APAP to CPAP?

[Sleepysuz]

Maybe with the higher minimum the cluster won't be so out of control that if I raise the maximum it won't kick in so long? I am going to try a higher max tonite to see what happens while we wait for approval for the bipap.

I think the doctor is perplexed and willing to do what I want after I showed her I was a little educated and 15 was crazy.
f I push for the sleep study I think I could get that ordered too, but in the meantime I imagine there is nothing to lose trying the bipap and at least I'd have that sooner than I could get in for the study.

I guess the only thing is if there is another problem that would overlooked up by not having the sleep study and ultimately would be a problem with my health. Other than a small crowded mouth I have none of the health and body issues usually related to making apnea worse. Could lose 5 lbs but so could almost everyone I know. I don't know enough about this stuff to know what we don't want to overlook though.

[Pugsy]

If the machine will respond with more pressure it could possibly break up the clusters. Might as well try. Doesn't look like it needs to be for very long so maybe will get lucky and not make the belly pain worse if only for a short period of time.

Worth giving the machine some room to roam around a bit and see what happens.

[Wulfman...]

And, the conundrum with this scenario is........
EPAP is set to eliminate Apneas.
IPAP is set to eliminate Hypopneas.......there are practically no hypopneas.

APAP/CPAP setting of 9 or 10 isn't eliminating the Apneas.
The "nature" of her Apneas is unknown. Most of them are "frank"......so, there's nothing to trigger pressure increases.
Practically no Flow Limitations preceding the "clusters" of Apneas.

I hear you but there's more than one way to skin a cat and get at those probable frank apneas. But I see with the last couple of reports the machine did max out it looks like....so it tried to respond it looks like.
Killing the apneas is easy.
Doing it without sacrificing sleep quality and quality of life might be a challenge but things sure aren't working now so might as well try the next step...and the next step...and the next step if need be.
And we take it one step at a time.

So.......why don't we just have her set it to 15 cm.? Or higher?

My primary concentration (so far) has been on avoiding the aerophagia and trying to see what pressure doesn't trigger it and what the results are if it's avoided.

SOMETHING is causing those clusters of "frank" Apneas.


Den

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[Pugsy]

My primary concentration (so far) has been on avoiding the aerophagia and trying to see what pressure doesn't trigger it and what the results are if it's avoided.

As is mine Den. You should know that by now.

Killing the apneas is easy with much higher pressures but that's not a viable option considering the aerophagia issues.

The only thing that MIGHT help now and I stress the might part is letting the machine try to deal with the clusters and see what happens. It's possible that the body won't rebel so much with higher pressures just part of the night as it does with all the night.
Maybe the machine will respond to some and not respond to others...anything is better than nothing as long as the belly is happy.

[Wulfman...]

My primary concentration (so far) has been on avoiding the aerophagia and trying to see what pressure doesn't trigger it and what the results are if it's avoided.

As is mine Den. You should know that by now.

Killing the apneas is easy with much higher pressures but that's not a viable option considering the aerophagia issues.

The only thing that MIGHT help now and I stress the might part is letting the machine try to deal with the clusters and see what happens. It's possible that the body won't rebel so much with higher pressures just part of the night as it does with all the night.
Maybe the machine will respond to some and not respond to others...anything is better than nothing as long as the belly is happy.

I know. I'm just "messin'" with ya.

Are we making wagers here? If you're thinking about opening up the upper pressure limit....... In the absence of "triggers" to send the machine pressures higher, I doubt that it will go high enough to "blast" away the apneas. And, in the meantime, the aerophagia is gonna be a BIG problem.


Den

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[Pugsy]

in the meantime, the aerophagia is gonna be a BIG problem.

Maybe...maybe not. I am the eternal optimist. I always think I can achieve success until it's proven I can't and I will always at least try. If we don't try there is no chance at all of success.

The time period that is need for the higher pressures is relatively short lived. Maybe...just maybe the machine will respond only briefly and well enough to break up the clusters. I don't expect total annihilation ....just hoping to break them up a bit....without puffer fish syndrome rearing its ugly head.

Finally...even with the clusters being present there is still significant improvement in apnea reduction other parts of the night and that's something. No, it's not ideal but sometimes we don't get ideal. There's still other options to try and until all options are exhausted I don't give up thinking that success is just one step away. If I didn't believe that then I have no business here. We gotta try even if the odds are stacked against us.

[Sleepysuz]

I appreciate all you both do for this community. BTW your dialogue is entertaining too!

[Wulfman...]

in the meantime, the aerophagia is gonna be a BIG problem.

Maybe...maybe not. I am the eternal optimist. I always think I can achieve success until it's proven I can't and I will always at least try. If we don't try there is no chance at all of success.

The time period that is need for the higher pressures is relatively short lived. Maybe...just maybe the machine will respond only briefly and well enough to break up the clusters. I don't expect total annihilation ....just hoping to break them up a bit....without puffer fish syndrome rearing its ugly head.

Finally...even with the clusters being present there is still significant improvement in apnea reduction other parts of the night and that's something. No, it's not ideal but sometimes we don't get ideal. There's still other options to try and until all options are exhausted I don't give up thinking that success is just one step away. If I didn't believe that then I have no business here. We gotta try even if the odds are stacked against us.

Is the patient willing?


Den

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[Wulfman...]

Maybe with the higher minimum the cluster won't be so out of control that if I raise the maximum it won't kick in so long? I am going to try a higher max tonite to see what happens while we wait for approval for the bipap.

I think the doctor is perplexed and willing to do what I want after I showed her I was a little educated and 15 was crazy.
f I push for the sleep study I think I could get that ordered too, but in the meantime I imagine there is nothing to lose trying the bipap and at least I'd have that sooner than I could get in for the study.

I guess the only thing is if there is another problem that would overlooked up by not having the sleep study and ultimately would be a problem with my health. Other than a small crowded mouth I have none of the health and body issues usually related to making apnea worse. Could lose 5 lbs but so could almost everyone I know. I don't know enough about this stuff to know what we don't want to overlook though.

What pressure were you thinking about?

Wanna try the max?.......20 cm.?

Then we'll know......."something".


Den

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[Sleepysuz]

One last shot at this: settings 9.5-20 woke up after a big cluster for pit stop - belly pain but not terrible
Thoughts?

[Pugsy]

Well it looks like it did try to respond to one cluster at least. That cluster right before you woke up the first time.
Didn't try during the second cluster.

How are you feeling otherwise?
How are you feeling compared to no cpap?
How is the sleep quality in general? I know it isn't ideal but how is it compared to when you weren't on cpap?
How does this AHI compare with pre cpap AHI?

[Sleepysuz]

How do I feel? Clearer in head. Not falling asleep at work. Not snoring 20% of night as I did at sleep study. Happy hubby not waking up with heart rate elevated - very happy
Overall? If i have to walk the dog to toot the first hour of morning and have a longer life I will opt for that. Wish I started this years ago. When engaged 38 years ago I would fall asleep at a play. Fell asleep at major ball game when in 30s. Mom had horrible apnea. I remember her gasping snores as a kid. She died of heart disease

AHI was about 7 in sleep study now slightly less

Last night was not typical. Was just restless Used to have nocturia now only the
Air belly wakes me. Almost all charts from last 5 weeks have same 3-4 clusters.

How do you and Den find the time to help so many people?

[Pugsy]

If the air in the belly is the only thing that wakes you up then I am not so sure that I wouldn't simply limit that maximum to maybe eliminate the belly issue. It's not going to make a huge difference in the AHI anyway.
Choice is yours of course. If the belly pain was a trade off or compromise in terms of huge improvements in the AHI or how you feel during the day then it might be worth it but if you feel about the same except for the belly issues then might as well opt for the settings that at least eliminate the belly issues. Eliminate the wake ups associated with belly issues in an effort to at least improve sleep quality a little.

Sometimes we have to make compromises and looks like your situation is one of those situations where a compromise is in order at least until you get a chance to try bilevel pressures.

It sounds like even though the AHI isn't where we would like for it to be you are noticing definite improvements in the other areas of your life and that's a big plus in itself. At least you are feeling better in general. That more than some people get even with nice low AHI numbers.

[Wulfman...]

That's about what I anticipated. Without "triggering" events (Flow Limitations and Snores), it won't increase pressure. And, they won't try to address an apnea once it's in progress. Last night you had a couple preceding events in the first part of the night for that cluster. The report back on page 4 (straight 9 pressure) actually looked better......until you said you were deliberately on your back. Of course, we don't sleep the same every night, so your 6+ AHI is still in the "ballpark"......give or take a bit.

Your decision, your therapy. Personally, I'd like to see some more reports of 9 - 9 or 9.5 - 9.5 settings, but you're the one who has to try to sleep with this.


Den

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[Sleepysuz]

Den, the previous night when I did 9.5-12 belly was ok. Seems like shooting up over 12 pumps my up
Went higher as it had stayed at 12 so long wondered if higher max was better which it was not

Question. If 9-12 is ok is there any advantage to doing a straight 9.5-9.5 on auto
Will be a few days till I get bipap so in the meantime want to stick with something consistent

Thanks again.