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[Pressure] Help Calibrating APAP Pressure
#71
RE: Help Calibrating APAP Pressure
Here is three snapshots from different nights, all on the VAuto.

I should add that I have my trigger set to high as of 06/30, if I recall correctly. I do not see a log of that change on OSCAR, so I will write down if if or when anything like that should change in the future.


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#72
RE: Help Calibrating APAP Pressure
It looks to me like you're being bitten by the characteristic consistently inconsistent attribute of CA. That's why I'm thinking you're going to want to look at the data and find a trend of some sort. When CA are lower you're not too bad by the numbers. But when CA spike, your numbers look correspondingly bad.

Unfortunate but I think time will need to be spent to see whether or not all of the VAuto tricks help enough. The 3 words for the goal IMO are trends of: comfort, rest, consistency.
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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#73
RE: Help Calibrating APAP Pressure
I think so too. I knew the moment I got the VAuto that I would be spending weeks just trying to establish a useful trend. It is comfortable enough, I don't mind wearing it necessarily, but I can't stay asleep and I feel very tired in the mornings. I still feel dizzy/headaches more often than not and somehow my memory/cognitive ability literally sways throughout the day. "Residual Sleepiness" is the slur that they call it, it's not, it's improper treatment. The brutal lesson here is not that some people just suffer from residual sleepiness or non-compliance, it's that people are given the wrong machines/pressures. But as long as compliance meets 4.5h and AHI is <5, who cares. I'm working on redacting my PSG from this last month, I'll post it soon.
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#74
RE: Help Calibrating APAP Pressure
OK yep I copy and have been there. In fact still an in that I'm waiting to go to Johns Hopkins pulmonary for COPD and Apnea testing.

It would be telling to see that PSG, specifically the events and count. There's other nuggets to dig out as well.
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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#75
RE: Help Calibrating APAP Pressure
Best of luck to you, Dave. I am grateful COPD is not something I have to deal with. Had I gone many years with untreated sleep apnea, I might have.
Here is my redacted PSG. I took out names, medical numbers, addresses, etc. with Acrobat which causes distortions in some of the document. Because of that, I have provided screenshots of the pages with charts for better clarity. Because of the upload size limit, I am going to have to break it into 3 parts- I will do my best to label and organize for easier viewing.
Interestingly, the computer in the lab crashed causing the data to be organized as two separate studies, however, conveniently (in a sense) I did not sleep much at all in the first half, so most of the useful data is probably located in the second part of the night. I was not aware this occurred until long after. I find it amusing how there was a note about how I woke up and told the tech the pressure he was giving me was too low and that I was correct. I do not know if he would have gone any higher if I had not done that. My first PSG was a disaster because they stopped at 6, when it later became clear I needed at least 9.


Attached Files
.pdf   Part 1 In Lab PSG 2021-06-10.pdf (Size: 1.01 MB / Downloads: 5)
.pdf   Part 2 In Lab PSG 2021-06-10.pdf (Size: 1 MB / Downloads: 5)
.pdf   Part 3 In Lab PSG 2021-06-10.pdf (Size: 313.34 KB / Downloads: 3)
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#76
RE: Help Calibrating APAP Pressure
Here are higher quality images of the charts from the PSG


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#77
RE: Help Calibrating APAP Pressure
I meet with my pulmonologist tomorrow. I plan on asking about going a month or two on the VAuto, and if there is no change in my daytime sleepiness, fragmented sleep, morning headaches/hard time keeping eyes open, and severe brain fog, if I can then rent an ASV for a month, just to see. Theoretically, it should be possible as I have no preexisting heart conditions. If insurance is going to be the only setback, then at some point I will ask for just the prescription its self so I can purchase a used one. My main problem, and I think most of us are victim to this in the sleep medicine field, is that I am trying to change the scope from looking at probability to start looking at possibility. When I did the order confirmation work over the phone with who I assume was an RT for the VAuto, I asked out of curiosity what my AHI was during my BiPap titration and I was told not to consider the number very much because it is about, "how you feel". It is all about that until you start throwing words around like ASV or VAuto and then you start seeing fingers flying on calculators.
Here are my last two nights on VAuto. I plan on lowering my pressure back to 9/5, trigger high.


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#78
RE: Help Calibrating APAP Pressure
OK well in PSG part 1, tech states sleep onset centrals and the breakdown has 20 CA ZERO Obstructive Apnea and 16 or so Hypopnea... CA make more that 50% of all events. You will have a high likeliness of needing ASV either now or soon.

So recap for us, is treatment good consistently? Do you think consistent CA treatment needs to improve? If yes, you need to point to the CA on your diagnostic and ask "shouldn't these pre-existing CA indicate I need ASV?".

I need to look at the rest later, I'm currently mobile.
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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#79
RE: Help Calibrating APAP Pressure
PS, the Titration of just a single pressure set and you had 10 CA, lots of sleep onset time, a few sleep sessions broken by wake times. And yet they call this successful? Ah but no Obstructive Apnea. See it is successful, but they forgot you had no Obstructive Apnea to be treated, just Hypopnea and Centrals.
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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#80
RE: Help Calibrating APAP Pressure
That is my thought as well. I have learned by now, the process will be slow, but I am going to push towards an ASV. No titration study, I just want to see if they will let me rent one, maybe see about a watchpat study or something. I'm not spending the time nor the money on another PSG since the ASV will  probably be the last destination anyway, insurance be darned. At my last appointment when I finally got the titration for Bipap approved, my doctor suggested looking into upper airway stimulation therapy, but that seems nonsensical at this point; from my perspective, if i can feel better, it will come from treating the central events- thus pointing back to ASV. Not to mention that particular treatment is far more expensive than all the machines combined, involves surgery, and may or may not help... However, I will give the VAuto its fair chance, especially to see about helping periodic breathing, FL, etc. This last PSG made me feel better about RLS, as it doesn't seem to be as big of a contributor as it could be and I have begun a higher dosage of gabapentin since then anyway.
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