Encore reports for your reading pleasure

girlsaylor · Post by **girlsaylor** » Wed Apr 04, 2007 7:29 am

Here's links to a couple of recent nights. Maybe y'all can help me fine-tune things a bit. I'm having some really good nights, and sometimes not quite as good, tho still acceptable.

The first report I had my pressures set at 15/8.5. The second report I had upped the EPAP, for a new pressure setting of 15/9, from the group's thoughts on my last posted stats. But, I didn't take my meds the night...my bad.

And last night's AHI was 5.3. Go figure.

Thanks in advance for you guys' thoughts.

girlsaylor

NightHawkeye · Post by **NightHawkeye** » Wed Apr 04, 2007 7:57 am

Girlsaylor, what I see of significance in the data is the string of apneas occurring later in the night after your machine is already at maximum IPAP pressure. When I've seen that in my own data, I've bumped the max pressure up a little and they've gone away. Of course, there's always the concern about CA's at those pressures, and if that's what's happening then those apneas wouldn't go away with increased pressures. However, I'd expect the BiPAP-auto to report NR events if those were CA's, and in your case no NR's were reported, so that's a good sign that you're not experiencing CA's.

Other than the single string of apneas in the latter hours of the night both days, your data looks pretty good to me.

Regards,
Bill

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 8:14 am

It appears to me the problem is leaks. It doesn't matter how high the pressure is set if it's leaking out it can hold the airway open. You've got to get that leak rate down to get good numbers.

And Bill, I've wondered about NR's I've never seen one recorded on any of my machines in a year and a half, I guess that a good thing. Jim

Girlsayor, I forgot what mask you are using, if I was guessing from the terriable leak rate I'm guessing a hybrid, maybe a different mask would help.

girlsaylor · Post by **girlsaylor** » Wed Apr 04, 2007 8:15 am

Hi Bill,

Thanks for replying. I didn't know for sure which pressure you are referring to when you said to bump it up a little - the IPAP or the EPAP?

Also, last night (no report posted), as well as the second linked report, I did not take either my stomach meds nor my breathing meds. This is my little concession to this latest pulmy's instructions. I'm wondering if I take my meds tonight and leave the pressures as is if that's gonna get me back to those low 2. something numbers.....Guess try either the pressure change or the meds, one at a time. Only way to know for sure.

girlsaylor

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 8:18 am

I see I guessed the mask correctly, by leak. when I was writing I couldn't see you post. That's why I know the hybrid wouldn't work for me. I have to get my leak rate between 32 and 36 LPM. Jim

girlsaylor · Post by **girlsaylor** » Wed Apr 04, 2007 8:24 am

Hi Jim-

I'm using the hybrid, correct. I've got dental issues, and the pressure on my mouth from the nasal interfaces is very painful. Ditto on the chinstraps used on my gaping mouth, where the chinstrap slides up over the front of the chin. I'd be very willing to try a different mask that wouldn't put pressure on my teeth and gums, if I could find one worth trying. The full face masks seem to be the only route, to not have those pressure issues. But then, I've read about leak problems with those....my DME is useless as far as mask fitting or anything else, so I'm pretty much on my own on this one...any mask suggestions are welcome...I'm still trying to work out the insurance issues for replacement parts and masks. Insurance company is ignoring me. I've cc'd the stat on the most recent request for status on this.

What's left - call my congress-person?

girlsaylor

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 8:33 am

I've never saw the government help us, unless it's to make our pocketbook lighter. I was a total guess on the mask, as I didn't look, but true to form the leak numbers are higher with it, and higher leak rates knock my numbers really bad. I'd think the leak rate probably has more effect than the change in med's. In a FF Mask, I used the ComfortFull, it was bothersom with leaks later in the night but I could keep it in the range I needed, sometimes it caused jaw pain. Jim

Guest · Post by **Guest** » Wed Apr 04, 2007 8:34 am

before calling your representative, I would contact your state's insurance commission. they usually have a reporting department where you can register your complaint regarding the insurance company. Insurance is heavily regulated at the state level. You may want to start there before going federal. Also, having copies of any letters/emails, requests you have made, appeal decisions etc. would probably be helpful if you bring it to the state regulator.

TM

allend · Post by **allend** » Wed Apr 04, 2007 8:40 am

Goofproof wrote:I've wondered about NR's I've never seen one recorded on any of my machines in a year and a half, I guess that a good thing. Jim

Jim,

On my report for a few nights ago, I have one NR at 0,1. What does that mean? Could that mean I have a central Apnea? That night I was awake for close to 45 minutes

I thought I slept well last night but I've been yawning a lot this morning. My AHI was 4.4 but the VS was 6.5 and FL was 1.2 and my NR was 0.0. My average Leak was 31.64. Is that 31.64 leaks per minute?

I wish the bipap would let me key in what mask I was using.

Allen

NightHawkeye · Post by **NightHawkeye** » Wed Apr 04, 2007 8:46 am

girlsaylor wrote:I didn't know for sure which pressure you are referring to when you said to bump it up a little - the IPAP or the EPAP?

What I noticed is that the IPAP goes up to its limit and then sits there while the string of apneas occurs. Perhaps if IPAP went higher, that would prevent a string of apneas similar to those seen in both nights of your data here.

Regards,
Bill

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 9:04 am

I prefer a machine like Remstar that doesn't have to be played with for each mask, the ones that have to be played with a lot of times are left set for the wrong type of mask making the readings false, and useless.

NR, means you had a problem that wasn't included on the report, but still was wrong, possibly a Central.

We all have good nights and bad, if I can keep my AHI under 3, I do ok , if it goes over 4, I can feel the difference, not right away, it takes a couple of day at it but I feel it, and then the light bulb comes on and I see what's wrong.

As you can see from my AHI I post monthly, I stay on top of it. Sometimes I'll try different things and that messes up my numbers , but we have to keep trying things, that's how we learn whats best.

Your mask leak of 31+ LPM works because your machine can keep up with that leak, at a high leak rate your machine doesn't maintain the pressure you need in your airway to hold it open, that's why the AHI goes up. The machines could stand to be made so they can cover a much higher leak rate effectively. That's why I think the Hybrid use is wrong, they should come with a better XPAP. Jim

CollegeGirl · Post by **CollegeGirl** » Wed Apr 04, 2007 9:18 am

allend,
If that NR happened between the 0 and 1 hours, it probably happened while you were still awake (especially since you report being awake for 45 minutes of that). Remember, what the machine records while you are awake is not reliable data, as you breathe differently while awake than you do when sleeping. What probably happened is that, while awake, you held your breath for a period of time (with or without being conscious of it). The machine upped the pressure, but couldn't get you to start breathing again, and so it got recorded as an NR. I wouldn't worry about it at all, if I were you.

rested gal · Post by **rested gal** » Wed Apr 04, 2007 9:56 am

girlsaylor wrote:Also, last night (no report posted), as well as the second linked report, I did not take either my stomach meds
-----
Guess try either the pressure change or the meds, one at a time. Only way to know for sure.

girlsaylor

Well, you already know what I think about the possibility of GERD interfering with your cpap treatment, GS.

The fact that you're getting those clusters of obstructives toward morning, after you've been laying down for hours (gravity, ya know) looks to me as if acid rising into the esophagus is doing its dirty work.

If I were going to work on one factor at a time (yes, you're right about "one at a time") I'd zero in on being sure that stomach acid is not a problem. 'Cause if nightly acid baths are making soft tissues in the throat irritated and swollen, or causing the vocal cords to spasm, "positive air pressure" can't do much to push rigid tissue aside.

If that's the case, upping the pressure is probably not going to do much. CPAP air can't push past a brick wall very well. Treating the acid reflux first is the way I'd go. But I'm no doctor.

-SWS's thoughts on loonlvr's massive clusters of events and loonlvr's followup post:
Nov 05, 2005 subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL

girlsaylor · Post by **girlsaylor** » Wed Apr 04, 2007 10:33 am

Yep, RG, you always seem to logic through these things for me.

I am thinking the new pulmy's recommendation was to remove meds that can be safely removed for a short time to see if meds are compounding my sleep issues. As the Advair has a steroid component, I can see possibly having night-time dosage issues causing sleep problems. I can't make the connection with the GERD meds at night compounding the sleep issues I have. So, with your help logic-ing through this, I think I'll try to add only the GERD meds, taking my Prilosec OTC tonight, and changing nothing else for a couple of days.

If you'll recall I got a couple of really good nights' stats on the 15/8 pressure, I think, (Need to double check those dates), when I took both the Advair and the Prilosec OTC twice per day. In order to know if it is one or the other drug, or the use of both twice per day, I will need to test one at a time, before going back to both.

The sad thing is that these sleep docs I've seen haven't a clue as to the relationship between GERD and OSA. It's hard for a layperson to convince a physician on an ego-trip that he doesn't maybe know everything. Brings me back to something said to me while studying accounting. I was running neck and neck for being first in my college division, there being 3 of us with a 4.0 GPA at the time. I had a prof greet me one semester with the observation, he had been checking my records, and he was gonna be the one to 'knock my GPA record down'. Duh, what that was all about I don't know. I replied to him, my grades only reflect that I work very hard and that I'm smart enough to know there's alot that I don't know. He laid off me from that day on...

girlsaylor

christinequilts · Post by **christinequilts** » Wed Apr 04, 2007 2:38 pm

Girlsaylor-

I tell you, we need to find you a doc like mine who recognizes everything in one person can potentially be related. I've learned more from him about some of my other medical problems then I did the doctors who treat me for them. I get so sick of seeing specialist who think we are just a bunch of separate parts.

How GERD & apnea can't be related is mind boggling- anyone who's swallowed something wrong knows there's a connection between the two systems. Add the xPAP pressure in the mix and you know what a combo it can be.

Encore reports for your reading pleasure

Encore reports for your reading pleasure

which pressure to bump up

hybrid mask

Re: which pressure to bump up

Re: which pressure to bump up

bathing in acid