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[Pressure] Best settings for my machine?
#1
Hi all. I've been lurking on and off for months. You've been real helpful.

My CPAP therapy seems to be going downhill, and I don't know why. No new meds, life changes, etc. Just a steady decline in therapy, and increasing AHI. Used to be 0.2 a couple months ago, now up to 4.0 and increasing. I'm feeling puny and my blood pressure is going up. I have mixed type apnea.

I've got a Philips Respironics RemStar Pro, C-Flex +. Pressure is 12.5, found during sleep studies.

Along with the increasing AHI, I now awaken nearly every morning between 2 and 3 am, very bloated, and have a difficult time going back to sleep. The machine is pumping air into my belly all night long. I suspect these new apnea episodes are central and not obstructive.

I don't have the C-Flex feature turned on. I suspect this could help, but thought I'd get some advice from more experienced people before trying anything.

My PCP doesn't really want to participate in my sleep therapy. He prefers to refer me to a sleep doc for everything, but insurance won't allow the referral - once per 12 months. I will probably have to find another doc who is more cooperative with my sleep med needs, but this is another hill to climb another day.

In the meantime do you have any suggestions what I can do? Any suggestions are welcome - sleep angle, pressure settings, C-Flex settings, new machine, etc. Thanks much.

--Chuck
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#2
I am not a doctor. Never even thought about being one.

That said, if you are indeed experiencing central events, raising the pressure will probably not help any. In most cases, raising the pressure will cause more central events rather than less.

I wasn't sure what C-flex was so I looked it up. It seems to be just a exhale/inhale pressure relief.

I couldn't tell if the Pro was an auto or a straight CPAP. I am guessing it is a straight CPAP.

Does the machine distinguish between central and obstructive events? Would the reported AHI include central events or just obstructive? An AHI below 5 is good.

You may be able to talk the PCP into helping you rent an oximeter for a few nights.

If the O2 is low but the AHI remains below 5, this would point toward central events.
If the O2 is within good range, then something else is to blame for you feeling ill.

How long have you had the machine? When was the last time you saw your sleep doc?
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#3
(04-03-2012, 11:51 AM)Chuck Wrote: In the meantime do you have any suggestions what I can do? Any suggestions are welcome - sleep angle, pressure settings, C-Flex settings, new machine, etc. Thanks much.

--Chuck
Hi Chuck, welcome to apneaboard
As Paula mentioned raising the pressure might cause more central in some people
The bloating feeling you describe is called 'aerophagia' swallowing air while on CPAP therapy, the treatment air goes into the stomach instead going to the lungs. Some find adjusting sleeping position and and placing a brick or two to raise the top end of the bed help to keep the airway open.
Turn the Flex to the maximum setting (3) so it will reduce the pressure at exhale by 3cm, so if your set pressure is 10 it reduce to 7 when you exhale and make more comfortable.
Another suggestion talk to the Doc about lowering the prescribed pressure, lowering the pressure by few cm,s would help and make the therapy more comfortable and tolerable to cope with and over time the pressure can be raised gradually to the prescribed pressure. The compromise is better than discomfort and not using CPAP. Usually the bloated feeling should settle down over time but some people find switching to APAP help as the pressure adjust breath by breath while asleep.
Another group of people find Bilevel machines helps as the difference between inhale and exhale pressures can be set much higher than 3cm.







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#4
You have already gotten a lot of good advice from Paula and Zonk.

I noticed from your profile you were not using software. You might want to consider using it and trending it over time.

There are links to the ResScan software http://www.apneaboard.com/forums/Thread-...nload-Link

and SleepyHead software http://www.apneaboard.com/forums/Thread-...e-software

Sorry you are dealing with uncooperative docs.

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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#5
Swallowing Air; New Bipap User Having Trouble With Bloating
http://www.apneaboard.com/forums/Thread-...aerophagia
........................................................................................
Another Noob from NC; Introduction
http://www.apneaboard.com/forums/Thread-...aerophagia
...................................................................................
Aerophagia
http://www.apneaboard.com/forums/Thread-...aerophagia
...........................................................................................
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#6
Thanks for the replies.
I want to check out the software, so I will try loading it tonight.
I definitely feel (without hard evidence, just a feeling) that my current pressure is too high. It used to be a good pressure, but I've been feeling much better lately, getting healthier, and perhaps need less pressure. I'm of a mind to decrease the pressure (slowly per your instructions in other threads). I read that high pressures can increase centrals.
I will change the flex setting.
Can anybody explain the difference between the C-Flex and the C-Flex Plus features? The manual (I have both the professional and user manuals) doesn't explain it well.
The machine's record available on the display shows only total AHI and periodic breathing, not central vs obstructive events. I understand that 4.0 is "good," but I'm feeling pretty miserable, more so as the AHI number has been creeping upwards this past month or so. I wake up with chest pains and feel and look terrible.
FYI, I took to CPAP like a fish to water. 1st night on it, I used it 5 hours. 2nd night, 7 hours. Every night since then - almost a year ago - 8 hours. I improved a great deal very quickly. It has occurred to me that I may need a bilevel or auto (or both) machine. I will have to check out the gray market for that. PMs are welcome.
My mask is a ResMed Quattro full-face. I didn't like nasal masks or pads. I prefer the full-face.
More asides / hx - my sleep studies weren't done well - I had 3 total in a short period. Then the place I went to went out of business. My doc never got a copy of the final (titration) study, but he and I both got word from the clinic that the pressure was 13 (I recently lowered it to 12.5). I am of healthy weight for my height, exercise regularly, but have a big neck (18.5" at 5'10") and had a CVA at age 31, which is when the CSA began.
My doctor isn't interested in working on my sleep issues, although he will write an order if I am loud enough. He says it's not a specialty of his. I'm willing to change the pressure on my own. If doc had his way he'd send me to a sleep specialist, a cardiologist, a neurologist and a gastroenterologist. No thanks.
Thanks again.

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#7
(04-03-2012, 07:12 PM)Chuck Wrote: Can anybody explain the difference between the C-Flex and the C-Flex Plus features? The manual (I have both the professional and user manuals) doesn't explain it well.
Philips Respironics Flex Family
http://flexfamily.respironics.com/

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#8
From my limited reading this morning (same link that Zonk posted above) the difference is the way it senses your breathing and how it responds. Pretty little graph images, though! LOL

If you are having more centrals, then perhaps a VPAP is what you need. It is for those with CSA but I think it can be used for mixed.

How long is the year date so you can see the sleep doc?

Start keeping a record of how you feel, kind of like a journal. Just simple notes of when you went to bed and when you got up and how you felt when you woke and/or during the night. If you have a blood pressure thingy, take your blood pressure every other day or so.

And I had a doc like yours once. I was wondering what I was seeing him for other than referrals. I understand that there are times when a referral is needed but come on!
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#9
Smile 
Hi chuck,
Air getting pushed into the stomach is more than likely caused by your head position when asleep,as will happen when administering c.p.r. to an unconscious person,unless the head is tilted back air can enter the stomach,when you are asleep and your airway is relaxed the same thing can occur.
Try using a flatter pillow(or no pillow at all,pretty uncomfortable though) this should do the trick,it worked for me.

good luck,
Peter
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#10
You can also try to raise the head of the bed a few inches. I keep 2 2x4 under the feet of the headboard. (note: screw them together! else they slide)

Another member said he sleeps with his head bent, his chin on his chest practically. The idea is, for most people, they cannot swallow if the head is bent. This does not work for me as I can still swallow and I would find it very uncomfortable quickly. But it worked wonders for him and that's what matters.
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