New to CPAP

[Swisssleeper]

Hi davepaulson,

Ouch indeed.... lol.

Here it is -

[Sleeprider]

I continue to suspect that you have diagnosed complex apnea that did not appear until you started PAP therapy. This can happen when an auto CPAP is prescribed to a patient diagnosed with obstructive apnea, but where no clinical titration is performed. The statistics are fuzzy, but about 7-15% of patients can develop some complex apnea, and yours is fairly severe. The best way to minimize the CA and H events is to use stable low pressure. I have suggested fixed pressure of 6.5 in CPAP or Autoset mode where the minimum and maximum pressure is the same. While some people respond to this strategy with lower AHI, there are no promises when we are clearly in severe territory at nearly 35 AHI.

If this continues, you should of course contact your doctor. Your first task is to ascertain if he has expertise in complex apnea, or central apnea onset with CPAP therapy. If he has the expertise, he will recognize your problem immediately, and can start the process of evaluating you for ASV.

If you can post the results of your diagnostic sleep test, I might have some additional ideas to offer.

[Swisssleeper]

Thanks Sleeprider,

I will try fixing the pressure tonight and then monitor over the next few days, I am away for a long weekend and see the doctor on my return. It will be interesting to see how much he knows and what his thoughts are. Being a newbie all the advice is invaluable and its great to have people who are so willing to help.

Fingers crossed for a better night

[Sleeprider]

You might find this thread an interesting read. It is the journey of another member who joined in March. It was quickly apparent he needed ASV, and today he posted back he finally got it. Great story full of the frustration and misguided medical advise you may encounter. http://www.apneaboard.com/forums/Thread-...to-ask-for

[ajack]

That's a nasty chart, given they will freely swap machines, It may be simpler to go back to your doctor with some pictures and the sd card (they like to use their own software) I doubt it's positional and I can't see pressure adjustment doing much with that, as sleeprider said.

[Swisssleeper]

Hi Sleeprider,

That thread you pointed me too is a really interesting read and I am pleased he got there in the end. It certainty will be interesting to see how my doctor responds to the charts and information that I have gleamed from the very helpful people on this site.

So last night I fixed the pressure at 7.0 and the first two hours were the best two hours in years! so a little celebration there but I woke (looking the the chart I was having an hypopnoea).   I couldn't get back to sleep no matter what position I tried, so the rest of the data below doesn't count. The problem I have is,, as I am falling asleep I stop breathing, the pressure builds in the mask and then shakes waking me every time, and the machine doesn't like it either making a sort of clicking noise until breathing resumes. This went on for some hours, I really tried but gave up and took the mask off after 3 hours of dropping off, mask shake, wake! and repeat lol, I held my breath to replicate the mask shake and it was exactly the same as when I am dropping off.

Is this something that the ASV machine will help with or is there anything I can do to help as I think my wife will kill me soon , she even said she prefers me snoring like a banshee to last night lol.

Ajack, it would be wonderful if he works like that although reading through the comments on the link that sleeprider provided I am not hopeful. That being said I cant make a call on that as I am yet to have my second appointment. I am going to call him today to chat things through.

[ajack]

Don't confuse the Swiss system with the US, it's almost criminal. My guess is they will sleep study titrate you. Not breathing isn't a good thing, though it looks as if the CA could be pressure induced

[Sleeprider]

ASV can overcome hypopnea, but this result from your first two hours exceeds my highest expectation! Your AHI dropped to about 2.5 for that 2-hour period (we throw out the non-sleeping portion). This suggests you may be able to tolerate fixed CPAP and have good results. Believe me, it is better to find a CPAP solution than to send you into ASV land unnecessarily.

Your experience when trying to fall back to sleep sounds like repeated CA. The machine responded to not detecting any breathing by implementing the FOT (forced oscillation technique) pulses to determine if apnea is central or obstructive. This disrupted your sleep and you aroused and did not record an apnea. Had you been on ASV, the machine would have responded to the cessation of breathing with a smooth increase of pressure to cause you to take a breath.

With fixed pressure and no EPR we may be able to get you where you need to be. Hopefully more sleep in the next attempt without the sleep transition centrals. No changes recommended for now. It is not uncommon for people to have sleep transition centrals, but they usually end as the autonomic breathing system takes over. In your case, those centrals seem to continue. A full face mask amplifies the FOT pulses and can be disruptive, and this is where a nasal pillows mask can be much less disruptive if you can control mouth leaks and breathing.

[Swisssleeper]

Hi Ajack,

I am lucky as the Swiss system is excellent, in the U.K. the doctors kept telling me go for a run that will sort it, this was over a very long period of time and multiple visits for feeling exhausted. Here sorted in a matter of weeks. 

The doctor wasn't available but his physiotherapist said to not force it and if I have extended periods where I can't sleep to remove the equipment and they will look at it in more detail on Wednesday. 

Once again thanks for your input sleeprider, I will leave it as is for now then and see how I get on. Would changing it to fixed cpap instead of auto help with the waking ? I know I set the pressure the same but I left it in auto mode ? 

I will ask about changing to pillows to see if that helps also. No harm in trying. ?

[Sleeprider]

It's not going to change anything I am aware of to use CPAP mode vs Autoset mode with equal min and max pressure. I just think your results were promising enough with fixed pressure to try again. I have seen this before, but I'll admit I don't really understand why it works.

Nasal pillows will work for you or maybe not, but the comfort is more than worth the cost of admission to find out.