[CPAP] High Pressure CPAP

[jkatitus]

I was diagnosed with sleep apnea about 8-10 years ago and have been using a ResMed CPAP with a humidifier ever since without any issues.  Have worn it every night since and I don't think I wake up once.

About six months ago, I started being woken up almost every night by high mask pressure (nasal pillows).  I had to reduce the setting from 15 to 12 in an effort to sleep through it, but even the constant pressure at 12 was too much to keep the mask on.

I am a retired engineer and tried to get the machine repaired.  At that time, I had not discovered this site or OSCAR so I had no information.  My doctor said the machine was old and I needed a new one.  He wrote a prescription, but even though my insurance company said that I didn't have to have a new sleep study, the medical supply companies wouldn't provide a new one without it.  My insurance would not cover the cost anyway due to the high deductibles and a sleep study would increase my expense.  I simply cannot afford all of that unless it is absolutely necessary.

Nobody would even look at my data to determine what the problem could be.  They're very quick order things but don't want to do any analysis.  I am hoping someone here will be willing to look at it and provide an opinion.  All input will be greatly appreciated.

[Dormeo]

Welcome! I'm sure an expert will drop by soon to help you. In the meantime, could you do a little reformatting on your charts? Close the pie chart (File, Preferences, Appearance), and include just these graphs in a single screenshot:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

You can scrunch graphs by grabbing the horizontal gray bar and moving it.

Also, a couple of questions about your mask. Could you double check the name of the mask you are using? And could you let us know how long you've been using your current headgear and current pillows?

[SarcasticDave94]

Hi jkatitus and welcome to Apnea Board. I'll ditto the info Dormeo mentioned. First impression is that your old machine is probably got some wear and is due for replacing. The problem is which to replace your CPAP with. I'll let the chart gurus chime in, but your pressure settings may need refining. If that can't help, a new machine that focuses on current apnea therapy needs will need to be obtained.

[Gideon]

Flow limits are one of the most overlooked stats out there, with ResMed Auto it is mostly the Flow Limits that drive pressure. Your flow limits are high normal on average. The trouble with this is they are rarely constant and I'm sure they are high enough to cause you issues.

Ask your doctor what he thinks of a BiLevel for you, specifically the ResMed VAuto.
It is Pressure Support that treats Flow Limitations, (hypopnea, RERAs, UARS, and snores as well) and your machine is limited to 3 cmw EPR which is efectively delivering 3cmw of Pressure Support. You cannot raise this and an increase is needed to better treat your blend of apnea.

I'm sure the OSCARs daily charts will bear this out, the stats do.

[jkatitus]

         Thank you very much for your input.  I have attempted to reformat the graphs as suggested and am reposting them below.

[SarcasticDave94]

2 things that I'm seeing is that first you've got a sometimes troublesome leak rate. You probably need to evaluate how to make sure the mask you have fits well and is adjusted properly.

To address this fully, after attention to fit and adjusting, if it hasn't addressed leaks successfully, then it would be time to shop for a better fitting mask suited to your facial shape.

Second thing is that although there's not many events giving an AHI over 5, there's still enough to disturb sleeping and proper rest likely isn't reached yet. This would first require pressure adjusting to get the best out of therapy. With most of your events being central, adjusting goals are somewhat different than for obstructional apnea. I think though in the end you might need ASV unless other health reasons indicate otherwise.

Start with reading up on mask fit and adjustments. We do have some info in the wiki area. Hope it helps and my best wishes success happens soon.

[jkatitus]

As an update, the insurance company has approved a new CPAP machine and it is ready for pickup. I have been authorized to take an "at home" sleep test. I understand that if it confirms my apnea, I will still need to go overnight for a titration study.

Is it best to get a full sleep study in order to have a full analysis and treatment prescription? Thank you all for your generous input.

[SarcasticDave94]

It's possible the home study may give enough data you could share here that we'd be able to assess what's happening. This might help you avoid the higher cost of the lab sleep study. Let's see what that home test results tell us would be my suggested action right now.

[DeepBreathing]

I agree with Dave. I'd also suggest that you give the titration study a miss if you can They really are of limited value and the real titration is done over a period of time once you are using the machine in your own home.

[jkatitus]

More valuable opinions - thanks. Should I arrange to pick up the new CPAP?