UPPP and possible cpap problem

[grandpap]

Greetings and may all have an enjoyable season with family and friends.
I am new to the board but not to xpaps.I had my first sleep study about 15 years ago and a uppp shortly there after,what a blunder that was.I used a non data machine for a few years and quit from the absolute discomfort with the equipment then.I am now returning to xpaps because of worsening medical conditions and sleep disorders.
A recent sleep study titrated me at 12cm and the sleep doc was kind enough to perscribe me a cpap data capable machine.He wanted to have straight cpap at 12cm because he thinks that the auto setting would just end up "chasing" events. I have been tracking my therapy on Encore Viewer and have noticed that my AHIs are not dropping and Vs is pretty solid all night.I decided to change to auto and made my max number 20cm and my min 12.Right away my graphs showed a rise of pressure up to an average of 16.8 and a 90% of 20cm .I have been pushing the min pressure up slowly and am at 16 now with a steady average at almost 18cm but still hitting a 90% of 20. My vs is nonexistent,fl is like a .3 but apneas are about 5 and hyps are 2.5.The real problem now is nrs are showing 2-3 times a night,usually when the pressure is falling off of max.Even though I am sleeping, my leaks look good and the numbers are dropping, I don't feel good,I have headaches, feel sleepy and very little energy.My question is am I chasing the wrong pressure or was the sleep study wrong.Should I stop at 17cm min with a 20 max and see what the numbers do.If it takes me to 20,I may have to see the sleep doc and ask for a machine with higher pressure.What do folks think? Thanks

[kteague]

Until someone else wakes up and replies, I can only say that I've read on here that the surgery you had can alter the anatomy in such a way as to make cpap treatment more difficult. You have the option of editing your post - it might help to change your title to reflect cpap trouble after UPPP to signal them in.

It's hard to say if your machine is chasing something or a higher pressure is actually needed to resolve apneas. Check your titration report to see they captured you in REM while supine. If they did not, that could account for a difference in identified pressure needs. Also check your diagnostic report to see if your apnea is worse when sleeping on your back as opposed to your side (positional). Maybe a lower pressure would be effective if you take measures to stay off your back.

Until you sort this out, it might be a good idea to limit that higher pressure and takes measures to stay off your back. Some on here have said they sleep with a backpack on so they can't roll onto their back. Hope you figure things out soon.

Kathy

[grandpap]

Thanks kteague for the suggestion.

[Pugsy]

When you have time you might post a screen shot image of a typical night's "daily details" graph from your Encore Viewer. Someone might spot something that might be a consideration.

[grandpap]

This is the best I can do Pugsy,hope it works http://s950.photobucket.com/albums/ad35 ... =12cm2.jpg

[Scarlet834]

It looks like you have posted a night from your straight CPAP pressure of 12. I think everyone will agree with you that the graph does not indicate you were being effectively treated at that setting. I think it might be helpful to also post a picture of where you are now. From what I understand the elimination of the vibratory snore indicates you moved in the right direction. I don't personally have experience with variable pressure machines and hopefully one of our more knowledgeable members will chime in to help you.

Another possibility is to go back to straight CPAP and monitor gradual increases in pressure, staying at each one at least a few days to see what the data tells you. I would be inclined to start lower than 16, but honestly I have no scientific basis for this. My own "sweet spot" was only 0.5 cm higher than the sleep lab titrated, and I can't believe it made such a difference.

My big question--did you have problems with headaches, sleepiness, and lack of energy before you switched your settings? If the answer to that is no, I think I would contact that sleep doctor now for next steps.

[grandpap]

I am currently set at 16-20cm and wake with pain from the shoulder blades up to the back of the neck with a headache.At a lower pressure of 12cm I was getting just the headache.
I do have a oximeter on order to check sats.When I have that info I will be approaching my sleep doc for answers from him.

[Pugsy]

Can you post an image of one of your better reports while in auto mode?

I did see the one with straight cpap at 12 cm. Obviously things are not controlled at that setting. Do you have reports showing maybe using a higher pressure in straight cpap mode?

I have read that having prior UPPP surgery can really mess up potential cpap therapy later......

[grandpap]

I have not tried straight cpap at like say 17cm only at 12cm.I was self titrating because I saw that my numbers were not woking and just got started last week.I had to get my leak rates under control before starting to run the pressure up.

[Gerryk]

Until someone else wakes up and replies, I can only say that I've read on here that the surgery you had can alter the anatomy in such a way as to make cpap treatment more difficult.

Kathy, I understand where you are coming from with that statement, but many people have been successfully treated by uppp surgery me bing one of them. I think the problem is that so many docs are doing the surgery when their are other better options to pursue. Not everyone who has OSA is a good candidate for successful UPPP surgery. I also believe the success of the surgery has a lot to do with the doctor performing the surgery.


Grandpap, unless I misread you are using a nasal interface and you are a mouth breather. Do you use a chin strap or are you able to shut your mouth off or is air just coming out your mouth constantly? I am not familiar with the numbers for the vent rate for your interface, but the leak numbers don't seem high to me but do have some higher spikes.

Have you tried a full face mask?

Gerry

[grandpap]

I tape when I use nasal pillows but use a FF of late with ok numbers from both.I think that the 12cm were nasal with tape and the higher CMs were FF.
Pugsy,can you see all 5 of my graphs or are they not showing?These are the best numbers I have been able to achieve.I am a bit concerned that I cammot do better.

[Wulfman]

I looked at all five of the reports.
It's apparent that a range of pressures is not going to help or tell you much......other that it won't produce good or the desired results. I thought I had read that about using an Auto when one had had the UPPP procedure......and it appears to be true.

Thoughts:
Sleep position? Avoid sleeping on your back.

Switch back to straight pressure at around 15 and work up if necessary. Be sure to give each pressure about 3 nights.

What bed pillow? They can make a huge difference in reducing leaks.

Your leaks may be one of the things that are driving the pressures up. Switching to CPAP mode may help, but you might also benefit from a full face mask (like an Ultra Mirage Full Face).

You may greatly benefit (all the way around) by switching to a Bi-PAP machine.


Den

[grandpap]

[quote="Wulfman"]I looked at all five of the reports.
It's apparent that a range of pressures is not going to help or tell you much......other that it won't produce good or the desired results. I thought I had read that about using an Auto when one had had the UPPP procedure......and it appears to be true.

Thoughts:
Sleep position? Avoid sleeping on your back.

Switch back to straight pressure at around 15 and work up if necessary. Be sure to give each pressure about 3 nights.

What bed pillow? They can make a huge difference in reducing leaks.

Your leaks may be one of the things that are driving the pressures up. Switching to CPAP mode may help, but you might also benefit from a full face mask (like an Ultra Mirage Full Face).

You may greatly benefit (all the way around) by switching to a Bi-PAP machine.

My thoughts also!


I use a soft pillow with and FF so I can lay on my side.I am a back sleeper but am going to correct that

[Wulfman]

I looked at all five of the reports.
It's apparent that a range of pressures is not going to help or tell you much......other that it won't produce good or the desired results. I thought I had read that about using an Auto when one had had the UPPP procedure......and it appears to be true.

Thoughts:
Sleep position? Avoid sleeping on your back.

Switch back to straight pressure at around 15 and work up if necessary. Be sure to give each pressure about 3 nights.

What bed pillow? They can make a huge difference in reducing leaks.

Your leaks may be one of the things that are driving the pressures up. Switching to CPAP mode may help, but you might also benefit from a full face mask (like an Ultra Mirage Full Face).

You may greatly benefit (all the way around) by switching to a Bi-PAP machine.

My thoughts also!


I use a soft pillow with and FF so I can lay on my side.I am a back sleeper but am going to correct that

That explains some things.

You might look into a different pillow. I had been using the Chiroflow/Mediflow water-based pillow for a number of years before I started this therapy and it's worked great with this therapy. About a year and a half ago, I TRIED to use a regular fiberfill pillow and had to give up halfway through the second night......I was leaking like a sieve. There are also a number of other pillows that others like, too.


Den