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Understanding "Success" with CPAP
#1
Understanding "Success" with CPAP
Hi,

I've been on CPAP for about 6 months now. I'm fighting mask leaks and have been trying to find a mask that works best for me. So far, the ResMed hybrid seems to be the least likely to leak (although I still have lots of leaks most nights... wish they made a large size, that might help) I also have the ResMed full face memory foam device that I got with my last shipment of supplies from my DME supplier. I had high hopes, but I can't seem to get a good seal with it. Bad face, I guess.

Last night I had better than normal AHI (just under 5). I had used the memory foam mask for a change due to an irritation under my nose from the hybrid. I had what appear to be terrible leak scores and average pressure down around 14/15 rather than the set 18... but good AHI. Is it possible that some controlled leaking like that works ok for me? (see last night's OSCAR info at bottom
).

I've been loyally using the CPAP since prescribed, but my AHIs tend to average a bit above 10 and I understand the goal to be 5 or under.

Any suggestions to help me understand the "success" of my therapy at this stage?

One more question: The masks seem to push my lower jaw back when the mask is on. It doesn't create any problem, but I wonder if it might affect my bite long-term. Any thoughts on that?

Thanks!

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#2
RE: Understanding "Success" with CPAP
Your attachment didn’t work. Delete and use the F12 button to take a screenshot and add it using add attachment at the bottom of the window.
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: Understanding "Success" with CPAP
Re-sending the screen shot from last night.


Attached Files Thumbnail(s)
   
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#4
RE: Understanding "Success" with CPAP
Your pressure is quite high and that is part of your leak problem. Your leaks are bad enough that you really have no idea what your AHI really is. Those leaks makes it impossible for the machine to tell if you are having apnea or not. 

WHY is your min is high?  You have an autoset tha can very the pressure to what you need. 

I would suggest you try
Min7
EPR 3 FULL TIME 
and see if that helps leaks. More on the leaks - you have both mouth and mask leaks. 

Next problem is you appear to also have positional apnea. Positional apnea is when you sleep in a position that cuts off your breathing. No pressure changes can help you need to stay out of that position. 

It is also known as chin tucking. Where your chin drops to your Sternum cutting off your airway. Please look at the link in my signature on collars. It may be what you need to stop the chin tucking.
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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#5
RE: Understanding "Success" with CPAP
I would say treatment so far has not been successful and it seems pretty obvious the higher pressure alone isn't fully treating your apnea and is causing problems with leaks.

I agree with trying lower pressure and higher EPR as a test to see what happens and how the machine responds to your breathing. Try that for a night and then post results.
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#6
RE: Understanding "Success" with CPAP
Pressures are what my Dr. ordered. Have been thinking about the collar, thanks, will look at your info and likely give that a try. I'm pretty sure you're right on that. I tried a chin strap... and while I've been fine with the mask headset, the chin strap just seemed like too much... and I found that unless I made it super tight (super uncomfortable), my chin would still drop.

Thanks!
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#7
RE: Understanding "Success" with CPAP
Did you have a titration study done (sleep study that you use CPAP in) to determine effective pressure?

If the doctor prescribed high pressure without a titration study he was guessing and we can do better self titrating with OSCAR. If you had a titration study done it would be good to see those results.
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#8
RE: Understanding "Success" with CPAP
Yes, he did do a study. I don't have it, but that's what he based the settings on. I've also sent him an email with my original questions and will update him with the suggestions you all have given. (I'm sure that will go well Smile. But he seems like a good Dr. and I'm pretty confident he would consider other ideas in the search for better results.

Thanks!
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#9
RE: Understanding "Success" with CPAP
Ask for a full copy of your titration report (not just summary page) and then post a redacted version here (remove any personal info). It should have data, charts and an interpretation by doctor.

You can try asking your doctor about making changes, key is to highlight how your AHI is consistently over 5 and results are not satisfactory. Not sure what he would do about it though other than maybe give you verbal approval to try other settings. Most members on here change their settings themselves, in rare cases a doctor will get annoyed but most don't pay attention to patients settings after they leave the office.
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#10
RE: Understanding "Success" with CPAP
I do know that my study showed untreated AHI in the low 40's. The titration was taken up to 14 and getting consistent results with what I'm getting now set to max pressure of 18 (AHI averages about 10-11... but varies widely night to night).
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