No relief after 1 year of CPAP

[Apnea Infant]

Hello

No experience to add to all other replies but just a reminder that any imported products are subject to tax. I was sent a request a bit after my APAP import last year and that was a a little sum (can't remember exact amount). So whilst importing was a little cheaper it was not that much at the end.

Resmed machines are considered reputable but I wonder how any 'guarantee' repairs might be carried out. Might be something to check before finally committing to sending that wad of cash.......

[PoolQ]

pretty much, but I can tell you that last night I slept great and not so much the night before (too warm). I went to a sleep doctor because I was not sleeping well, now if I wanted to know what part of sleep was being disrupted, then yep EEG.

[Larch45]

I am going to preface my comments by stating I am not a doctor and what I am going to suggest is only based on my own experience, however if it helps I will be pleased to have offered this information.

Almost 20 years ago I had my first sleep study and trial with a CPAP. I couldn't handle it because of the condensation. At that time there did not have heated hoses. I gave up the idea of CPAP (I have since become a CPAP user) but was also dealing with a weight problem. I recall clearly reading "the Chocolate Addicts Diet" while they were prepping me for the night. I began to follow that diet and have for the last 20 years. When I started the diet I was pleasantly surprised to find my daytime sleepiness melt away. It was a completely unexpected result. My understanding is this is a result of better regulation of my blood sugar.

My snoring and my husband moving to another bedroom a few years ago drove me back to have another sleep study. Daytime sleepiness wan't my problem, just my load snoring. I use the dreamwear nasal mask and a 9 CPAP level.

I will also offer some advice on the coughing. I have asthma with my only symptom being a cough. I have two triggers. If I take my morning vitamins or medicine with too little water my right side of my throat will have a flem buildup that creates a need to cough. The doctor explained that the right bronchial tube is closer to the esophagus and acid and particles from my vitamins were coming back up my esophagus and entering my airway. It is a form of asthma as the bronchial tube is reacting and causing breathing difficulty. I have solved this by drinking plenty of water with my medicine and vitamins. 

My other trigger is psyllium. I began using psyllium for digestive health and found it causes asthmatic coughing. I stopped the psyllium and the cough stopped. I tried this a few times just to confirm and it was definitely the psyllium causing the problem. I have since changed to oatmeal.

Look carefully at your medicines and food intake to see if you can isolate your asthma triggers. Good luck

Larch45

[bpn1]

Big update: I have now received the machine (Resmed Aircurve 10 VAuto) and I have a SD card for it already. Are there are recommendations for where I should start for settings? I was thinking Min EPAP 6, Max IPAP 13, PS 4.0 for a range of (6, 10)  to (9, 13). Usually I get little to no obstructive events with EPAP 7, and I can't really tolerate an EPAP higher than about 9 right now. I've also switched to using the Resmed Swift FX Nano nasal mask.

I'm a bit more interested in things like trigger sensitivity and timing, I'll attach one of the recent nights with my old machine. I was running EPAP 8, IPAP 11 via C-Flex. The flattening around flow rate=0 makes me think that triggering may have been an issue?

   

Lastly, while I was sorting out the machine and waiting for delivery, I used the cervical collar for a few nights, didn't help. What may have helped (possibly) is adding another pillow when I sleep. A bit early to tell, but it seems to improve things slightly.

[jaswilliams]

On the VAuto I would not limit the Max Ipap it will only go as high as it wants to

[PoolQ]

Well congrats on the new machine. Others here will give you much better advice on pressure settings, but do to the time differences your suggested starting point does not sound bad. Worth a try if no one gets back before you sleep.


So here is what Trigger, Cycle, and Timin/max do:

Trigger is how sensitive the machine is to detecting when you start to inhale. This was the most important thing for me and I needed to make it 2 settings more sensitive

Cycle is for at the other end, detecting when you stop inhaling

Ti min will keep the pressure up for at least that long if you try and breathe shallow
Ti max will cut you off (drop pressure) if you try and breathe too long.

Ti settings. These were not a real problem for me as far as treatment goes. you Doctor will set these if you have more specific things going on. I breathe slowly, nothing wrong, just 3+ seconds for an inhale when I sleep. If Ti max is set too short it will feel like right at the end of an inhale someone is covering your nose and cutting off your breathing. If you just set TiMax to 4-5 seconds it will just not do anything to your breathing.

Now for the Trigger and Cycle. For me this was trial and error, but I did not have to actually sleep to test them out.
Give yourself some time to play with the settings where you can relax. make one step adjustment and lay there and see if it's better, worse, or no change. Give it a couple steps before you decide to try the other setting. Then get them both set to the best and try them together and then overnight.


For me it was not a huge change, but I could get a kind of general "better" or "worse" on trigger and did not notice anything with cycle


http://ccn.aacnjournals.org/content/31/3/30.full
so this is the article that got me thinking about all of this. I know this is for ventilators and not CPAP, but it is about how some settings that both of these have in common and how we react to them. Look at what they say is the impact and importance of settings

[Sleeprider]

I like your initial pressure settings, and in your case, I disagree that you should let IPAP run up to whatever happens. There is a good chance that your flow limits would raise pressure higher than you would be comfortable with. Once we see how 6 to 13, PS 4.0 works out, we can do some fine-tuning. Good luck!

[bpn1]

Well congrats on the new machine. Others here will give you much better advice on pressure settings, but do to the time differences your suggested starting point does not sound bad. Worth a try if no one gets back before you sleep.


So here is what Trigger, Cycle, and Timin/max do:

Trigger is how sensitive the machine is to detecting when you start to inhale. This was the most important thing for me and I needed to make it 2 settings more sensitive

Cycle is for at the other end, detecting when you stop inhaling

Ti min will keep the pressure up for at least that long if you try and breathe shallow
Ti max will cut you off (drop pressure) if you try and breathe too long.

Ti settings. These were not a real problem for me as far as treatment goes. you Doctor will set these if you have more specific things going on. I breathe slowly, nothing wrong, just 3+ seconds for an inhale when I sleep. If Ti max is set too short it will feel like right at the end of an inhale someone is covering your nose and cutting off your breathing. If you just set TiMax to 4-5 seconds it will just not do anything to your breathing.

Now for the Trigger and Cycle. For me this was trial and error, but I did not have to actually sleep to test them out.
Give yourself some time to play with the settings where you can relax. make one step adjustment and lay there and see if it's better, worse, or no change. Give it a couple steps before you decide to try the other setting. Then get them both set to the best and try them together and then overnight.


For me it was not a huge change, but I could get a kind of general "better" or "worse" on trigger and did not notice anything with cycle


http://ccn.aacnjournals.org/content/31/3/30.full
so this is the article that got me thinking about all of this. I know this is for ventilators and not CPAP, but it is about how some settings that both of these have in common and how we react to them. Look at what they say is the impact and importance of settings

I like your initial pressure settings, and in your case, I disagree that you should let IPAP run up to whatever happens. There is a good chance that your flow limits would raise pressure higher than you would be comfortable with.  Once we see how 6 to 13, PS 4.0 works out, we can do some fine-tuning.  Good luck!

Thanks for the advice you two. I have last nights data, but unfortunately there doesn't seem to be much improvement. The settings I used were as stated above, and I set trigger sensitivity to very high.

Something I've noticed is that while I'm lying down in bed I tend to 'forget' to breathe for a few seconds and then 'remember' when I'm breathing shallowly like I usually do. I wonder whether this could have anything to do with my problems. I've only noticed it since I've been using the BiLevel technology, but I wonder whether this could have been occurring before even.

   
   

Some observations:

• I seem to get pretty serious oscillation of my flow rate in the areas which I can pick out as 'bad' sleep. I imagine there is a lot of arousal there. This is always reflected very well in the tidal volume.
  
• My inspiration and expiration times seem to be all over the place.
  
• The 'average' waveform for my flow rate seems to be pretty similar to my old machine, maybe a bit better due to the triggering? As far as I can tell it doesn't look how breathing 'should' look.
  
• The machine seems to want to ramp up the pressure to the max at times, but this doesn't seem to resolve anything.
  

I think it may be worth looking at my pulse and oxygen saturation, although I'm fairly confident my pulse rate will mirror the fluctuations in tidal volume. I am hoping that it doesn't turn out that I needed an ASV or something. For tonight I will probably just increase the max IPAP by 1.0 and leave it at that for now.

[PoolQ]

Your CA's are 0.0 now I may be wrong but I doubt you need ASV. Others will reply with more confidence

So when you lay down do you just start inhaling shallower and shallower until you stop and then take a couple deep breathes and start the cycle again? This is what I was doing and got them to test me for COPD. With me the COPD and Sleep Apnea were mixed together and masking each other. I could not find the right settings until after I was treated (inhaler) for COPD and then the settings settled down and were fine.

Will wait for some others to chime in.

[Sleeprider]

I'd like to see a close up of typical flow rate wave-form where flow limitation is not high. This new graph actually looks okay, but I think there is still some hypopnea and flow limits. AHI is still low and we have not seen the emergence of any CA events. Tidal volume has improved and the inspiration/expiration times look normal now, rather than inverted as with the Philips CPAP. If you want to try clearing this up a bit more, I'd like to increase EPA EPAP min to 6.6 and pressure support to 5.0 cm. IPAP max will have to move to 14 to allow these higher settings.

For some reason, only EPAP is showing on the pressure graph. I will reserve judgement on the trigger sensitivity until we see the graph, but I'm inclined to say high rather than very high. Let's also consider Ti Min and max when we see the close-up. ASV is absolutely not a consideration here.