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[Treatment] Case Presentation
#1
Case Presentation
Dear colleagues,
 
First of all I’d like to express my gratitude for the valuable information the forum provides to all users. Congratulations for the excellent forum dedicated to the SLEEP APNEA issue!.
 
Please let me share with you my clinic history…
 
Ø I’m a 70 years old man, height 73 inches, weight 319 pounds
Ø ISCHEMIC CARDIOPATIA (revascularized angina pectoris 2 stens) for 20 years
Ø EPOP (moderate) for 5 years
Ø PACEMAKERS for 2 years
Ø SEVERE SLEEP APNEA, 36 apneas per hour and up to 57 seconds each. 
Ø The sleep apnea was diagnosed in November 2019.
Ø CPAP treatment from December 2019 up to June 16, 2020 with a brick (ecostar de sefan)
Ø Currently Philps DreamStation Auto CPAP
Ø I also bought a soft collar. I have a big neck.. (21.7 in)
 
After processing a lot of information from the forum, I configured the machine with the information that seemed to be correct to me.
 
So now the question is: 
Why have I so many variations from one day to another and why with the number of IAH being within the normal range I do not get a restful sleep? 
 
I’m not sleeping enough time and I wake up with lack of air and completely tired. I am in bed for 8 to 9 hours but once I wake up in the middle of the night, I can no longer fall asleep again.
 
I’m not sure whether the data provided is enough for you to try to give me some advice or suggestion. Hope you can help me to improve a bit my sleep and consequently my life!
 
I remain at your disposal for any further data you could need in this case.
Thanks in advance for your help!
Best Regards
chergan
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#2
RE: Case Presentation
To know anything you really need to download OSCAR (free at the top of the site) and post the graphs for it. No one can give you any real answers without looking at your sleep patterns, pressures, leaks... Everything here is free, please take advantage of it.

http://www.apneaboard.com/wiki/index.php...ganization
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#3
RE: Case Presentation
Welcome to Apnea Board.
For us to assist, we'll need the sleep data from the machine. If your current CPAP is capable, the best way to do this is via OSCAR, the free report tool. You would need to download it onto a computer, and when paired with data saved on an SD card after your sleep session, you then can open OSCAR to look at the Daily info and then attach files to a post to show us what is going on. An SD card that you may need to buy is a standard SD or SDHC in 2-32GB of any brand. You may find these at camera shops or electronics shops near you. Second action is to get your clinical manual above in the CPAP Setup Manuals link in the black banner. Search for your exact CPAP.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Case Presentation
            FURTHER INFORMATION!
Please find enclosed the main data obtained from my CPAP.
- worst data (from 10th august)
- yesterdays's data
- stadistical data from June 2020

Please don't hesitate to contact me for any extra information you could need from me.

Hope you can help me!

Thank you so much!!! 
Thanks


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#5
RE: Case Presentation
Thank you so much for the prompt answer!!

Data from Oscar software was enclosed in my previous post!

Thanks
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#6
RE: Case Presentation
The chart with 11-20 pressures is better, with only some Hypopnea. Respironics flags VS2 and we disregard these. Supposed snores go here but other vibrations get flagged that falsify this.

The biggest thing now is to get better comfort. Maybe add in Flex 1 or 2 if it's not on now, or unless it makes your Clear Airway go up. It's shown in purple on the left panel. Remember, apnea will change a bit each night. The newer chart has good results and the old chart has bad results according to the numbers.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Case Presentation
Welcome to the forum.

Why the day to day fluctuations?
On 10 August you had considerable chin tucking resulting the the clusters of obstructive apnea. If this occurs frequently you need to take action, that would be to use a soft cervical collar, see the link in my signature.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: Case Presentation
Very friendly Sarcastic
It is the objective that achieves greater comfort, I have the machine regulated with AFLEX level 1 but I don't get good sensations,
 I tried it with 2 and 3 but CA was triggered above what was desired.
I hope and wish that I can improve my rest
Greetings
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#9
RE: Case Presentation
I can only thank you for the time and dedication you dedicate to the forum
From which users benefit even in the most remote places on the planet
thank you very much
The daily fluctuations are due to my inexperience and my desire to solve problems in the fastest way that occurred to me at that time.
The events of August 10 I solve them by buying the cervical collar and it helped me in 2 ways
1st to not flex the chin
2nd helps to keep your mouth closed

I reiterate my gratitude and I hope that little by little my rest will improve
[Image: thanks.gif]
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#10
RE: Case Presentation
Very good: I attach the OSCAR data from the 27th
The numbers are not bad but
I am concerned about the large number of periodic breathing events because I think they could be related to my heart disease or the pacemaker that I carry
In addition to the bad feeling of waking up tired, without having had a good night's sleep.
Can you think of any variation of the current configuration of the DreamStation Auto CPAP that could improve my rest and as far as possible reduce the number of events?
 
Do you think that some other machine with superior benefits would have the capacity to improve the results and consequently my problems?
 
greetings
Chergan


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