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S mode vs CPAP
#1
Until last night, I had been in S mode, per dr's instructions, and following a sleep study in April, he had lowered initial pressures from 26/19 to 20/12, owing to excessive leak issues under the greater pressures. In addition, he increased my nighttime supplementary oxygen from 2-4, which gave an oximeter saturation reading of 98. But despite stubbornly resistant AHI numbers in the high moderate range, Dr is pleased at progress and has released me until December. I too am content to a degree, enjoying 4-5 hrs uninterrupted sleep before a single wake-up, followed by another 2-3 hrs sleep, and improved energy during the day. Still ...

If I may, I would like to direct this post to Paula02 in particular, as we have discussed this matter, in part, once before, and also as her pressure numbers are similar to my own ...at least until last night, when my AHI frustration led me to revert to CPAP mode, using the default 8 pressure.

I had switched to CPAP briefly, once before, quite by accident, and the change was immediate and astonishing, registering a week of AI's and AHI's approaching the norm. But when I notified DME, they reported the results to the Dr, who ordered a return to S mode and former pressures.

Last night, though, following my desire to somehow re-establish results in the mild if not entirely normal range, I switched again to CPAP, with the same remarkable results. My most recent S numbers were AI 25.2, AHI 25.9, 0 leaks, MV 7.8, and 8.2 hrs sleep. With CPAP, only one night later? AI 3.8, AHI 8.6, leaks 0, MV 6.1, 9 hrs sleep. I fully expect the CPAP results to get even better, they did before.

But the change brings up several questions:

-- Should I at some point increase or decrease the CPAP pressure?

-- Is there a chance the CPAP mode could lower my sats to under 90?

-- What other negative factors can come into play if I remain w/CPAP?

-- Dr's initial examination indicated a partially deviated septum, and listed my COPD, asthma, diabetes, hbp, mouth breather, etc. Did these elements lead to his 26/19 RX back in March?

-- I realize that one should not make large pressure changes all at once, but how else was I to achieve readings that I knew were possible?

-- In my recent appointment w/Dr he suggested I could return to the CPAP 8 if I really wanted to. I said I would think about it, but we made no real plan to do so, or to set up any other parameters to help achieve results.

-- Dr has also said that he does not believe my AHI's are either obstructive or central, nor are there any significant events in support of either. In fact, he says, "they may not be anything." Also, we have both noted that the number of leaks, even when excessive, have little effect on the apneas.

-- Some have suggested I would be better off in ST mode. How would that improve matters?

I know so little, especially about the effects of pressures, and I must admit this move to CPAP feels ...iffy and rushed, if not downright dangerous. I guess I need some reassurance and guidance. Thanks, everyone. And a special thanks to Paula02. Jim
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#2
In S mode, the machine is running as a bilevel. The machine lowers exhalation pressure.
With COPD, this is often needed to permit proper exhalation. I'm going to guess that is the reason your doc insists on S mode.
A Pressure Support (PS) of 8 (20-12) is a wide split. You must really need it.

Why don't you get the software and look at what type of events are being recorded. (CA, OA, HA)
Right now, you are "stabbing in the dark."

Your questions are premature. You are thinking too far ahead.

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#3
Then I should just settle down and ignore AHI numbers and just stay with the status quo? All I can say is that readings have remained in the high moderate area for over 3 months, and if that is to be the limit of my therapy, then I wonder why we are so concerned about the numbers after all. Dr said once that I might not get much better than this. If he's right, ok, but I would just like to be more certain. And then I can forget all the questions And settle for what I have, which is a lot, actually, and I don't mean to set aside the progress the therapy has given me. But if there is more out there, if there is something missing, I want it.

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#4
you have a great attitude to want the best therapy you can get. You have a lot of medical issues that probably make things harder to get really low AHI but I wouldn't say it is impossible. What are you doing for the mouth breathing? I can't help you with the copd, asthma and afib or diabetes for that matter except that I heard that DioVasc supplements can help with diabetes. As always, ask your doctor because what I hear may not be accurate and your doctor knows your history when I don't.
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#5
ff masks for the mouth breathing -- alternate between simplus and mirage quattro, both of which are great on leaks. the mouth breathing gives me an occasional dry mouth, but not terribly uncomfortable. i'm a type II diabetic, glucose under control, and I have found that the apnea therapy has brought my A1C down to 5.8, which was quite a pleasant surprise. Ditto on 15 lb weight loss.
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#6
You know that the pressures you had in bi-level of 20/12 were always 12 cmH2O and above (20 inhale, and 12 exhale). If I understand you, the CPAP mode was 8 cmH2O (8 inhale and 8 exhale). I wonder why you didn't pick 12 since that would be the lowest setting the exhale would have been.

Your new A1c results are nice. I hope your body recovers even more to make your blood sugar control even better. You know 5.6 is the high end of normal! You are so close!

Your doc's comments - not sure they are even apneas. I wonder what he is talking about. Can you look at your numbers in SleepyHead, specifically how long the events are? If you have events that are 10 to 15 seconds long, I can see doc may be saying they are not desaturation level issues. Anyway, if your oxygen levels are boosted with supplemental, the normal effect of lengthly apneas may be eliminated.

I don't think I have yet seen a post by you that says what part of your apneas are considered CA (clear airway). When you post replies can you break your AI into OAI and CAI?

You may have read here there are several of us that have reduced our CAI by using a straight CPAP or reducing the PS pressure support some, so there is less difference between the inhale pressure and the exhale pressure.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#7
Dr says no OAI, and no CAI. Cannot determine their nature. I didn't change the CPAP pressure, left it at the default because, simply, that was where I stumbled into it the first time, back in March. If I stay with CPAP, I will definitely adjust. If I return to S mode, though, which I may, I will definitely follow your lead and reduce the PS. I very much appreciate your input Thanks again.
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#8
how about a screenshot of a night where AI is in the 20's?
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#9
Unable to download to my linux machine, and I had to install sleepy on my son's ms computer, which gave rise to 2 problems: He must access personally, and I must find a time in his schedule that allows me a few minutes to observe. Not the most ideal situation, admittedly, but one cannot always control his destiny, eh? I'll see what I can do. Jim
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#10
You can install sleephead on your linux machine most likely. It runs much faster than on windows in my experience. I have no knowledge of apple.
Archangle has published a script for linux that worked flawlessly for me on Mint 17.1 I also run win 7 sleepyhead in Virtual box. I do envy you seem to have an engaged sleep doc I. I am so very grateful for this BB!
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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