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Terrible LOFTA Sleep Results
#1
Terrible LOFTA Sleep Results
Here's the Summary and Diagnosis:

  • Obstructive Sleep Apnea (G47.33) - Severe based on pAHlo=67.7 and 02 nadir of 83%

  • Central Sleep Apnea (G47.31) - Moderate based on pAHIc=22.3
  • 90 RDI events per hour
  • AHI 90.
Recommended BIPAP set max IPAP 25, min EPAP 6, PS 4 cm H20 with heated humidity and mask/interface fitting. 

Note: My doctor got ahead of the sleep test and ordered me a Airsense 11, which is giving me 2-5 AHI. Which compared to the non CPAP numbers look pretty good.

With that said, the results came in suggesting a BIPAP machine! Why is that?

Any advice overall would be very helpful, as I just received these results and I'm in shock at how bad they are.
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#2
RE: Terrible LOFTA Sleep Results
Hi cartab!  -  Welcome

The AS11 is not a Bi-Level machine.  The highest pressure that it can provide is 20cm.  Also, its closest equivalent to a PS (Pressure Support) is the EPR (Expiratory Pressure Relief) option, and that only goes up to 3 cm.   For your knowledge, a PS setting is added to the EPAP (Exhale Pressure) value to arrive at the IPAP (Inhale Pressure) value.  An EPR setting is subtracted from the IPAP pressure setting of the CPAP.  On a CPAP, like the AS11, there is only a IPAP pressure setting, either to a single pressure or to a pressure range.  Also, neither the Bi-Level nor the CPAP are targeted at treating CAs (Central Apneas - also referred to as Clear Airway apneas; no obstruction in the airway.)  Insurance usually requires that  you fail treatment with a lessor machine before they will allow the added cost of a device designed for Central apneas.  The name for this device is an ASV (Auto Servo Ventilator).  It's a fancy name for a very expensive CPAP.

Based off your prescription, your EPAP would range from 6 to 21 cm and your IPAP (EPAP+PS=IPAP) pressure range would be 10 to 25 cm.  The closest that can be obtained on an AS11 to these settings would be a pressure range of 9 to 20 cm, using an EPR setting of 3.  This will yield an IPAP of 9 to 20 cm and an EPAP of 6 to 17 cm (IPAP-EPR=EPAP).

Keep in mind, even though your prescription calls for the machine's maximum pressure as the upper limit,  very, very few ever reach the maximum pressure limit.   Let's hope you are not one!

Good luck!
- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#3
RE: Terrible LOFTA Sleep Results
(06-23-2022, 04:16 PM)Crimson Nape Wrote: Hi cartab!  -  Welcome

The AS11 is not a Bi-Level machine.  The highest pressure that it can provide is 20cm.  Also, its closest equivalent to a PS (Pressure Support) is the EPR (Expiratory Pressure Relief) option, and that only goes up to 3 cm.   For your knowledge, a PS setting is added to the EPAP (Exhale Pressure) value to arrive at the IPAP (Inhale Pressure) value.  An EPR setting is subtracted from the IPAP pressure setting of the CPAP.  On a CPAP, like the AS11, there is only a IPAP pressure setting, either to a single pressure or to a pressure range.  Also, neither the Bi-Level nor the CPAP are targeted at treating CAs (Central Apneas - also referred to as Clear Airway apneas; no obstruction in the airway.)  Insurance usually requires that  you fail treatment with a lessor machine before they will allow the added cost of a device designed for Central apneas.  The name for this device is an ASV (Auto Servo Ventilator).  It's a fancy name for a very expensive CPAP.

Based off your prescription, your EPAP would range from 6 to 21 cm and your IPAP (EPAP+PS=IPAP) pressure range would be 10 to 25 cm.  The closest that can be obtained on an AS11 to these settings would be a pressure range of 9 to 20 cm, using an EPR setting of 3.  This will yield an IPAP of 9 to 20 cm and an EPAP of 6 to 17 cm (IPAP-EPR=EPAP).

Keep in mind, even though your prescription calls for the machine's maximum pressure as the upper limit,  very, very few ever reach the maximum pressure limit.   Let's hope you are not one!

Good luck!
- Red

Thank you so much for your response. Here's two Oscar screenshots. Would you be so kind to take a look?

I am discovering I had CA. And based on these screenshots it seems like the A11 is doing a good job. Would a ASV machine be better?

I do tell you, I wish I had easier time breathing out. 

I am very appreciative of your response by the way. 


Big Leak, was testing the ResMed N30, and I don't think it works for me. I don't know if the leak came from open mouth, or just leak. (Full size link: https://i.imgur.com/gCFW7Dr.png)

[Image: gCFW7Dr.png]


This is so far my best night sleep ever. I am not sure what mask I used, I think I forgot to change it on the App. (Full size link: https://i.imgur.com/7oWxWj3.png)


[Image: 7oWxWj3.png]
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#4
RE: Terrible LOFTA Sleep Results
Your bad night showed considerable positional apnea that most likely resulted from chin tucking. Your good night showed some but not enough to be concerned with.

Tell us about your pillows? Was anything noteably different between the two nights?

I also think that your CA events are false and are mostly obstructive as they are mixed in with your chin tucking. Read about the soft cervical collar, link in my signature. Use 1 vs 2 pillows and think flatter, less firm to help straighten out your neck.

I suspect that you had this chin tuck issue on your sleep test. It is something that the vast majority of doctors, RTs, and Sleep techs will miss.
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#5
RE: Terrible LOFTA Sleep Results
To add to Gideon's advice, turn your Ramp off.  It is just delaying you receiving proper therapy pressure.  With you being new to this, you will initially experience a feeling of too much pressure.  Allow yourself about 5 minutes before giving up on this.   You'll be surprised how quickly your body will adapt to the pressure.   Also, the large pressure changes can cause you to have sleep arousals.  This can lead you to awake more tired than when you went to bed.

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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
RE: Terrible LOFTA Sleep Results
(06-23-2022, 05:37 PM)Gideon Wrote: Your bad night showed considerable positional apnea that most likely resulted from chin tucking.  Your good night showed some but not enough to be concerned with.  

Tell us about your pillows?  Was anything noteably different between the two nights?

I also think that your CA events are false and are mostly obstructive as they are mixed in with your chin tucking.  Read about the soft cervical collar, link in my signature.  Use 1 vs 2 pillows and think flatter, less firm to help straighten out your neck.

I suspect that you had this chin tuck issue on your sleep test.  It is something that the vast majority of doctors, RTs, and Sleep techs will miss.

Gideon; thanks a ton for your response. There is a new pillow in my bed.... This might have to do something with it. I'm going to remove that from the variables. I really hope my CA events are false, as I am already worried thinking I need an ASV machine. But I first want to do a more in-depth exam than the "Lofta" one. I'm waiting for my doctor to reply with a referral. 


(06-23-2022, 05:50 PM)Crimson Nape Wrote: To add to Gideon's advice, turn your Ramp off.  It is just delaying you receiving proper therapy pressure.  With you being new to this, you will initially experience a feeling of too much pressure.  Allow yourself about 5 minutes before giving up on this.   You'll be surprised how quickly your body will adapt to the pressure.   Also, the large pressure changes can cause you to have sleep arousals.  This can lead you to awake more tired than when you went to bed.

- Red

Done, I removed the ramp off.

Question for both Crimson and Gideon; from my 'good night' I see my 99.5% was 13.42 pressure, is that the therapy pressure that best works for me? 

Crimson, to your answer about receiving proper therapy pressure, looking at the 'good sleep' night what would you set the low and high, while keeping EPR at 3?
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#7
RE: Terrible LOFTA Sleep Results
Narrowing your pressure range will probably feel better. I would set the pressure range 9 to 12. This will allow a 3 cm swing, which will (should?) be more tolerable.

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#8
RE: Terrible LOFTA Sleep Results
(06-23-2022, 07:10 PM)Crimson Nape Wrote: Narrowing your pressure range will probably feel better.  I would set the pressure range 9 to 12.  This will allow a 3 cm swing, which will (should?) be more tolerable.

- Red

Thanks, I've set it up 9-14, to make sure I'm covering my 99.5% of 13.42. 

Do you think that as a good idea?
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#9
RE: Terrible LOFTA Sleep Results
It's your decision. A 5 cm pressure variance can be unsettling, especially to a new user. I was more interested in controlling the bulk of your apneas.

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#10
RE: Terrible LOFTA Sleep Results
(06-23-2022, 07:52 PM)Crimson Nape Wrote: It's your decision.  A 5 cm pressure variance can be unsettling, especially to a new user.  I was more interested in controlling the bulk of your apneas.

- Red

You are right. I’ll go with 9-12 and will report results soon. Hopefully tomorrow I wake up with a result under 2!

Thank you!
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