APAP to CPAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Wulfman...
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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 3:04 pm

Upon reviewing the report.......
I think a fixed pressure of 10 (or even 9 cm.) may be a reasonable place to start. Your events are higher when you go over that but we don't know if it's a "chicken or egg" situation. The reflex reaction from the aerophagia or something else may be causing the pressure increases which may cause more aerophagia and more reflex actions......interpreted by the machine as a need to increase pressures. So, it can be a self-feeding situation.


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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 3:07 pm

Sleepysuz wrote:couldn't figure out the .png thing to shrink it down.


Just got a message that the DME is switching me to try a constant 15 tonite as per doctor's order. Hope I don't explode like Mr. Creosote who ate one too many Thin Mints in Monty Python's the Meaning of LIfe.

They said if that doesn't work I'm getting a Bipap. Seems like it might be overkill for mild OSA. They were on the fence in the beginning if I even needed a machine at all! This is getting crazier.
What did they base THAT decision on?
Too high in my opinion.

However, Bi-PAP MAY be an option to consider if they can't get the aerophagia resolved with CPAP.


Den

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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 3:14 pm

Wulfman... wrote:What did they base THAT decision on?
Too high in my opinion.
Probably because it went there a couple of times.
I agree with you...too high in my opinion.
Looks like either REM stage sleep or supine sleeping needing a little more pressure to deal with the clusters but if the minimum pressure wasn't so darn low it could do a better job preventing instead of trying to fix after the fact.
My crystal ball predicts aerophagia is likely to rear its ugly head with 15 cm cpap. Hope I am proved wrong.

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Re: APAP to CPAP?

Post by palerider » Tue Sep 16, 2014 3:14 pm

Sleepysuz wrote:couldn't figure out the .png thing to shrink it down.


Just got a message that the DME is switching me to try a constant 15 tonite as per doctor's order. Hope I don't explode like Mr. Creosote who ate one too many Thin Mints in Monty Python's the Meaning of LIfe.

They said if that doesn't work I'm getting a Bipap. Seems like it might be overkill for mild OSA. They were on the fence in the beginning if I even needed a machine at all! This is getting crazier.
quote my message above with the example, and compare the two lines that are in there, you should see the difference

as to overkill... the pressures needed don't really have anything to do with the severity of the apnea, you could have mild apnea and need to have high pressures to prevent it, or really severe, multiple times a minute apnea and only need a little pressure to prevent it

my first thought looking at your graph is that you do need more pressure than what you're getting now.

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 3:30 pm

Pugsy wrote:
Wulfman... wrote:What did they base THAT decision on?
Too high in my opinion.
Probably because it went there a couple of times.
I agree with you...too high in my opinion.
Looks like either REM stage sleep or supine sleeping needing a little more pressure to deal with the clusters but if the minimum pressure wasn't so darn low it could do a better job preventing instead of trying to fix after the fact.
My crystal ball predicts aerophagia is likely to rear its ugly head with 15 cm cpap. Hope I am proved wrong.
Pugsy,

From what I see, the areas where there is a LACK of Apneas seem to be below the pressure of 10 cm.
Also, there appear to be quite a few flow limitations that the machine may be responding to......needlessly.
To me, flow limitations are not worth chasing most of the time.
Positional sleeping (or positional apneas) could be part of it but if in fixed pressure, the events will show up and then we could get a better "visual" on that situation. If the user suspects it's positional, things could be done to try to minimize that.

Do you agree? Or, do you have different ideas?


Den

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Re: APAP to CPAP?

Post by Sleepysuz » Tue Sep 16, 2014 3:37 pm

It already has reared its head. Took me 6 hours to deflate today. When my husband has to scrape me off the ceiling maybe the doctor will listen.
Thank you all for the wonderful input. Have learned so much today.
We are still in the renting mode here or I'd start playing with the settings Have to pretend I'm compliant but am dreading tonite.

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 3:46 pm

Sleepysuz wrote:It already has reared its head. Took me 6 hours to deflate today. When my husband has to scrape me off the ceiling maybe the doctor will listen.
Thank you all for the wonderful input. Have learned so much today.
We are still in the renting mode here or I'd start playing with the settings Have to pretend I'm compliant but am dreading tonite.
If you haven't showed your doctor the reports, print that one and take it to him/her and point some of those things out.
There's absolutely NO reason you should have to suffer through THEIR incompetence.

Even if you're "renting", I would think that this machine would be "yours".......unless they swap it for a different one somewhere down the line. Is it actually "rent to own" or is it "try ours till we figure out what you need"?
If your insurance is paying and this machine will actually be yours at some point, I would think you should have some latitude to make your own settings changes.......especially if you can justify them.


Den

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Re: APAP to CPAP?

Post by palerider » Tue Sep 16, 2014 3:50 pm

Sleepysuz wrote:It already has reared its head. Took me 6 hours to deflate today. When my husband has to scrape me off the ceiling maybe the doctor will listen.
Thank you all for the wonderful input. Have learned so much today.
We are still in the renting mode here or I'd start playing with the settings Have to pretend I'm compliant but am dreading tonite.
compliant doesn't mean "left it at the settings they made" it means "used the machine for enough hours on enough days". the compliancy data doesn't record anything beyond your usage....

just sayin

and, if you're afraid of floating away, then maybe some handcuffs or ropes around the ankles (eyeballing ricalynn and chunkyfrog) might be in order

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Re: APAP to CPAP?

Post by palerider » Tue Sep 16, 2014 4:00 pm

Wulfman... wrote:
Pugsy wrote:
Wulfman... wrote:What did they base THAT decision on?
Too high in my opinion.
Probably because it went there a couple of times.
I agree with you...too high in my opinion.
Looks like either REM stage sleep or supine sleeping needing a little more pressure to deal with the clusters but if the minimum pressure wasn't so darn low it could do a better job preventing instead of trying to fix after the fact.
My crystal ball predicts aerophagia is likely to rear its ugly head with 15 cm cpap. Hope I am proved wrong.
Pugsy,

From what I see, the areas where there is a LACK of Apneas seem to be below the pressure of 10 cm.
Also, there appear to be quite a few flow limitations that the machine may be responding to......needlessly.
To me, flow limitations are not worth chasing most of the time.
Positional sleeping (or positional apneas) could be part of it but if in fixed pressure, the events will show up and then we could get a better "visual" on that situation. If the user suspects it's positional, things could be done to try to minimize that.
there's another chap on the forum here who I've been talking to on the irc chat, who's wife got a pr560 and she was having a lot of problems with nasty clusters at lower pressures. she'd been titrated to 11, but the doctor or dme screwed up and set her machine to 8-10, ... after a lot of looking at graphs and discussion, the husband raised his wifes pressures slowly, and now that she's running something like 11-14 pressure, her ahi has gone from around 9 to low 2's.

point being, the really low pressure that sleepysuz has may be setting her up for a cascade effect, and the machine keeps going higher to stop it, but once the trainwreck starts, it goes on for a while.

starting around 10 might help head off the wreck, and reduce the need for higher pressures.

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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 4:15 pm

Wulfman... wrote: Do you agree? Or, do you have different ideas?
Oh, I agree with you. The bulk of the big pressure increase seems to be when then OA clusters show up.
Looking at the 9/16 report at about 2 AM ...whatever the cause (my money is on REM sleep because these reports pretty much mimic mine) it's obvious more pressure is needed but I really, really believe that if the minimum was up around 8 or 9 we wouldn't see nearly as much pressure increases in response to FLs and the OAs would be better prevented....and I think that the pressure line would stabilize and there would be less chance for aerphagia to rear its ugly head.
You know me....I like apap mode but I am not opposed to a very tight range in situations like this especially with aerophagia complicating things. I think your idea of 10 cm cpap or in apap with min and max set at 10 would also be a viable option. I like knowing about FLs (just in case) and of course in cpap mode we lose FL flagging.

She's going to need at least 8 or 9 or 10 most likely whether it be minimum with a small range or fixed.
I would really need to see a report with a more optimal minimum to get a better feel though. When the range is so wild it's hard to get a grasp on what might work.

Problem is we don't know where the line is for aerophagia....heck it might be 8 cm and then we're screwed.
Going from 5 cm starting the night to 10 cm fixed...that's a chunk of air for a newbie to get used to. Might be fairly uncomfortable.
I think I would be a little more cautious and maybe try apap with tight range...8 min and 10 max and just see what happens.
See how the aerophagia issue is and if we peg out the max very much and if we do what events slip past the defenses.

15 cm cpap mode....recipe for disaster IMHO. I have had the pleasure of having bad aerophagia on a couple of occasions. It's ugly and it's a lot more than just a few belches and farts. It made me sick all day. I wouldn't want anyone to go through that if there was anyway to avoid it.

We need to figure out the fine line for aerophagia though...and then see if we stay below that line what events end up sneaking past the defenses (if any).

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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 4:34 pm

palerider wrote:point being, the really low pressure that sleepysuz has may be setting her up for a cascade effect, and the machine keeps going higher to stop it, but once the trainwreck starts, it goes on for a while.

starting around 10 might help head off the wreck, and reduce the need for higher pressures.
Yep, the machine is so busy trying to "fix" the train wreck it can't prevent. If it could better prevent the train wreck from happening then the machine wouldn't have to work so hard.
I actually think that 10 cm is probably not needed. Plus it's big pill to swallow when going from 5 to 10. Her reports aren't as bad as mine were when I first started therapy and 2 cm more was all I needed to break up the clusters and that's really all that is needed here...break up the clusters and prevent them from being so ugly. We will gladly accept a random OA or hyponea if the clusters weren't present...or since aerophagia is also an issue maybe let an occasional small cluster slide by.
She's close but not quite there.
Sleepysuz wrote:We are still in the renting mode here or I'd start playing with the settings Have to pretend I'm compliant but am dreading tonite.
Your insurance doesn't give one whit what pressures you are using...they just want you to use the machine.

If you are not comfortable making changes yourself then tell the DME that you can't handle that big leap to 15...that you want to go up slowly in stages... tell them it's either that or you can't use the machine. They will come around because they want you to use it so they can get paid and don't have to take the machine back.

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 4:39 pm

And, you know me.......one of the reasons I like straight pressure is that it's a "constant". It eliminates some of the variables that ranges of pressures can cause. In other words, if that one thing isn't moving, it's something else.

From all "The Tales of Aerophagia" (a pun on "The Tales of Wells Fargo") I've observed on the forum, the threshold seems to be around the 10 cm. mark. Some need a lower pressure and some can tolerate a little higher. But, most of them seem to be around there somewhere.
Also, in my past observations, some have had to experiment with different exhale relief settings.....or, going to Bi-Level.

But.......15 cm.?????? Oooooooh my gosh.......


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Re: APAP to CPAP?

Post by Sleepysuz » Tue Sep 16, 2014 4:47 pm

I just adjusted it myself. Am not going to passively sit by and suffer. You folks are the best. Will update soon

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 4:48 pm

Pugsy wrote:I actually think that 10 cm is probably not needed. Plus it's big pill to swallow when going from 5 to 10.
I agree, but was leaving the door open at 9 cm. And, after yet another look at that report, the numbers of events between 5 and 9 are really not significant. A few flow limitations, but nothing much to worry about. It's when the machine gets above 10 cm. that things start to go bad.


Den

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 4:49 pm

Sleepysuz wrote:I just adjusted it myself. Am not going to passively sit by and suffer. You folks are the best. Will update soon
To what? Then we can all wait with baited breath for the next episode......


Den

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