Not feeling well, please look at settings

[sleepymonkie]

I am considering a change to my settings, have not felt well for three weeks. I have been in treatment since August 2008 and have been reading this forum since September. You have helped me through mask leaks, rainout, changing to Bipap, hose covers, data card software and becoming proactive with my treatment. Until this last couple of weeks treatment, I felt better than I had in years.

Before treatment I felt worn out all the time for no reason. I had also had an unexplained weight grain of 90 pounds over a year and a half. I gained weight and was unable to control it through diet. I went through three doctors, each of which failed to help me. The fourth doctor also blamed the weight gain on diet, but he did think about my case. He asked my wife about my sleep habits at her appointment, two weeks later. It was then that he made the diagnose of sleep apnea. I have been in treatment every since. In December I felt so good I was able to start another attempt at losing the weight. I have lost over 50 pounds.

Am I understanding the settings correctly? My AHI is up (2.5 to 8.5) and my apneas (1.5 to 6) are on the rise. My 90% ipap is 14.9.(edited.. thanks) I am considering raising the MaxIPaP. My assumption is the the auto bipap does not have enough room over the MaxIPap. My 90% Epap is 13.

Current Settings
MaxIPAP 15.0
Min EPAP 8.0
Max Press Sup 5.0
Bi-Flex Setting 2
Autoramp time 0:5
Autoramp 8.0
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

[Wulfman]

I am considering a change to my settings, have not felt well for three weeks. I have been in treatment since August 2008 and have been reading this forum since September. You have helped me through mask leaks, rainout, changing to Bipap, hose covers, data card software and becoming proactive with my treatment. Until this last couple of weeks treatment, I felt better than I had in years.

Before treatment I felt worn out all the time for no reason. I had also had an unexplained weight grain of 90 pounds over a year and a half. I gained weight and was unable to control it through diet. I went through three doctors, each of which failed to help me. The fourth doctor also blamed the weight gain on diet, but he did think about my case. He asked my wife about my sleep habits at her appointment, two weeks later. It was then that he made the diagnose of sleep apnea. I have been in treatment every since. In December I felt so good I was able to start another attempt at losing the weight. I have lost over 50 pounds.

Am I understanding the settings correctly? My AHI is up (2.5 to 8.5) and my apneas (1.5 to 6) are on the rise. My 90% epap is 14.9. I am considering raising the MaxIPaP. My assumption is the the auto bipap does not have enough room over the MaxIPap. My 90% Epap is 13.

Current Settings
MaxIPAP 15.0
Min EPAP 8.0
Max Press Sup 5.0
Bi-Flex Setting 2
Autoramp time 0:5
Autoramp 8.0
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

The EPAP setting is the one that should take care of the Apneas......and it appears that the Apneas are the majority of your AHI numbers. Therefore, if it was me, I'd be raising the Min. EPAP setting to about where it's showing your 90% number is (13 or 14). You could also raise your Max IPAP a few numbers, too. Where the Min EPAP setting is now, it has too far to increase to take care of your apnea events......which can take too long and too many events will occur before it gets to where it needs to be.

You might also consider the possibility that the pressure changes are disturbing your sleep and try straight Bi-PAP settings at some point if these changes don't help.

Den

[jnk]

I am considering a change to my settings, have not felt well for three weeks. I have been in treatment since August 2008 and have been reading this forum since September. You have helped me through mask leaks, rainout, changing to Bipap, hose covers, data card software and becoming proactive with my treatment. Until this last couple of weeks treatment, I felt better than I had in years.

Before treatment I felt worn out all the time for no reason. I had also had an unexplained weight grain of 90 pounds over a year and a half. I gained weight and was unable to control it through diet. I went through three doctors, each of which failed to help me. The fourth doctor also blamed the weight gain on diet, but he did think about my case. He asked my wife about my sleep habits at her appointment, two weeks later. It was then that he made the diagnose of sleep apnea. I have been in treatment every since. In December I felt so good I was able to start another attempt at losing the weight. I have lost over 50 pounds.

Am I understanding the settings correctly? My AHI is up (2.5 to 8.5) and my apneas (1.5 to 6) are on the rise. My 90% epap is 14.9. I am considering raising the MaxIPaP. My assumption is the the auto bipap does not have enough room over the MaxIPap. My 90% Epap is 13.

Current Settings
MaxIPAP 15.0
Min EPAP 8.0
Max Press Sup 5.0
Bi-Flex Setting 2
Autoramp time 0:5
Autoramp 8.0
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

I hope you don't mind my saying so, but your post confuses me a bit. Did you mean to say your 90% IPAP was 14.9? And did you really lose over 50 pounds in three months?!

If you can find a way to post your graphs here, that might help. If your 90% IPAP is 14.9 and your Max IPAP is 15.0, I would guess that you are right about your pressures hitting the upper limit too often. If I were in your shoes and found that to be happening with my therapy, I might first consider raising Max IPAP one cm to 16.0 to see what that did for me for a week or so. If I understand the way that machine works, the EPAP should be able to raise up to within a few cm of your Max IPAP if it is sensing apneas. I agree with Wulfman that EPAP will need to come up too. I just might start with raising my Max IPAP first, in view of the 90% number there.

But if that weight loss figure isn't a typo (50 pounds since December 2008), or I'm not somehow misreading what you wrote, I would make sure my doc was on board with my rate of weight loss. Losing 2/3 of a pound a day is quite a loss and can seriously affect more about your health than your PAP therapy. I would want my doc in the loop about most of my health decisions if I was losing weight that fast.

[sleepymonkie]

You are right my 90% IPap is 14.9. I missed it in the proof reading.

Yes I have lost 50 lbs since December, I have had recent issues with the mask fit and leaks. I have been to the sleep doctor in January and he did remark that my weight loss seemed fast at that time, he told me to come back in July. I am not on an extreme diet, I am using weight watchers. I will contact the office again and bring up the weight loss. Thank you for your input.

[dsm]

Hmmm, I ve seen this before Take a look at these charts - same types of settings you have
http://www.internetage.ws/cpapdata/menu_0724.html

Note the AHI (through the roof). It stayed that way until I raised epap to 10 CMs.

That setup looks like trouble to me & what I am showing in the above chart was my own machine until I stopped running such a big gap & raised epap to a sensible 10 CMs.

Good luck

DSM

[sleepymonkie]

DSM -
I see what you are saying. These are the settings from the doctor, I have not changed them as of yet. I think I will adjust the Max Ipap, address the gap with the Epap and make another appointment. I am working on posting my charts.

Den-
I will ask the doctor about your Auto to straight bipap suggestion.

Thanks

[ozij]

With a 50 pound weight loss, and those results, I would suspect too much pressure as well as too little.
The Respironics technique for identifying pressure induced apneas is far from perfect. If your OSA is weight related, then weight loss should have lessened your pressure need. Of course, that is not necssarily the case, but the option of "to much pressure at present weight" should at least be considered.

What did the sleep doctor look at when you saw him in January? And how much weight have you lost since that visit? Have you told your doctor about the change in you AHI? I for one don't feel I have enough info to tell whether your pressure is too high or too low.

You say you were feeling great in the beginning -- so I don't think its the spread that is causing problems.

And I agree with Jeff's point about the rate of that weigth loss.

O.

[Gale Hawkins]

Say I have a CPAP setting of 12 that works well but I go to the doctor and she sends me home the new Auto set at 5/15.

Does it run at 5 until it gets the input it needs to be higher?

[dsm]

Say I have a CPAP setting of 12 that works well but I go to the doctor and she sends me home the new Auto set at 5/15.

Does it run at 5 until it gets the input it needs to be higher?

Gale,

Pretty well yes.

5 though is a very low starting point & few here would endorse it. 8 or 9 would make more sense if you were on 12.

DSM

[Wulfman]

I guess a followup to ozij's point would be to ask if you have a copy of your sleep study and were there any Central Apneas noted in it?

Den

[Gale Hawkins]

Say I have a CPAP setting of 12 that works well but I go to the doctor and she sends me home the new Auto set at 5/15.

Does it run at 5 until it gets the input it needs to be higher?

Gale,

Pretty well yes.

5 though is a very low starting point & few here would endorse it. 8 or 9 would make more sense if you were on 12.

DSM

So there will be less lag time before correct pressure develops? If so is the lag like a second or two to say go from a 5 to a 12 output?

It would seem to me the life of an Auto would be reduced because speeding up and slowing down all night would really be a lot of work for an electric motor it seems to me.

Does the Auto give better rest or something? Going on 5 years with a standard CPAP and doing just fine I just do not see the fuss over the Auto versions just yet.

[dsm]

An Auto takes minutes to raise CMs and even after a long lag will stop bumping it up after it has traversed 3 CMs. It typically takes stock & based on what it was doing before may even reverse before trying to raise pressure again. The brand of machine has a lot to do with the action taken & how long it takes.

The actual description & sequence gets so convoluted it is not easy to describe in a few words even when we stick to one brand.

DSM

[Gale Hawkins]

An Auto takes minutes to raise CMs and even after a long lag will stop bumping it up after it has traversed 3 CMs. It typically takes stock & based on what it was doing before may even reverse before trying to raise pressure again. The brand of machine has a lot to do with the action taken & how long it takes.

The actual description & sequence gets so convoluted it is not easy to describe in a few words even when we stick to one brand.

DSM

WOW that was longer than I expected. If I knew 12 was my magic number then I would have an Auto bottom number at 9 if not 10 which just about negate the reason to buy and Auto or is about everything new today have the Auto mode?

By the way your description was very easy to undertand as is typical of your posts.

By the way I do understand there is good reason for all of these newer features yet they do not permit their mindless use. Maybe I was just so motivated but I have never had any real issues using the standard older technology.

Getting the oximeter last week and seeing my saturation and pulse rates in the normal range was the first feedback in a technical sense my treatment was working well.

[sleepymonkie]

Ozij -
The doctor stated that he expected he would have to lower the pressure if I maintained my weight loss. I did try to get in his office at the end of Feb., could not get appointment. I took my data card into be reviewed, was told everything was fine. His nurse said he noted the raise in AHI and we would review it in July. I also reminded informed them of my weight loss. My concern is the six months wait, I don't want it to get out of hand. You used the term pressure induced apnea, is this a central or something else? I have had three sleep studies, one noted 6 centrals. There were no centrals on the other two. I was first put on an auto cpap (10-20). I was then put on auto Bipap (ipap 12 epap 8 ). The doctor adjusted my auto Bipap settings to ipap 15 epap 8, he was trying to address snore. I also have allergies which have kicked in the last couple of weeks, I thought that might up my pressure. I am about 5'9" tall and my normal weight range is 165 to 175. My peak weight was 269, I am currently at 218. I believe that I have had sleep apnea since my 20's, I am currently 50. I have always snored loudly and had breathing pauses. It never occurred to me that this was abnormal.

[ozij]

Pressure induced apneas are central apneas, in the sense that they happen when the central nervous system doesn't send your body a command to breathe. Central apnea or pressure induced apneas are open air apneas - not obstructive.

You allergies kicking in, and any medication you take against them could certainly explain the way you feel, and the rise in your AHI.

While some times snores should be eliminated - there are cases where you can let snores happen, and still get good therapy.

Was the doctor concerned about the snores bacause they bothered you, or because he say them on the chart? Did you feel any different at 15 and at 12? Could you get your doctor to prescribe a one night pulse oxygen test?
Have you tried nasal irrigation (e.g. http://www.neilmed.com) to treat the allergies?
O.