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[Treatment] Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
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jmortensenjr Offline

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Posts: 5
Joined: Aug 2016

Machine: Respironics System One Auto CPAP (DS560HBTS)
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air F10
Humidifier: Respironics Heated
CPAP Pressure: 7
CPAP Software: Other Software

Other Comments:

Sex: Male
Location: Albuquerque, NM

Post: #1
Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
I need some advise, as CPAP treatment doesn't seem to be working for me.

I've been using BiPAP/APAP/CPAP for about 8 of the last 10 months with a 2 month gap, when I switched to a new sleep center about 6 months ago. First 2 months were with a ResMed BiPAP rental (7/3cm, 8/4cm), then 2 month gap with no treatment, then 1 month on another ResMed rental (7cm), then last 5 months with Respironics System One Auto CPAP (6-9cm, 6-12cm, 6-14cm, 6-9cm, 7cm). Overall, treatment seems to have, at best, only a marginal benefit on my sleep and overall well being, but I definitely crashed during my 2 month gap without treatment and I was notable worse than before I started. Seems like I became dependent on treatment.

I adapted easily to treatment, however, after a week or so at prescribed APAP pressure (6-9cm), my AHI increases from around 7 and becomes erratic (12-30), with a big increase in clear apneas. On APAP, my 90% pressure moves to the max. Sleep Center raises max pressure a bit (6-12cm), and AHI improves for a week or so, 90% pressure increases to max again, then AHI becomes high and erratic again. Sleep Center raises max pressure a bit more (6-14cm) and cycle repeats. At the higher pressure, I was not sleeping well due to sound of small air leaks, air in the eyes, dry mouth, etc. Machine never recorded any air leaks.

I finally insisted on seeing a doctor face-to-face to review my sleep experience and AHI pattern, and get some explanations. Bottom line was that the doctor told me she didn't trust the readings of the machine, and only trusted the results of the sleep study. She also said that many patients don't notice an improvement, but that doesn't mean treatment is not working. She had me gradually reduce pressure back to the original pressure that worked during the sleep study (fixed 7cm). My AHI gradually seemed to stabilize at just under 10, then the same pattern repeated itself (AHI 4-50, averaging about 20; obstructive apneas erratic, averaging about 1/hr; clear apneas erratic, averaging about 5/hr; hypopneas erratic, averaging about 10/hr). These are just rough numbers looking at the daily numbers in DreamMapper over a couple of weeks.

I tried SleepyHead, but it only worked for 2 days and then started crashing on download. I reported it months ago, as have others, bit still no fix. Analyzing the 2 nights, I don't have a high degree of confidence in the clear apnea readings of the Respironics. I am quite sure I was awake during one of the recorded clear apnea events. Maybe the doctor is right and the machine's readings can't be trusted.

I'm at a loss as where to go from here. Do I have a bad Respironics machine? Does CPAP just not work for some people? Why do I always hit the max pressure when doing APAP? I don't recall my AHI being so erratic on the ResMed (but it's been a long time ago) - does a different algorithm make a big difference for some?

2 sleep study centers put me at a pressure of 7cm, but Respironics APAP took me to 14cm. What's up with that? Can't be trusted?

I see the doctor again in a week or s. What questions should I ask?

Thoughts?
08-29-2016 11:05 PM
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trish6hundred Offline

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Posts: 6,449
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #2
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
Hi jmortensenjr,
WELCOME! to the forum.!
I'm curious, why were you switched from a BiPAP to an AutoPAP machine?
Hang in there for more answers to your questions and good luck to you with getting your CPAP therapy working better for you.

trish6hundred
08-30-2016 09:15 AM
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richb Online

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Posts: 534
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #3
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
You seem to have several issues that we might be able to help with. First you do need to re-install Sleepyhead ip

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
08-30-2016 01:22 PM
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jmortensenjr Offline

Members

Posts: 5
Joined: Aug 2016

Machine: Respironics System One Auto CPAP (DS560HBTS)
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air F10
Humidifier: Respironics Heated
CPAP Pressure: 7
CPAP Software: Other Software

Other Comments:

Sex: Male
Location: Albuquerque, NM

Post: #4
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
(08-30-2016 09:15 AM)trish6hundred Wrote:  I'm curious, why were you switched from a BiPAP to an AutoPAP machine?

At the first sleep center, the technician had me try on a couple of masks for a minute or so before the sleep study and checked for leaks. He asked me how it felt, and I said it seemed difficult to exhale. Technician then flipped a switch (BiPAP) and I said that was better. That's how I was prescribed BiPAP.

Second sleep center thought it was unusual to have BiPAP at such low pressures (8/4cm), and did tritration study without it. Told me, most patients adjust fine at those pressures without BiPAP, and I never really had an issue with exhaling until pressures got up to 12-14cm. Then Ramp and AFlex/CFlex settings seemed sufficient.

Does BiPAP provide other benefits other than comfort? This has never come up since the the titration study.
08-30-2016 01:56 PM
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jmortensenjr Offline

Members

Posts: 5
Joined: Aug 2016

Machine: Respironics System One Auto CPAP (DS560HBTS)
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air F10
Humidifier: Respironics Heated
CPAP Pressure: 7
CPAP Software: Other Software

Other Comments:

Sex: Male
Location: Albuquerque, NM

Post: #5
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
(08-30-2016 01:22 PM)richb Wrote:  You seem to have several issues that we might be able to help with. First you do need to re-install Sleepyhead ip

SleepyHead was a wealth of info when it worked (first 2 days). I've reinstalled multiple times, purge my SleepyHead data and reinstalled, but the issue persists (i.e., crashes when importing data). See issue 30 at bugs.jedimark.net. I'm open to any tips on how to resolve this issue. Seems like it doesn't like certain data. After my doctor's appointment next week, I'll have them wipe the SIM card and try again.

I've read the entire SleepyHead guide and had a good working knowledge of the software. I'd pay good money for a commercially supported product that worked and did 1/2 of what Sleepyhead does. Is there such a product for Respironics or ResMed?

I wished the doctors/technicians at the sleep center spent a little more time reviewing, analyzing and explaining the data. They seemed more focused on compliance data than anything else. When I did ask about the data collected, the doctor said she didn't trust it and wouldn't read much into it.
(This post was last modified: 08-30-2016 02:27 PM by jmortensenjr.)
08-30-2016 02:16 PM
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Ghost1958 Offline

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Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #6
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
You are hitting max all the time because your min pressure is to low.
If you can gradually bring up your min pressure to near an effective level chances are good your max will stay much lower.
Its taking to long for your machine to catch up with your events.
If you can reduce or turn off your flex relief it will likely reduce the CAs.

Your doc is saying she doesnt trust the machine data to cover the fact she doesnt understand it nor have a clue what to do to change it.
Most Drs dont. Sad fact but true.
(This post was last modified: 08-30-2016 02:39 PM by Ghost1958.)
08-30-2016 02:36 PM
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chill Online

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Machine: DreamStation X500
Mask Type: Full face mask
Mask Make & Model: Walk-in Mask Closet
Humidifier: DreamStation
CPAP Pressure: 13-16
CPAP Software: SleepyHead

Other Comments: CPAP True Believer

Sex: Male
Location: Vancouver, Canada

Post: #7
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
I am less cynical about the doctor's approach to the machine data. It is all interpreted/assumed based on measurements related to air flow. The last sleep doctor that I saw also said he does not have much faith in its accuracy due to that. "The software is a work in progress. Sometimes it gets it right, sometimes it does not". As a diagnostic tool, a full sleep lab test provides the most different data points to correlate.

That said, it is all that we have and it seems useful despite the probable inaccuracies, sleep/wake junk for example.
08-30-2016 02:57 PM
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jmortensenjr Offline

Members

Posts: 5
Joined: Aug 2016

Machine: Respironics System One Auto CPAP (DS560HBTS)
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air F10
Humidifier: Respironics Heated
CPAP Pressure: 7
CPAP Software: Other Software

Other Comments:

Sex: Male
Location: Albuquerque, NM

Post: #8
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
(08-30-2016 02:36 PM)Ghost1958 Wrote:  You are hitting max all the time because your min pressure is to low.
If you can gradually bring up your min pressure to near an effective level chances are good your max will stay much lower.
Its taking to long for your machine to catch up with your events.
If you can reduce or turn off your flex relief it will likely reduce the CAs.

Thanks for the feedback.

I guess the question is, how do I know what an effective level is? Both tritration studies put me at an effective pressure around 7cm (BiLevel 7/3cm with AHI of 6.1, then fixed 7cm with AHI of 7.7). For whatever reason, the Respironics (both APAP and auto Trial) wants me at 12cm. My AHI reading on Respironics becomes high and erratic (AHI 4-50, averaging about 20) regardless of pressure settings once I settle in for a week or two. I'm beginning to think I'm better off with a lower fixed pressure, and should ignore the reported AHI, Clear Apneas and Hypopneas and focus on just the Obstructive Apneas to determine an effective pressure (which don't seem to go lower above pressure of 8cm). That said, I realize I'm just circumventing the algorithm of the Respironics APAP.

My CFlex is at the lowest setting, but look into turning it off as I don't think I really need it for comfort.
08-30-2016 03:52 PM
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HGMonaro Online

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Posts: 24
Joined: Feb 2016

Machine: Philips Respironics System One 60 Series
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: inbuilt
CPAP Pressure: 8 -12
CPAP Software: SleepyHead

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Sex: Male
Location: Melbourne, Aust

Post: #9
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
(08-30-2016 02:16 PM)jmortensenjr Wrote:  SleepyHead was a wealth of info when it worked (first 2 days). I've reinstalled multiple times, purge my SleepyHead data and reinstalled, but the issue persists (i.e., crashes when importing data). See issue 30 at bugs.jedimark.net. I'm open to any tips on how to resolve this issue.

I also had similar problems with the new version so I've continued using the old. What version are you using? If the latest, maybe worth trying the older one (I'm assuming someone can point you in the direction to get hold of it... I'm at work at the moment so can't check if I've still got the download file)
08-30-2016 08:24 PM
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Ghost1958 Offline

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Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #10
RE: Auto CPAP, high/erratic AHI, high Clear Apneas - it's not working
(08-30-2016 03:52 PM)jmortensenjr Wrote:  
(08-30-2016 02:36 PM)Ghost1958 Wrote:  You are hitting max all the time because your min pressure is to low.
If you can gradually bring up your min pressure to near an effective level chances are good your max will stay much lower.
Its taking to long for your machine to catch up with your events.
If you can reduce or turn off your flex relief it will likely reduce the CAs.

Thanks for the feedback.

I guess the question is, how do I know what an effective level is? Both tritration studies put me at an effective pressure around 7cm (BiLevel 7/3cm with AHI of 6.1, then fixed 7cm with AHI of 7.7). For whatever reason, the Respironics (both APAP and auto Trial) wants me at 12cm. My AHI reading on Respironics becomes high and erratic (AHI 4-50, averaging about 20) regardless of pressure settings once I settle in for a week or two. I'm beginning to think I'm better off with a lower fixed pressure, and should ignore the reported AHI, Clear Apneas and Hypopneas and focus on just the Obstructive Apneas to determine an effective pressure (which don't seem to go lower above pressure of 8cm). That said, I realize I'm just circumventing the algorithm of the Respironics APAP.

My CFlex is at the lowest setting, but look into turning it off as I don't think I really need it for comfort.

Gleaning a little more understanding from your reply.

I try not to be long winded but bear with me.

If you had software Sleepyhead or Encore basic for thePR machine id bet s dollar to a doughnut hole youd see the high AHI is caused by CAs.
The auto trial nor auto mode will respond to CAs. So it titrated you on auto trial to 12 based on OA Hypops FLs. But it cant treat the CAs. 12 IS the 90% pressure you need for obstructive events, but ill bet the erratic ahi is due to alot of CAs one night not so many the other.
You dont say if you had centrals on your sleep study that I saw.

Certain meds can bring on tons of CAs,.
My wife just had this happen with her AHI shooting up to 22 from s normal 0.5.
Nurotinin was the culprit for her. Got rid of it ,couple days she was back to normal.

In a nutshell you need to find out if your having CAs .
If so you may have complex anea which would mean you are on the wrong machine and need an ASV machine.
But whatever is causing them off and on like that im betting the high AHI nights when you are at 12 cm or near it are Cas

And please dont be offended but your DR is clueless. She proved that with the statement " people can have bad numbers but that doesnt mean the treatment isnt working".
Really??? So I can have an ahi of 15 but because the DME and Dr get paid my therpy is working??
Baloney. Id urge you to change Drs a week ago.
(This post was last modified: 08-30-2016 09:13 PM by Ghost1958.)
08-30-2016 08:57 PM
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