Thoughts on doc's change in therapy (SleepyHead data)

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
TyroneShoes
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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by TyroneShoes » Wed Nov 19, 2014 3:13 pm

Pugsy wrote:
TyroneShoes wrote:Any thoughts?
Thoughts on what? What you did or your doctor suggested?
There are arguments for and against either.
If you never hit your 12 maximum...it really doesn't matter that you use the 12 max and doctor was okay with 20 max.
Just because it can go there doesn't mean it will go there and if it never even goes to 12 cm it really becomes a moot point. The minimum pressure is the most critical setting anyway.
Both are appreciated.

I found myself being wakened by the CO2 relief valve on the Swift FX NPs when pressure got higher, which was not often; maybe 3 times in the first 50 days.

But my reasoning was that the APAP goes there for probably a good reason, so if I cripple it back to a CPAP with straight 8, how is that better? So I brought it down below the level that woke me, but still allowed it to function within a smaller range as a APAP.

But then my reasoning has no basis in anything other than common sense. My Dr.s reasoning is based on the fact that he is a practicing neurologist with a fellowship in sleep studies. I probably should have deferred to his expertise. I see him in three weeks, and I will do a couple weeks at straight 8 to see how that goes.

AHI went to ~3 from ~5 after the pressure change. It has averaged ~1 for the last three nights, so I must be doing something right.

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Pugsy
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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by Pugsy » Wed Nov 19, 2014 3:28 pm

TyroneShoes wrote:But my reasoning was that the APAP goes there for probably a good reason, so if I cripple it back to a CPAP with straight 8, how is that better? So I brought it down below the level that woke me, but still allowed it to function within a smaller range as a APAP.
Sometimes the reason the apap mode wants to increase the pressure isn't maybe a huge reason that really needs to be dealt with.
Maybe the reason is for snores or flow limitations that wouldn't grow up to be a full fledged apnea event that would earn a hyponea or OA flag.
Sometimes trying to kill those snores and FLs that wouldn't grow up to be worthy of a flag creates more of a problem than the snore or FL causes. Like when people have aerophagia issues above a certain pressure threshold or when people find they have a problem with a pressure above a certain threshold like you do.
Sometimes the cure is worse than the disease.
Sometimes we simply have to make a compromise..maybe "cripple" the machine and let a few apnea events slip past the defenses if doing more creates more of a problem than letting a little something slip past the defenses.

As to the reasoning behind your doctors suggestion....you will need to ask him.
I know that my sleep doctor suggested I open up my APAP range to allow the machine to go where it wanted to go as long as it didn't bother me (and it didn't). I had already optimized the minimum pressure.
Some docs are hell bent on fixed pressures though...reasoning being whatever they choose. I don't even attempt to read minds....but then I also don't think that just because somebody has a bunch of letters after their name that they walk on water.

It sounds like you need to have a chat with your doctor so that you can understand where he/she is coming from.

In terms of therapy...there's more than one way to achieve good results.

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TyroneShoes
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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by TyroneShoes » Wed Nov 19, 2014 8:00 pm

Hmmm. Not an exact science, is it? Not exactly.

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Sibbs
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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by Sibbs » Sun Nov 23, 2014 8:26 am

Well, the therapy is getting comfortable and isn't waking me up at night, but doesn't seem to be doing enough-- AHI during some segments of the night remains somewhat high. Seems like a good reason to up the pressure a little, but I wonder if a little will be enough.

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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by Pugsy » Sun Nov 23, 2014 8:33 am

Sibbs wrote: I wonder if a little will be enough.
Sometimes a little works wonders.
2 reasons for making an increase slowly.
1...it makes for easier adjustment
2...might get lucky and not need as much was what we initially thought we might need

If you need more than 2 cm more to clean up your AHI I would be really surprised. Most likely 1 cm would clean it up well.
I would still do 0.5 cm increases though...might get lucky.

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Sibbs
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Re: Thoughts on doc's change in therapy (SleepyHead data)

Post by Sibbs » Sun Nov 23, 2014 9:23 am

Pugsy wrote:
Sibbs wrote: I wonder if a little will be enough.
If you need more than 2 cm more to clean up your AHI I would be really surprised. Most likely 1 cm would clean it up well.
I would still do 0.5 cm increases though...might get lucky.
Thanks for the continued support. I wish I could have my insurance company reimburse you and the folks here-- far more helpful than my doc's office for making my therapy successful.
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