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Severe Sleep Apnea
#1
Severe Sleep Apnea
Hi all, newbie here. I'm so grateful to have found this website Thanks  I've been reading posts and trying to go solo with helping my husband with his diagnosis of severe sleep apnea. I've been telling him for years he had it and we finally got him a sleep study (at home). The sleep doctor hasn't been in his office much at all since covid so It's been extremely difficult getting any help.

I finally got him the Respironics dreamstation Auto cpap and last I checked no returns allowed because of covid so I probably really messed up right?

Anyway, that's the backdrop of our story. We got the machine 3 weeks ago and started him on apap at a min of 5 and 20 and he had troubles with the pressure so I turned it down 4 to 20, and his AHI started to get worse so I moved it up to 6 and 20. I also messed with Aflex and Cflex and we put it at Aflex 3 with a humidity of 3.

The first day AHI 17 and then numbers started to go up averaging around AHI of 60 and I was thinking about taking him off of it-- but the first night he used it he felt better than he had in 20 years, so he wanted to keep trying.

The next week we started to see the numbers go down averaging around 20, but of course he is waking up tired and staying that way. Feeling more encouraged I continued researching and we decided to get him some mouth tape (he is a major mouth breather) which we used last night and he felt better today than he has the last 2 weeks... however his numbers went up from 20 to 27. 

So that's where we are at today, after reading posts on here I've turned his aflex down to 1, and turned his humidifier up to 5 for comfort tonight. Other than that will we ever get his numbers down?

I'm hoping you guys can help me get on track or maybe have some advice anything will be very much appreciated. I'll post a few images of his last results.


   

   

   
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#2
RE: Severe Sleep Apnea
Tweetie, unfortunately it looks like your husband has complex sleep apnea with a lot of centrals in the mix. Let's drop the AFlex to 1 and set pressure to 8.0 minimum, 10.0 maximum. The other issue may be positional from chin tucking. The signature of positional apnea or chin-tucking is clusters of obstructive apnea like we at many places. on all three charts. I will link the positional apnea wiki article and information about the solution, soft cervical collars. Basically when the chin tucks, it obstructs the airway, more in some people than others. There is a n exercise in the wiki that shows how to screen for this. No pressure can resolve a positional apnea, so we just work to prevent chin-tuck. Resolving the positional issues should reduce the AHI by 50% or better, then we will see what we have left to deal with. Read these and let us know what your think. Many members have benefited from using this important aid.

Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar
Sleeprider
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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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#3
RE: Severe Sleep Apnea
Thank you so much for taking the time to reply! I'll read and look into this and get back with you.
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#4
RE: Severe Sleep Apnea
Edit: posted in wrong spot.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
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Attaching Files
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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: Severe Sleep Apnea
Hiya,

So I changed my husbands settings to what you said and also ordered this SCC last night. He definitely had a better night, his AHI staying around 21 up until this morning he was up pretty late and I noticed his chin was down into his neck. I had him do that exercise of moving his neck down last night and sure enough he couldn't breath and did a snorting type thing.

Here's his results last night, and thank you again. Should I keep this setting until he gets the collar?


   
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#6
RE: Severe Sleep Apnea
Once he starts using a collar, his pressure requirements will be reduced and the events significantly reduced. I limited the upper end of the pressure out of concern for the CA events, and those sometimes respond to lower more steady pressure. What I didn't discuss last post is that there are a significant number of CA and H events. The Philips Dreamstation auto CPAP may not be the ideal machine for addressing those issues, but we really need to address the positional obstructive component before we can sort that out. Given the amount of obstruction remaining, I think we should go ahead and allow the machine more pressure. We are at 8 to 10, and I think a minimum pressure of 9.0 and maximum pressure at 12.0 may get you a bit closer to the target.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#7
RE: Severe Sleep Apnea
Okay, I'll change that today and report once he gets his collar. it said we should get it by Thursday, hopefully sooner!
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#8
RE: Severe Sleep Apnea
Good morning,

I changed the settings things were going good until he had a bad mask leak somewhere around 4:30 to about 5:30. I think it was due to me removing one of his pillows.

Here's last night's results, no collar yet.


   
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#9
RE: Severe Sleep Apnea
Tweetieheart, I still think we need to see the results with a collar, but let's talk absout complex sleep apnea in case that is where we need to go. Complex apnea is the presence of both obstructive and central apnea in the same individual. While constant positive air pressure (CPAP) can treat obstructive events, it cannot treat centrals. For that, we use an Adaptive Servo Ventilator (ASV) which acts like a CPAP to prevent obstructive apnea, but uses "pressure support" to treat hypopnea and central apnea. Pressure support is the difference between inhale and exhale pressure, and the ASV provides an increase in pressure during inhale when needed and as needed to maintain normal respiratory volume and rate. This is a noninvasive ventilator and is used and looks just like CPAP.

In the graphs we have seen so far, your husband has had very high residual AHI with 2 to 1 ratio of central to obstructive apnea, and considerable hypopnea. If this does not resolve with a soft cervical collar, the next step will be to request that the doctor perform an overnight clinical titration to find a pressure that provides efficacy. That test needs to include a doctor's order to move to ASV if CPAP does not resolve the apnea and hypopnea. We have seen many members with this problem, and they usually achieve less than 2-AHI with a device like the Resmed Aircurve 10 ASV. We prefer the Resmed device because it has proven more effective, comfortable and easier to use. This is a link to the Resmed Clinical Titration Protocol. It has lots of good information about all types of CPAP, bielevel (VPAP) and the ASV. Read as much as you can, but focus on page 27 to 31 to understand central and complex sleep apnea and how it is treated. I have a feeling you're going to need to know this.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#10
RE: Severe Sleep Apnea
Okay, yeah I had no idea it was going to be this bad. I just want him to feel better and he is willing to do anything that will help him get there. Hopefully if it comes to that I can return this machine or exchange it for the other.

I'll start looking into the machine and the reading the information you've mentioned, again thank you so much for helping us out! I'll post back by the end of the week.
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