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[Pressure] ScienceDad - Therapy Assistance
#1
Exclaimation 
ScienceDad - Therapy Assistance
Long story short, I had a "home" sleep test in 2017 that revealed mild sleep apnea. They prescribed either (1) side sleeping, or (2) CPAP with pressure range of 5-15. I was gifted a CPAP from my brother, but I was never given a titration study or setup because I didn't "buy it" from the respiratory supply. Anyhow, fast forward to now, and I've been having arrhythmias for 8 months since having COVD. Nothing complex, so the cardiologist says it's benign, but it is frequent...very frequent. I've gone every which way trying to resolve them and I've come down to it may be my sleeping causing them. I had another "home" sleep study (the ring you wear on your thumb), which said I had no sleep apnea. But trust me, I do. And because I have this "normal" test, my pulmonologist says I can't get a Sleep Clinic study done.

What I'm noticing is a lot of hypopneas. My AHI is many times under 1.0, but it's usually between 1.0 and 2.0, sometimes 2.0 to 3.0. A normal night will have 15-20 hypopneas with 3 or 4 CSA (occasionally no CSA). My CPAP doesn't usually show many (if any) OSA. Almost all nights I have what appears to be periodic breathing, but sometimes it even cycles through a hyponea or CSA (see picture attached). This cycling happens once or twice per night for usually a total of 5 to 10 minutes.[attachment=66404][attachment=66404] I'm using a Respironics Dreamstation 1 with nasal cushions and I have the settings at 5-15 with an EPR of 3. 

Honestly, I know I need a Sleep Clinic study, and I'm trying to get one done, but in the meantime, I'm hoping you guys have some suggestions. I wake up feeling like doo-doo every day. Any ideas?


   
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#2
RE: Need some help with pressures and EPR
Welcome

It's hard to tell anything from your chart.  You need to set it up differently.  

1.  We need to see the whole night's sleep, not just an expanded version of a short time.  Only post those when someone asks you to. Otherwise, they are not helpful.

2.  If you use your F12 key your chart will be mostly fine.  Just be sure to include Flow Limits at the bottom in a way that allows us to see to the very bottom of the Flow Limits.

With that data available we will be much better able to help you.  Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#3
RE: Need some help with pressures and EPR
Unfortunately, Sleepyhead doesn't have the Flow Limits graph you stated you needed to see. I believe that's part of OSCAR. However, here is a view of the whole night's sleep with Flow Rate, Pressure, and Minute Vent. If I should post something else, please let me know.

Thank you very much for helping out. I greatly appreciate it.

   
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#4
RE: Need some help with pressures and EPR
ScienceDad - A Philips only displays Flow Limits in the Events graph (FL). Resmed is the brand that displays this parameter as a graph.
- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#5
RE: Need some help with pressures and EPR
Might be you need to discuss with primary care about a lab sleep study. Your pulmonologist sounds unwilling to be a help or benefit, and sounds like a waste of money.

You might benefit more from the ResMed VAuto than the Philips Respironics CPAP.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
Funny pressure spikes on Sleepyhead last night
I had a REALLY good night last night (as far as AHI goes). Still woke up tired, but that's not unusual; I'm working through it. However, when looking at my Daily on Sleepyhead, there are a bunch (25ish) of Pressure spikes that aren't associated with any Events. I even checked the Flow Rate for maybe unidentified Periodic Breathing or another event, but saw nothing. Anyone have any suggestions as to the cause?
   
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#7
RE: Funny pressure spikes on Sleepyhead last night
Are you referring to the pressure graph? If so, those spikes are the machine testing the airway. Philips does this funny thing where if it detects a flow limitation it does this pressure increase to probe the airway to make sure it is open. Resmed does the same thing, but with gentle puffs, not a 1-2 cmH2O increase in pressure.

BTW, if you can please upgrade to using OSCAR.
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#8
RE: Funny pressure spikes on Sleepyhead last night
If you are referring to intermittent those sharp peaks, that is Philips' way of testing to see if a higher pressure is needed.
- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#9
RE: Funny pressure spikes on Sleepyhead last night
Thank you for the reply. I will look into changing to OSCAR.
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#10
Reducing Hyponeas
According to the Optimizing Therapy page on the Apnea Board "It is the exhale pressure that needs to be elevated to prevent Obstructive Apnea (OA), and it is the pressure differential between inhale and exhale that helps relieve hypopnea." I have reached the the incredibly awesome point that I am having very few, if any, obstructive apneas during the night. CPAP definitely works for me. However, I am left with a range of hyponeas that can be as little as 6 or 8 all night and can be as many as 30 in 8 hours of sleep. I have my PR Dreamstation set to C-Flex with a Flex of 1.

Am I understanding that I should remove the C-Flex to reduce the hyponeas? Thanks in advance for any help.
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