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What's next to fix/change?
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jgoole Offline

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Posts: 11
Joined: Jun 2016

Machine: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Mask Type: Nasal pillows
Mask Make & Model: Philips Respironics Dreamwear Nasal Sleep
Humidifier: PR System One 60
CPAP Pressure: 5-20
CPAP Software: EncoreBasic

Other Comments:

Sex: Male
Location: Maine, USA

Post: #1
What's next to fix/change?
Hi,

I have been using my APAP for about a month now, with little improvement. My AHIs tend to be in the 11-18 range, and I'm not sure what to do to get it lower. At first I was having a lot of large leaks, but I switched masks and those have mostly been eliminated, but I still have the high AHI. Here is last night's data, which is pretty typical since I switched masks.

Since I am using an APAP, it is my understanding that changing pressure won't help. Is that correct? If so, what else should I change?

Thanks in advance,
Greg
07-21-2016 09:45 PM
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eseedhouse Online

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Posts: 878
Joined: Dec 2014

Machine: ResMed Airsense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: SimPlus
Humidifier: ResMed
CPAP Pressure: 7-10
CPAP Software: SleepyHead

Other Comments: Also on supplemental O2 at 3L/min. while sleeping.

Sex: Male
Location: Victoria, British Columbia

Post: #2
RE: What's next to fix/change?
(07-21-2016 09:45 PM)jgoole Wrote:  Since I am using an APAP, it is my understanding that changing pressure won't help. Is that correct?

No, that's wrong. These machines need help, usually by narrowing down their range and usually doing that by bringing the lower pressure up. I'd move up to at least 7 on the low end, probably higher, but don't do it all at once. A half centimetre a week will give you time to adapt but you may find you can go faster. Typically a DME will set these things up wide open and that's usually a definite mistake.

There are other things you can change to improve your experience and help you sleep better.

Download SleepyHead and learn to use it, and to post your graphs on the forum. There is power in knowledge and knowledge requires data.

Ed Seedhouse
VA7SDH

I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
07-21-2016 10:51 PM
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DeepBreathing Offline
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Moderators

Posts: 2,294
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #3
RE: What's next to fix/change?
G'day jgoole. The SleepyHead chart you linked to shows you have a complex mix of obstructive and central apneas and a lot of hypopneas. This needs some careful consideration, and is not just a matter of raising the minimum pressure.

First thing is to have a look at your sleep test report and find out what your central apnea / obstructive apnea and hypopnea indices were in the untreated condition. If you already had a high proportion of central apneas then an ordinary CPAP isn't going to fix them. If, on the other hand, you had few or no centrals, then it's likely they have been caused by the machine and are pressure-induced central apneas. Often these will go away of their own accord but sometimes need more active treatment.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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.
07-21-2016 11:29 PM
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kwhenrykerr Offline
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Advisory Members

Posts: 238
Joined: May 2016

Machine: DreamStation Auto, AirSense 10 Auto
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Philips, AirSense 10
CPAP Pressure: 12-20
CPAP Software: SleepyHead

Other Comments: 2L added oxygen with CMS50F to check usage

Sex: Male
Location: Florida

Post: #4
RE: What's next to fix/change?
I raised my pressure settings faster than some have suggested. But I also take more chances than many people do. It has worked out for me with cpap so far.

Others on this forum are much more informed than I. I would suggest that you listen to the many good suggestions and chose your path. I will suggest that you give each change you make time to show its effect before making another change.
Sleep-wellOkay

Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
07-22-2016 04:40 AM
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jgoole Offline

Members

Posts: 11
Joined: Jun 2016

Machine: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Mask Type: Nasal pillows
Mask Make & Model: Philips Respironics Dreamwear Nasal Sleep
Humidifier: PR System One 60
CPAP Pressure: 5-20
CPAP Software: EncoreBasic

Other Comments:

Sex: Male
Location: Maine, USA

Post: #5
RE: What's next to fix/change?
(07-21-2016 11:29 PM)DeepBreathing Wrote:  First thing is to have a look at your sleep test report and find out what your central apnea / obstructive apnea and hypopnea indices were in the untreated condition. If you already had a high proportion of central apneas then an ordinary CPAP isn't going to fix them. If, on the other hand, you had few or no centrals, then it's likely they have been caused by the machine and are pressure-induced central apneas. Often these will go away of their own accord but sometimes need more active treatment.

Thanks, DeepBreathing. My sleep test results were (from a 5 hr. 50 min. sleep session):
Total Respiratory Disturbance Index: 24.7
Total Apneas: 50
Total Obstructive Apneas: 11
Total Hypopneas: 49
Total Central Apneas: 37

Apnea Index: 12
Unclassified Apnea Index: 0
Obstructed Apnea Index: 3.00
Central Apnea Index: 9.00
Mixed Apnea Index: 0

Of course, most of these numbers mean nothing to me.

The diagnosis was, "Findings are consistent with Moderate Obstructive Sleep Apnea," with a recommendation for an Auto PAP machine.

Is 37 a high number of Central Apneas?

So far, I have not seen a DME or sleep therapist. I bought my stuff online and have been using Apnea Board to learn what I need to know. Maybe it's time to consult a sleep therapist? My only option was Apria and I didn't want to deal with them since they were charging outrageous amounts for equipment, and I don't have insurance coverage.

Thanks,
Jgoole
07-22-2016 08:53 AM
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cate1898 Offline

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Posts: 784
Joined: Aug 2015

Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #6
RE: What's next to fix/change?
Welcome to the forum jgoole!

Sounds like your SA may be better treated with a different kind of machine, but I am far from an expert. You need the knowledgeable people on here to comment on this. My knowledge is extremely limited. Whatever the fix, you need to get your AHI lower.

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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07-23-2016 07:13 AM
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PoolQ Offline

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Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #7
RE: What's next to fix/change?
You have the machine now and your centrals are not "off the chart" so I would suggest trying to get the hypopneas under control and see if it can be done without increasing your centrals. Sometimes centrals can be caused by pressure changes.

As far as increasing the low end pressure, from a pure therapy reason the rate you increase is not the main issue, it's you tolerating it that is mostly the problem. Your body will react to it right away as long as it does not disrupt you sleep. I would bump it up by 0.5 and watch your data: look for your HA going down and your CA not going up- a few is fine.

It might be nice to see a close up of the CSR area.
07-23-2016 11:32 AM
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kwhenrykerr Offline
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Advisory Members

Posts: 238
Joined: May 2016

Machine: DreamStation Auto, AirSense 10 Auto
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Philips, AirSense 10
CPAP Pressure: 12-20
CPAP Software: SleepyHead

Other Comments: 2L added oxygen with CMS50F to check usage

Sex: Male
Location: Florida

Post: #8
RE: What's next to fix/change?
Greg might ask what position you sleep in ? On your back ? on your side ? Flat or raised head ? Do you tuck your head when sleeping ?

I do very bad on my back. I try to sleep on my left side. It gives me my best sleep. I have started to use a soft neck brace to keep me from tucking my head, it has worked. Like the rest of the gear I had a hard time getting over using it. It is now just part of the trip to la la land. I am up to about 4 hours of sleep on a good night.

I just keep reading and trying stuff.Sleep-well

Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
07-23-2016 08:24 PM
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