The more I try, the worse it gets.

[robysue]

Yeah, those are the correct graphs.

Your events are almost equally split between CAs and OAs on this night, but the OAs are still too numerous. How restless were you on this night?

Leaks are under control---you don't need to worry about them if this is typical of what your leak line looks like. Since you said the nuance kept falling away from your nose, I wonder if you were simply hyperalert and caught some very small leaks that the S9 did not pick up when computing the excessive leak numbers for the night. And if you were fiddling with the mask all night, that might explain the higher number of CAs as well.

[lliann]

Last night was pretty much more of the same. Had a wicked thunder/lightening/rain storm and cats were all on the bed. I did change the pillow from large to medium. It felt like a better fit, even felt like better sleep but the charts don't support that.


I won't keep sending charts until something has changed. I will keep the settings as is because its only a week away (or maybe I will try a full face at the old settings) The lower settings were there to accommodate my trying nasal masks. I want to let them know that this business of saying I cant make changes when I have all this info is crap if they cannot be on call or available. I called 2 weeks ago saying my asthma and sleep issues were worsened and they said they would put me on the cancellation list. Nada so far so they just are holding me to standards they won't apply to themselves. Either they set a precedent with me, I go rogue or I try to find another doctor. Really not easy here since its a ferry ride($25) to additional medical.

One things I wonder about. When I was on the doxepin, even tho I was too tired all the time, I did go into a deeper sleep. Even tho I am still doing some dreaming, I feel that I have lost that ability to just fall asleep fast and stay asleep, and when I get disturbed, it takes longer to get back to it. Part of it feels like I am so aware I am being monitored. I wonder if a small amt of sleep aid would benefit me or would it just put me at poor risk for more lousy breathing/oxygen?

I really am torn about changing things by myself. I do own my machine and intellectually I feel its mine to adjust if I am getting educated and proactive, but since my apnea is still so not under control, I don't want to give them a way out(legally) to absolve themselves from my treatment.



S9 VPAP Auto
Mode: APAP 0-0cmH2O
Date Sleep Wake Hours
4/14/14 00:46 04:29 03:43:02
AHIApnea / Hypopnea Index 18.83
HypopneaHypopnea 0.27
ApneaUnspecified Apnea 0.27
ObstructiveObstructive Apnea 12.37
Clear AirwayClear Airway Apnea 5.92

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 7.97 4.56 8.00 8.00 8.00
IPAPInspiratory Pressure (cmH20)
W-Avg: 12.97 9.56 13.00 13.00 13.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 5.55 0.00 5.38 8.38 10.75
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 13.60 0.00 13.80 17.00 26.60
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.01 0.00 0.00 0.02 0.25
LeaksLeak Rate (L/min)
W-Avg: 0.54 0.00 0.00 3.60 13.20
SnoreSnore (unknown)
W-Avg: 0.03 0.00 0.02 0.10 0.34
I:EInspiratory:Expiratory (ratio)
W-Avg: 39.65 3.00 41.00 55.00 70.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.24 0.00 1.24 1.54 1.98
Exp TimeExpiratory Time (seconds)
W-Avg: 3.36 0.00 3.02 5.72 10.00
Tidal VolumeTidal Volume (ml)
W-Avg: 409.48 0.00 380.00 600.00 840.00

Machine Settings
Pr. ReliefPressure Relief EPR x0

Session Information
SessionID On Date Start End
CPAP Sessions
1397450803ResMed CPAP 3h, 43m, 2s 4/14/14 00:46 04:29

[robysue]

I won't keep sending charts until something has changed. I will keep the settings as is because its only a week away (or maybe I will try a full face at the old settings) The lower settings were there to accommodate my trying nasal masks. I want to let them know that this business of saying I cant make changes when I have all this info is crap if they cannot be on call or available. I called 2 weeks ago saying my asthma and sleep issues were worsened and they said they would put me on the cancellation list. Nada so far so they just are holding me to standards they won't apply to themselves. Either they set a precedent with me, I go rogue or I try to find another doctor. Really not easy here since its a ferry ride($25) to additional medical.

My advice would be toquietly go rogue. Do and don't bother telling them until (unless) they notice and bring out the wet noodle to whip you with.

One things I wonder about. When I was on the doxepin, even tho I was too tired all the time, I did go into a deeper sleep. Even tho I am still doing some dreaming, I feel that I have lost that ability to just fall asleep fast and stay asleep, and when I get disturbed, it takes longer to get back to it. Part of it feels like I am so aware I am being monitored. I wonder if a small amt of sleep aid would benefit me or would it just put me at poor risk for more lousy breathing/oxygen?

A lot of people do wind up taking small doses of something like Ambien while on CPAP without too many problems. During the Second War on Insomnia, I wound up sadly agreeing to try taking Ambien every night for a while---regardless of whether I thought I needed it or not. The doc agreed with allowing me to cut the 5mg tabs in half because I'm so prone to having Ambien "hangover" in the morning. I now am down to taking it on an as needed basis.

You could also ask the sleep doc about cognitive behavior therapy for insomnia. There are ways to train your body to relearn how to fall asleep quickly and stay asleep and (just as important) not respond to normal wakes by waking up fully for extended periods of time. It's not easy, but it can work well for people who are highly motivated and for people who wish to minimize the use of prescription sleeping pills.

[Pugsy]

What were the original pressure settings that were used with the full face mask? Mode and EPAP and IPAP?
Why were they changed when the mask change to nasal pillow mask was made? For comfort?

My advice would be to quietly go rogue.

Ditto.
Though to be honest I don't consider it all that rogue to change the pressure to something that was in line (or close to) what your original settings were when you were using a full face mask. It's not like you were never prescribed a higher pressure...is it?

Don't feel like it is the end of the world if you feel the need to take a little something to help with sleep quality.
Especially now when the therapy is obviously not optimal.
Maybe a much smaller dose or different med than the one you took that may have contributed to the central increase.

[lliann]

Rogue it is. went in and changed 19/15vpap to 15/10.

There was something else. Did you say change the PS to 4? Its at zero currently. I don't know what that one is for.

[kaiasgram]

Rogue it is. went in and changed 19/15vpap to 15/10.

There was something else. Did you say change the PS to 4? Its at zero currently. I don't know what that one is for.

Hi B -- PS is Pressure Support. PS is the difference between your IPAP and EPAP pressures.

I'm not 100% sure about this, but I think that if your pressure support (PS) is set to zero then your machine is basically functioning like an Auto CPAP. With your current 15/10 settings, for example, if you set PS at 3, then when your IPAP is at 15, your EPAP will be at 12, IPAP=13 then EPAP=10, and so on. So if PS is set to zero, I'm thinking that tells the machine "no difference" between IPAP and EPAP -- which means your pressure can vary between 10 and 15, but it will just be a single pressure (IPAP=EPAP) that can move between 10 and 15.

I didn't even know you could select PS=0 in VPAP Auto mode, so I could be way off base in my reasoning here. But there are only two other modes on our machines, CPAP and "S" and there's no PS in either of those menus.

Curious -- can you post the pressure line graph from the same night?

[Pugsy]

I didn't even know you could select PS=0 in VPAP Auto mode, so I could be way off base in my reasoning here.

Not off base at all.
With PS set to 0 then EPAP will equal IPAP in Auto mode and that makes it function like an APAP in auto mode.
So you are quite correct in your thinking.
BTW we can do the same thing now with the PR S1 760 model machines...make them work like an APAP.
Sort of gives these auto adjusting bilevel machines a 4th mode of operation even though it is an unofficial mode of operation.

[lliann]

Rogue it is. went in and changed 19/15vpap to 15/10.

There was something else. Did you say change the PS to 4? Its at zero currently. I don't know what that one is for.

Hi B -- PS is Pressure Support. PS is the difference between your IPAP and EPAP pressures.

I'm not 100% sure about this, but I think that if your pressure support (PS) is set to zero then your machine is basically functioning like an Auto CPAP. With your current 15/10 settings, for example, if you set PS at 3, then when your IPAP is at 15, your EPAP will be at 12, IPAP=13 then EPAP=10, and so on. So if PS is set to zero, I'm thinking that tells the machine "no difference" between IPAP and EPAP -- which means your pressure can vary between 10 and 15, but it will just be a single pressure (IPAP=EPAP) that can move between 10 and 15.

I didn't even know you could select PS=0 in VPAP Auto mode, so I could be way off base in my reasoning here. But there are only two other modes on our machines, CPAP and "S" and there's no PS in either of those menus.

Curious -- can you post the pressure line graph from the same night?

Thanks J.

I got a little confused so I changed it to fixed 14/10. I'll do some reading to try to understand what I am doing before I do it....hoping you all will be patient with my learning process.

I went and looked and saw the vpap auto mode had a start epap of 4. Maybe that is what Pugsy suggested and I confused it with the ps? I'll just try a slower change with the fixed for tonight and see what the graphs show?

[lliann]

I didn't even know you could select PS=0 in VPAP Auto mode, so I could be way off base in my reasoning here.

Not off base at all.
With PS set to 0 then EPAP will equal IPAP in Auto mode and that makes it function like an APAP in auto mode.
So you are quite correct in your thinking.
BTW we can do the same thing now with the PR S1 760 model machines...make them work like an APAP.
Sort of gives these auto adjusting bilevel machines a 4th mode of operation even though it is an unofficial mode of operation.

I am temporarily confused<g>

[kaiasgram]

I am temporarily confused<g>

Well that's preferable to permanently confused.

[Pugsy]

Fixed 14/10 is fine.
Actually I would like to see those results compared to previous fixed nights before making the big change to auto mode.

If/when you want to go to auto bilevel mode I would suggest
EPAP 9 or 10 (depending on what happens with fixed 14/10)
PS of 4 or 5....test both if you wish to see which one feels the best. 4 PS is the most common starting PS number and is where most bilevel titrations start from.
Maximum IPAP 15 or 16 or 17...depends on if you want a tight range or moderate range available.

[kaiasgram]

The bottom line is that you currently have no exhale relief -- your machine has the same pressure for both inhale and exhale. Now that one pressure can go up and down between 10 and 15 (I think you said you just changed IPAP to 14, so that range would now be between 10 and 14), but it's just a single pressure going up and down. This is because you have PS set to zero.

Pugsy -- thanks for confirming.

[Pugsy]

I am temporarily confused<g>

Your machine in auto adjusting bilevel mode can be made to work like an APAP machine in auto adjusting mode.
It's not an official mode of operation but instead it is a way we can go in the back door to do something.
With PS of 0 in auto mode...EPAP has to equal IPAP so you get one single pressure instead of 2. So you would have 1 single pressure that auto adjusts which is what the S9 Autoset does in apap mode (with EPR off).
You are having enough to learn about without having to understand back door modes.
So your machine can do it...but we don't want to do it. You want the 2 different pressures as it makes the breathing easier.

[kaiasgram]

Fixed 14/10 is fine.
Actually I would like to see those results compared to previous fixed nights before making the big change to auto mode.

If/when you want to go to auto bilevel mode I would suggest
EPAP 9 or 10 (depending on what happens with fixed 14/10)
PS of 4 or 5....test both if you wish to see which one feels the best. 4 PS is the most common starting PS number and is where most bilevel titrations start from.
Maximum IPAP 15 or 16 or 17...depends on if you want a tight range or moderate range available.

OK, wait -- she's already running in auto (APAP) mode, isn't she? Just without any pressure relief.

[Pugsy]

OK, wait -- she's already running in auto (APAP) mode, isn't she? Just without any pressure relief.

Not to my understanding

I got a little confused so I changed it to fixed 14/10.

I took this to mean S (fixed bilevel mode) and not auto mode.

I don't think that auto mode will allow IPAP of 14 and EPAP of 10 with PS of 0.
Meaning without PS we can't set IPAP...but I no longer have the S9 VPAP Auto to see which gives first.

With PS of 0 I think that all we could get would be EPAP/IPAP equalling 10 and ranging to 14...just like APAP machine.

Perhaps it would help if lliann would clarify the mode she has chosen to use and go rogue with. S or auto bilevel modes?

Though I think that since past reports were with fixed (S) mode...I actually think it would be a good idea to stick with fixed mode and do the 14 IPAP and 10 EPAP.
See what happens to the OAs...then think about what to do next.