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increasing supplemental nocturnal oxygen from 2L to 3L
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nativedancer Offline

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Machine: Resmed S9 Vpap ST
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CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

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Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #11
RE: increasing supplemental nocturnal oxygen from 2L to 3L
thanks, vaughn. i'll sure give liners a try. also going back to my simplus again tonight. haven't been able to use my sleepy this week, so don't know central/obs relationship. everything is so messed up here that day to day i don't know which way is up, but maybe it will get resolved soon. best, jim
05-08-2015 09:57 AM
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nativedancer Offline

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Posts: 118
Joined: Mar 2015

Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

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Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #12
RE: increasing supplemental nocturnal oxygen from 2L to 3L
woozie38, i appreciate your explanation for increased need of O2; the escaping O2 had not occurred to me. thanks, jim
05-08-2015 02:50 PM
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nativedancer Offline

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Posts: 118
Joined: Mar 2015

Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #13
RE: increasing supplemental nocturnal oxygen from 2L to 3L
i'm so disheartened. after my overnight oxy test, the dr elevated supplemental oxy from 2L to 4L at night. he also revised the pressures to 18-8. my leaks have ranged from 0-50, but no matter what the leaks come to, up or down, the ahi has remained stubbornly high, 20-50. i am told there will be a follow-up oximeter test, but I had better ahi numbers back in January, 8-9 Yet I sleep comfortably, and get up only once/night. i do have some daytime drowsiness, but attribute that to my lasix rx. with a new cushion, my bruised cheek has pretty much gone away. and every morning i determine to bite the bullet and not be so impatient. but it's difficult. and i guess the COPD adds some difficulty.
(This post was last modified: 05-10-2015 08:33 PM by nativedancer.)
05-10-2015 08:27 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Location: California, USA

Post: #14
RE: increasing supplemental nocturnal oxygen from 2L to 3L
(05-10-2015 08:27 PM)nativedancer Wrote:  ... the ahi has remained stubbornly high, 20-50. ... Yet I sleep comfortably, and get up only once/night. i do have some daytime drowsiness, but attribute that to my lasix rx. with a new cushion, my bruised cheek has pretty much gone away. and every morning i determine to bite the bullet and not be so impatient. but it's difficult. and i guess the COPD adds some difficulty.

Sounds like the therapy is helping a great deal already.

If your apneas are primarily central, then you may need a change to an ASV machine, which would be able to treat both central and obstructive apneas.

But is is also fairly common for central apneas to gradually decrease as we adjust to PAP therapy, over the first few weeks or months of therapy.

Also, lowering the Pressure Support would likely reduce the number of CA events. It sounds like your PS is 10, which is higher than usual. But COPD may require more PS than usual.

I suggest obtaining a recording Pulse Oximeter for your own use, since lowering PS would be expected to lower the number of CAs, but lowering PS may tend to lower your SpO2, and I suggests it would be best for your SpO2 to mostly stay in the 94% to 96% range (except during occasional short dips from apneas.)

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 05-11-2015 01:23 AM by vsheline.)
05-11-2015 01:07 AM
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nativedancer Offline

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Posts: 118
Joined: Mar 2015

Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #15
RE: increasing supplemental nocturnal oxygen from 2L to 3L
saw dr yesterday. he showed me the graphs and charts from my machine, and said there is no way the 30+ numbers i've been seeing are accurate, machine is "messing up" in that area. i am doing okay, he says, though it make take a while for things to stabilize. sleep oxygen is good now, but actually, he says, i may never reach the kind of plateau that many of you have experienced, and i may ultimately have to settle for a higher ahi median. he raised pressure slightly to 12/22, and last night i slept 6.5 hrs w/out getting up at all. i do continue experiencing some daytime drowsiness and sleeping in the chair, usually about 2 hrs after i have taken my morning lasix, which seems to be the main culprit. dr ordered a follow-up oximeter study in a couple of weeks. see him again in june. and ahi has decreased somewhat over the past 4-5 nights -- currently 27.5. nothing to brag about, but still an improvement, and nowadays i will take whatever i can get.

thanks everyone, for following me down this torturous path to knowledge.
(This post was last modified: 05-16-2015 09:13 AM by nativedancer.)
05-16-2015 09:07 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #16
RE: increasing supplemental nocturnal oxygen from 2L to 3L
(05-16-2015 09:07 AM)nativedancer Wrote:  saw dr yesterday. he showed me the graphs and charts from my machine, and said there is no way the 30+ numbers i've been seeing are accurate, machine is "messing up" in that area. i am doing okay, he says, though it make take a while for things to stabilize. sleep oxygen is good now, but actually, he says, i may never reach the kind of plateau that many of you have experienced, and i may ultimately have to settle for a higher ahi median. he raised pressure slightly to 12/22, and last night i slept 6.5 hrs w/out getting up at all. i do continue experiencing some daytime drowsiness and sleeping in the chair, usually about 2 hrs after i have taken my morning lasix, which seems to be the main culprit. dr ordered a follow-up oximeter study in a couple of weeks. see him again in june.

Hi nativedancer,

I think you may need a smaller amount of Pressure Support in order to reduce the number of centrals you are having, at least until your prescriptions can be adjusted.

Also, I suggest the EPAP pressure should not be chosen to eliminate all obstructive events but to minimize the AHI. Often patients with lots of centrals will find that a lower EPAP or lower PS will dramatically reduce the number of centrals they have, but may slightly increase the number of obstructive events they are having. So they lower the EPAP and/or PS until they have a lower AHI with an equal balance of central and obstructive events. I think that is all that can be done unless changing to Adaptive Servo Ventilator (ASV) type of CPAP machine which is able to treat both obstructive and central apneas. And, if after balancing their central and obstructive events the AHI or RDI remains worse than 5 (or 10 or whatever - depending on insurance coverage), they are changed to ASV therapy.

Regarding "no way the 30+ numbers i've been seeing are accurate, machine is "messing up" in that area":

Is your doctor dismissing the validity of the data reported by the machine, just because it is different than what he expects or has seen with other patients? Maybe he is good in other areas but is just stubbornly holding to his own opinion in this area, not recognizing that it is known that for a minority of patients bi-level therapy can cause/induce central apneas, especially if the Pressure Support is too high. But I am not sure how COPD changes the available treatment options. Perhaps COPD causes you to need such a high PS? Has the doctor explained why the PS needs to be so high?

By looking carefully at the Flow waveform you can check for yourself whether the apneas reported are valid.

Normally, when an apnea starts the inhale/exhale pattern in the Flow waveform drops off to zero, the machine starts waiting for breathing to resume, and at the end of the apnea the machine records the event and resumes cycling the pressure back and forth between IPAP and EPAP.

Please look closely at the Flow waveform to see this: Zoom in until 5 or 10 minutes fills the screen, and adjust the vertical scale on the Flow waveform to be about -75 Liter/minute to +75 L/m, or perhaps -50 L/m to +50 L/m.

Positive Flow represents the rate (in Liter per minute) at which we are inhaling air into our lungs, and negative Flow is the rate we are exhaling.

Look at each apnea to verify that the inhale/exhale pattern in the Flow has truly dropped near zero during each apnea, and that at these times the Leak was steady and less than about 24Liter/minute.

The only times I have seen that the machine scored an apnea when one had not occurred was during periods of huge Leak or during big changes in the amount of Leak. And this does not happen very often.

When a large leak ends, the machine will keep the pressure steady by reducing the amount of airflow it generates. However, at first, because it takes some time for the machine to properly calculate the change in the leak, the machine will falsely assume that part of the reason that less airflow is needed is because we have started to exhale. The data will show this as the Flow suddenly becoming hugely negative (with our normal inhalation/exhalation pattern still there but falsely offset hugely negative by the inaccurate calculation of changing Leak), and if it takes longer than 10 seconds for the machine's algorithms to correct the mistake it may have decided in the meantime that no inhalations had occurred for 10 seconds and therefore it may have falsely scored an apnea as having occurred. This mistake is more likely to occur if the large leak ends gradually rather than suddenly all at once.

Similarly, when a leak is gradually increasing, the machine will falsely show the Flow becoming hugely positive and may mistake this for an unending inhalation and may falsely score an apnea.

But except for these rare mistakes caused by varying Leak, the data the machines record is very accurate.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 05-18-2015 04:31 PM by vsheline.)
05-17-2015 04:13 PM
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nativedancer Offline

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Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
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Humidifier: Resmed H5i
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CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #17
RE: increasing supplemental nocturnal oxygen from 2L to 3L
vaughn, i do appreciate your thorough and astute comments. i have very limited use of sleepy, depending on when my son is around to boot up his windows, where it is installed. even then, though, we are both so ignorant that the info means very little to us. i respect this dr and the local word on him is very favorable. my immediate course is to persuade the dme to examine the machine, and/or send it back to resmed for analysis. last night my leaks were 124, but i am accustomed to the feel and rush and noise that identify leaks, and none were present. the night before, i had zero leaks, same mask, same characteristics. ahi last night, 23; night before 26, with impossibly varied leaks. i have noticed a gradual fall in the ahi over the week, from 35.1-23. i always sleep soundly, and get up only once/night, if that. but my ahi was in the 8-9 range, same machine, as far back as january. yet, the dr is convinced that i am showing improvement under the therapy. go figure.
(This post was last modified: 05-18-2015 11:37 AM by nativedancer.)
05-18-2015 11:36 AM
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nativedancer Offline

Advisory Members

Posts: 118
Joined: Mar 2015

Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #18
RE: increasing supplemental nocturnal oxygen from 2L to 3L
good news, i hope. dme is swapping the machine for a new one. if we see no improvement after that, i will have to shoulder the burden again myself. at least, right now, everyone is trying to cooperate.
05-19-2015 03:31 PM
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bwexler Offline

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Sex: Male
Location: San Marcos, CA, USA

Post: #19
RE: increasing supplemental nocturnal oxygen from 2L to 3L
If it were me I would INSIST on an auto adjusting machine.
I would also convince the son to teach you how to boot Windows and access Sleepyhead. Using a PAP machine without software is like driving a car with NO dash gauges. How fast am I traveling do I have any fuel?
I would also have a recording wrist oximiter like the CMS 50i. I do.

You can get plenty of help with Sleepyhead here.
05-19-2015 05:22 PM
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nativedancer Offline

Advisory Members

Posts: 118
Joined: Mar 2015

Machine: Resmed S9 Vpap ST
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: 17.8/12.4
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Hell's Half Acre, Piedmont Plain, NC

Post: #20
RE: increasing supplemental nocturnal oxygen from 2L to 3L
machine is auto adjust -- an s9 vpap. it's just not up to snuff for some reason. i can't afford a recording wrist oximeter, cheapest i've seen runs about a hundred bucks, way beyond my ss budget. and with sleepyhead, the problem is not so much my son as interpreting the info. my machine gives me substantially what i need --ai, ahi, mv, leaks, etc -- and anything beyond that is fairly esoteric to me anyway, but i appreciate your input, i do, and thanks.
05-19-2015 07:37 PM
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