Clueless and Needing help

[jpmogler]

I guess I reached a maximum so am not able to share the more recent ones?

[jpmogler]

I guess I reached a maximum so am not able to share the more recent ones?

since those first ones they had him go way up on pressure …. we have determined that the max he can go up to without leaking problems is about 17 … at that he is having 28-42 events 

I can share more of those screenshots .... have each day saved to a folder from the beginning till now

[DeepBreathing]

Hey you did it!

At this stage you've given us plenty to work with so don't worry about posting additional charts just yet.

The most obvious thing in these charts is that all of the obstructive apneas are occurring in clusters, with very well controlled breathing in between. This typically indicates that the apnea is strongly positional. There is something about the position he's sleeping in which is causing the obstruction. My bet is that he's tucking his chin down to his chest, which puts pressure on the wind-pipe. You can easily do this yourself - just sit up straight, breathe normally and let your chin drop. You'll feel the difference in your throat.

The most successful remedy is to use a soft cervical collar. It should be worn just tight enough to stop the head from drooping, but not so tight as to cause discomfort. Alternatively he could try an orthopaedic pillow which supports the neck in a very slightly chin-up position.

At this stage I wouldn't make any changes to pressure or other machine settings. Just get him sorted with the pillow or (preferably) the collar and his symptoms will improve greatly.

Some extra reading here: http://www.apneaboard.com/wiki/index.php...cal_Collar

[jpmogler]

OK thanks for the reply. I did order him a cervical collar which should arrive either Friday or Monday. The question is the charts that you are seeing is from the beginning of treatment. Since then they have had him turn it way up to try different things. Should I have him go back to the settings that he was at that first week where the results were somewhat acceptable?

[jpmogler]

I deleted one of the old attachments to show a more recent one at a higher pressure … the past week has looked more like this …. this night there was not a lot of leak … the nights before that and after that at a pressure of 17- 17.5 the leak was greater

[Sleeprider]

I originally said the problem was one of two things, and it was the positional apnea one. These clusters of obstructive apnea are the result of the airway being obstructed by the sleeping position, usually chin-tucking. It is so common, we included it in our Optimizing Therapy wiki here http://www.apneaboard.com/wiki/index.php...onal_Apnea In addition, we have a soft cervical collar wiki here http://www.apneaboard.com/wiki/index.php...cal_Collar

Both of those articles include charts of other members that show the same pattern, and also illustrate before and after the use of a soft cervical collar. Those are real results of real people, and the improvement happens very quickly with the right collar. Once that issue is resolved, we can further optimize the settings for comfort and efficacy. Well done on the charts, but we could have told you that the symptoms here are classic with only one of them. I think the settings of 9 to 14 with EPR 3 will eventually work well. There is a considerable flow limitation that causes the Autoset to increase pressure, so limiting maximum pressure to comfortable levels is going to be important. Eventually a bilevel machine might help more with the flow limits.

[Dormeo]

Congrats on getting the data into Oscar! I really hope the collar will cut way down on the obstructive events (and the flow limitations). I'll just flag this for the experts: somewhere along the line, the EPR was reduced from 3 to 1.

[jpmogler]

perfect thanks … I did already order the collar after you suggested it … my question is where should we set the machine?  To where it was recommended on the study and where it was set at the beginning or to where it is set now which is higher pressure but producing leaks?  I can totally see after your advice that the obstructions were in clusters at the beginning, but now it seems they are all over the place or is that just because it is leaking and the data is not accurate?  Just wanting to confirm where we should set the pressure to now.


thanks so much

[jpmogler]

The EPR was adjusted from 3 to 1 on Nov. 30 …

[Sleeprider]

EPR helps people with flow limitations to breath easier because inhale pressure is higher than exhale pressure. What you need to understand is that lower exhale pressure is the result of EPR, so when the CPAP is set to a range of 9.0 to 12.0 with EPR 3, the real presures are 9/6 to 12/9 (IPAP/EPAP). Keeping the higher pressure range compensates for using EPR, and EPR keeps breathing more comfortable and lower flow limitation. This wiki discussed Flow Limitation and shows why pressure support can help normalize restricted inspiratory flow. http://www.apneaboard.com/wiki/index.php...limitation

My advise is to continue with the current 9-12 setting with EPR at 3, and use the soft cervical collar which will not only reduce positional apnea clusters, but should significantly help with leaks.