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Strange Question, Well maybe!
#1
Okay, I have been diagnosed very recently with Severe Obstructive Lung Disease. This was by my Primary Care. No one seems to know what is causing the obstruction although one Nurse suggested Moderate COPD. It seems the speacialist is quite busy and may not get me in until March! I asked them to put me on the "cancellation list" in case they can get me in early. Here's my dilemma. I was wrongfully put on 7cm straight pressure for 22 months before we caught the error. When I got my new Autoset about a month ago it was set at 6-12cm. I have hitting the max, 12 for a few days now and 11.8-11.9 before that. I decided as a test to turn it up to 13 last night, ReScan hit the 13 Sleepyhead 12.89. Two questions. One, could it be that the machine is trying to open both Obstructions? Two, should I set the machine to 6-20cm and see where it lands for a week or so? I'm not just sure what to do! Appreciate any replies!
Tim
Finger Lakes Region, NY
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#2
(12-22-2012, 11:12 AM)2Tim215 Wrote: ... should I set the machine to 6-20cm and see where it lands for a week or so? I'm not just sure what to do!

It has been noted here in the past (in threads discussing the silliness of requiring prescriptions) that even 20 cm. H2O cannot harm you. However, I don't know if that also applies to someone with your condition. But here's a test: Set the machine to a straight 20 cm. (not Auto mode) and sit with your mask on and the machine running during the daytime when you are awake. If you can breathe normally with that pressure while awake, then it should be safe while asleep as well. In that case, go ahead and set it for 6-20 in Auto mode for a week or so. The results might be very interesting.
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#3
(12-22-2012, 11:12 AM)2Tim215 Wrote: When I got my new Autoset about a month ago it was set at 6-12cm. I have hitting the max, 12 for a few days now and 11.8-11.9 before that. I decided as a test to turn it up to 13 last night, ReScan hit the 13 Sleepyhead 12.89. Two questions. One, could it be that the machine is trying to open both Obstructions? Two, should I set the machine to 6-20cm and see where it lands for a week or so? I'm not just sure what to do! Appreciate any replies!

Hi Tim,

The big questions are:

How are you feeling with the current pressure range of 6 to 13?

What's your leak rate?

What's your AHI if there's no leaks?

The S9 AutoSet ALWAYS tries to deliver the lowest possible amount of air to keep your airway open but it only responds with a higher pressure to an "event" and afterwards it starts slowly dropping the pressure again.

I know others might disagree but, I don't see a real need to set an upper limit below the maximum of 20 cm. It's like using a water faucet, you only turn it on enough to suit your current water requirement but there's still more pressure/volume available if you open the valve all the way, that's what the AutoSet does.

Since it's always trying to deliver the lowest flow of air possible, it will only turn-up the flow if and when it's necessary, the highest mine has ever gone up to is 19 cm during a pretty big leak, the airflow on my face woke me up and I fixed the problem and fell back to sleep as the pressure was dropping back down, meanwhile, the AutoSet was trying to compensate for the leak by upping the pressure to try and keep my airway open.

If you don't have a leak and you only require say 12.8 cm to overcome your breathing restriction, then the AutoSet will only deliver 12.8 cm of air and you'll never use the maximum amount of "potential" air if it's set to 15 cm or 20 cm.

As to your other breathing obstruction, my feeling is you might need more pressure to overcome it, especially while you're asleep. The best way to help figure it out would be with an oximeter to determine if your SpO2 is possibly low even when you're not having an apnea type event.

Ren
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#4
(12-22-2012, 11:49 AM)JJJ Wrote: It has been noted here in the past (in threads discussing the silliness of requiring prescriptions) that even 20 cm. H2O cannot harm you.

Doh!

We're typing at the same time again! Too-funny
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#5
As you know, one night is not a trend. Let it sit for a while.

And no, the CPAP is not clearing whatever obstruction is causing the other condition. Unless it is a polyp in your throat and the air is swinging it out of the way, but I think they would have found something like that.

COPD is usually where the bronchial tubes or further down are swollen or enlarged and narrowing where the air goes to do its thing.

My advice is to leave it where it is for at least 7 days to see how it goes. If you continue to hit the top, then either open it up to 20 or go up just another 1cm. But, like the others say, test the 20 out first to make sure you can breathe against it.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#6
Tim--Paula's suggestion sounds like a good one to me: leave it where it is for a full week. Then, if it's continuing to top out (or very close to the top), raise the top pressure to 20 and see where it wants to settle. Keep in mind that it's likely you'll see differing high end pressures from night to night, as I do. Mine seems to change over a range of about 3-plus cm. Some night are just better than others for unknown (to me) reasons.
Ren's description of how the Autoset responds to events and changes pressure matches my understanding.
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#7
Here are my last three nights,
[Image: 12-18-12_6-12cm.png] AHI=3.94 Leaks MED = 2.40

[Image: 12-20-12_6-13cm.jpg]AHI=2.50 Leaks MED = 3.60


[Image: 12-21-12_6-13cm.png]AHI = 13.97 Leaks = 2.40

Based on this data, does everyone feel the same recommendations? As far as how I feel, I feel much better with CPAP on as I'm having difficulty breathing since my latest diagnosis. My 02's are low during the day, seem to be getting worse, 91-93, average when moving around then sitting and checking them. Sometimes though still able to 94-99 during the day, depending on what I'm doing, or not doing!
Tim
Finger Lakes Region, NY
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#8
call the plumber
maybe you've got some leaking to fix Too-funny
Sleep-well
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#9
Hi Zonk, are my leaks bad? Sometimes I turn off the machine when I use the BR, guess I'll need to break that habit for more accurate data.

Also I stand corrected from the above reply. My 02's are hitting into the 85 range several times during the day. To stressed with breathing issues to get back into details already posted in another thread. But first time I recorded my 02's during the day awake and nap for approx 5 hour period, I hit 85's and in the 80's several times. Probably related to this last diagnosis I suppose! Nothing I can do now minus an ER trip which is quite costly. Just curious about what others thought with the CPAP helping with both issues now until I get my supplemental 02. I just called emergency DME line, he had no access to my records because he was "new" and basically an emergency delivery technician. I'll tough it out for now, guess someone will be there Monday. Here's my daytime and nap pic,
[Image: 12-21-12_02_Daytime_awake_and_nap.png]
Tim
Finger Lakes Region, NY
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#10
Yeah, you have a leak issue. Not sure why it has such a low median but the max each night in the 70s indicates a major leak at least once.

Do you get up during the night? If so, do you leave the machine running or do you turn it off?

With a max leak that high, not sure how valid the AHI result is.

My opinion is to leave it alone. You've got too many issues going on at once.

The key question is: are you feeling like you are getting enough sleep and adequate sleep? If so, leave it alone until this other stuff settles.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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