events increasing need advise please

[kiteboy]

Hi
I have been on CPAP for about 2 1/2 years and have averaged around 1 apneas per hour until recently when I have had one night with 7 and averaging around 5 for the last several nights. My wife has noticed a change too that has not been for the better. She has even questioned the number feeling it should be higher. This has made me much more tired and I would like to improve and feel like I did, when 1 was the average. Currently my pressure is set to 9. So here are my questions:
Do I need another sleep study to get someone to change my pressure setting?
Do I need a pressure setting change?
Who would do that?
Could allergies be the issue?
My supplier has a nurse that is all but useless and not at all helpful, how can I find a better supplier?

Thank-you for any and all suggestions.

[Jeff_Snore_No_More]

1) Personally, I would say another sleep study would be ideal.

2) Determining a pressure change would be the result of the sleep study. My doctor gave me prescription for the TITRATION part of the sleep study only, since the first part of a sleep study is determining if you have sleep apnea. if you already know you do, then I would think that part can be skipped, and you can go right to the second part (titration) for determining your pressure(s). However, I don't know if the titration part can determine how many "apneas" per hour.

3) Your health care provider would change your pressure setting.

4) I don't know if allergies could be the issues or not. I don't think so, but maybe. Not sure.

5) Google "health care provider in <your area>", or perhaps look in your insurance company participants directory.


Opinion: if your last sleep study only showed one apnea per hour, that is so low, I'm kind of surprised you were prescribed a machine and mask to begin with. A guy I work with was diagnosed with 2 per hour, and the doctor told him he wouldn't bother putting him on a machine. Now who knows, maybe the doctor was wrong, so maybe I'm wrong.

[LSAT]

You have a machine that provides all sorts of data regarding your sleep therapy...You can't use it unless you download the Sleepyhead software. See my signature area. You don't need your supplier unless you are purchasing something. Most of the time their advise is useless.

[Jeff_Snore_No_More]

You have a machine that provides all sorts of data regarding your sleep therapy...You can't use it unless you download the Sleepyhead software. See my signature area. You don't need your supplier unless you are purchasing something. Most of the time their advise is useless.

It has been my experience in the last 14 years or so that the sleep apnea patient knows a hell of a lot more than the health care provider, when it comes to his/her own needs. I wouldn't necessarily say their advice is useless, but I would say to take their advice with a POUND of salt. However, who does the sleep study these days? A trained technician or doctor? Or the health care provider? Are you referring to the health care provider when you say "supplier"? A sleep study certainly wouldn't hurt in this case.

[Julie]

When and if you look at Sleepyhead to see what's going on, you'll either find out that your pressure does need changing (and we'll help you with that... don't need docs etc. to do it), or you'll find out pressure is not the issue but you'll then need to address whatever it is. But until there's something to look at, we can't just randomly guess at what to do.

[kiteboy]

Sorry for the slow posting of data, but I can't get a readable chart out of Sleepyhead. I have loaded the program twice. I have adjusted and readjusted everything under appearance. I have changed fonts which helped some but not that much. I have spent 10 hours playing around and have nothing to show that is readable. I have also run windows compatibility more than 20 times. I can read screens that other post and samples from sleepyhead so I know what screens should look like. Data headings are fine, but all data is way to small to read. Charts have Headings that are printed over the scale. Sleep duration stops at 4:30 no matter how wide you try to stretch the charts. When program starts charts need to be pulled in by shrinking the left side data, which fills the width of the screen. Some chart data lines appear to be too thin, making them almost invisible. The only thing I have found is the program likes 32 bit machines and all of mine are 64.

[OkyDoky]

Did you go to the TNET site with the links at the bottom of LSAT's post? Are you seeing the charts on your computer? What OS are you using?

[palerider]

Sorry for the slow posting of data, but I can't get a readable chart out of Sleepyhead. I have loaded the program twice. I have adjusted and readjusted everything under appearance. I have changed fonts which helped some but not that much. I have spent 10 hours playing around and have nothing to show that is readable. I have also run windows compatibility more than 20 times. I can read screens that other post and samples from sleepyhead so I know what screens should look like. Data headings are fine, but all data is way to small to read. Charts have Headings that are printed over the scale. Sleep duration stops at 4:30 no matter how wide you try to stretch the charts. When program starts charts need to be pulled in by shrinking the left side data, which fills the width of the screen. Some chart data lines appear to be too thin, making them almost invisible. The only thing I have found is the program likes 32 bit machines and all of mine are 64.

You can upload a zipped copy of your sd card here:
https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H

64 bit shouldn't matter.

[kiteboy]

Sorry again for the slow reply. Attached find my screen shot. This is the worst night since I started. Changing computers made it doable. What do I need to do to improve this. Thanks

screenshot-20180519-104748.png (118.55 KiB) Viewed 4462 times

[Pugsy]

More pressure than the 9 cm fixed you are using.
Either more fixed pressure or change over to auto mode and have a range of pressures with the minimum starting at 9 cm.
The events are clustered...when we see this we think why is the pressure working fine at some parts of the night and obviously not optimal during these times. What changed???
Usual 2 culprits...supine sleeping or REM stage sleep. You need more pressure during whatever is happening to cause the OSA to worsen.
Given the pattern...my first suspect is REM stage sleep.

You have a machine that will auto adjust but you are using it in fixed mode...any special reason?

You can use auto mode and let the machine go higher when it feels the need....or you can increase the fixed cpap mode pressure and use higher pressures all night. Your choice.

Alternately another choice is to reduce or turn off EPR because the lower EPAP that EPR offers might be a factor in allowing the airway to try to close. Again your choice.
Reducing EPR effectively will increase the overall pressures just a little bit. Might be enough to break up the clusters.
I like EPR myself so if it were me I would just switch to auto mode and let the machine sort it out and leave EPR alone.

[kiteboy]

Thank-you Pugsy. I change over to auto and set the minimum to 9 and max to 12. I left the EPR alone for now. My provider HCS, set the machine to the Cpap setting rather than the auto setting. They are not very helpful and can't even get my mask order figured out. Let me try this for a few days and then I will post how it is working. Thanks for the reply. I finally feel that I have a good chance of getting this fixed. For that I am truly grateful.

[Pugsy]

That's what I would have tried if I were in your shoes.
See if the machine even wants to to 12 or not. You never know with REM or supine sleeping changing pressure needs.
My OSA is worse in REM and sometimes the pressure needs are significantly higher and sometimes not. I just open up the max and let the machine sort it out but it hurts nothing to limit the max at first. That's how I ended up figuring out that I might as well have the max at 20 because I saw it hit 18 cm quite often.

Sometimes the machine going a lot higher creates potential issues with leaks and aerophagia or just disturbing sleep in general so working your way up has its advantages in limiting potential issues at least until you figure out what you need and does it create any potential issues. For me I always slept through the pressure changes and never really had any aerophagia issues or leak issues but if I had then I would have re-evaluated the max pressure setting as needed.

I tend to make changes slowly and less aggressively than others might make changes.
You will figure out rather quickly if the machine wants to go higher or not.

[kiteboy]

Wow what a change. Feel way more rested and down to 0.5 AHI. Thank-you Pugsy and all those that contribute to this great site. Even my doctor did not have a suggestion for me. I think I will celebrate by taking a bike ride. Thank-you all.