APAP Success Story

I know this is long but I wanted to document my experience. For those just wanting a quick scan for information, you can read just the first and last paragraphs:

I started using CPAP 5 weeks ago and I just had my best night ever. During the first 4 weeks, I had rather mixed results. I was still feeling pretty tired most days and my AHI ranged from 8 to 15 most nights. My results just seemed to be random with some nights high and others lower, without any identifiable reasons. While this was still a significant improvement in my AHI prior to CPAP (AHI was 104.4), the goal of consistently getting an AHI below 5 seemed out of reach. Using Encore Pro and Encore Pro Analyzer really helped me to monitor exactly what happened each night so that I could get quantitative measurements. I also decided to get an Oximeter so that I could measure the oxygen saturation in my blood, since after all, that’s really the end goal. Now I have to admit, I am a data junky and a techie so it came natural to me, to start looking and evaluating all this data. I would have preferred to have a Doctor engaged since I consider my sleep apnea as life threatening, but as many others have commented on this site, I was pretty much left to fend for myself when it came to my treatment.

I started using my Oximeter and it was really interesting. With my CPAP set to 11 cm-H2O (based upon my sleep study), I had 64 occurrences of O2 desaturation during the night with a large percentage of those dropping by 10%, and that brought my O2 blood saturation into the low 80’s. Also, my AHI was 14.5. No wonder I was feeling poor. With these results it seemed like my current treatment was far from optimum.

The randomness of my results started me thinking about what are all the variables that could be impacting my results. These included mask leaks, CPAP pressure setting, sleep position, machine calibration, allergies,… I suspect the list of variables could be endless but I decided to begin at least with these. I already resolved most of my mask leaks so I decided to start using the auto feature of my CPAP. Since the setting I was prescribed in the Sleep Lab just 7 weeks ago was 11 cm-H2O, I decided to begin with a range from 7 to 14. After the first night on auto, the results from my Oximeter showed my O2 saturation had improved and the numbers of desaturations went down to 26 (previously 64) and my AHI was down to 10.8 (previous 14.5). The Encore Pro results showed that my maximum pressure setting that I had set on my now APAP was set too low since the machine pressure was reaching the maximum setting of 14. The next night I adjusted the maximum setting to 16 and again found that it was too low but still saw a further improvement with my O2 saturation with a reduction in the number of desaturations down to 15 (previously 26) and an improvement in my AHI down to 8.4 (previously 10..

I now felt that I was going in the right direction but started questioning why my new APAP settings, that definitely seem to be working for me, are so different from the settings prescribed in my Sleep Study that was held just 7 weeks ago. The Encore Pro data showed all my apneas and hypopneas were bunched together and that there were long periods that I didn’t have any significant number of incidents. I started to suspect that the apneas and hypopneas were occurring when I slept on my back. I usually start the night sleeping on my back since I have more control over my mask to prevent leaking and then usually sometime during the night I will roll over to my side or stomach. The apneas were all occurring during times that I believe I was sleeping on my back.

The next night I decided to increase the APAP maximum pressure setting to 18 since I had reached that maximum setting of 16 that I had set the previous night. In addition, I was determined to spend most of the night sleeping on my side or stomach. The next morning (today) I woke up feeling great. My AHI rating was 2.3 (previous 8.4) and the number of occurrences of O2 desaturation went down to 8 (previous 15). None of the O2 desaturations were greater than 5% and my O2 blood saturation never was below 90%. That’s a significant improvement from what I was experiencing just a few days ago. Also, the APAP pressure never reached the maximum pressure setting. Toward the end of the night, I did roll over to my back so I could see how the APAP pressure would adjust. It got close to 18 but didn’t reach the maximum pressure that I had set. During most of the night, the APAP pressure was significantly less.

I have struggled with sleep apnea all my life and had to adjust to the debilitating effects. For the first time, I believe that I have some control over this problem. I now realize that the position that I sleep during the night effects the degree of my sleep apnea. When I sleep on my back, the number of apneas and hypopneas increases significantly and that I need a much higher APAP pressure than I need when I sleep on my side or stomach. This makes it clear to me that using the auto setting is absolutely mandatory for my treatment. My body is not any different from most people, so I suspect that most would benefit from using an APAP. I believe that an APAP should be the standard treatment for anyone with sleep apnea. I also believe that providing people with sleep apnea with the necessary tools to monitor and manage their own treatment is essential. Without this information, patients are unable to make the necessary adjustments. I know that these beliefs are not generally accepted in the medical community, but that truly explains why there is only a 50% compliance rate in CPAP treatment.

Bill

Bill,

I'm glad you're starting to get really positive results from your therapy.

I agree with you - APAP should be the standard.

Also, reading about your experience (and the experiences other CPAPers have shared here) is really helpful for me, a fellow new CPAPer.

Thanks,
Ron

Wdburke
I am very interested to know which particular oximeter you are using. I like you “tech” approach to your/our problem. In fact I think this is how really professional approach to SA should be by any doctor who is trying to treat (to pretend that he is treating?) you.

Bill......

Your long post is a first-rate piece of work. Thank you so much for giving us your opinions. I believe you have hit several nails right in the middle of their heads!

I too wish to know which Oximeter you are using. I'm about to purchase one myself....so that I can manage my treatment just as you are managing yours.

Whatever you can tell us about your Oximeter system will be very helpful to all of us.

Thanks again!

Gerald

Wdburke,

a very nicely done and informative post.

I am newly diagnosed and was very fortunate to find this forum. As a result of the information I found here I was able to educate myself and found an excellent sleep lab and DME. My sleep Dr. said he would give me anything I wanted. And he did! I am using the Respironics M Series Bipap Auto with BIFLEX (DS700SH). I proved it can be done with Medicare.

It appears we are opposites when it comes to our best sleep position. I like to sleep on my side but I find the pressure goes much higher in that position. My titration was done on my back only. Comparing our results I wonder if a titration should be done using more than one position.

Please keep us informed of your ongoing results.

I would like to comment on your sleep study vs apap titration results.
It is true that the sleep lab has better tools than the cpap users for the titration. They can track pretty much everything from apnea events to your sleep architecture, BUT it is only one night under unusual conditions.
Here is where the APAP gains it's advantage, it is there with you every night in your own house, in your own bed, and you don't have anyone looking at you all night. The APAP keeps auto adjusting when you sleep on your side, when you sleep on your back, when you are having a cold and when you are not, basically it will adjust to your changes whatever they are.
The APAP will work fine as long as you keep a good range of pressures for your needs.
And as an added benefit, you can enjoy a lower pressure most of the night since it will only rise the pressure when needed.

I agree, APAP's should be standard, since the APAP's will also work as a straight CPAP.

I believe that if everyone started out with an APAP instead of CPAP, more people would comply with their therapy, just ask anyone who uses an APAP now; And you are a great example of that.

I am glad that it is getting better for you, and I hope that it keeps getting better. Sleep well,

Ernesto

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I also believe that providing people with sleep apnea with the necessary tools to monitor and manage their own treatment is essential. Without this information, patients are unable to make the necessary adjustments.

Exactly.

And if we consider how many nights it took you to discover the problem and the solution, we understand why sometimes sleep labs just don't get it right the first time. There are simply too many variables.

Thanks for taking the time to write that long report - and congratulation on taming the OSA!!!

O.

Hi,

Thanks for your replies. I have been helped so much by the people on this forum and the information that they have provided, that I would really like to give back and help share at least my own personal experiences with others.

The Oximeter I purchased was an SPO 7500 Pulse Oximeter that I purchased through Turner Medical. I have been using it for less than a week but it does a great job. It records about 8 hours of O2 Saturation and Pulse data at a one second or greater interval that can then be downloaded into your computer using a USB port. The software that comes with the Oximeter generates (3) different types of reports and also enables you to view a complete plot of your O2 saturation and Pulse at whatever interval the user specifies. It appears to be a well made product and I have not experienced any difficulty so far. The only negative I have identified is that it requires a special battery that I have been only able to find at Radio Shack for $15. The battery appears to still be fully charged after 4 nights use, so I hope to get one week’s use out of a battery. That should be factored into the total cost of ownership when you compare Oximeters. Below is the link to the Oximeter:

http://www.turnermedical.com/SPO_PulseO ... imeter.htm

If anyone has any questions on using the SPO 7500 Pulse Oximeter or the software that comes with it, I am more than willing to try and help.

I will give an update on my progress after a coupe of weeks to see if I truly have my apnea under control.

Ernesto – yes, I agree completely with you on the benefits and the value of APAP. Well said.

Bill

Very informative. It's great the way you have taken charge of your therapy and found what works for you.

I've been considering getting an oximeter too, I think it would help present a more complete picture of how well the xPAP therapy is really working.

@WDBurke,
Congrats on your success so far.
Here's an interesting thought to mull for a while: You mentioned that watching your O2 sat was "The Point" of the therapy. Certainly lacking Oxygen is a bad thing, but during a long talk with my sleep doc, we discussed some other problems..
With an untreated AHI of about 56 (for me), imagine the detrimental effect of getting adrenaline "pumped" that many times every hour, while trying to sleep!
This would certainly have a bad effect on my overall health, even without the oxygen deprivation!
Sometimes I wonder how that has affected other parts of my health over these last ten years.

Just pondering.. Welcome Aboard!
LyleHaze

Bill.....

Did you purchase the SPO 7500 with SPO software for just under $500.....or did you go for the SPO 7500 equipped with ProFox software for about $700?

James Skinner reported that he liked the SPO software better than the ProFox.

The SPO reports seem to be very adequate....but, I'd like your opinion before I submit my order to Turner.

Gerald

Hi Gerald,

I am using the Vitabase software that came with the Oximeter. The Oximeter and software was bundled together for about $479. The software met all my monitoring needs though quite frankly I had no experience with Oximeters other than what we see in the hospital, up until a few weeks ago. But, if you are looking for a tool to measure what's happenning with your O2 saturation, this software is more than sufficient.

Good luck.

Bill

Bill,

Excellent! This is my first time on the site and your post was the first one I read! I have always believed that, whenever possible, you need to be your own patient advocate when it comes to health care. You have no idea about how encouraging your post is to me and how it all makes perfect sense! I was recently diagnosed with OSA (within the last 2 weeks) and have taken some steps to ensure that I will take an active role in my own therapy.

LB

Hi LB,

I am glad that you found my story helpful. Since you are just starting this journey, be sure to get an xPAP that provides more than just compliance data, otherwise you won't be able to effectively monitor what occurs each night.

Good luck,

Bill

Thanks Bill.........

I'll purchase the SPO 7500 with their own software........

Gerald