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Two weeks on ACPAP
#1
Two weeks on ACPAP
Home sleep study showed OSA 26 events per hour.   In the first two weeks of Auto CPAP I've had between 8 and 35.90 AHI averaging 20 AHI per hour with about quarter of them being central/CA. I know sometime central events go away for new users with more use.   How long does take for them to go away?   

I have more energy in the morning.  On days with higher AHI have more brain fog and feel like I worked out in my sleep.  I'm still getting used to the pressure of CPAP especially at pressures more than 15 cmH20.

Dr started me with 5 to 15 cmH20 and moved me up to 8 to 15 cmH20.  I haven't noticed a change in AHI.   Dr. has recommended a titration study but doesn't have an opening for weeks.  I'm checking with my ENT who also does titrations to see if he can do it sooner.    I've been using the ENT as second opinion and found out from him I have 99% deviated septum on one side. ENT can normally get me in quicker than my sleep dr. 

I've tried higher pressures up 18 cmH20 starting with 8 cmH20 increasing 1 cmH20 every 5 min another on Sept 28 attached.   Sept 26 was "normal" night for me so far.   Please  help me find the best pressures with my AirSense 10.   I want to be equipped with data to reach the best treatment so I can make smart suggestions to my doctors and self advocate.    I've got a feeling I'm going to need an ASV based on what I've read on this board. 

Thanks


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#2
RE: Two weeks on ACPAP
G'day Ian. Welcome to Apnea Board.

Assuming there were no centrals in your diagnostic test then you have treatment-emergent central apnea. Often this will go away over time, which could range from a few weeks to a few months. But there are a few other things happening which we should address before we start thinking about different machines.

First, can I ask you to reformat your charts so that we can see all the machine settings? Turn off the calendar and pie chart as shown here: http://www.apneaboard.com/wiki/index.php...ganization

Your obstructive apneas are pretty heavily clustered which might be an indication of chin-tucking. A lot of people seem to do this once they get the mask on - tuck the chin down to the chest, which tends to collapse the airway. This can be overcome with a properly contoured pillow or a soft cervical collar (or snore collar) worn loose. I suspect that once that is addressed a lot of the problems will go away.

Next I'd increase the minimum pressure up to around 10, which is just below your current median. Increase the max to 20 so the machine can go higher if it needs to. It looks like you have EPR set to 3 - reduce that to zero if you can tolerate it, or to 1 if you need it. Reducing the EPR will help get the centrals under control. Later on we'll have a closer look at the pressures and optimise them.

Lastly (for now) we have to recognise that your sleep on Saturday was so badly fragmented that it's impossible for the machine to give you proper treatment. I don't think it's realistic to experiment with your own pressure "on the fly" like this. You and the machine need time to get into a regular sleep rhythm.

Regarding the titration study - don't rush it. I personally believe they are of limited value and the results from your machine will be a good guide to optimising the therapy.
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#3
RE: Two weeks on ACPAP
I agree with db. For more information on use of a soft cervical collar read this article. http://www.apneaboard.com/wiki/index.php...cal_Collar
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#4
RE: Two weeks on ACPAP
This morning I purchased a cervical collar, read above on usage, and changed my Oscar formatting. DB I will change the pressures and see how I do with new EPR tonight. Tomorrow I'll post new screenshots and let you know how it went.

Thanks for the help.
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#5
RE: Two weeks on ACPAP
G'day DB,

Correct there were not central in my diagnostic test before CPAP.  I'm hoping I've got treatment-emergent central apnea and the home study didn't miss my CA.    My father has both CA and OSA and has for decade.  

I used the settings as long as could with EPR of 1 along with the 3m Futuro soft cervical collar. AHI was 10 AHI for first 1.5 hours. Going to take time to get used to additional pressure and EPR of 1  At the end it's like I get tried of breathing and can't exhale anymore and then my AHI increase.  I think I've got aerophagia.  At the lower pressure aerophagia got better with a few days use. 

What's the next step in optimising therapy?  I'm happy to try EPR of 0 and see if I get better under pressure.


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#6
RE: Two weeks on ACPAP
Ian, my apologies I missed your response.

Normally I'd say an AHI of 18 isn't very good, but it's half what you had before so that's a great improvement. Have you been able to maintain this since your last post?

Can I suggest you modify your charts to show the following graphs only: Event flags; flow rate; pressure; leak rate; flow limitations. Resize each one so they all fit on a single screen. For the moment we don't need to see the other graphs. Can you also zoom in on a five minute window centred on when the pressure starts kicking up at 0:40 please? Something has occurred to make the pressure jump and kick off a cluster of apneas - I suspect this is positional and your collar is not doing its job properly.
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#7
RE: Two weeks on ACPAP
DB,

No problem thanks for helping.  I've been able to improve my AHI by taping my mouth shut along with the collar.    Up to 3 AM I can maintain AHI at 5 pretty consistently over the last few nights. Lowering the EPR to 1 has allowed me to lower pressures.  After around this time each night my AHI goes up a bunch.   The good news is I'm down around 10 AHI per night.  However, my AHI for the night depends on when I stop treatment as the results decrease throughout the night.   I keep going until I can't stand the pressure any more.

I've attached the zoom you requested from the 30th. I've also attached my charts from today.  The zoom of the first cluster from today has the same pattern as one from the 30th.  


Thanks for your expertise.


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#8
RE: Two weeks on ACPAP
I still see clusters, and the close-up you provided demonstrates there is minimal recovery time between apneas. It's basically an apnea followed by a gulp of air and another apnea following immediately. I'm pretty sure this is still positional and the collar isn't doing its job - maybe it needs to be tightened a little or repositioned. We're looking for the trade-off between support, comfort and not choking yourself with the collar.

My hope is that if the collar can be made to work properly we can lower your pressures and close the range between min and max. That will in turn benefit the central apneas.
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