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[Treatment] Cant seem to adjust pressures
#1
I am a long time user of cpap / bipap therapy. Now that I have become more informed of my therapy or lack of I realize that I may not have been receiving the best treatment. For years I have been using my machine for an average of 9 hours a night with mixed results, some good days and some not so good. About 2 years ago I committed to loosing weight and that seems to have started a downhill slide on the effectiveness of my therapy. Not much surprise but as I lost weight I was finding that I had what seemed to be too much pressure which was leaking out my mouth and leaving me not feeling rested. A trip to my sleep doc resulted in a lecture on sleep hygiene and a chin strap. Since I had moved and I was feeling frustrated and not treated I decided that maybe it was time for a new sleep doc. I was sent for a new sleep study which was done as a diagnostic study, was never sent for a titration and was given both a new prescription and new machine. The pressure was reduced and I would say I was feeling better but still not great. My new DME promised the world for follow up when I got my new machine and then I never heard from them unless I was trying to get supplies which was never easy. Still feeling frustrated by the process and lack of care I talked with my primary care doc and he recommended yet another change in sleep doc. Long story short I went for yet another diagnostic study which still showed mild apnea 7 per hour but my o2 sats were dropping into the mid 80's. This time I was sent for a titration, where I was titrated to 12 cpap (from bipap 5-11) even though I had been using bipap for the last 10 years or so. When I asked my sleep doc about this I was told "it's data driven" with the attitude of don't question me.... With my new prescription at 12 my sleep was HORRIBLE, and my partner couldn't sleep either because the leakage out my mouth was keeping us both awake. After a week of no sleep I made a trip to my new DME and was given a couple of new masks to try. I have changed to the mirage quattro FFM and seem to be having much beter results with leakage. However I am still exhausted. My sleep doc is content that my therapy is working well because my AHI is almost always less than 2 but with my insistance that something had to change she reduced the pressure to 10. I don't feel that I am getting the best of my therapy yet as I am still dragging thru my days. I finally jumped into the do it yourself group this past week and don't seem to be making any progress yet. The first thing I did was put my machine back to bipap with the lower pressures that I had before my last study. What I am seeing that I can't seem to find an answer for on the forum is with bipap I am seeing flow limitation events that I did not have with CPAP. Was this the "data driven" that my doc was talking about??? So this newbie would like some guidance as to how to find that sweet spot in the settings where I can get a good night sleep. Has my apnea become so mild that I should return to CPAP and just lower the setting even more? One interesting side note the best I have felt since my new study was the night I got my FFM put it on, forgot to turn the machine on and slept well and felt much better the next day???? Of course since the machine was off I have no data to support the way I felt. I apologize that this post is so lengthy but it's a long story... I am happy to provide any data or charts but am not sure what would be the most helpful, what it used to be, what happened with the new doc prescriptions or what has happened since I started pushing the buttons. Thanks in advance for any help you can provide
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#2
Welcome

I believe the data driven decision with respect to bilevel is that bilevel is most often used when pressures exceed about 14. Bilevel is also used for people who have some respiratory problems such as COPD.

I wonder if you would not be better served by an auto PAP.

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
(09-25-2015, 06:19 AM)Cookie Wrote: I apologize that this post is so lengthy but it's a long story.

I don't mind reading a long story but it wasn't the length that deterred me, it was the lack of paragraphing. Couldn't handle that.

Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#4
Cookie,
I, too had some trouble in following your post.
Can you be more specific as to what machine you are using and the settings?
Look at the Sleepyhead data and give us a breakdown of your Apneas, and AHI.
Also, look for the medium and 90% pressure numbers.
Any current information would be helpful. Wink
OpalRose
Apnea Board Moderator
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How to Organize and Post ScreenShots

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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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#5
Hi Cookie,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with getting your machine set up to work for you.
trish6hundred
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#6
First my apologies for my long winded unformatted post. I was trying to give my lengthy history for some background and also ask some questions and can understand why it was difficult to follow.

For clarity I have inserted a chart of some random dates from sleepyhead data. Headings would not format for each column but are date, AHI, CA, FL, HY OB, pressure setting EPAP 95% and IPAP 95%
25-Sep 2.2 2 11 7 11 7-11 9.5 11
24-Sep 1.36 3 7 5 5 7-11 7 9.4
23-Sep 2.01 4 12 8 8 6-11 8 10
22-Sep 1.68 5 7 10 2 5-11 5.5 7.5
20-Sep 1.77 0 0 12 5 10
19-Aug 1.04 0 0 4 4 10
18-Aug 1.34 0 0 5 7 10
1-Aug 3.76 13 0 8 26 12
29-Jul 3.8 8 0 4 26 12
14-Jul 1.26 4 11 3 6 5-11 8 10.7
9-Jun 0.37 1 14 1 1 5-11 6 8.8
6-May 0.73 2 15 1 3 5-11 6 9
8-Apr 0.64 1 14 2 2 5-11 6 8.9
12-Mar 0.88 3 9 2 4 5-11 6 8.3
11-Feb 0.74 2 11 2 2 5-11 6 8.3


My latest sleep study was in mid July and resulted in the pressure change to 12 which was then reduced to 10. September 22 is when I started twisting knobs.

My AHI was and still is considered controlled but I am exhausted. I am concerned about the high number of FL that seem to happen with bi-flex
As seen above my AHI is still considered controlled but I feel exhausted.

How do I decrease both FL and apnea / hypopnea's? So far I seem to be trading one for the other.

Thanks to all for any help you can offer.
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#7
It looks like you are using a bipap machine, which I don't have any expertise in advising settings.
I originally thought you were using an APAP.

Could you fill out your profile with the "exact" model machine you are using. Resprionics system one describes several machines.

Hang in there, someone who uses this type of machine will come along to help you, although the only thing I can advise is that when you make a pressure change, you should leave it be for a week to 10 days minimum to see any real results.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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
(09-26-2015, 06:45 AM)Cookie Wrote: How do I decrease both FL and apnea / hypopnea's? So far I seem to be trading one for the other.

This can be true. CA may increase with pressure. Auto biPAPs do not increase pressure with a detected CA. FL, HA and OA respond to pressure and auto machines will up pressure in response.

One really needs to see graphs and time durations of scored events to determine if significant. A 10 second central is of little concern.

Unfortunately, forum rules to prevent SPAM are set to 8 posts before an attachment or link to a photo sharing site can be made.

Fatigue comes with many other conditions; and your PAP may be working fine; but, another medical issue may be causing fatigue.
I suggest you seek medical council for that issue; and have a full M.O.T. (Brit slang for a complete workup -- comes from their testing of vehicles for roadworthiness by the Ministry Of Transportation.)
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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#9
Hi,
My machine is an Phillips Resprionics system one 760P with humidifier.

I was provided this machine about 18 months ago and it was set as a bipap.

After my last sleep study my new prescription was to set it to cpap at 12.

This was a horrible first 10 days with a nasal mask. I saw my DME for a mask fitting and was given a couple of FFM to try. Using sleepy head I decided the best leak results came from the Mirage Quattro which I am now using.

My follow up appt with my sleep doc reduced my pressure to 10 which was more tolerable but still not rested, feeling well. It has been about a month and I finally found the courage to make some changes myself so I put it back to bipap which I thought worked better.

Thanks to all
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#10
(09-26-2015, 10:15 AM)Cookie Wrote: This was a horrible first 10 days with a nasal mask. I saw my DME for a mask fitting and was given a couple of FFM to try. Using sleepy head I decided the best leak results came from the Mirage Quattro which I am now using.

My follow up appt with my sleep doc reduced my pressure to 10 which was more tolerable but still not rested, feeling well. It has been about a month and I finally found the courage to make some changes myself so I put it back to bipap which I thought worked better.

Hi Cookie,

When I was using the Mirage Quattro FFM I needed to use a ResMed Gecko gel pad (nasal pad) over the bridge of my nose, to protect it from getting chewed up and to eliminate leaks near the eyes.

Now I like the F10 FFM, but need to use a "mask liner" to eliminate mask flutter/leaks.

From the data you posted it looks like your therapy mode is BiPAP Auto, is that right?

What are all your pressure settings?
Min EPAP = 7?
Max IPAP = 11?
Min PS (Min Pressure Support) = 1.5?
Max PS = 4?

Flow Limitation results from partial obstruction of the airway during inhalation.

On a BiPAP machine, the normal way to reduce FL is to raise the Min PS setting.

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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