Fired My Sleep Doctor

Well, that wasn't the direction I wanted this to go. I set the BPM to 6. I don't know if that is responsible for the increase in AHI. I am slightly more groggy this morning. Suggestions?

how are you ok with a BPM of 6?

sickwithapnea17 wrote:how are you ok with a BPM of 6?

I don't know. Could be something like gills?

Here is the data from last night. I left everything the same. Any suggestions on anything to change to get my AHI down lower?



Here are a couple zoomed in sections where I was having clusters of hypopneas. It doesn't look like the machine is really responding to those. Is this what you were talking about, palerider, when you said a machine with a more aggressive algorithm would be more effective?

Raise your PS min to 6.0 and see what happens. IPAP is what will knock out obstructive hypopneas.

Paper_Nanny wrote: Is this what you were talking about, palerider, when you said a machine with a more aggressive algorithm would be more effective?

yes.

be cautious with raisedfist's advice, because too much minimum PS can exacerbate central apneas.

also, please stop scrolling down the left panel before screenshots.

palerider wrote:

Paper_Nanny wrote: Is this what you were talking about, palerider, when you said a machine with a more aggressive algorithm would be more effective?

yes.

be cautious with raisedfist's advice, because too much minimum PS can exacerbate central apneas.

also, please stop scrolling down the left panel before screenshots.

yes I started going with 0 min ps and I feel a lot better. I do lose clarity and get foggy later on in the day but when I wake up it's much better clarity and maybe energy

palerider wrote:be cautious with raisedfist's advice, because too much minimum PS can exacerbate central apneas.

Thanks for the warning. I will be cautious. It is at 4 right now. I will raise it to 5 tonight to see what happens. Will raise or lower depending on what does happen.

also, please stop scrolling down the left panel before screenshots.

I will pay more attention to that.

raisedfist wrote:IPAP is what will knock out obstructive hypopneas.

It is quite probable these are central hypopneas... I was having only central apneas before the fired sleep doctor changed my settings. After the change, I was having no apnea, but many hypopneas.

sickwithapnea17 wrote:how are you ok with a BPM of 6?

raisedfist wrote:For Respironics, their titration guide recommends the following starting point for ASV:

If you experience an inadequate breathing rate on Auto mode: Set fixed rate of 8 - 10bpm, or 2bpm below spontaneous rate. Then set inspiratory time of 1.5 seconds.

So, I double checked this on data from last night. I looked at several section of two to three minutes each when I was breathing fine with no events and counted my breaths. I looked at minutes throughout the night to get a better sample. Sample size was not scientifically wonderful, by any means, but I was only looking for anything close to perfection.

During the minutes I looked at, my spontaneous respiration rate was around 8. I set my rate 2 bpm below my spontaneous rate. Which is how I am okay with a rate of 6.

I know the Respironics titration guide is talking about inadequate breathing, but I would think it would apply to over adequacy, too.

Paper_Nanny wrote:

raisedfist wrote:IPAP is what will knock out obstructive hypopneas.

It is quite probable these are central hypopneas... I was having only central apneas before the fired sleep doctor changed my settings. After the change, I was having no apnea, but many hypopneas.

I thought that the change was after your medication change in december.

though all I've got is your cpap data, not a good timeline of what external things also happened.

palerider wrote:though all I've got is your cpap data, not a good timeline of what external things also happened.

12/13/16-- Surgery to replace medication pump. Resulted in dose change. (AHI went up, events were almost exclusively central apnea).
03/10/17-- Increase in medication dose.
03/21/17-- Sleep doctor changed settings on machine. (Events now almost exclusively hypopneas).
04/07/17-- Change in timing of medication, but no change in overall dose.

If additional information about the medication would be helpful, let me know.

Last night's data. I made no changes to the machine settings

Everything after 8:45 can probably be discounted. My dog woke me up at 8:45, I went back to sleep, but it was pretty restless and I was aware several times of fighting with my machine because I felt like I was having to breathe against what it was doing. There were 24 events during that time period.

Paper_nanny, you don't give your location. Someone might know of a good sleep specialist in your area. Or, if you're near enough to a major metropolitan area to make occasional visits, you might look into a sleep specialist at a major medical center or university hospital. That's what I'm doing--I'll be traveling 4 hours to Los Angeles and staying one night in order to see the fellow who wrote the book on REM behavior disorder, who is at UCLA.

I'm wishing you the best in finding a solution!

so having a 0 ps min is going to help centrals and lower central apnea events?
the epap is supposed to treat obstructives, I don't know if 4cm min is a good idea for me since I have severe obstruction of the soft palate