New to CPAP - Need advice!

[Gideon]

I do feel that most Doctors see EPR, flex etc as a COMFORT setting (as the manufacturers market it) that reduces exhale pressures and NOT a therapeutic setting as we frequently use it.  I'm not going to dispute its use as a comfort setting, but there is a therapeutic capability there.  EPR/Flex frequently causes a negative impact on therapy with those that are showing significant Central Apneas (CPAP is not the machine of choice for these users).

[Sleeprider]

I'm very happy to hear you will be getting the Airsense 10 Autoset. I'm confident you will experience a difference that will surprise you. That's great news, and I can only hope that once we get you settled in you can show the difference to your doctor and dispel the nonsense that "they are all the same".

[avaholic]

Thx. I hope so too! 

Would the CPAP cause me to have headaches or feel dizzy during the day? 

If I turn off FLEX tonight, will that help? 

Should I raise my minimum pressure from 12 to 13?

[Rtype]

Thx. I hope so too! 

Would the CPAP cause me to have headaches or feel dizzy during the day? 

If I turn off FLEX tonight, will that help? 

Should I raise my minimum pressure from 12 to 13?

If you decide to make equipment setting changes, make one change at a time, so you know what specifically worked or didn't work.   And then test the new setting for a couple days before further modifying it. 

Personally, I completely shut FLEX off from a setting of 3 first.  I've read others get benefit from turning it down to 1.   I noticed a significant improvement the next day.  Immediate effect.  Then, I titrated pressure upward from 24 to 25, then finally to 26 for my inspiratory pressure.  But, I increased my expiratory pressure from 19 to 21, then 22.   

I made these changes rather quickly, over the course of less than a week after getting a completely new machine and changing from CPAP to Bi-PAP, but have 13 years experience with CPAP-Dependent Sleep Apnea.

[Sleeprider]

I'm looking forward to the Resmed, so I really don't know what to say about the current machine. Flex is a true comfort feature. Some like AFlex, some like CFlex and some like it off. It's not very comparable to what you will experience with Resmed EPR.

I just wanted to add, your doctor's comments raise an important issues. Most doctors do not discuss what is best practice, or what their knowledge should tell them is the solution that will give you the best results. Instead, like your doctor, they tell you how hard it is to get insurance approval for a particular therapy. I don't give a rat's ass what your insurance is going to do, although I do take that into consideration because it's important for people that can't afford to do what's right, as opposed to what's covered. I think the Resmed Autoset with EPR stands a very good chance of solving your problem, and I'm glad you have the chance to try it without risk. On the other hand, I'm disappointed that a professional in the field of sleep medicine would rather do what is easy, or what insurance tells them to do, or perhaps is so uninvolved and following rote procedure that she doesn't care, rather than using her knowledge and current research to do what is right. It's entirely possible your doctor is a moron, and really doesn't know better. Either way, I would find someone else after the compliance period is satisfied.

[avaholic]

I learned 2 things last night.

1 - you guys obviously know what the heck you're talking about! I wish I hadn't waited so long to listen. 
2 - my body can not deal with 'FLEX' at all.

I slept much much better last night with FLEX disabled. I know that a bit over 5 AHI is not great but after having many AHI 9-15 nights previously, AHI 5 is terrific IMHO. I notice on last night's chart that my central apneas were much lower than obstructive apneas. Does this mean that FLEX was actually causing those 'fake' centrals previously?

Thursday
[attachment=8255]

I'm still trying to grasp the concepts of this leak data using:
http://www.apneaboard.com/wiki/index.php..._Leak_Data

My leak stats from last night.

Leak Rate
Rate of detected mask leakage (L/min)
W-Avg: 11.50 6.00 10.00 18.00 29.00

Total Leaks
Detected mask leakage including natural Mask leakages (L/min)
W-Avg: 47.86 41.00 46.00 56.00 67.00

What do those stats mean exatly? 
Remember that I am a definite mouth breather probably 90% or more of both sleeping and waking hours.


A couple of zoomed in FR charts.

2 minutes of breathing. It appears that even with FLEX turned off, I get a spike above zero during exhalation. What does that mean?
[attachment=8256]

12 minutes of sleep with events. Are these 'real' events?
[attachment=8257]


Note I should be receiving the ResMed 10 AutoSet **hopefully** sometime next week but that means I need to try and get the best usage of this unit for a few more nights.

Thanks!

[sheepless]

something to put on the back burner as you have more immediate things to address (events and a new machine).

you had 14 periodic leg movements (4.3/hr) on cpap during the second half of your sleep study. 100% of them caused arousals. apparently that isn't a lot of plm but to me it's desirable to minimize any and all arousals. plus yours occurred in one short snapshot of time that may or may not accurately characterize your plm. you may be experiencing more (or less).

IDK if significant: all plm during your study appear to have occurred when pressure reached the max for the night at 14cm.

based on very slim evidence (one report from my wife that I was awakened by plm followed by a look at the flow rate graph leading up to that awakening), I suspect - wonder if, might be more accurate - the flow pattern in your 12 minute chart might be indicative of plm.

I have no evidence other than the one association to confirm this and I have not yet figured out what to do about it. I'm just mentioning as something to watch for, particularly if you continue to feel unrested after you get your ahi down and because 'they' don't seem to pay much if any attention to disturbances other than apnea and to a lesser degree, hypopnea.

[Sleeprider]

I can’t wait to get you on the Autoset with EPR to see if we can make a dent on those flow limits. Glad to see you finally got the message on Flex.

[Rtype]

I learned 2 things last night.

1 - you guys obviously know what the heck you're talking about! I wish I hadn't waited so long to listen. 
2 - my body can not deal with 'FLEX' at all.

I slept much much better last night with FLEX disabled. I know that a bit over 5 AHI is not great but after having many AHI 9-15 nights previously, AHI 5 is terrific IMHO. I notice on last night's chart that my central apneas were much lower than obstructive apneas. Does this mean that FLEX was actually causing those 'fake' centrals previously?

Congratulations on getting some better sleep after turning FLEX off.  Did your headaches/dizziness improve after better sleep?

Based on your Sleepyhead chart, I would consider raising your minimum pressure to 13, as your machine is consistently increasing your pressure to 13 throughout the night, and at times up to 14.  

Remember though, whenever you increase pressure, you may need to anticipate more leakage and tighten mask straps down a tad more.

[avaholic]

"Did your headaches/dizziness improve after better sleep?"

It's definitely better but I still had a headache this morning. Although, I've noticed I have not experienced much dizziness so far today. 

I thought perhaps my mask straps were too tight but after loosening them and testing the mask at pressure, it immediately started to leak. I think the way its currently set is as loose as it can be before tons of leakage occurs. 

Were those leak stats good enough or is there still too much leaking?