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Over a month and no improvement
#1
Over a month and no improvement
So I have been on my Dreamstation CPAP daily for over a month now. And I can honestly say I feel absolutely no improvement:  do not feel rested upon waking or any time of day, tired all of the time and if I sit down to read or do something quiet in the afternoon, I drift off in no time flat.

I am trying to understand my data from OSCAR to see if there might be good explanation for my lack of improvement.  Attached is a screenshot of one of my typical night's data.
Really would appreciate any guidance here, thanks.

   
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#2
RE: Over a month and no improvement
Ask your supplier if they will allow you to swap the Dreamstation for a Resmed Airsense 10 Autoset. The Resmed machine uses exhale pressure relief that is actually bilevel pressure of up to 3-cm difference between inhale and exhale (i.e. pressure support). Pressure support has a direct therapeutic effect on flow limitation, RERA and Hypopnea. If you zoom in on your flow rate chart in Oscar, you may see a lot of the inspiration waves are flat or downward sloping, rather than nice and rounded. That is inspiratory flow limitation http://www.apneaboard.com/wiki/index.php...limitation

We can suggest increasing pressure to deal with the airway resistance that appears to be at the root of your problems with CPAP therapy. By increasing pressure you may improve the resistance in the upper airway. It's not as good as pressure support, but it's the only tool in the box with Philips. I suggest increasing minimum pressure by 1-cm increments until you really feel some relief. Your minimum pressure is quite low, and there is plenty of room to increase it and probably improve all those snores, RERA, FL and hypopnea. Once characteristic of the Philips Autos CPAP is that it is very reluctant to increase pressure, so you have to manually increase the minimum for problems like this. It is the respiratory effort required to overcome the flow limitation that is causing micro arousals and keeping you from feeling rested.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: Over a month and no improvement
Thanks so much for this great insight.

I had been looking at the data on the machine and in the dream mapper app, and everything looked pretty good to my untrained eye -- AHI, pressures, leak, so I thought that I was doing well.

I was a bit lost looking at the data from OSCAR and certainly never would have discovered a flow limitation problem.

I will try to work on increasing the min pressure gradually to see if that does the trick.  If I went with the Resmed machine it would be at my expense -- a bit reluctant to try that right off.

What a great resource this board is.  So glad that I found it.  The information can be a bit overwhelming for a newbie  though.

Sincere thanks.
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#4
RE: Over a month and no improvement
Another edit that may help for now is reducing flex from 3 down to 2. Flex 3 has been reported to be disruptive.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Over a month and no improvement
I'm sure you will do better with higher minimum pressure. I agree with Dave. I had Philips CPAP once upon a time, and Flex over a setting of 2 was a problem with breathing sync.
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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#6
RE: Over a month and no improvement
Will give this a try as well... thanks
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#7
RE: Over a month and no improvement
Another quick question:

Would the Resmed Airsense 10 Autoset be considered the current optimal treatment for this flow limitation?

Going to give adjusting the min pressure a try for now -- just thinking ahead to other options.

Thanks
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#8
RE: Over a month and no improvement
I'd say yes go for the AutoSet. It's far more capable at dealing with your events. You'd gain EPR, a 3 cmH2O limited pressure support. That alone is worth gaining over Philips flex.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Over a month and no improvement
For some people whose sleep is really disrupted by flow limitation, additional pressure support is needed. For that, a ResMed Aircurve VAuto would be advisable. But you're very far from a point at which you'd really want to give that consideration.

When you zoom in to look at your flow rate, in addition to flat tops and downward slopes, also look for dents in the top.
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