Quantcast

Bookmark and Share
General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Melinda
 
Posts: 9
Joined: Wed Mar 17, 2010 2:44 am
Location: Sydney, Australia
Gender: Female

Getting lots of apnea's still

Postby Melinda on Sat Mar 27, 2010 6:43 am

Even though I have a APAP machine, it's showing I'm having lots of apneas a night.
My AHI average per night is 9.
I see a number of people here lucky enough to have maybe 1 an hour if that.
In reading Dave21's guide to less apnea's I have changed my pressure from 5 to 20, to 9 to 13.
My average pressure is 11.5.
Once the pressure gets to 13 and above, the flow waveform shows the top half chopped off compared to a lower pressure where it is higher and nice & rounded.
Data shows my apneas are all under 30 seconds, and typically group together which I now understand that is when I'm in a deeper rem sleep.
Is this ok? or should I get a sleep study done again with the view to purchasing a BiPap / VPAP?
I'd like to say I'm normal weight, but I'm an easy 30kgs overweight which I know is the cause of my problems.

User avatar
dave21
 
Posts: 720
Joined: Tue Mar 09, 2010 1:05 am
Location: United Kingdom
Gender: Male

Re: Getting lots of apnea's still

Postby dave21 on Sat Mar 27, 2010 7:33 am

Melinda wrote:Even though I have a APAP machine, it's showing I'm having lots of apneas a night.
My AHI average per night is 9.
I see a number of people here lucky enough to have maybe 1 an hour if that.
In reading Dave21's guide to less apnea's I have changed my pressure from 5 to 20, to 9 to 13.
My average pressure is 11.5.

Hi Melinda, do you know what pressure you were titrated at from your sleep study?
I presume by your average pressure of 11.5 this is what you're seeing in the data on a PC from your machine?
If most of the the Apneas you are seeing are Obstructive and not Central then here's what I would do...

I wouldn't drop the 20 (Max) to 13, you want to leave that as it was at 20cm. By reducing your Max to 13 means that if you have an Apnea at say 14, then the machine will not be able to treat it and up the pressure to 14 because you set the maximum to what it can go to as 13cm. So you should always leave the Max setting at it's highest value.

You're doing good at increasing the Min number from 5 to 9. I would try changing the Max back to 20 and see if at 9cm your AHI reduces a little. If it doesn't and your average pressure per night is 11.5 then that would suggest to me that some of your Apneas are spiking up above this, possibly to something like 12 or 13 or 14. So I would see if you can increase the Min little by little to get closer to 11.5. What you don't want to do is basically remove the Obstructive Apneas and replace them with Central Apneas (which it is possible to do) so be careful.

You don't need to necessarily set your Min pressure to 11.5, you just need it something a little below this so the machine can react quick enough to keep the Apneas and Hypopneas at bay.

Most of my Apneas and Hypopneas are around 10 seconds, some will spike up to 15 or 18 seconds. Try to aim to get your AHI to <5. Anything <1 will be superb. :)

The other thing to watch out for is your mask leaks as you're wearing a full face mask. You tend to get more mask leaks on full face masks and that can in-turn mean you don't get enough oxygen and it reduces the splint in keeping your upper airway open which in-turn (yes you guessed it) increases your AHI figure :(

Good luck!

_________________
Machine Mask 
Additional Comments: Running AirSense 10 AutoSet CPAP, previously S9 AutoSet and S8 AutoSet Spirit
Image

User avatar
ozij
 
Posts: 8720
Joined: Fri Mar 18, 2005 11:52 pm
Gender: Female

Re: Getting lots of apnea's still

Postby ozij on Sat Mar 27, 2010 8:01 am

Melinda, is your machine an S9 like it says in the profile?
Do you know how to get info about the types of apneas -- central or obstructive?
Did changing the range from 5-20 to 9-13 make any change in your results?
Are you using EPR? At what level?
O.

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Software: Updated version of ResScan. First machine (5 years) was PB420E. Tried others including Autoset S8 II
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

Mtnviewer
 
Posts: 136
Joined: Wed Dec 10, 2008 6:10 pm
Location: B.C.
Gender: Male

Re: Getting lots of apnea's still

Postby Mtnviewer on Sat Mar 27, 2010 8:46 am

Melinda: Have you checked in what sleeping position that you are having your apneas? Are the majority of them are while you are in the supine (on your back) position? Mine were. Pressure needed to be higher and higher because of this, which caused mask leaks etc., and the higher pressure alone was hard to sleep through. Also I think that APAP is mostly "reactionary", so it may start at a lower pressure but only responds with a higher pressure after it senses an apnea, in order to try and prevent future apneas. Often this is hit or miss and so with a wide pressure range you are likely to still have some apneas to which the machine will try to respond.

My suggestion would be to see if you can determine if your sleeping position is causing any of your apneas and to adjust your sleeping position accordingly and then hopefully you can lower your machine pressure and also narrow the range. I'd strongly suggest that you video record your sleep to see what may be going on. This is the best way to monitor your sleep and to see if indeed your sleeping position is a factor or what else may be going on. But you may have a partner that can also watch you or if on your own and you do wake from apneas, try to make note of the position that you woke in so as to give you a clue. Without visual evidence, you are just guessing at a cause.

For a time I was consistently frustrated by doing most everything right and still having periods of apneas at various pressures and ranges and so being tired. Then I gradually figured out that being on my back, partially or completely increased my OSA. I have tried various things like tennis balls, wedges, and more to keep me in a side sleeping position and I saw immediate improvements, but these were not long lasting as my body/brain figured out new ways to turn onto my back, even if it was just my head turning. Then I experimented with various ways of to reduce or eliminate even that and now I have a method that seems to be working. My AHI as a result is most often at 0.0, and occassinally higher but still below 1.0 and zero to only a few random apneas recorded. My APAP pressure range is 8-9, but most often at 8. My sleep has improved greatly, with longer and longer sessions before finally waking for a bathroom break. If I had video taped myself sleeping a few years ago, I would have seen the main cause of my OSA immediately and could have then figured out solutions, vs. the hit or miss years of frustration and lack of sleep.

Let us know what you find?

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: Dental Appliance to keep my Mouth Shut & No Jaw Advancement, Contec CMS-50E Oximeter & v.98 software
I MUST stay off my back to reduce OSA & snoring. I use a small backpack of solid styrofoam to keep me on my side (tennis balls too small), & use DIY customized soft foam pillow to keep my head in a side sleeping position to eliminate most OSA.

donger
 
Posts: 3
Joined: Fri Mar 26, 2010 6:31 am
Location: Longview,Tx
Gender: None specified

Re: Getting lots of apnea's still

Postby donger on Sat Mar 27, 2010 8:51 am

How did you find how to adjust your c-pap? I have two machines, one ones a remstar auto m series that supposed to adjust, but they have the top number as 15! My normal pressure is a 15.
Which IM like you they should have it higher, but trying get it adjusted Md wants a sleep study. I don't sleep well on this one so I don't use it and wish I could.
I also have a remstar Plus whitch has a flat rate of 15! If someone knows how or where to locat info on how to adjust my m series it would be great!
Don Gertz
[i]Don Gertz Jr[/i]
It's better to go ahead and do what you want and then beg forgivness!
Than to seek approval in the first place!

User avatar
KatieW
 
Posts: 1625
Joined: Sun Sep 27, 2009 11:07 am
Location: southern AZ
Gender: Female

Re: Getting lots of apnea's still

Postby KatieW on Sat Mar 27, 2010 9:40 am

donger wrote:How did you find how to adjust your c-pap? I have two machines, one ones a remstar auto m series that supposed to adjust, but they have the top number as 15! My normal pressure is a 15.
Which IM like you they should have it higher, but trying get it adjusted Md wants a sleep study. I don't sleep well on this one so I don't use it and wish I could.
I also have a remstar Plus whitch has a flat rate of 15! If someone knows how or where to locat info on how to adjust my m series it would be great!
Don Gertz


Here's a link:

http://www.apneaboard.com/CPAP%20Adjustment.htm

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Mirage Activa™ LT Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: ResScan 3.10, PapCap Plus, Hozzer, AEIO Headrest Nasal Pillows
KatieW

Melinda
 
Posts: 9
Joined: Wed Mar 17, 2010 2:44 am
Location: Sydney, Australia
Gender: Female

Re: Getting lots of apnea's still

Postby Melinda on Mon Apr 05, 2010 6:14 am

I have not replied straight away, thinking that it maybe just a fluke(one off).
But in increasing the max pressure back to 20, the min at 9, I was getting AHI's of 5.
Having now increased the min pressure to 10, leaving the max at 20, I'm getting AHI's 3 to 4! Wow! :D
Before I was getting massive bunches of apnea lines/events, with one as bad as 32 seconds.
I now get a number of 10 second central apnea's and the odd 20-24 second obstructive apnea's. How the machine knows this, it's very hard to see how, as to my eye the central and obstructive apnea flow wave forms look very similar.
So I'm pretty happy.

Before, when I had it set min 6 and max 20, the apap was always heading back to 8 before sharply going up again, to then return down.
In recent days with the min pressure change, it has not gone below 11 once passed this point.
So I am going to try a new min pressure of 11 now.

I dislike having the pressure at a max of 20, as from about 18 onwards the mask is leaking air. I have had my full mask that tight to stop leaks that I got a red blister mark on the ridge of my nose. This was good in a way, as I went two days without apap and relived the 2pm run down(tired) feeling I had forgotten I use to get without using apap.

Melinda
 
Posts: 9
Joined: Wed Mar 17, 2010 2:44 am
Location: Sydney, Australia
Gender: Female

Re: Getting lots of apnea's still

Postby Melinda on Mon Apr 05, 2010 7:08 am

ozij wrote:Melinda, is your machine an S9 like it says in the profile?
Do you know how to get info about the types of apneas -- central or obstructive?
Did changing the range from 5-20 to 9-13 make any change in your results?
Are you using EPR? At what level?
O.

The place I bought the S9 from prints out the reports about the data collected, if they are not busy for me(for free). From there it tells you how many apneas etc have happen.
Going from a starting min of 5 to 9 made a big difference. Again in the reports you can see what pressure was used during the night. Keep in mind I'm using a full mask(more pressure needed) and not a nasal one(less pressure needed).
Using EPR of 1.

donger wrote:How did you find how to adjust your c-pap? I have two machines, one ones a remstar auto m series that supposed to adjust, but they have the top number as 15! My normal pressure is a 15.
Which IM like you they should have it higher, but trying get it adjusted Md wants a sleep study. I don't sleep well on this one so I don't use it and wish I could.
I also have a remstar Plus whitch has a flat rate of 15! If someone knows how or where to locat info on how to adjust my m series it would be great!
Don Gertz

For some reason remstar only go to 15? I find above 15+ you need a tight fitting mask.
KatieW's link will get you sorted in adjusting your machine.

User avatar
dave21
 
Posts: 720
Joined: Tue Mar 09, 2010 1:05 am
Location: United Kingdom
Gender: Male

Re: Getting lots of apnea's still

Postby dave21 on Mon Apr 05, 2010 7:41 am

Melinda wrote:I have not replied straight away, thinking that it maybe just a fluke(one off).
But in increasing the max pressure back to 20, the min at 9, I was getting AHI's of 5.
Having now increased the min pressure to 10, leaving the max at 20, I'm getting AHI's 3 to 4! Wow! :D
Before I was getting massive bunches of apnea lines/events, with one as bad as 32 seconds.
I now get a number of 10 second central apnea's and the odd 20-24 second obstructive apnea's. How the machine knows this, it's very hard to see how, as to my eye the central and obstructive apnea flow wave forms look very similar.
So I'm pretty happy.

Be careful of the Central Apneas, I don't know if your Apneas were mostly Obstructive, or Centrals or a mix of the two, but if they were mostly Obstructive on a night for night basis, and increasing the pressure means you have reduced these but now Central Apneas have taken their place, you might want to think about backing off the Minimum pressure until you find the right balance. If you were getting mostly Centrals before then the machine will notice the difference between the two (although sometimes it's marginal when you look at your Flow Limitation graph).

Melinda wrote:Before, when I had it set min 6 and max 20, the apap was always heading back to 8 before sharply going up again, to then return down.
In recent days with the min pressure change, it has not gone below 11 once passed this point.
So I am going to try a new min pressure of 11 now.

That's the idea of reducing the gap between the Min and Max by increasing the lower pressure. That way for instance if you are having Obstructive Apneas and your pressure is increasing to 11cm when you are in an Apnea zone then it means the machine can react much quicker going from 10cm to 11cm and reduce the amount of time you spend in an Apnea or even prevent it from happening altogether if you were to have an Apnea around 10cm pressure.

Melinda wrote:I dislike having the pressure at a max of 20, as from about 18 onwards the mask is leaking air. I have had my full mask that tight to stop leaks that I got a red blister mark on the ridge of my nose. This was good in a way, as I went two days without apap and relived the 2pm run down(tired) feeling I had forgotten I use to get without using apap.

It's important to note that you most likely won't ever be getting 20cm, so the mask leaks won't be associated with this. Check what your max pressure was for the night, I suspect it's around 11cm or 12cm, in which case changing the Max 20cm back to 18cm won't make any difference. The max is there just like a car speedo, if your car has a max limit of 100mph then it means that the car can do 100mph if it needs to, but only if you force it to go that fast. It's just like the APAP pressure. So if you have a really bad night where for instance your pressure needed to be increased over 18cm, it won't increase if you set the Max to 18cm as you've told the machine that's the highest it can go to.

Mask leaks can and will happen with more pressure pushed into the mask, and that might be what you're seeing. You also might be experiencing leaks because of rolling over or readjusting where your head lies on the pillow.

Keep an eye on it, the drop from 20cm to 18cm isn't a lot so probably won't make much difference if your average pressure in an Apnea is around 11cm, but just be aware that you are setting a maximum ceiling on what the machine can do (almost like a 200mph car that has a speed limiter set at 150mph).

Melinda wrote:I dislike having the pressure at a max of 20..... got a red blister mark on the ridge of my nose.

I know some people that actually buy some sticky back toweling and place this around the edges of their masks and they find it creates a good seal as well as stopping the mask rubbing and causing blisters or sores. I personally never have found a need to do this, but if the mask isn't the correct size, or down to facial features, you might find that will help. It's basically the same material you would buy from a tennis/sports shop to re-tape a handle on a tennis racket.

Thanks
Dave

_________________
Machine Mask 
Additional Comments: Running AirSense 10 AutoSet CPAP, previously S9 AutoSet and S8 AutoSet Spirit
Image


Return to CPAP and Sleep Apnea (CLICK HERE TO READ POSTS)

Who is online

Users browsing this forum: No registered users and 42 guests