Ok all my info and some questions

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
snostorm
Posts: 22
Joined: Wed Oct 22, 2014 5:33 pm

Ok all my info and some questions

Post by snostorm » Thu Nov 20, 2014 4:43 pm

First off I am relatively new here and I would like to thank all of those who have replied to some of my earlier posts.

This might be a little long but its all relevant. Suspicious of having Sleep Apnea my PCP prescribed me a sleep study back in 2009. The results of that study where severe sleep disturbed breathing characterized predominantly by obstructive hypopneas. Oxygen saturation normal Respiratory disturbance index was 36. Recommendation CPAP titration study.

So I went for the titration study. Based on the study the doctor prescribed BiPAP 22/16. My DME delivered a Resmed VPAP S with humidifier attachment. The one that's shaped kinda like a football. With these settings I could not tolerate wearing the mask. It felt like the machine was forcing me to breathe when my body wasn't ready...it was like out of sync. I asked for adjustments they where hesitant as this is what was prescribed. I got the DME to change me settings to 20 CPAP I still couldn't comply. fast forward to about a month and a half ago desperate and feeling terrible I pulled out the machine and put the nasal mask exhausted from working and fell asleep for an hour. I was thrilled I actually slept with it on. I was encouraged so that night I tried desperately to sleep with the mask on. My belly blew up with air and it was very uncomfortable. So I researched on the internet and changed my settings to 14 cm H2O. I started to have success sleeping with it on. initially my AHI's where lile 1.1 to 1.3. As i adapted to the mask my AHI's increased. I will post 1 week results: I went back for a consult and saw a different doctor and he told me no wonder you didnt comply those initial settings are ridiculous and officially prescribed 14

Leak: 0.12L/S
VT: 440-600
Resp Rate: 13-17
MV: 6.6-8.7
press: 11.8
AHI: 3.2
AI 0.2
% spont: T 0%
% spont C: 0%

Equipmet: Resmed VPAP S, Fisher and Paykel Simplis full face mask.

settings:

MODE: CPAP
CPAP: 14.ocmH2O
SMART START: OFF
MASK: STANDARD

Adv Settings:

EPR: FULLTIME
EPR LEVEL: 3
EPR Inhale: MED
EPR ACCESS: OFF
LEAK ALERT: OFF
Tube Length: 2M
MAX RAMP: 45 MIN
START CPAP 5.0

Now I feel better no question. I still get tired during the day and my AHI's are in the 3's. I use full face mask as my mouth opens when I use a nasal only mask. Obviously I seek optimal therapy with out aerophagia. Why was I initially perscribed BiPAP? do I need to be on BiPAP with primarily obstructive hypopneas? what would be an optimal setting for me based on this info?

thanks for all replies

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Julie
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Re: Ok all my info and some questions

Post by Julie » Thu Nov 20, 2014 5:51 pm

Hi - do you know how many obstructive apneas per hr were recorded during your sleep study? I ask for a reason but won't get into it unless you respond (may be good news ).

snostorm
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Joined: Wed Oct 22, 2014 5:33 pm

Re: Ok all my info and some questions

Post by snostorm » Thu Nov 20, 2014 6:19 pm

Julie wrote:Hi - do you know how many obstructive apneas per hr were recorded during your sleep study? I ask for a reason but won't get into it unless you respond (may be good news ).

SPontaneous arousals/hour 36.4

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Julie
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Re: Ok all my info and some questions

Post by Julie » Thu Nov 20, 2014 7:33 pm

Oh, ok, was a bit confused by how you put it in your note. Unfortunately I can't tell you after all that e.g. you may have positional apnea that might be fixed by not back sleeping, etc.... just something in your note gaveme the idea, but must have misread it. Sorry, but I know you'll get lots of help from others.

Sleeprider
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Location: Murrysville, PA

Re: Ok all my info and some questions

Post by Sleeprider » Thu Nov 20, 2014 10:17 pm

Snostorm, good for you sticking with it and looking for what works. Many would have quit after that initial experience.

Most Bipaps are prescribed for people with central apneas, or who have to use such high pressure to stent the airway, that more pressure relief is needed to allow exhalation. Given the remarkably high pressure prescription you received, I'm not surprised at the Bipap. It doesn't matter, as you can use that machine in CPAP/APAP modes so you basically got a machine with more options if that's the way you go.

Even at 14 cm your pressure is relatively high, and you might see what response you get in your data if you start trying lower pressures. Finding a place where you sleep well, and have sufficient pressure to prevent obstructive apneas could be a lot more comfortable, and accomplishes what needs to happen here. It sounds like you're on the right track, and know how to use the tools and data to evaluate the effectiveness of your therapy. All I can say is most people here use that information and do exactly that.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: Sleepyhead software. Just changed from PRS1 BiPAP Auto DS760TS

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Pugsy
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Location: Missouri, USA

Re: Ok all my info and some questions

Post by Pugsy » Fri Nov 21, 2014 11:00 am

snostorm wrote:Why was I initially perscribed BiPAP?
Because the initial pressures prescribed weren't available on a standard cpap/apap machine which would only go to 20 cm.
snostorm wrote:do I need to be on BiPAP with primarily obstructive hypopneas?
Your VPAP bilevel machine isn't the type of bilevel machine that is used to treat centrals. Instead it is primarily used to treat obstructive apnea events (either obstructive apnea or hyponeas).
Bilevel is also a good choice for people who have aerophagia issues.
snostorm wrote:what would be an optimal setting for me based on this info?
Actually what you are using...cpap mode with 14 cm and EPR of 3 is really no different from Bilevel fixed (the S mode) settings of 14 IPAP and 11 EPAP.
That's what EPR does...let's you change the exhale pressure to make it easier to exhale and lessen any aerophagia issues.
So what you are using is just fine if you aren't having any aerophagia issues.
Your particular model VPAP uses an older algorithm that was known to be a bit aggressive in regards to flagging hyponeas. AHI of 3.2 and AI of 0.2 means 2.8 hyponea index. Pretty much what I would expect with this machine and considered to be a very acceptable result. No real need to change anything. No need to try to reduce the AHI any further. I have no idea why you were initially given such a high pressure RX. 14 cm is doing a great job for you.

If you are feeling good and not experiencing aerophagia...keep the settings where you have them because they are doing a good job. If you are experiencing some aerophagia issues you probably have some room to play with the settings a bit and not allow too many apnea events to sneak past the defenses....like maybe change to S mode and use IPAP 14 and EPAP 10...which would be like using EPR of 4 if it would do 4 which of course it can't.
In terms of general therapy...we usually look at the EPAP (exhale pressure) for OAs and IPAP (inhale pressure) for hyponeas.

If you aren't having any problems...I see no need to change anything.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

snostorm
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Joined: Wed Oct 22, 2014 5:33 pm

Re: Ok all my info and some questions

Post by snostorm » Fri Nov 21, 2014 3:38 pm

Thank you very much for your response. I noticed the mask setting is set at standard and i use a full mask...would it be better to switch the setting to full?

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Pugsy
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Location: Missouri, USA

Re: Ok all my info and some questions

Post by Pugsy » Fri Nov 21, 2014 3:59 pm

Yes...change the mask setting on the machine to full face mask.
It really isn't hurting anything though in the actual therapy treatment. That mask selection feature affects the leak calculations but not enough for it to be a big deal.
The mask selection doesn't affect how the machine actually blows the air or anything like that.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

snostorm
Posts: 22
Joined: Wed Oct 22, 2014 5:33 pm

Re: Ok all my info and some questions

Post by snostorm » Fri Nov 21, 2014 4:17 pm

Oh ok. Also thanks for explaning the EMR setting for me. One question I forgot to ask was my confusion over the change in pressures on inhale and exhale while I had it in CPAP mode.