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newbie with AHI~50 & a new dream station biPAP
#11
RE: newbie with AHI~50 & a new dream station biPAP
My best guess is that you are correct about positional apnea....but only partially so.

I think there are as many as three issues going on. The most significant is the postural/mechanical one that you identify. The 2nd is a fairly recent (~last 6 months) increase in upper airway mucous secretion. It's so thick it can obstruct the airway. The challenge is that I don't swallow well....and it's even more challenging if I'm horizontal.....so I sleep partially sitting up....which leads to head nodding. And finally, I'm struck by the subjective lack of respiratory drive which leads to transient desaturation...even when I'm awake. Mechanistically, I've wondered if the right carotid sinus (with its baro- and chemoreceptors) &/or its innveration got blasted by radiation or is now being impaired by advancing fibrosis....thereby changing some of the sensory inputs that regulate breathing.

I'll try to find a soft cervical collar today....and report back.

Many thanks for your help!!

ps: any idea why SleepyHead and DreamMapper report different AHI values? They are close but not the same.
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#12
RE: newbie with AHI~50 & a new dream station biPAP
I hope you get significant relief with the use of a cervical collar, however I'm surprised your doctor has not been more aggressive in finding a therapy that works, rather than slapping a Band-aide (oxygen) over it. If you have a central apnea issue, in addition to obstruction, then CPAP therapy is far from ideal.

It appears that at a minimum, you sould benefit from bilevel pressure support, where inhale pressure is higher than exhale. This transfers much of the effort of respiration to the machine, and makes higher pressure more comfortable. Furthermore, bilevel pressure can enable the use of Positive End Expiration Pressure (PEEP) which is a critical factor in improving oxygenation in people like yourself. In your case, the machine is setup at a minimum EPAP pressure of 7.0 with PS at 5.0, and maximum IPAP pressure at 17. I will talk about this in a separate post.

Finally, if true central events do exist, an adaptive servo ventilator (ASV) is the way to cause a breath even when the patient does not spontaneously initiate a breath. Your data does not show much in the way of centrals and the data you posted shows predominately obstructive events. The fact you are still on CPAP and having the level of problems shown in your data suggests apathy or lack of awareness of these options, on the part of your doctor(s). What gives?

There can be minor data discrepancies in the statistical presentation of sleep data between different software, however as you note, results are generally very close. Dreammapper is a very rudimentary summary of sleep data compared to Sleepyhead, and a more accurate comparison would be to use Respironics EncoreBasic 2.2.8, also available free from the forum. That is a professional level software that your doctor would recognize.
Sleeprider
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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.
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#13
RE: newbie with AHI~50 & a new dream station biPAP
I am going to return to the data you posted yesterday. This chart shows you are using PS 5.0 over 7.0-17.0 pressure.  The big problem here is that it is EPAP that controls obstructive apnea, and your minimum EPAP pressure is far too low to accomplish that task.   I would like to suggest some alternative settings for you to consider that will improve your results.  

Your EPAP min should be increased to 12.0 cm.  I would really like to see a detail chart to see if there is a pressure that at least partially resolves your OA, but the Philips Dreamstation BiPAP is far too slow to increase pressure when it starts this low (7. 0).  Changing your EPAP minimum to 12 simply raises it to start at the median pressure you actually recorded in this session.  It gives the machine a better chance at reaching effective therapy pressure.   Your current pressure support of 5.0 is very effective in preventing flow limitation and hypopnea.  I don't see any reason to change PS.  Your IPAP max needs to be increased to the full range of your machine, 25 cm.  Setting your machine up at PS 5.0 over 12.0-25.0 may give you a shot at reasonable therapy in combination with the cervical collar.  Your data shows a minimum pressure of 4.0 which suggests you have ramp on. You MUST turn off ramp. You have a severe obstructive apnea problem and ramp pressure this low is undermining your therapy. As I said,  I think we need to look closer at details and make sure we are not dealing with central events, but the information we have suggests your problem is overwhelmingly obstructive, and we need to set up the machine to deal with that. 

I want to emphasize, you have obstructive apnea and your machine settings are preventing it from properly treating you. Your EPAP pressure can only rise to 12 cm because you have a PS of 5 and max IPAP of 17 in the settings. It is EPAP that treats OA and controls your oxygenation. Your settings are undermining your treatment. You need higher minimum EPAP and much higher IPAP. If you implement the settings I suggested here, they should work well. You can talk to your doctor first is you prefer. If you have questions of how BiPAP works, please ask. I hope I can help you understand how this works and why what are using does not work.

[Image: 4kYtzbZ.jpg]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#14
RE: newbie with AHI~50 & a new dream station biPAP
Thanks, Sleeprider!!

Let's go step by step....
1.) cervical collar
2.) change settings after consulting with my sleep doc
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#15
RE: newbie with AHI~50 & a new dream station biPAP
More data....[Image: N4tnvIe.png]
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#16
RE: newbie with AHI~50 & a new dream station biPAP
More data:
[Image: 8bPL95z.png]
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#17
RE: newbie with AHI~50 & a new dream station biPAP
Do as Sleeprider suggested and increase your pressure limits. I think you should Max out your settings and set max ipap to 25 and have your epap range increased also(10-20).

your 95% pressure is currently at the max of the settings you currently have. let the auto bipap work by not limiting it's capabilities.
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#18
RE: newbie with AHI~50 & a new dream station biPAP
A cervical collar is not going to hurt, but the pressure settings I suggested are important for you. Please understand this kind of event rate is health-threatening. I promise, the settings I suggested are based on well-established approaches for bilevel titration, and consider your current settings. I would be interested to hear how your current settings were decided.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#19
RE: newbie with AHI~50 & a new dream station biPAP
Cervical collar results......
Subjectively, it felt like a pretty good night. The collar (Futuro brand) was comfortable....and it prevented the head nod that I know can obstruct my airway.
That said, I was suprised that the AHI and the OA count did not decrease more....although the overall O2 picture looks a bit better. The most severe desaturations (if they are accurate) are gone from that early portion of sleep.

I heard, loud and clear, the recommendations to change the settings. 
I will discuss with my sleep doc. I don't want to make those changes without his knowledge and concurrence.

Here are some graphs of data:

[Image: xTRBdkv.jpg]


[Image: jgKTL52.png]
[Image: N4tnvIe.png]
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#20
RE: newbie with AHI~50 & a new dream station biPAP
Sleeprider asked for some details.....so here you go. Let me know if some of the other traces are needed to interpret.
Those little chirps reminded me of the sound of black holes colliding!

Why am I getting that sort of oscillation in flow?
And, what is the Dreamstation detecting to call those CA and OA events?
[Image: dbVFpqI.png]

More detail - about a 3s period within the chirp.
[img]blob:http://www.apneaboard.com/352a42fa-bdf4-4ae3-b3dc-30fa6115fc32[/img]

Detail....thru Imgur:
[Image: IwkvkRZ.png]
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