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suffering terribly, help!
#1
I remember I was feeling better, sleeping better in september and woke up with clarity and concentration but I can't remember the settings. sometimes I get heavy fog from these lower settings. it seems I have less events and no clear airway events on these lower settings and the graph only spikes to about 15cm, so can I lower the max IPAP or max ps?
It seems the standard setting of auto bpm, max ipap 20cm, EPAP 8-12cm isn't working for me and is too much. I'm really curious about the bpm setting, because on auto and a max ipap of 20cm I wake up not feeling great and a bit like I hadn't slept at all. maybe the high settings don't allow you to get stage 4 sleep?
my 90% EPAP is about 7cm. I am only getting 16 vibratory snore events so maybe a lower EPAP is ok for me? mostly I am getting about 45 pressure pulse events?

#2
Hi Physicstudent13, welcome to the forum.

Could I ask you to provide a bit more information, in a slightly more structured way please? From Sleepyhead, can you read off the Min, Med, 95%, and Max for each of the following: EPAP, IPAP, PS, Pat trig breaths, Leaks. Can you also let us know your AHI, broken down by hypopnea, obstructive and clear airway. And finally the machine settings: Epap, IPAP and PS. All this information is on the left side of the "daily" screen, below the calendar.

Once we have all that, we will be able to provide some advice on what might be happening. Can you also tell us if you have recently changed your settings - it was working well in September but not now. What has changed in the meantime?

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
#3
Hi physicsstudent13,
WELCOME! to the forum.!
What DeepBreathing said.
I'm SORRY you are having such a rough time with your machine right now but hang in there for more suggestions.
trish6hundred


#4
Actually if you are using SleepyHead, just go back through the data to find out what changes you made.

Also, the front page of SH has a list of each set of changes.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.




#5
Thanks so much! I finally got a Phillips bipap auto sv and it works much better than the resmed s9

Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 6.60 4.00 6.90 7.90 8.20
IPAPInspiratory Pressure (cmH20)
W-Avg: 9.18 6.50 9.50 10.40 11.30
PSPressure Support (cmH20)
W-Avg: 2.58 1.90 2.60 2.90 4.20
Pat. Trig. BreathsPatient Triggered Breaths (%)
W-Avg: 98.56 71.00 100.00 100.00 100.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 9.08 7.00 9.00 13.00 21.00
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 15.49 12.00 16.00 17.00 21.00
LeaksLeak Rate (L/min)
W-Avg: 0.68 0.00 0.00 3.00 3.00
SnoreSnore (unknown)
W-Avg: 0.04 0.00 0.00 0.00 1.00
Insp TimeInspiratory Time (seconds)
W-Avg: 2.18 0.20 2.20 3.00 3.86
Exp TimeExpiratory Time (seconds)
W-Avg: 1.60 0.20 1.52 2.40 3.00
Tidal VolumeTidal Volume (ml)
W-Avg: 574.11 440.00 530.00 830.00 1210.00

My apnea was so bad I couldn't understand or read a sentence and now I'm still crippled and was in a car accident.

Clearairway-3events, Flow limitation, 2 events, hypopnea 2, pressure pulse 94, vibratory snore-11
my sleep study showed mixed apnea with centrals and an AHI of about 30 and then my apnea got worse and I would have terrible, heavy fog lasting 2 days and waking up with headaches. I got some oxygen and take 5 liters a minute. I have asthma and can't exhale and my O2 varies from 88-94 during the day.

In september I was going with manual bpm settings like 8-12bpm and Ti 1-2.0 and taking klonopin and sam-E. some of the experienced patients recommended auto bpm and a high ipap max like 20cm and above but I don't feel rested- sometimes I do have clarity on auto bpm. I tried tracheotomy for 6 weeks but it didn't cure me patients told me I should have stuck with it for 3 months. I have a deviated septum and started fluticasone sprays again. I weigh about 190, BMI 24 so maybe I'm 35 pounds overweight.

#6
First a disclaimer - I'm not a doctor or health professional, so treat what I say as a suggestion only.

From the numbers above, it looks like your apnea is actually well controlled. Assuming you slept four hours, your total of 3 apneas and 2 hypopneas gives an AHI of 1.25 which is well within the target zone. I don't think flow limitations are counted, but even taking them into account the overall number is good. Your machine will only take the pressure as high as it needs to, and in your case it's only getting up to 11.3, which is way below the maximum setting of 20. Your minimum EPAP + PS is also pretty low - in fact I don't think the machine can go lower. So I don't think pressures are the problem.

I'm not sure how the Philips works in relation to BPM, but the numbers show your 95% Patient Triggered Breaths is 100% and the minimum is 71% I suspect (and I stand to be corrected) that you don't need the machine to be setting a breathing rate for you. Is it possible to turn this setting to off?

I wonder if your major problem is not the apnea at all, but the asthma and/or the mix of medications you're on, or something else that's happening to you? Have your talked to your doctor / pharmacist about possible drug interactions, and if any of them could be worsening the effects of the asthma?
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.


#7
thanks very much!
the graph of my patient triggered breaths has erratic down spikes, at least 27 times on this day.
my O2 yesterday was going down to 86-88 and I can't exhale with the asthma. I started taking 2 tablets of iron since I was anemic before.
my scientist friend says auto mode is amazing on the phillips, but I don't feel like I get deep sleep on it
I ordered diamox, acetazolamide maybe I'll finally be able to try it tomorrow after years of waiting
#8
(11-30-2013, 02:48 AM)physicsstudent13 Wrote: thanks very much!
the graph of my patient triggered breaths has erratic down spikes, at least 27 times on this day.
my O2 yesterday was going down to 86-88 and I can't exhale with the asthma. I started taking 2 tablets of iron since I was anemic before.
my scientist friend says auto mode is amazing on the phillips, but I don't feel like I get deep sleep on it
I ordered diamox, acetazolamide maybe I'll finally be able to try it tomorrow after years of waiting

what do you mean that you ordered Diamox, acetazolamide? are these prescribed by a doctor? are you saying you are getting both of them? for what are you going to take them? and, about the iron....are you told to take iron by a doctor?
#9
(11-29-2013, 09:47 PM)physicsstudent13 Wrote: I remember I was feeling better, sleeping better in september and woke up with clarity and concentration but I can't remember the settings. sometimes I get heavy fog from these lower settings. it seems I have less events and no clear airway events on these lower settings and the graph only spikes to about 15cm, so can I lower the max IPAP or max ps?


Hi physicsstudent13, welcome to the forum!

I wouldn't lower the max IPAP or the max PS, because your machine will not go that high unless it needs to, in case clear airway events happen again. A general rule of thumb is to allow the max PS to be at least 10, and to set the max IPAP to at least the sum of the max EPAP plus the max Pressure Support.

A person with normal lungs may require the Pressure Support to be automatically raised to 10 cm H2O during a central apnea to counteract the central apnea and maintain adequate breathing.

I suggest talking to your doctor about increasing the minimum Pressure Support, which may make breathing easier and may also help stabilize and improve the breaths per minute when the respiration rate is set to Auto.

Is there any way you can see a doctor about these problems? It would be best if you could talk to a doctor, especially about the medications you are taking, and whether the medications may be interacting in unwanted ways. Also, since you are taking Oxygen, please understand that O2 can interact with other medications and can decrease their effectiveness.

Also, since you are taking Oxygen, please understand that too much O2 can be as bad as too little O2. If possible, see if you can get a recording pulse oximeter, so you can review the recorded data to see how high and low the SpO2 is getting while you are sleeping. The wrist mounted pulse-ox type will exert less pressure on your finger and will be far more comfortable if wearing all night and for several nights in a row. Long periods with SpO2 higher than 97% may be undesirable when you are sleeping.

From your post, it sounds like you lowered the settings, and you now have fewer events and no clear airway events on these lower settings.

Before the settings were lowered, were you using doctor-prescribed settings? (The doctor's office should be able to provide you with a copy of your original prescription for your personal medical records.)


(11-29-2013, 09:47 PM)physicsstudent13 Wrote: It seems the standard setting of auto bpm, max ipap 20cm, EPAP 8-12cm isn't working for me and is too much. I'm really curious about the bpm setting, because on auto and a max ipap of 20cm I wake up not feeling great and a bit like I hadn't slept at all. maybe the high settings don't allow you to get stage 4 sleep?
my 90% EPAP is about 7cm. I am only getting 16 vibratory snore events so maybe a lower EPAP is ok for me? mostly I am getting about 45 pressure pulse events?

Again, I wouldn't lower the max IPAP or the max PS, because your machine will not go that high unless it needs to, if clear airway events happen.

You may want to ask your doctor about the advisability gf raising the minimum Pressure Support to increase your minimum O2 levels.

Take care,
--- Vaughn

By the way, have you tried the ResMed VPAP Adapt? It has fewer settings. (More settings are automatic.)
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.


#10
last night I tried bpm 8, ti 1.7, max ipap 16cm and feel foggy and tired today.

I think I get less events on higher pressures- I was titrated on the resmed s9 on max ipap 20cm, ps 5/15, epap 5cm, but I still was really foggy like when I lowered the ipap to 12cm. I kept demasking on the resmed, I was also titrated on 18/14 bipap and that didn't work. is there a cure for the disease? I hope I can try the Diamox soon, I read about someone who lowered their centrals with theophylline on another forum, but it's toxic at high doses.
am I suffering from this terrible disease because my neurons are deteriorating or I'm overweight?

a sleep apnea professor told me to raise the min epap to 8cm for my mixed apnea I guess.



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