CPAP not providing adequate therapy - Next Step?

[Jason S.]

I have tried several different pressure combinations. None of them seem to be working. I am still scoring between 16 and 20 AHI every night. I am wearing a device that helps me stay on my side but I am still scoring highly. Would a BiPAP be helpful? I go back to sleep doctor in about a month. Thanks in advance for any comments or suggestions.

[D.H.]

What was your baseline AHI? If it was significantly higher, CPAP is partially effective.

Also, please share your OSCAR (formerly SleepyHead) reports. Somebody might be able to help you.

BTW, what is you AHI not sleeping on you side?

[Jason S.]

Baseline is 30 AHI, much worse on my back. So yes, I am getting partial treatment, but not enough to stop me from having an enlarged heart, which the cardiologist says is the result of untreated sleep apnea.

Suffice it to say a pressure of 15, or even 20 is not high enough. Last time I posted a chart I got a bunch of “wow, what a horrible chart”, or “man, that is ugly”. So having several people piling on doesn’t help my problem.

Is BiPap recommended?

[Pugsy]

Is BiPap recommended?

Not going to help if you persist in using minimum pressures too low and restricting the machine from going up where it needs to go.

Some history and software reports here folks.
viewtopic/t176058/Need-tips-to-stay-sle ... l?start=15

At this point we don't know if you need more that 20 cm....and that would be the main reason for going with bilevel...so the machine can go higher than 20 cm if it needs to.

You've not given your current machine a fair trial yet with the limitations you put on it.

[Jason S.]

What limitations? I have use the machine daily for approximately 200 days. That’s not enough of a trial? I started a minimum of 12 with a maximum of 20 and it made no difference. I continue to have a string of apnea with pressure at 20. I sleep alone so I can only make assumptions about my position. Assumption - When I am on my side pressure of 5 is sufficient but when I am on my back a pressure of 20 is not enough. I have tried many things in order to stay on my side without success. A wedge, a tennis ball, a sleep noodle, a backpack. Apparently I just roll over on my back anyway despite the discomfort.

[Pugsy]

I haven't seen a report with the pressure at max of 20. I don't have time to go through all your posts...I quickly found the one with 15 max.

When using the pressure starting at 5 because it works for side sleeping....the machine doesn't have the ability to get to where it needs to be when you end up on your back and need pressures over 15 cm. It simply cannot go up that high that fast...so a truck load of apneas happen and no machine out there will attempt to increase the pressure during the obstructive event. They just don't do it.
You have to wait until the airway is clear and the machine gets a chance to evaluate things again and then try going up slowly...only to have the airway close up and then it stops the increase and waits for the airway to open up again and then it has to start the increase again.

Bilevel machines won't respond any differently...
Not to mention you are using a Respironics apap which is notoriously slow to respond to anything.

If you can't stay on your side then you have to use a minimum pressure that gives the machine enough head start to get to where it needs to be to keep the airway open when on your back. Same thing would happen with a bilevel only if you do need more than 20 cm a bilevel can go there.

If you persist in setting EPAP too low on the bilevel....you will end up with the same results you are seeing with the apap.

Do you happen to have a report with say 10 or 12 minimum and 20 max???

[D.H.]

If you need a pressure over 20, you'll probably need to geta BiPAP; "regular" CPAP machines don't go above 20.

The other reason that you might need a BiPAP is if you have problems exhaling against the pressure.

BTW, I can't stand even the modest pressure relief of a "regular" CPAP.

[Pugsy]

Don't shoot the messenger because you don't like the message.
I do know how these machines work and I know about the algorithms and the response time.
If you have given 15 minimum and 20 max a try....and it doesn't get the AHI down and you max out at 20 then for sure you need a bilevel machine but you have to understand that to deal with the stuff on your back you have to be more preemptive about the minimum pressures. Even the bilevels can't go from 5 to 15 in the blink of an eye....and while apnea events are happening they sit by and twiddle their thumbs just like the apaps do. None of these machines will do anything when an apnea is actually occurring.

The only exception would be the ASV bilevel that forces a breath when a central or open airway event is happening and that's not your primary problem.

[palerider]

What limitations? I have use the machine daily for approximately 200 days. That’s not enough of a trial?

Not if the machine is set wrong, it's not.

[Jason S.]

It’s good to know about the machines inability to change pressure expeditiously during events. I have no problem starting with a higher pressure, however I haven’t been successful doing this. I don’t have a problem with high pressure - I could start at 20 and have it at 20 constantly if that worked for me, but it doesn’t. Yes I have a graphs where I started at 12 and Maxed at 20. My understanding from the sleep doctor was that it is best to have the lowest pressure set if you do not need to have pressure to stop events. that is why he had me start at 5, they determined at sleep study that 5 is sufficient when I am sleeping on my side. He also said going above 15 would not help if 15 wasn’t high enough, and frankly he was quite correct about that, at least in my case.

I am not obese like many people with OSA. I am thin. CPAP or BiPap may not be a solution for me. My problems arise from a small mouth, big teeth, a set-back chin all of which contribute to overcrowding. I may have to have some kind of structural surgery although I know these are unpleasant with mediocre success rates.

[Pugsy]

Would you mind sharing one of those 12 min and 20 max graphs?

[Pugsy]

My understanding from the sleep doctor was that it is best to have the lowest pressure set if you do not need to have pressure to stop events. that is why he had me start at 5, they determined at sleep study that 5 is sufficient when I am sleeping on my side. He also said going above 15 would not help if 15 wasn’t high enough, and frankly he was quite correct about that, at least in my case.

Well...you can't stay on your side (you already tried that didn't you)...and if you need more than 15 it makes zero since just to throw up your hands and not use more than 15.

Is your doctor by chance part of the sleep center where another sleep study would be done?

If you don't want to hear our thoughts....why bother to ask us if you have so much faith in your doctor?

[Jason S.]

Because I want to do the best I can for myself right now because I don’t get into see the doctor until next month and then if he schedules another sleep study that will be another month, assuming insurance approves a third study, and then the follow up appt. with him will be another month so now we are out to November already. Yes the sleep doctor is connected to the sleep study. And yes, if your only myopic recommendation for all apnea issues is to jack up the pressure, both max and min, then I do not care to hear your thoughts, but would be happy to entertain the thoughts of more broad-minded individuals.

[Pugsy]

Very well. I will bow out and see if anybody has figured out a way to deal with obstructive apneas that doesn't involve more pressure.

Have a nice day.

[Patriot Partner]

Wow

I'm soo sorry this is happening

I'd try a Bipap.

You gotta keep that airway open