from unique, and is the reason this forum exists. The professionals rarely get it right from a clinical sleep study and titration. Patient empowerment in CPAP therapy is essential to success, and yet the whole industry is in league to keep patient's hands off the controls, to the extent that the clinical manuals are removed by DMEs.

Your results are pretty satisfactory for starting out, and we usually see significant improvement as people adapt to the therapy. Your CAI is probably a mixture of transitional sleep or sleep/wake junk, but I suspect some of it is real, especially if it is clustered. Your machine provides up to 3 cm pressure support between IPAP and EPAP and can induce some CA from CO2 washout. Trying a lower EPR may help. Your intuitive deduction of the cause is pretty accurate, and it can be more-so with bilevel therapy with higher pressure support.

You may have a reason for using a full face mask (FFM) interface. If you have access to alternatives, give nasal pillows a try. Most of us can avoid leaks through the mouth, and the improved comfort, quiet venting, flexibility and seal of nasal pillows is well worth it. Resmed Airfit P10 is very popular, and unless you KNOW you can't use nasal therapy, give it a try.

You should download Sleepyhead software from the link at the top of this page. You will understand the information it gives you and there are extensive breath by breath graphs of events, respiratory flow, machine pressure, as well as respiratory rate, volume and other data. I'm sure with your understanding you will find it interesting and useful.

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#9
Hi Aether087,
WELCOME! to the forum.!
Much success to you with your CPAP therapy and hang in there for more responses to your post.
trish6hundred
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#10
My provider who prescribed the slee study/CPAP is my cardiologist doing "preventive cardiology" as we have a strong history of premature CAD in my family. So far, I am GOOD TO GO (knocks on wood). I will tell him about my experience at my April appointment.

I have a deviated septum from a broken nose when I was in high school (I did end up getting the girl!) with resultant airflow resistance. I tried a nasal pillow during the CPAP trial and ended up "breath stacking" due to the difficulty exhaling against the pressure. So, full facemask for me as I am a mouth breather. No way will I have nasal surgery as I have a severe needle phobia!

I downloaded the "sleepyhead" software. This is where the data that I quoted is from.
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