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new user - advice needed
#1
new user - advice needed
Hi all,

I had a sleep study in 2015, got a Dreamstation APAP, and just could not get used to it or fall asleep with it. Several months ago, the effects of the apnea started to become debilitating, so I decided to start trying again in earnest. I'm really happy that i can now sleep 5 to 7 hours with the mask on.

Then I found this forum and started to experiment with min and max pressures, and read a lot of good advice. I seem to have a good mix of centrals, hypopneas, and RERAs, with very few obstructives. Whether I have more centrals or hypopneas seems to depend on the pressure settings. I'm interested in hearing your opinions about what to do to improve. My best result so far has been with min 7.5 and max 12.5 cm, but I've attached a few nights' results with various pressure settings.

This forum is such a great resource, and I'm grateful that it exists. Thanks!  Smile


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#2
RE: new user - advice needed
In considering potential solutions, remember that their are advanced machines (bi-pap, asv) which may be necessary to treat advanced or complex issues. ASVs may be particularly useful to treat central sleep apnea.

Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#3
RE: new user - advice needed
You can research complex apnea, which is a combination of obstructive and central events, and seem to be unrelated to CPAP pressure. You have provided 4 charts with different pressure settings, and the best results are notably where a lower maximum pressure (7.0 to 12.5) was used on June 10. This is fairly common for members that show indications of central and complex apnea. In that chart, we see the pressure increases in response to obstructive events, and that as pressure rises above 10.0, the events seem to become predominately central. Throughout the charts, a pressure of 10.0 appears to trigger more central events and periodic breathing.

Hypopnea appear to be clustered in places, and this may suggest a positional obstruction issue in-play. We have found many people unconsciously tuck their chin during sleep, and this causes restrictions in the airway that result in flow limitations, hypopnea and even obstructive apnea. If positional apnea is present, this wiki may help to understand its mechanism and possible solution http://www.apneaboard.com/wiki/index.php...onal_Apnea

My initial take is that you would benefit from minimizing your A-Flex setting to 1, and trying fixed pressure to find if stable pressure reduces events. To do this, I would start at a fixed pressure of 8.0 cm and see if this resolves the central apnea, or increases obstructive events. We can then decide if you'd benefit from increases of pressure, or perhaps start isolating the cause of obstruction. To implement this, you can stay in auto mode with a minimum and maximum pressure of 8.0 or use CPAP mode at 8.0.

As Srlivine1 points out, if you have complex apnea, adaptive servo ventilation bilevel therapy may be the best option, but before we get there, we need to gain an understanding of how you respond to CPAP pressure. So the first step I'm suggesting is a stable pressure that seems to work well for obstructive events without triggering more central events.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#4
RE: new user - advice needed
Congratulations on finding the forum and posting here.

I'm learning as you are; my well-being has increased greatly being a participant here. I wish the same for you.
DaveL
compliant for 35 years /// Still trying!

I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

http://www.apneaboard.com/wiki/index.php..._The_Guide

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#5
RE: new user - advice needed
Thanks a lot for all of your comments! Sleeprider, I am going to try your settings ideas tonight. Also, i'll give the soft cervical collar a shot.
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#6
RE: new user - advice needed
I look forward to seeing how it works out for you. If you have complex apnea, it is consistently inconsistent, and we will be able to tell a lot from the fixed pressure experiment.
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: new user - advice needed
Ok, i tried the fixed pressure = 8 with FLEX setting = 1 last night, attached are the results (0718), which are worse. Two nights ago I used my prior best settings and attached those results for comparison (0716). The 0716 was the best night's sleep I've had since i was a kid. Today I feel like someone poured cement into my sinuses and skull lol. But it's worth it to learn more and get more insight.

I was kind of wondering if APAP wont be enough to do the trick here, I'm prepared to go to bipap or ASV if needed. Thanks!


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#8
RE: new user - advice needed
This is progress (believe it or not). Events are predominately hypopnea, and we will assume obstructive. Let's increase to 9.0 and see if that reduces the the events. This does not look very promising because, the central events index did not diminish, even with fixed, lower pressure, but obstructive events increased. I'd still like to see you try another night of fixed pressure. If this trend is consistent, then we really need to refer you back to your doctor for evaluation of treatment onset complex apnea, or perhaps centrals were in your diagnostic sleep test and you are not aware of it.

If you have the detailed sleep study results, it would help if you posted them. What we want to see is the breakdown of obstructive and central events. If you don't have the detailed sleep study results, request them. They are yours under HIPAA.
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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#9
RE: new user - advice needed
Welcome to Apnea Board!

I'm glad that you are optimistic about your treatment and you should keep your enthusiasm as you learn and move forward in this process.

I'm not implying that you need ASV. I just wanted to inform you of a typical process by which you advance in therapy modes. Just an FYI post so to say. I want you to maintain a serious attitude as advancing through these modes should you have to, and the process will come as no surprise.

CPAP or APAP is prescribed as the first step in the process. Many times, even though a sleep study will indicate that central apnea have occured, a standard first prescription includes CPAP or APAP.

A patient will have to demonstrate that he/she is not responding to treatment using APAP or CPAP, and almost inevitably will be prescribed the bilevel or auto bilevel machine. A trial period on bilevel must be completed and, once again, the patient has to "fail" at treatment with BiPap (bilevel, Vpap, etc.)

Only after 2 attempts and failures on the modes previously described will a patient be considered for advanced bilevel therapy (ASV, BiPap /ST..). When this consideration is made, a second sleep study is usually ordered to evaluate the patient for advanced bilevel necessity, and a determination is made. Sometimes the second sleep study will include an evaluation on the advanced bilevel machine. Other times the study will be inconclusive.

It's not easy and it often times is lengthy and frustrating. However, those who demonstrate a need for advanced bilevel therapy and are compliant, and become acclimated to the advanced therapy mode, improve significantly.

It's not to be taken lightly, but it's for your own benefit and should be pursued if you truly need it.

I suggest that you exhaust all the advice given here by the wise folks before getting real serious about moving forward, while keeping the idea in the back of your mind. And keep the positive attitude Smile
Jesse


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#10
RE: new user - advice needed
Thanks for the feedback, all. I will have my doc request the sleep study result, i'm curious about it too. They said my apnea events were position-related, but it may have changed since then.

Attached are the flat pressure = 9 results, it's progress from 8 I think and i definitely feel better. It's hypopnea dominated still. I guess it would be good to go to 10 cm?

Jesse, i know it could be a long process, but I've already made a ton of progress so I'm optimistic. It's really hard to communicate the effect of sleep apnea to people that have never experienced it. Bad nights really are the worst feeling Ive ever known. Thanks again!


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