Data worse with APAP treatment after one week?

[ww]

Appreciate any help in understanding what is going on. Sleep test results this month(March):
Total AHI=13.6 events/hour (reduced to 2.3 events/hour after titration=7cm)
Supine AHI=13.8 (reduced to 5.2)
Rem AHI=70.3 (reduced to 0.9)
OA=34 (reduced to 0)
Hypopneas=25 (reduced to 12)

Although I am sure (hope) that the results are not worse with APAP treatment than it was prior to treatment, that is what the results look like on most days. Any and all suggestions appreciated. These are the settings the machine was delivered with 10 days ago and although I had changed them originally, they have been back to original for the last 5 days. I am waiting on the DME for a full face mask in case I am breathing some through my mouth.

APAP min=6mm max=10mm Aflex=3. Ramp set to 5mm initial pressure. Respironics TypeM Auto w Aflex, Heated Humidifier set on 3, Respironics Nasal Pillows OptiLife mask.

These results looked pretty good (but not great) and is my best day:AHI=4.7 events/hour

]

These results from today look worse than not using the APAP at all. Yes, I slept terrible and woke up many times! There must be a reason like breathing through mouth or leaks or something. Since my titration was at 7mm and the APAP seems stuck at 10 today, something is sure different. Wonder if it is the way the machine measures or are things really this bad? Is it now time to set new limits on the machine or wait and try a full faced mask? AHI=14.1

[Babette]

Short Answer: Some folks don't respond as well to the variations of the APAP and do better on straight CPAP. I didn't do well on APAP. I tried juggling the numbers, narrowing the range, finally just went back to straight CPAP and "I'm feeling MUCH BETTER now."

Might be your story. I personally think 6-10 looks kinda wussy. What was your titrated pressure? 7? I'm of the opinion that anything under 10 is just bogus. Maybe because I'm a Perfect 10? Could be... Anyway, I can't tolerate anything BELOW 10 - makes me suck air like it's a milkshake. But you might try just running straight 7cm and see what it does for you.

So.... Try re-setting to 7, or whatever your straight prescribed pressure was, and see if that helps. Oh, and skip the ramp. Ramp really drove me nutty. Try just going in at full pressure, with Cflex at 3.

Try it for a night, see if you can swing it. If so, try it for a week, check your stats, and then play around some more.

Cheers,
Babs

[Snoredog]

there is no "NR"'s showing up, so open the Max up to about 14 cm.

It may also help if you increase the Minimum to 8.0 cm. What Aflex setting are you using?

I'd put it at #2 and see what happens.

You also need to control mouth leaks it really came apart at the end of that session.

Enable the Auto:Ramp, set the Ramp pressure for 7 cm (where your Minimum is now), set the Auto:Min=8.0, set the Ramp timer to 45 minutes.

When you go to bed with the new settings, put on the mask when the machine starts hit the Ramp button, it should drop to 7.0 (where your Minimum was) then increase to 8.0 cm after 45 minutes, hopefully you are asleep by then.

You may want to try taping your mouth and comparing a night's leak report to the one above.

You might also try using another mask if you have one, certain masks can make your AHI worse because of the characteristics of the mask alone. I doubt you used an optilife during your titration (if that is what you are wanting to compare).

As long as you are having VS, you could use an increase to Min pressure. Were any CA's or MA's reported on your PSG?

[Wulfman]

Seems like we had this conversation before.......

viewtopic/t29308/New-and-wondering-what ... -CPAP.html

I don't know why you insist on having your bottom pressure so low. Between your leaks and snoring, it's driving your pressure up and creating a self-perpetuating "mess".
.
Like Babs said, try setting your machine in CPAP mode at a pressure of 10 and see what it looks like.
Try taping or using Polident adhesive denture strips to keep your lips shut till you get a full face mask.

I'd suggest a C-Flex setting of 2.

Den

[ww]

Babette: Thanks and yes, I did try that my second night, but with the following results:
1st Night (Auto 10 max and 5 min) got AHI=8.4 and 90% pressure=10. This seemed much worse than at the sleep clinic, so I found how to set the machine back to simple CPAP with pressure of 7 as originally prescribed.
2nd Night (CPAP with 7 setting) AHI=11.5 avg or 15.4 for that night. This seemed even worse. I slightly increased the upper pressure on the auto mode to 12 and the min pressure to 6. OA was better at 0.6 but H was 15.4
3rd Night (Auto 12 max 6 min) AHI increased to 12 avg or 11.2 for this night with 90 pressure 10.7. At least it didn't go to maximum this time.

I posted this at the url in Wolfmans post, but I was not trying to duplicate my previous post - just finally have a little more data to try to figure out.

Yes, I am really puzzled at this point.

Snoredog: Central and Mixed were zero before and after titration at the sleep lab. I was using Aflex=2 most nights, but set at 3 the last couple of nights. I may not be using the ramp as I have never pushed the button. The machine just comes on when I start breathing and I push the power button to shut it off when I take off the mask to get out of bed at night. Does this reset the pressure when I do this? I would love to use another mask, but have been talking to the DME for nearly a week and no new mask, yet. I was titrated in the Swift II mask, but the DME did not have them in stock and substituted the OptiLife nasal pillow mask.

Wulfman: I tried not to post the same thing again, but you suggested that it was difficult to see what was going on without any data, so I waited and collected about 10 days of data. I did try Auto=8min/12max but OA=2 or more/hour.

Yes, I tried the higher pressure and was not sure what the results meant, so put everything back to square one and ran it for a week with no changes from the way the machine was delivered to me. It seems that I wasted this time, but now I am trying to be sure what changes I should make and how long to wait for results. I like the try it for one night much better than try it for one week. I was unaware of using adhesive strips to keep your lips shut. I will try that if you think it is safe to do that. I am desperately trying to see if the data tells me what changes to make to get MUCH improved results.

Will I learn more in a couple of nights with CPAP=10 or APAP=8min/14max? I can't get that tape until tomorrow night or so. There are not many stores close by.

[ozij]

Congratulations on getting the software!

I like the try it for one night much better than try it for one week.

You can't get any good info that way. You have to try things for a week or more to understand the impact of the change. Our results may vary naturally from one night to the other even if we make no changes. By switching frequently you're adding confusion to the picture.


This is from the thread Den quoted.

One night's data on a fully data capable CPAP "or" an autoPAP does NOT the entire story tell. Heck, even just one night at a good sleep lab for a titration study isn't always adequate to find your ideal pressure range!!!

Gathering data for a week is not a waste of time.
Yes, its possible to have a large discrepancies between the titration results and your real needs.

Here's a post that seems to have been written especially for you: satating out at 7, ending up at 10.
viewtopic.php?p=254370#254370
O.

[Snoredog]

Snoredog: Central and Mixed were zero before and after titration at the sleep lab. I was using Aflex=2 most nights, but set at 3 the last couple of nights. I may not be using the ramp as I have never pushed the button. The machine just comes on when I start breathing and I push the power button to shut it off when I take off the mask to get out of bed at night. Does this reset the pressure when I do this? I would love to use another mask, but have been talking to the DME for nearly a week and no new mask, yet. I was titrated in the Swift II mask, but the DME did not have them in stock and substituted the OptiLife nasal pillow mask.

Yes, pressing the "Ramp" (left most button) will bring the pressure back down to the Auto:Min setting or enable Ramp pressure & timer if enabled. You can press it as many times as you want.

Most of your problem seen on the report has to do with the too low Auto:Max setting of 10 cm. If you look at your reports above, the purple Auto pressure line disappears into the yellowish orange Max pressure line. That means the Max pressure is NOT high enough and you are preventing the machine from doing its job, reason AHI is so high.

Increase the Max to at least 14cm or higher and compare your next report to the above. About the only thing that increased pressure may do is wake you up that is about it.

[ww]

Snoredog: Central and Mixed were zero before and after titration at the sleep lab. I was using Aflex=2 most nights, but set at 3 the last couple of nights. I may not be using the ramp as I have never pushed the button. The machine just comes on when I start breathing and I push the power button to shut it off when I take off the mask to get out of bed at night. Does this reset the pressure when I do this? I would love to use another mask, but have been talking to the DME for nearly a week and no new mask, yet. I was titrated in the Swift II mask, but the DME did not have them in stock and substituted the OptiLife nasal pillow mask.

Yes, pressing the "Ramp" (left most button) will bring the pressure back down to the Auto:Min setting or enable Ramp pressure & timer if enabled. You can press it as many times as you want.

Most of your problem seen on the report has to do with the too low Auto:Max setting of 10 cm. If you look at your reports above, the purple Auto pressure line disappears into the yellowish orange Max pressure line. That means the Max pressure is NOT high enough and you are preventing the machine from doing its job, reason AHI is so high.

Increase the Max to at least 14cm or higher and compare your next report to the above. About the only thing that increased pressure may do is wake you up that is about it.

[ww]

I certainly agree and he was using the Swift II mask! Yes, I hope I will learn what the key things to watch for are in the data and be able to intelligently make changes to the equipment until the results are satisfactory.

Congratulations on getting the software!

I like the try it for one night much better than try it for one week.

You can't get any good info that way. You have to try things for a week or more to understand the impact of the change. Our results may vary naturally from one night to the other even if we make no changes. By switching frequently you're adding confusion to the picture.


This is from the thread Den quoted.

One night's data on a fully data capable CPAP "or" an autoPAP does NOT the entire story tell. Heck, even just one night at a good sleep lab for a titration study isn't always adequate to find your ideal pressure range!!!

Gathering data for a week is not a waste of time.
Yes, its possible to have a large discrepancies between the titration results and your real needs.

Here's a post that seems to have been written especially for you: satating out at 7, ending up at 10.
viewtopic.php?p=254370#254370
O.

[ozij]

A congested nose always has a bad impact on cpap therapy.

Try nasal irrigation - e.g. NeilMed's sinus rinse. I find the squeeze bottle very simple and efficient to use.

Masks are a very personal thing - they have to fit, and if the Swift II fits you better that the Optilife, you should certainly use it. If it felt good in the titration, why not buy yourself a mask online - before the prices are raised? I've never tried mask trading or cpapauction - by I get the impression people are generally satisfied with both.

O.

[ww]

Short Answer: Some folks don't respond as well to the variations of the APAP and do better on straight CPAP.

Thanks for the input. I couldn't set up to all of the recommendations, but yours was easy to do, so I tried it first. I set up for 10 CPAP last night and did sleep a lot better. I also went back from the large to medium nasal pillows in the optilife, but the leakage seems all over the place and considerably higher than normal. The snore probably wasn't real in the first six minutes. Overall AHI=4.5 and OA=1.4 still need to come down further.

One other thing. When starting out with CFlex=3 and CPAP=10 I can tell that I was breathing against pressure when starting out, but the pressure seemed to get much less breathing against later in the night. Any ideas?

Please keep up the suggestions as this got me back close to my best night!

[Wulfman]

Short Answer: Some folks don't respond as well to the variations of the APAP and do better on straight CPAP.

Thanks for the input. I couldn't set up to all of the recommendations, but yours was easy to do, so I tried it first. I set up for 10 CPAP last night and did sleep a lot better. I also went back from the large to medium nasal pillows in the optilife, but the leakage seems all over the place and considerably higher than normal. The snore probably wasn't real in the first six minutes. Overall AHI=4.5 and OA=1.4 still need to come down further.

One other thing. When starting out with CFlex=3 and CPAP=10 I can tell that I was breathing against pressure when starting out, but the pressure seemed to get much less breathing against later in the night. Any ideas?

Please keep up the suggestions as this got me back close to my best night!

You get used to the pressure as the night progresses. If, at some point, you wake up and wonder if the machine is even on.......that's the reason.

Next suggestion.......leave everything alone for a week......well, except for the leakage.......it's still pretty "wild". You need to get that one figured out and then your numbers might come down even more, without having to adjust pressures.

Den

[ww]

You get used to the pressure as the night progresses. If, at some point, you wake up and wonder if the machine is even on.......that's the reason.

Thanks for the answer and now I won't wake up and think that something is wrong with the machine.

I will try the larger nasal pillows with the OptiLife mask as they seem to seal better than the medium pillows.