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anomaly32 (Therapy Thread)
#1
Trouble controlling apnea
I received my BiPAP machine 2 weeks ago, and am still not getting good results as far as controlling the apnea. I've had a couple nights under 5 AHI, but mostly it's been in the 9-18 range. I'm not having mask leakage, for the most part, and haven't had too much trouble adjusting to the therapy, other than some aerophagia. My doctor has been changing the settings little by little, but I'm feeling pretty discouraged that this isn't working yet. Is it normal to take this long to see improvement? I have OSCAR information if anyone wants to see it.
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#2
RE: Trouble controlling apnea
Oscar is needed to give you help. Please look at my signature for the charts needed. Use F12 for the screenshot.

Check out wiki (at the top of site) for Oscar. Excellent review and how to use.
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: Trouble controlling apnea
Yes it can take several weeks to begin noticing improvements with sleep while on PAP therapy. You likely suffered from Apnea for years like most of us. Some lucky few do feel somewhat better fairly quick though.

Agreed with Stacey, let's see OSCAR data.
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: Trouble controlling apnea
Here is the OSCAR data. I had to do 2 screenshots to get all the information in the left sidebar. This is from last night, but the machine settings have been changed quite a few times, and my AHI has been all over the place in the last 2 weeks.

   

   
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#5
RE: Trouble controlling apnea
All those clusters are almost certainly the result of chin tucking, which closes down your airway. You might want to invest a few dollars in a soft foam cervical collar. Additionally, we routinely advise against low pressure limits near4-5 cm. I would try a minimum of 5.5 or 6.
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#6
RE: Trouble controlling apnea
Ew, uh let's see, a few pointers. You're ok doing your own setting edits, right? All those purple and light blue flagged areas in the middle are not pretty.

1. About the time of the trainwreck, were you possibly transitioning between sleep and wake? If yes, then that may explain the purple CA/Central Apnea but probably not the blue Obstructive Apnea. If you were transitioning, this may be SWJ/Sleep Wake Junk.

2. If the answer is no to the question in area 1, you may need to dial back PS to 3 due to those purple CA. If you do that edit, review in one night and post a current OSCAR chart identical to shot one.

3. The blue Obstructive are possibly from Positional Apnea due to kinking the neck. Think of the garden hose that's kinked and water is restricted. Maybe this is why you've got some of these Obstructive events. If that's the case, a soft cervical collar can help. First, check your pillow and make sure there's only one and reasonably flat to prevent this. Or if not that, then the collar is a good idea.
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: Trouble controlling apnea
So...yes, I was awake from about 2:00 until sometime after 3:00. And it's absolutely possible that my airway was closed off, because I've been sleeping propped up, which makes my neck fall at a weird angle. The first night I used the machine, I had absolutely terrible aerophagia, and wasn't very functional for a few hours the next morning. My doctor told me to sleep propped up, and it seems that if I do that, the aerophagia is manageable, but if I sleep flat, it's not. Even so, I woke up around 2:00 with lots of air in my stomach.
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#8
RE: Trouble controlling apnea
I see several changes
1. Set PS=3, see if we can reduce CA events, maybe lower later
2. The big one. The cluster of obstructive events says you are tucking your chin. Try adjusting pillows. Read the wiki on cervical collars, link in my signature
3. Change your min EPAP. I suspect you have been increasing pressure to treat those positional Apneas, that will never work. Set min EPAP =4. Yes a big change. You are not experiencing significant obstructive events outside f the positional.

All these changes should also help your Aerophagia
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#9
RE: Trouble controlling apnea
   

   

OK, I changed the PS to 3 and the minimum EPAP to 4. I slept flat and tried to tuck a pillow under my chin since I don't have a cervical collar. I was awake from 2:00-3:00 (I just realized that in OSCAR the time is an hour off, so on the chart it would be 3:00-4:00) and several other times after that, particularly from 4:45-5:15 (5:45-6:15 on the chart). The large leak is from unhooking my mask for a minute. I didn't have a significant amount of aerophagia.
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#10
RE: Trouble controlling apnea
Still clusters, with a high AHI. I’m thinkin’ the pillow bailed.
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