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apnea continues after titration and new pressure
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Dawei Offline

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Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #1
apnea continues after titration and new pressure
A little over a month ago, I had a new sleep study as requested by the pulmonologist, since his raising my pressure a couple cm didn't eliminate the moderate apnea. The titration results showed that going from the previous 10 cm up to 13 brought the AHI down to zero (at least for a short while during that sleep study). So, my pressure was increased to 13.
The problem that has reared its ugly head is that after the recent titration and resulting pressure reset, there has been only one night of under 5 AHI (and that was a 4)! All other nights my AHI is in the high teens or low-to-mid 20s with a much higher spiking AHI on one or two nights.
The earlier mask leak problems have been resolved, and I now have had close to two weeks with leaking well under control on a nightly basis, yet the AHI continues in the 20s nightly.
Has anyone else experienced this situation?
I feel the recent titration was a waste of time and money, leaving me right where I started.
Now I'm thinking about making some selected SH printouts to take with me to an upcoming follow up appointment with the doc. I feel this appt. is an important one and don't want to misuse the few mins. I'll have with him. And of course, I'm hoping he has some magical solution (or wish I could believe that).
02-27-2012 08:50 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: apnea continues after titration and new pressure
Hi Dawei
Usually i take the laptop with me for the doctor to check the download.
I would suggest to download ResScan just in case your doctor isn't familiar with SH.
May be ask the doctor for a trial on the AutoSet.
Best of luck with the follow up appointment.
(This post was last modified: 02-27-2012 09:28 PM by zonk.)
02-27-2012 09:25 PM
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SuperSleeper Offline

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Posts: 9,970
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #3
RE: apnea continues after titration and new pressure
Dawei,

Check out this page: How to find the optimum pressure on your constant-pressure CPAP machine

The truth is that getting an optimum single CPAP pressure setting in a noisy, busy, unfamiliar sleep lab "bedroom" is problematic sometimes, simply because it's a terrible environment to get a good night's sleep with wires attached to every conceivable point on your body and the knowledge that you're "being watched" by a lab tech.

My first guess would be that the higher pressure might be wrong. Have you looked at SleepyHead to see if you're getting more CSA (central sleeep apnea or clear airway events)?.... if those increased with the higher pressure, you might try lowering it a bit.

If you have reason to believe that the new titration is not accurate, the best possible scenario would be to obtain an APAP. Certainly another expensive night in a sleep lab isn't going to solve the problem, assuming you can't get "normal sleep" there; plus you can get a brand new fully data-capable APAP (ResMed S9 Autoset or PR System One REMstar Auto) for less than the cost of most overnight sleep studies.

See here for benefits of auto-CPAPs:

http://www.apneaboard.com/APAP.htm

Now, if you can't get an APAP, then using your own scientific and logical methods, (slowly in small increments over time, noting your AHI every night after each small adjustment in pressure)... might actually work better for you than heading back to the lab.

As always, consult with your doc first, they might even agree that there's no harm in trying to make small adjustments on pressure to see the effect.

If you need the Clinician Setup Manual for your machine to change pressure settings, go here:

http://www.apneaboard.com/CPAP%20Adjustment.htm

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

02-27-2012 09:46 PM
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Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #4
RE: apnea continues after titration and new pressure
Thanks for your thoughts, Zonk! I'm thinking that your idea of having my SD card's info printed in the ResMed software's format may help the doc quickly understand what's been going on with me.
I'll see if I can find somewhere on the forum where one can download the ResMed software (haven't yet begun to look).
P.S. For myself, I'm quite happy with Sleepy Head. Although I'm still learning more about understanding its info, I have figured out a good portion thus far and like the way it's set up.
02-29-2012 08:09 PM
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Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #5
RE: apnea continues after titration and new pressure
I appreciate your helpful advice and info, Super. I don't think Central is a problem for me. I've been seeing either 0.0, or 0.1 or 0.2 for the past couple weeks when mask leak has been under control. Even earlier, I don't recall a Central (Clear airway) number above 1.2.
I can see that APAP may be the way for me to go, but my understanding is that this decision (along with pressure changes) is up to the doc. I plan to suggest the idea of APAP to him if he doesn't mention it himself.
P.S. Although this forum has supplied me with info on how to change the pressure of my S9 Elite, I have resisted the urge to do so, since I don't want to alienate the docs who my DME tell me must write a Rx for the DME to change pressure settings. Guess it's my desire to remain a "compliant" patient.
02-29-2012 08:39 PM
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Cutter Offline

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Posts: 324
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Machine: ResMed S9 Elite
Mask Type: Nasal pillows
Mask Make & Model: Swift LT
Humidifier: Hi5
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Kansas

Post: #6
RE: apnea continues after titration and new pressure
The ResScan download link starts HERE.

This post is a natural product. The slight variations in spelling and 
grammar enhance its individual character and beauty and in no way 
are to be considered flaws or defects.
 
(This post was last modified: 03-01-2012 08:04 AM by Cutter.)
03-01-2012 07:51 AM
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Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #7
RE: apnea continues after titration and new pressure
I presented the doc with printouts from my SD card via ResScan software (thanks to this board). To the question of why the recent titration found an AHI of zero at 13cm, yet since then my AHI has been averaging 20.4 with four nights over 30 during the past 18 nights (with no Mask leak problems), he had no answer.
So, I suggested the idea of an Autoset, and he agreed, writing a script for me to use one for a month and bring him readouts from the AutoSet. Guess I can't "buy" the AutoSet since I recently got an S9 Elite and ins. won't go for another machine.
Hopefully the AutoSet will discover the correct pressure.
03-06-2012 11:44 AM
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greatunclebill Offline

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Posts: 549
Joined: Feb 2012

Machine: Respironics System one Auto A-Flex
Mask Type: Full face mask
Mask Make & Model:
Humidifier: System one
CPAP Pressure: 8-12
CPAP Software: SleepyHead EncoreViewer

Other Comments: quattro fx full face

Sex: Male
Location: L.A. (Lower Alabama)

Post: #8
RE: apnea continues after titration and new pressure
(03-06-2012 11:44 AM)Dawei Wrote:  I presented the doc with printouts from my SD card via ResScan software (thanks to this board). To the question of why the recent titration found an AHI of zero at 13cm, yet since then my AHI has been averaging 20.4 with four nights over 30 during the past 18 nights (with no Mask leak problems), he had no answer.
So, I suggested the idea of an Autoset, and he agreed, writing a script for me to use one for a month and bring him readouts from the AutoSet. Guess I can't "buy" the AutoSet since I recently got an S9 Elite and ins. won't go for another machine.
Hopefully the AutoSet will discover the correct pressure.

i was in the same boat not being able to get the auto machine thru insurance. alot of people here swear by the resmed's and that's their right. i went to supplier 6 and bought the pr system one automatic w/ a-flex which does similar things as well as resmed for a real nice affordable price that i paid out of pocket. you won't find a better price on it new anywhere. if you're interested pm me and i'll send you the exact link to what i bought. if you want it have the doc write for a-flex because the system one comes in different configurations.
03-06-2012 12:06 PM
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Dreamcatcher Offline

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Machine: Resmed Autoset Spirit II with Quattro F/F & FX Masks
Mask Type: Full face mask
Mask Make & Model:
Humidifier: H4i
CPAP Pressure: 10 - 18 cmH20 (auto range)
CPAP Software: ResScan SleepyHead Other Software

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Sex: Male
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Post: #9
RE: apnea continues after titration and new pressure
This is how I started testing. I am still creeping my pressure up slowly with my resmed S8 Autospirit II. I splashed out on the cards and data readers, grabbed the software and am now slowly getting it right, My AHI which was all over the place and as high as 16 is now down around the 2 to 3 and my pressure is around 10cm, Im still hoping to get it down a little more
03-06-2012 12:57 PM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #10
RE: apnea continues after titration and new pressure
If you are running a datalogging XPAP, collecting all the data to analyze with ResScan/Sleephead etc. That is marvelous.
However...you are not getting the whole picture yet.

What is it we are fighting so hard for here with all this work and fancy equipment?

Oxygen saturation numbers...

It doesn't matter what numbers your air flow / AHI stats come up with, if your O2 is still going into desats you need to KNOW this so you can ACT on it promptly.

Getting a wearable logging pulse oximeter is cheap insurance if you ask me. It is an important cross check on how well your XPAP therapy is working (or isnt)
What if your XPAP is drifting out of calibration? You'll never know it without daily O2 numbers as well!
Maybe the XPAP needs to go in for a service check and adjustment?

I am also using a digital manometer to see what pressure I am actually getting out of a given machine/mask system.
The XPAP may be set for 12 cm of H2O...but are you really getting that? What if you change to a mask with a different calibrated leak or a longer hose? (exhaust has more or fewer holes drilled in it) Is your machine compensating for each different system change...or not?

So, daily O2 saturation monitoring and a periodic pressure check with a good manometer
just might help keep you alive.

Think about it.
12-13-2012 08:42 PM
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