Help! on APAP since 9/13 AHI still over 20

[theresemp]

Aside from checking compliance and keeping my SD card, I have had no further evaluation from my sleep Dr. All he said was "good" you are using your machine.

My daughter, also on APAP, came to visit for a couple of days, and noticed I still snored and have apnea. I didn't know at the time even what the SD card was for, so she has been helping me with this. (I am 86 years young). She bought me an SD card and downloaded sleepyhead for me. Last night, my AHI was over 20.

My ramp time was 45 min and we have lowered it to 15 min last night. That was actually better. We are also noticing my pressure is on auto, with a range of 4-20, but after the ramp time, stays about 19, almost as if it were on CPAP mode, but it is not. The EPR is off. To try to make a difference, tonight I will try the EPR at 3.

Other than making an appointment as soon as possible, what else should I be doing? I will try to post some sleepyhead data and graphs. I can tell you, there are no major leaks. All the leaks were below 15.

I tend to sleep on my back and switch to my side. My daughter says on started on my side and switched to my back during the night. ( I also crowded her at of bed ).

[BlackSpinner]

My ramp time was 45 min and we have lowered it to 15 min last night. That was actually better. We are also noticing my pressure is on auto, with a range of 4-20, but after the ramp time, stays about 19, almost as if it were on CPAP mode, but it is not. The EPR is off. To try to make a difference, tonight I will try the EPR at 3.

Other than making an appointment as soon as possible, what else should I be doing? I will try to post some sleepyhead data and graphs. I can tell you, there are no major leaks. All the leaks were below 15.

I tend to sleep on my back and switch to my side. My daughter says on started on my side and switched to my back during the night. ( I also crowded her at of bed ).

Find out what your 95% pressure is.
Move the minimum pressure to within 2 of that pressure. ie if your 95% is 9 then change the 4-20 to 7 -20. It takes time for the pressure to ramp up to where it needs to be. An Apap should never be left open like that unless it is being used to find the 95% pressure for a few nights.

[Wulfman...]

Aside from checking compliance and keeping my SD card, I have had no further evaluation from my sleep Dr. All he said was "good" you are using your machine.

My daughter, also on APAP, came to visit for a couple of days, and noticed I still snored and have apnea. I didn't know at the time even what the SD card was for, so she has been helping me with this. (I am 86 years young). She bought me an SD card and downloaded sleepyhead for me. Last night, my AHI was over 20.

My ramp time was 45 min and we have lowered it to 15 min last night. That was actually better. We are also noticing my pressure is on auto, with a range of 4-20, but after the ramp time, stays about 19, almost as if it were on CPAP mode, but it is not. The EPR is off. To try to make a difference, tonight I will try the EPR at 3.

Other than making an appointment as soon as possible, what else should I be doing? I will try to post some sleepyhead data and graphs. I can tell you, there are no major leaks. All the leaks were below 15.

I tend to sleep on my back and switch to my side. My daughter says on started on my side and switched to my back during the night. ( I also crowded her at of bed ).

Yes, I agree.......your wide pressure range is your biggest problem. You need to increase your minimum pressure......a bunch. Your events are occurring before your machine can respond. I'm not sure that using EPR will help. That actually lowers your "effective" pressure at the point where you exhale and begin to inhale. Many people have their apnea events at that point. But, you can try it and see what it does to your numbers and sleep quality.

At some point, you might also want to try CPAP mode with a fixed pressure. Did you have a "sleep study"? Were you prescribed a specific pressure?

Welcome to the forum.


Den

.

[HoseCrusher]

Have you heard? 86 is the new 50... [wink]

You may want to consider tightening the range your machine is set to. With a range of 4 - 20 you start off at 4 and work your way up. If you are spending a majority of time around 19 you may want to raise your starting pressure to something like 12.

After trying the various EPR settings, I settled at 2. Experiment and see what is most comfortable for you.

[theresemp]

Thank you. My daughter will reset the EPR to off and change the pressure range to 12-19. She doesn't want to change too many things all at the same time. This is the last night she will be visiting, so anything after tonight will have to be with phone support until I see the sleep Dr. My daughter will go with me to my appointment.

I don't know if I was prescribed a pressure. I never had a sleep lab study or titration. I was diagnosed with a home sleep study, and sent home with this machine and no further instructions.

[theresemp]

I'm not sure if the images are posted correctly. If not I'll try again tomorrow, hopefully with improved numbers.

[theresemp]

more graphs from sleepyhead for last night.

[HoseCrusher]

I had a similar experience. I did have a sleep study but my prescription was for something like 5 - 17. By monitoring my data I was able to bring the starting range up closer to what my "normal" pressure is and that made this therapy much easier to comply with. I hope you find your new settings much better.

[djhall]

more graphs from sleepyhead for last night.

Yowza! Okay, first lets do a quick review what the events mean. CA means the machine detected your airway is open but you still weren't breathing, presumably because you weren't trying to breathe even though you could. H means the airway is partially collapsed so you are getting than half of the air you would normally, but you are still getting at least a little air. OA means the airway is fully collapsed so you aren't getting any air for at least 10 seconds.

The partial airway collapse of H events and full airway collapse of OA events is directly related to pressure. You don't appear to have much of an issue with CA events, but the repeated strings of H and OA events is a clear indicator of insufficient pressure. So lets take a look at your pressure information. Your machine is set to auto adjust the pressure between a minimum of 4 and maximum of 20. With those settings the machine will start out at 4cm pressure and when the machine detects multiple OA or H events it will raise the pressure a little at a time until the events are controlled. The median pressure is 19.92, which means the machine is basically climbing in pressure until you hit 20 and staying there most of the night. It doesn't go higher than 20 because you machine CAN'T go higher than 20.

So what can we do? One option would be to increase the minimum pressure from its current setting of 4 up to the maximum of 20 (probably not all at once) or switch the machine to straight CPAP at a pressure of 20. Check your AHI and the number of OA and H events. If you are running a fixed 20 and your OA + H > 5, then you need more pressure than your current machine is capable of delivering and you should look into changing to BiPAP which can go to pressures of 25 or 30 and provide enhanced pressure relief to make breathing easier.

[BlackSpinner]

The median pressure is 19.92, which means the machine is basically climbing in pressure until you hit 20 and staying there most of the night. It doesn't go higher than 20 because you machine CAN'T go higher than 20.

It could be doing that because it "runs away" trying to chase those events. They might disappear if the minimum is set higher to prevent a lot more of them. If they don't, then yes I agree she needs a Bipap. Another thing would be to be 100% sure there is no mouth breathing happening when those pressures spike. She didn't post the leak graphs.

[djhall]

The median pressure is 19.92, which means the machine is basically climbing in pressure until you hit 20 and staying there most of the night. It doesn't go higher than 20 because you machine CAN'T go higher than 20.

It could be doing that because it "runs away" trying to chase those events. They might disappear if the minimum is set higher to prevent a lot more of them. If they don't, then yes I agree she needs a Bipap. Another thing would be to be 100% sure there is no mouth breathing happening when those pressures spike. She didn't post the leak graphs.

Agreed, though the statistics have leak data of 0.0 Median, 0.0 95%, and 3.6 Max, which leads me to believe the leak graph probably isn't too awful. The "check it at 20 and see if you are aren't under control" strategy seemed a little more direct and simpler to explain,but, yes, raising it a few cm at a time and re-checking a few days data at each step along the way is indeed the "preferred" procedure.

[theresemp]

I don't know what happened to the leak graph. I thought it posted, but there were no bad leaks. Nothing over 15.

My daughter has the ramp set to 6 for 15 min and then a range of 10-20 for tonight. The EPR is off since I don't have feel I have trouble exhaling against the pressure. We will give this a few days at these setting and post again. Thanks to all for the advice.

[Pugsy]

Minimum of 10 now instead of the 4 cm should improve things a lot.
Give it a few nights (3 or 4 and let's see what happens)...sometimes we get lucky and with a more optimal minimum pressure we don't see the pressure line pushing so high up near the maximum so much.
It's an easier adjustment to go up in small increments too.

[Sludge]

...but the repeated strings of H and OA events is a clear indicator of insufficient pressure.

Unless the CA detection algorithm isn't accurate...

[Sludge]

...but the repeated strings of H and OA events is a clear indicator of insufficient pressure.

Unless the CA detection algorithm isn't accurate...

...and the assumption that you're actually asleep during those periods is an...

...assumption.