Why doesn't my APAP work as well as the titration?

[fijibear]

Newbie here. Please forgive me if this info is somewhere else. My brain fog is crippling and it's hard for me to dig for information at all.

After a long series of misdiagnoses, I finally was diagnosed with sleep apnea (AHI 16.2). The only way I was able to get it to trigger for the sleep study was to sleep on my back, which I almost never do. I was given the titration machine, which was a RemStar AFlex, and an Eson nasal mask. I used it for a week, and started to feel an improvement. Then of course, the insurance gods told me I had no DME coverage, so Kaiser ripped the machine from my hands, and it was two more weeks before I could order one from CPAP.com. I ended up going with the Airsense 10, with the Slimline heated tube and all the bells and whistles. Long story short, it's been 30 days, and I feel just as crappy as I did before starting PAP therapy. I have tried going back to the standard size tube, using a full face and nasal pillows masks, narrowing the range on the APAP, but nothing seems to get me feeling like I did that first week. Also, it doesn't feel like sleep debt, because in that first week, though I felt better, I felt like my sleep was actually doing something positive and I wanted more of it (feeding the debt). Now I don't feel that.

I have no idea where to go from here. I'm still trying to work with SleepyHead to pull my data, but am running into technical difficulty. Thanks in advance for the help.

[BlackSpinner]

What was to original one set at? What are the settings of the new one?

[LSAT]

Why did you change masks if the Eson worked so well at the titration? Go back to the Eson. Make sure that your machine pressureis set the same as your titration. Tube shouldn't make any difference.

[fijibear]

What was to original one set at? What are the settings of the new one?

Both machines were set to 4-20 cm H2O. The titration showed my average to be 9 cm H2O. Currently, I'm using 6-12, because I felt like I was suffocating on the low end and was experiencing aerophagia when it was too high.

At

Why did you change masks if the Eson worked so well at the titration? Go back to the Eson. Make sure that your machine pressureis set the same as your titration. Tube shouldn't make any difference.

Because when I did the titration, I was using Afrin regularly, as I normally have a lot of trouble breathing through my nose. It's not due to congestion, but inflammation of my nasal cavity. I have since quit the Afrin and am using Flonase, but still have trouble breathing. I'm having a sinus CT done next week that should hopefully yield some answers. I have been using the Eson nasal mask regularly for the past week and a half. I tried the nasal pillows in the hopes that the pressure would be enough to keep my passages open and reduce leaks, which it did, but for some reason, the tip of my nose hurts the next morning.

[Wulfman...]

Newbie here. Please forgive me if this info is somewhere else. My brain fog is crippling and it's hard for me to dig for information at all.

After a long series of misdiagnoses, I finally was diagnosed with sleep apnea (AHI 16.2). The only way I was able to get it to trigger for the sleep study was to sleep on my back, which I almost never do. I was given the titration machine, which was a RemStar AFlex, and an Eson nasal mask. I used it for a week, and started to feel an improvement. Then of course, the insurance gods told me I had no DME coverage, so Kaiser ripped the machine from my hands, and it was two more weeks before I could order one from CPAP.com. I ended up going with the Airsense 10, with the Slimline heated tube and all the bells and whistles. Long story short, it's been 30 days, and I feel just as crappy as I did before starting PAP therapy. I have tried going back to the standard size tube, using a full face and nasal pillows masks, narrowing the range on the APAP, but nothing seems to get me feeling like I did that first week. Also, it doesn't feel like sleep debt, because in that first week, though I felt better, I felt like my sleep was actually doing something positive and I wanted more of it (feeding the debt). Now I don't feel that.

I have no idea where to go from here. I'm still trying to work with SleepyHead to pull my data, but am running into technical difficulty. Thanks in advance for the help.

You're comparing apples to oranges........Fords to Chevys.
The different manufacturers (have to) use different algorithms in their APAPs. (copyright/patent ownership)

And, machines set to the wide range of pressure settings ( 4 - 20 cm. ) typically don't do very well at treating folks.
What you're feeling could be from all the pressure changes during the night.

If you can get Sleepyhead figured out, you should be able to see what's going on.

I'm also curious as to why you chose the ResMed over the P/R machine if you felt better with the P/R.

And, after reading your last post, maybe you should try a straight pressure of 9 cm.


Den

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[fijibear]

I'm also curious as to why you chose the ResMed over the P/R machine if you felt better with the P/R.

And, after reading your last post, maybe you should try a straight pressure of 9 cm.

.

I have several friends who work for ResMed and they convinced me of the superiority of their machine. I'm starting to think I may need new friends

What's the thinking behind the straight pressure?

[Wulfman...]

I'm also curious as to why you chose the ResMed over the P/R machine if you felt better with the P/R.

And, after reading your last post, maybe you should try a straight pressure of 9 cm.

.

I have several friends who work for ResMed and they convinced me of the superiority of their machine. I'm starting to think I may need new friends

What's the thinking behind the straight pressure?

Because that's what you said your titrated pressure should be. Try it......it may work. I always recommend users at least TRYING their titrated/prescribed pressure to see whether it does or doesn't work. If it doesn't.......well, then some experimenting may be called for.

The titration showed my average to be 9 cm H2O.

Den

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[Pugsy]

The algorithms for the 2 machines just go about their jobs differently and some people may do better with the way one machine goes about its job over the other machine.
ResMed machines tend to respond faster and the change in the pressures could potentially disrupt sleep quality even if you don't remember being awakened during the night.
Limiting that variation significantly or using a fixed pressure could maybe eliminate those potential arousals (if you happen to be sensitive to the way the machine is changing the pressures and how it goes about doing its job).

Some people are simply more sensitive to even the minute changes that happen as the machine goes about doing its job. Respironics apap algorithm is a little "softer" "slower" in how it goes about things so perhaps you are sensitive to the pressure changes and the way the ResMed machine does its job is maybe just something you happen to be sensitive to. Using a really tight range or even a fixed pressure could maybe help you get more restorative sleep if you happen to be one of those people who are sensitive to pressure changes.
Not everyone will do well with apap and some people could potentially do better with one algorithm over the other brand.

Worth at least trying to see if it helps you feel more rested.

[palerider]

ResMed machines tend to respond faster and the change in the pressures could potentially disrupt sleep quality even if you don't remember being awakened during the night.

on that subject, the 'fishing expeditions' that the respironics do when everything is *great* can cause disruptions!

I've looked at some charts, and when the pressure spikes and drops back I've seen warbles in the flow, indicating some disturbance... with regularity.

[fijibear]

That is really interesting information. I will give the constant pressure setting a try this evening and report back! Thank you!!!

[fijibear]

So it's a few days later, and I think the suggestion of a constant pressure is a good one! I've bee using 9 cmH2O, but after reviewing my Sleepyhead data, it looks like I might want to bump it to 10?

Anything else y'all see in this data?


Before Constant pressure, average night



After adjustment to 9 cm H2O




Thanks!

[Wulfman...]

Lookin' good there, fijibear!

Does it feel like you're sleeping better? (without the pressure changes)
Those reports look good, but there shouldn't be a problem trying 10.

See what happens and report back.


Den

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[fijibear]

I definitely am feeling better with fewer arousals. Still have some optimizing to do around comfort and tube management. Thanks so much for the advice! You are literal lifesavers.