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kiminabmw1 · Post by **kiminabmw1** » Mon Sep 18, 2017 6:09 am

Hi everyone, I'm new here. Please pardon my lack of knowledge, as I am new to CPAP. I just picked up Respironics Dream Machine last Tuesday, with their Nuance Pro Nasal Pillows. I used the machine for 3 nights, 7 hours the first night, 8 hours the second night, and 7 hours the third night with an AHI of 3.7, then 3.2, then 3.9. The pressure range my machine was set at is 8-11. I took my machine in to have the "flex" added to it on Friday, not sure if that is the right term, but I wanted some relief of pressure when I exhale. My choices were flex of 1, 2 or 3. I opted for 2. Last night I used the PAP again, but only for 2 hours (first time using it after the "flex" was added) and my AHI was 13.8. What do you think happened?? I suppose I should say the reason I didn't use the PAP for 2 nights (after the 1st 3 nights of using it) was I felt so bloated up with gas/air I was horribly uncomfortable for 2 days, and am having heart palpitations. Sorry for the long post, but my main question is why do you think I went from an AHI in the 3's for three nights in a row, to 13.8 and the only difference was having the "flex" added, and again I apologize if that is the wrong term. Thanks so much for your time and knowledge. Kim

ChicagoGranny · Post by **ChicagoGranny** » Mon Sep 18, 2017 6:29 am

kiminabmw1 wrote:... my main question is why do you think I went from an AHI in the 3's for three nights in a row, to 13.8 and the only difference was having the "flex" added

This question can't be answered without seeing the data.

Here is only a wild guess:

A flex setting of 2 lowers the pressure on exhale by roughly 2 cm. It could be that the pressure on exhale is no longer high enough to maintain the patency of your airway.

The suggestion is to provide us some data from the free Sleepyhead software:
https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

Pugsy · Post by **Pugsy** » Mon Sep 18, 2017 6:30 am

Which model DreamStation are you using?
Model number is on the bottom of the blower....stars with DSX then 3 digits and some letters...need to know the 3 digits.

We need to know what the event category breakdown for that AHI is.

Since you mention a pressure range...I assume apap capapble machine...
Get the available software
https://sleep.tnet.com/equipment

It will show the event category breakdown which is not available on the LCD screen.

If the AHI is primarily CA or Clear Airway...Respironics term for central apnea...try turning Flex back off and see if the AHI reduces.

Maybe if you need exhale relief starting out the night we could maybe use the ramp feature instead of Flex if it works out that Flex is causing CAs . It's rare but it can happen.

Pugsy · Post by **Pugsy** » Mon Sep 18, 2017 6:33 am

Actually the Flex setting of 2 isn't automatically a full 2 cm reduction during exhale...Respironics machines reduce the amount during exhale based on flow rate (or how forcefully someone breathes) and they may or may not get the full maximum 2 cm...which is as high as it can go even at the setting of 3.

And sometimes adding Flex/or any exhale relief triggers Complex Sleep Apnea...in a very small number of people.

So very important to know which category of event got increased when Flex was added because the treatment is different for each.

Julie · Post by **Julie** » Mon Sep 18, 2017 6:46 am

I also wonder why your high setting of 11 is that low... it's usually a good idea, at least when starting out and exploring, to set it higher so that potential, even if isolated, high level events can be seen and noted, and having the setting higher won't impact other things the way e.g. a high(er) low setting might. I'd move the high one to at least 15, if not 20 for now.

Pugsy · Post by **Pugsy** » Mon Sep 18, 2017 6:49 am

I wouldn't increase the maximum setting at all until I knew for sure it even needed to be increased.
If the high AHI is central/CA events primarily....more available pressure won't fix it and might cause more problems.

Before increasing the pressure...make sure you know that what you are fighting is even fixable with more pressure.

Doublev · Post by **Doublev** » Mon Sep 18, 2017 6:51 am

You have come to the right place. Get SleepyHead and post the data from it.
If you have some technical skill (could you have set your VCR clock if you wanted to? ) then you should just make the changes yourself. I would never take my equipment in for a setting change.. with that time spent going and coming back you could have become an expert with your unit and the clinician manual.

If you can post the data we can help

Julie · Post by **Julie** » Mon Sep 18, 2017 7:49 am

Excuse me, but I've seen over and over again where advice re leaving the high pressure setting 'wide open' at e.g. 20 is not a problem, only that the low setting could be one if raised too high quickly and potentially causing centrals. Why is it suddenly a problem here... because I suggested doing it?

Pugsy · Post by **Pugsy** » Mon Sep 18, 2017 8:04 am

Julie wrote: Why is it suddenly a problem here... because I suggested doing it?

No...doesn't matter who would say "open it up".... I won't advise it without knowing all the facts first. The machine is a full data machine...won't hurt to wait and see what we are fighting before changing things.

And I didn't say anything about what you said being right or wrong...all I said was that I wouldn't advise it and stated why.

Why do you feel that I target your responses...did I say "Julie is wrong"?? Did I mention you any any way shape or form?
No...I offered a different opinion than yours and that's all I did.
Why are you so paranoid anyway? I wasn't even talking to you.
You are entitled to your opinion and I am entitled to mine.

Kiminabmw1 · Post by **Kiminabmw1** » Mon Sep 18, 2017 9:57 am

[quote="Pugsy"]Which model DreamStation are you using?
Model number is on the bottom of the blower....stars with DSX then 3 digits and some letters...need to know the 3 digits.

Thank you so much for your replies! Full disclosure, I'm borderline a moron when it comes to technology. I was diagnosed with OSA in 2005 and did nothing about it, never went back for the PAP machine, until this month. (told you I'm a moron) So I'm wondering if 12+ years of being oxygen deprived has now turned me into a super moron.

The model is DSX500T11C. I will work on getting the other info.

My original Sleep Study said OSA with and AHI of 28. My Titration Study (done this month) had a AHI of 11.5, with both Obstructive and Central apneas. The Central ones freak me out. I will get the other info requested, thank you again for this group, and your knowledge ..... I have a lot to learn!!!

Okie bipap · Post by **Okie bipap** » Mon Sep 18, 2017 10:41 am

Kiminabmw1 wrote:My original Sleep Study said OSA with and AHI of 28. My Titration Study (done this month) had a AHI of 11.5, with both Obstructive and Central apneas. The Central ones freak me out. I will get the other info requested, thank you again for this group, and your knowledge ..... I have a lot to learn!!!

The centrals may or may not go away. When I first started, I my sleep tests also indicated central apneas. Once I started treatment, they diminished. After almost two and a half years, my central apneas are less than two per hour, which is too low of a number to be concerned about.

Sleeping Ugly · Post by **Sleeping Ugly** » Mon Sep 18, 2017 11:21 am

Kiminabmw1 wrote:
Pugsy wrote:Which model DreamStation are you using?
Model number is on the bottom of the blower....stars with DSX then 3 digits and some letters...need to know the 3 digits.

Thank you so much for your replies! Full disclosure, I'm borderline a moron when it comes to technology. I was diagnosed with OSA in 2005 and did nothing about it, never went back for the PAP machine, until this month. (told you I'm a moron) So I'm wondering if 12+ years of being oxygen deprived has now turned me into a super moron.

The model is DSX500T11C. I will work on getting the other info.

My original Sleep Study said OSA with and AHI of 28. My Titration Study (done this month) had a AHI of 11.5, with both Obstructive and Central apneas. The Central ones freak me out. I will get the other info requested, thank you again for this group, and your knowledge ..... I have a lot to learn!!!

You can sit next to me! I am a technology moron, too!

Goofproof · Post by **Goofproof** » Mon Sep 18, 2017 11:24 am

Julie wrote:I also wonder why your high setting of 11 is that low... it's usually a good idea, at least when starting out and exploring, to set it higher so that potential, even if isolated, high level events can be seen and noted, and having the setting higher won't impact other things the way e.g. a high(er) low setting might. I'd move the high one to at least 15, if not 20 for now.

Before it becomes a Good Idea, it's a Good Idea to have Sleepyhead's data to go by, so you aren't driving your car into the trees, operating it without a steering wheel.

In the meantime i'd raise the head of the bed 4 or more inched, might help with the swallowing air problem, I doubt if Flex is the problem. Jim

kiminabmw1 · Post by **kiminabmw1** » Mon Sep 18, 2017 5:16 pm

I have an adjustable bed base, and it normally sits between 30-45 degrees while I sleep. My Titration Study also had an adjustable bed base, and the Sleep Doctors recommendation was for me to sleep with the bed at 45 degrees. Part of the reason the gas/bloating bothers me so much is that 3 years ago I had a Nissen Fundoplication with Hiatal Hernia repair surgery, and it left me unable to burp (or vomit) so the trapped air has to pass through if you know what I mean. I'm still working on Sleepyhead ..... well, husband it going to set me up .... no joke, I think Technology for Dummies would be too advanced for me!!

jiminacamry69 · Post by **jiminacamry69** » Mon Sep 18, 2017 5:22 pm

kiminabmw1 wrote: . . . Nissen Fundoplication with Hiatal Hernia repair surgery, and it left me unable to burp (or vomit) . . .

I have never seen a more diverse set of maladies as those described on this forum.

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