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[Pressure] Need some help to find right pressure
#1
Need some help to find right pressure
Greetings,
I had a sleep study below are the results

 Sleep Disordered Breathing: Severe SDB, with a respiratory event index (REI/AHI) of 31/hr. The majority of events were obstructive, consisting mainly of hypopneas. Events occurred more frequently in the supine position (REISUPINE= 35 vs.
REINONSUPINE= 20). The patient spent 69% of the MT in the supine position.
Oxyhemoglobin Saturation: : Severely disturbed. Baseline O2 saturation was 93%. The oxygen desaturation index (ODI) ≥ 4%
was 28.3. Mean O2 saturation was 90% and the patient spent 49.6% of study time with an O2 saturation < 90%. Minimum O2
saturation was 82%.
Cardiac: The average heart rate was 58 bpm and the highest recorded heart rate was 94 bpm.
Miscellaneous: Moderate snoring was detected.
Subjective: The patient rated the quality of sleep as worse than usual.
IMPRESSION:
Severe OSA, not only supine-sleep related, with severely disturbed nocturnal oxygenation. (G47.33, G47.10)


Doctor ordered auto CPAP 5-20 AHI never got below 25 in 3 weeks Doctor changed it to 8-20, AHI to 12. Then Doctor changed it again to 9-20, AHI back up to 15. Lots of changing by the doctor with no explanation why he was making the change. It is time I take the reins and take this Dreamstation for a pressure test drive myself, hopefully knowing why I am changing pressure. here are 3 Oscar screenshots 1 at 5-20 one at 8-20 and one at 9-20. Any advice would be really appreciated.


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#2
RE: Need some help to find right pressure
Hopefully these charts are better. kinda new at this...


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#3
RE: Need some help to find right pressure
G'day Ben. Welcome to Apnea Board.

Thanks for posting your daily charts. I suggest you read up on the best way to format and post your charts to get the best value out of them. The default outputs give us a fair bit of less useful information and cover up some of the important stuff. (The Oscar developers are working on a fix). See the instructions here: http://www.apneaboard.com/wiki/index.php...ganization

Looking at your charts the first thing to catch my eye was the high number of central (clear airway) apneas. These occur when the "breathe now" message from the brain to the lungs isn't sent or received appropriately. Many new CPAP users experience centrals for a while and they will often go away of their own accord. However we need to know if they occurred before you used the machine. Therefore, can you please post the full version of the sleep report, including all the tables? Quite often there is important information there which is overlooked in the summary.

Once we have a handle on whether the central apneas are endemic or pressure-induced we'll be in a position to offer some better advice.
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#4
RE: Need some help to find right pressure
Thanks for helping me out
Sorry about the graph formatting I will correct that. 
I have no tables or anything as far as the sleep study goes its a one page report. I did remove a couple of lines becaus eI thought them to be useless but I have re copied and pasted full report below.


Reason for study: High Pre-Test Probability of OSAHS; habitual snoring, with daytime hypersomnolence
Type of study: Home Sleep Apnea Test (HSAT) - Type 3 monitor (4 - 7 channels)
The patient was taking AMLODIPINE, CELEBREX,and OMEPRAZOLE at the time of the test.
The patient reported no alcohol consumption prior to the study. The study quality was considered technically adequate. The recording
start time was 9:51:26 PM and end time was 5:29:20 AM, for a total monitoring time (MT) of 457.9 minutes. The patient was
instructed and supervised in the application of the sensors by a sleep technologist. For the identification of RE (respiratory events) an
oronasal thermal airflow sensor/nasal pressure transducer was use. Respiratory effort was measured using a single RIP belt. The
sleep specialist interpreting this study conducted an epoch-by-epoch review of the raw data recording.
Sleep Disordered Breathing: Severe SDB, with a respiratory event index (REI/AHI) of 31/hr. The majority of events were
obstructive, consisting mainly of hypopneas. Events occurred more frequently in the supine position (REISUPINE= 35 vs.
REINONSUPINE= 20). The patient spent 69% of the MT in the supine position.
Oxyhemoglobin Saturation: : Severely disturbed. Baseline O2 saturation was 93%. The oxygen desaturation index (ODI) ≥ 4%
was 28.3. Mean O2 saturation was 90% and the patient spent 49.6% of study time with an O2 saturation < 90%. Minimum O2
saturation was 82%.
Cardiac: The average heart rate was 58 bpm and the highest recorded heart rate was 94 bpm.
Miscellaneous: Moderate snoring was detected.
Subjective: The patient rated the quality of sleep as worse than usual.
IMPRESSION:
1. Severe OSA, not only supine-sleep related, with severely disturbed nocturnal oxygenation. (G47.33, G47.10)
RECOMMENDATIONS:
1. Treatment for this severity of SDB, in general, may include CPAP, oral appliance, ENT surgery, and behavioral modification
(restrict sleep to non-supine position, recommend weight loss, if appropriate, and avoidance of alcohol / sedating
medications).
2. CPAP is the most reliable therapy for this degree of SDB, and is preferred when associated with significant daytime
sleepiness, disturbed nocturnal oxygenation, or comorbidities.
3. Obstructive sleep apnea has been associated with hypertension, cardiovascular disease, and diabetes. Given these
associations, further evaluation and management should be considered if indicated. 
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#5
RE: Need some help to find right pressure
FYI that is the summary. There are usually charts with the full report.
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#6
RE: Need some help to find right pressure
And no mention of event breakdown and no Centrals of any type mentioned, again this doesn't mean they aren't there.
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#7
RE: Need some help to find right pressure
Ben, you have what appears to be treatment emergent central apnea. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721059/
You will ultimately have to follow your doctor's instructions and demonstrate whether the condition clears up, or resolves. In many cases, this condition results in the user requiring an advanced bilevel machine known as Adaptive Servo Ventilation (ASV) which treats obstructive apnea using an auto-adjusting base pressure (EPAP), and providing pressure support as needed, when needed to treat hypopnea, central apnea and even periodic breathing. ASV is a relatively expensive machine, and insurance requires that you first fail at CPAP and often BiPAP. Please see the Wiki article Justifying Advanced PAP http://www.apneaboard.com/wiki/index.php...P_Machines
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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