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+--- Thread: Clueless and Needing help (/Thread-Clueless-and-Needing-help)
RE: Clueless and Needing help - jpmogler - 12-11-2019
(12-07-2019, 11:17 PM)DeepBreathing Wrote: Jess, can you confirm these are his current settings: Min 9, Max 12, EPR always on at 3?
I'd expect to see an immediate and fairly dramatic improvement when using the collar. My initial guess is that the collar he has is not supporting him properly - it's either the wrong size or he hasn't got it correctly fastened. Some members have reported that if the collar doesn't fit properly then the chin-tucking continues. I suspect that's what we're seeing here.
This is going to be heavy going, trying to provide detailed technical help over such a long distance. I really admire the way you've jumped in to help a relative like this.
(12-11-2019, 09:41 PM)Sleeprider Wrote:Anything is worth a shot … we did do two nights at a fixed 6 … both of which resulted in AHI of close to 40 (pre collar) … will give 6/10 3 EPR a shot tonight and see if by some small miracle it does anything(12-11-2019, 09:26 PM)jpmogler Wrote:(12-10-2019, 08:12 PM)Sleeprider Wrote: He is capable of breathing normally, but when things go bad, they go really bad. Why? We are saying this is a positional apnea, the apnea just goes crazy once pressure goes over 10.0. I don't actually think it will work, bu let's try a maximum pressure of 10.0 with EPR 3 and see where it goes. I have never really seen such persistent obstructive apnea with the use of a collar or eliminator.
What should minimum be set at?
It really doesn't matter as pressure rises to the top of what is set when the centrals start. Stay with 6 or 7 as a minimum. My theory is that if he has problem exhaling against higher pressure, it results in respiratory stacking which mimics obstructive apnea. I could be full of it, but have seen it before on rare occasions.
RE: Clueless and Needing help - jpmogler - 12-12-2019
(12-07-2019, 11:17 PM)DeepBreathing Wrote: Jess, can you confirm these are his current settings: Min 9, Max 12, EPR always on at 3?
I'd expect to see an immediate and fairly dramatic improvement when using the collar. My initial guess is that the collar he has is not supporting him properly - it's either the wrong size or he hasn't got it correctly fastened. Some members have reported that if the collar doesn't fit properly then the chin-tucking continues. I suspect that's what we're seeing here.
This is going to be heavy going, trying to provide detailed technical help over such a long distance. I really admire the way you've jumped in to help a relative like this.
Result last night was 41.6 AHI … and to top my frustration off, he went to all the running around to get me the new data and only what was on there the last time showed up … not sure if he did not have the card fully inserted, or office max messed it up and I know he is getting frustrated too … his appointment with the doctor is not until the 19th and he leaves for Florida the 25th so not a great scenario
RE: Clueless and Needing help - jpmogler - 12-12-2019
[quote pid='323228' dateline='1576026735']
He is capable of breathing normally, but when things go bad, they go really bad. Why? We are saying this is a positional apnea, the apnea just goes crazy once pressure goes over 10.0. I don't actually think it will work, bu let's try a maximum pressure of 10.0 with EPR 3 and see where it goes. I have never really seen such persistent obstructive apnea with the use of a collar or eliminator.
[/quote]
Somehow I quoted the wrong thread this morning ... anyhow here are Results last night with settings of 6/10 EPR 3 ….was 41.6 AHI … and to top my frustration off, he went to all the running around to get me the new data and only what was on there the last time showed up … not sure if he did not have the card fully inserted, or office max messed it up and I know he is getting frustrated too … his appointment with the doctor is not until the 19th and he leaves for Florida the 25th so not a great scenario
![[Image: sad.gif]](http://www.apneaboard.com/forums/images/smilies/sad.gif)
without the data, I know there is not much to look at for the experts here who have been trying to help … I mailed him an iPhone adapter to see if we can get results that way without having to run to office max to get to a stick and then library to get from stick to me on google drive.
I have a couple of questions ...
Assuming he stays at 30-40 AHI … does the machine still do any "good" vs. not having anything? He really does not mind the mask and really likes that he gets humid air which solves a nose bleed issue he has in the winter.
For now, I think we will set it at 6 min, 13 max with EPR at 3 which seems to be the best that we have seen in past several weeks … and then I guess we wait till doctor and see if they actually do anything?
Thanks again!
RE: Clueless and Needing help - jaswilliams - 12-13-2019
The dr should pick this up at the 30 day just make sure they notice
RE: Clueless and Needing help - Sleeprider - 12-13-2019
I'll be the first to say the experiment with lower pressure failed. So far, nothing we have suggested has been able to overcome the long and persistent clusters of obstructive apnea at any pressure. Results are inconsistent which is even more confounding and makes finding a solution through a sleep study more difficult. It's probably time to take this problem back to the doctor and get his input. Something you might want to ask for is an oximeter study that looks at his oxygen levels through the night. We want to resolve the apnea, but barring that, his oxygen levels need to be protected for basic health reasons, and supplemental oxygen may be a possible approach. Most likely, these results point to a failure with CPAP and the need to move to a different therapy level, likely bilevel at even higher pressure. A titration study is likely to be requested by the doctor. I think the sooner you get his doctor aware of the persistence and severity of the problem, the sooner it can be addressed.
RE: Clueless and Needing help - jpmogler - 12-14-2019
(12-07-2019, 11:17 PM)DeepBreathing Wrote: Jess, can you confirm these are his current settings: Min 9, Max 12, EPR always on at 3?
I'd expect to see an immediate and fairly dramatic improvement when using the collar. My initial guess is that the collar he has is not supporting him properly - it's either the wrong size or he hasn't got it correctly fastened. Some members have reported that if the collar doesn't fit properly then the chin-tucking continues. I suspect that's what we're seeing here.
This is going to be heavy going, trying to provide detailed technical help over such a long distance. I really admire the way you've jumped in to help a relative like this.
(12-13-2019, 02:47 AM)jaswilliams Wrote: The dr should pick this up at the 30 day just make sure they notice
(12-13-2019, 08:38 PM)Sleeprider Wrote: I'll be the first to say the experiment with lower pressure failed. So far, nothing we have suggested has been able to overcome the long and persistent clusters of obstructive apnea at any pressure. Results are inconsistent which is even more confounding and makes finding a solution through a sleep study more difficult. It's probably time to take this problem back to the doctor and get his input. Something you might want to ask for is an oximeter study that looks at his oxygen levels through the night. We want to resolve the apnea, but barring that, his oxygen levels need to be protected for basic health reasons, and supplemental oxygen may be a possible approach. Most likely, these results point to a failure with CPAP and the need to move to a different therapy level, likely bilevel at even higher pressure. A titration study is likely to be requested by the doctor. I think the sooner you get his doctor aware of the persistence and severity of the problem, the sooner it can be addressed.
Thanks so much for all your help …. going to wait and see what the doctor says on the 19th … will keep you guys posted … apprciate the help so much!
RE: Clueless and Needing help - jpmogler - 12-19-2019
Just giving a little update ... SO ... he had his 6 week follow up today and the doctor thinks there is something wrong with the machine so he picked up a new one today ... I want to be optimistic, but just wandering if this has ever happened to anyone else on the board?
Will update after tonight and see if it helped.
RE: Clueless and Needing help - Dormeo - 12-19-2019
It can happen, though it is rare. Fingers crossed this was the problem.
RE: Clueless and Needing help - SorryIamNormal - 12-19-2019
(12-19-2019, 05:21 PM)jpmogler Wrote: Just giving a little update ... SO ... he had his 6 week follow up today and the doctor thinks there is something wrong with the machine so he picked up a new one today ... I want to be optimistic, but just wandering if this has ever happened to anyone else on the board?
Will update after tonight and see if it helped.
So when you say 'new machine'. Do you mean another cpap machine or a machine of a different type (auto cpap/bipap)?
RE: Clueless and Needing help - jpmogler - 12-19-2019
(12-19-2019, 05:33 PM)SorryIamNormal Wrote:Same one. He thinks it was malfunctioning ?♀️(12-19-2019, 05:21 PM)jpmogler Wrote: Just giving a little update ... SO ... he had his 6 week follow up today and the doctor thinks there is something wrong with the machine so he picked up a new one today ... I want to be optimistic, but just wandering if this has ever happened to anyone else on the board?
Will update after tonight and see if it helped.
So when you say 'new machine'. Do you mean another cpap machine or a machine of a different type (auto cpap/bipap)?