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[Pressure] Pressure Range Assistance
#11
[quote pid='189403' dateline='1485281562']
 I no longer get up nearly as often as I did before I started therapy.
[/quote]

Quite a few people report a decrease in nocturia.

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JustMongo passed away in August 2017
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~ Rest in Peace ~
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#12
Hi Autarch,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and getting it fine-tuned to meet your needs.
Hang in there for more responses to your post.
trish6hundred
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#13
That was a tad more intense. I ran with 9-20 last night. I woke up in the middle of the night with it at 16 and could not go back to sleep with the pressure that high, since I'm not use to it I assume, so I restarted the machine so it would start back over at 9. 
   
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#14
With obstructive events that prolific, we have often seen improvements by doing some things with body position. For some, using a soft cervical collar works to keep the chin from moving to the chest, and cutting the airway. Others find they need to stay off their back. If you have any reason to believe that your head drops towards your chest, and this might be a problem, a soft cervical collar is inexpensive (under $20) and is effective. If you found yourself on your back, you might need to find ways to avoid that position in sleep.

All of this is based on the assumption that your apnea events are obstructive, and that pressure may reduce their occurrence. That assumption may be in error. An alternative possibility is that you are actually experiencing central events that are being recorded as obstructive. What we have seen so far, is that your event rate is correlated to increased pressure...the higher the pressure, the more events you are experiencing. I don't think we should ignore the possibility that this is a form of complex or mixed apnea. If you would like to evaluate this possibility (kind of a long shot), then set your machine to CPAP pressure at 8.0 without flex. If the number of events drops significantly, your problem is not simple obstructive sleep apnea. You can set a CPAP mode on your machine without changing the setting in the auto mode, so you can return to the auto mode easily if the experiment with lower pressure CPAP fails.

It's really up to you how to pursue this. You don't have a lot of diagnostic information to work from, and were not provided a titration study. If a suspicion of complex apnea is affirmed, you will need some additional help from your doctor to get the right equipment. Even if you end up pursuing simple obstructive sleep apnea, you may need to be evaluated (titrated) for bilevel PAP therapy since you do not tolerate pressures above 16 cm.

Let me know what you think.
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#15
(01-25-2017, 09:24 AM)Sleeprider Wrote: With obstructive events that prolific, we have often seen improvements by doing some things with body position.  For some, using a soft cervical collar works to keep the chin from moving to the chest, and cutting the airway.  Others find they need to stay off their back.  If you have any reason to believe that your head drops towards your chest, and this might be a problem, a soft cervical collar is inexpensive (under $20) and is effective.   If you found yourself on your back, you might need to find ways to avoid that position in sleep.  

All of this is based on the assumption that your apnea events are obstructive, and that pressure may reduce their occurrence.  That assumption may be in error.  An alternative possibility is that you are actually experiencing central events that are being recorded as obstructive.  What we have seen so far, is that your event rate is correlated to increased pressure...the higher the pressure, the more events you are experiencing.  I don't think we should ignore the possibility that this is a form of complex or mixed apnea.   If you would like to evaluate this possibility (kind of a long shot), then set your machine to CPAP pressure at 8.0 without flex.  If the number of events drops significantly, your problem is not simple obstructive sleep apnea.   You can set a CPAP mode on your machine without changing the setting in the auto mode, so you can return to the auto mode easily if the experiment with lower pressure CPAP fails.

Since I should be able to post links now let me link to more data. Previous I had a 'brick' for about a week and then realized I could not pull any data and took it back for the auto. 
https://drive.google.com/open?id=0B9ZSlp-Tx7r8cThPcUlEbE10cGM This includes 4 days of data at a fixed 7 without flex. I looked over it and the obstruction events are sometimes in the thirties and then as high as fifty. I'm not sure if that meets the goal of the test you were looking for.

Is there specific info from my diagnostic which I can provide? My sleep study was an at home one, I knew I should have copied the data off the card.

Edit. I added some photos from my diagnosis paperwork to that folder as well.
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#16
That's a lot of information. Your best result was at 10 cm fixed. You might try that without flex and see if it is improved. I think you're going to find the ideal pressure is in a narrow band or fixed, and that you may not achieve a consistent AHI below 5 with CPAP. Your diagnostic study confirms that you have a considerable central apnea component to deal with. Also, your recommended pressure was 7.0 CPAP (predicted), and that is not too far off.

I would try to focus on pressures around 10, and avoid variable pressures for a while, trying to find what works "best". I would also anticipate you may eventually require ASV, however we have seen some members with complex apnea that achieve good enough results with CPAP that it becomes a reasonably good treatment.
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#17
I uploaded last nights where I had tried 7-13 and it still hung around 13 but as before there seems to be clusters of obstructive at the higher pressure of 13 if I am reading it correctly. 
I've also disabled flex for now as I think the change in pressure bugs me, at least currently at the pressures I am using.

So you're interpretation of data and the diagnostic as that the CPAP is treating the obstructional part of the mixed thus my drop from an AHI of 24 to 8-12 and that the central is the component keeping me above 5?

I am going to try and get all the data I have to my doctor and see what they suggest as well but for now I'll try and set it to 10 as you suggested.
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#18
I think you are experiencing similar issues to the member in this thread http://www.apneaboard.com/forums/Thread-...gh-numbers

Now the solutions we are suggesting there, are somewhat different than what is being recommended for you, but the strategy is the same. You appear to have a complex apnea, in which the pressure from your CPAP actually causes apnea clusters at higher pressure. Although they are being recorded as obstructive, this is a form of central apnea. In our experience, this is best treated through constant, unchanging pressure calibrated to reduce actual obstructive events, but not to exceed that pressure or fall below it. The auto algorithm built into your machine is not well-suited to adjusting pressure in individuals with central apnea characteristics, so we use a fixed pressure.

Many doctors are not very familiar with CPAP induced apnea (a.k.a. complex apnea), but you can search for that subject online. Understanding the issue we are trying to address here may help you in your discussion.
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#19
I'll try and run at 10 with flex off but still in apap mode as you suggested in the other thread in order to keep all the data.
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#20
Last night was 2nd best so far @ 6.26 AHI. I added the screenshot to the folder but here is the direct link. 
https://drive.google.com/open?id=0B9ZSlp...2tJaDV2eFk

When I woke about 3 and turned off the machine the AHI was between 4-5. It looks like after I got back in bed though that my leak rate was bouncing around. Would that have contributed to raising it for the 2nd half of the evening?
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