Not such good news,,YET

[Canadianguy]

HI all,
Well I had my titration and visit with the Dr., she said my pressure is best at 9 as my central apnea’s increase above this pressure.
I asked them to send a copy of my study to the supplier that I use, which they did. I was very concerned to learn that at this pressure
I was having apnea’s with a oxygen level about 10 % less than my normal rest rate. From what the provider could see on the test results
at no time did the sleep technician increase the pressure above 9. I have been using an Auto set apap machine set min. 5 to max 12,
on most nights it was running 10 to 12 peaks and an average pressure of 7-9. The Dr. requested that I return in 6 months and then again in 12,
she said I may have to have more studies done. I was also informed that the health insurance we have in this Province will only allow a further
sleep titration study after a review of the request and it may take some time. My provider has gone over and above for me; she has given me a
blood oxygen meter to use for 2 nights as well set the apap machine from 5 min. to a max of 15.
This is for a trial period only, and then she will look at the data from the oxygen sensor as well as the apap machine and send this data to the Dr. for further consideration.

This was not the news I wanted to share or that I wanted to hear, but I feel my provider is looking after my best interest.
This gives me some comfort to know, as she said blood oxygen levels in the low 80’s is not good for the heart and this is what we are trying to fix.

Canadianguy

[Guest]

I was also informed that the health insurance we have in this Province will only allow a further
sleep titration study after a review of the request and it may take some time.

No, no, no. Canadian health care is perfect. Haven't you heard about all those Americans running north to be part of the Canadian health care system? Please do not say that health care there is slow and limited by bureaucratic rules.

[n0hardmask]

HI all,
Well I had my titration and visit with the Dr., she said my pressure is best at 9 as my central apnea’s increase above this pressure. ... From what the provider could see on the test results at no time did the sleep technician increase the pressure above 9. I have been using an Auto set apap machine set min. 5 to max 12, on most nights it was running 10 to 12 peaks and an average pressure of 7-9... My provider has gone over and above for me; she has given me a blood oxygen meter to use for 2 nights as well set the apap machine from 5 min. to a max of 15.
Canadianguy

I'm a bit confused on the pressures.. I highlighted what you said, that you were running settings of 5 to 12; that above 9 the centrals increase; and the Dr upped the pressure range to '5 to 15'. I hope some more savvy folks chime in, in case I'm not understanding what's going on. I would think that if you centrals increase above 9 that one might want to cap it less than 12, but I would not push it up to 15. Someone please clarify this for me and Canadianguy. earl

[dtsm]

Can you post some data; my first thought is you've got some serious leaks and thus the peaks 10-12? Also, what are you Hi and Ai levels?

[Pugsy]

I would think that if you centrals increase above 9 that one might want to cap it less than 12, but I would not push it up to 15. Someone please clarify this for me and Canadianguy. earl

In theory yes, if the centrals are increasing due to pressure increases one would want to limit the pressure increases. One would really need to see the reports and see where any pressure increases go and then see if any centrals pop up at those pressures to have a better idea what is going on.
From the information given here where OP says average pressure of 7 to 9 and peaks 10 to 12 leads me to believe it didn't stay extremely long at the upper end of the pressure or the average would be a bit higher.

Also just because a machine can go to 15 doesn't mean that it will go to 15.

Perhaps the doctor is wanting to see if the machine is wanting to go higher for other reasons (like deal with obstructive events). Perhaps wanting to see just how much of an impact on centrals those pressures might bring. Any number of reasons that we can't see because we can't see all the reports. There simply is not enough information here to make much of an assumption about pressures. Like how much of an increase with pressures above 9?? A couple or 20?

The doctor is still experimenting and since we don't have all the information, we really aren't in a position to comment other than "in general". In general if centrals are pressure induced, then yes we limit the pressure increases and try to find a compromise between having enough pressure to zap the obstructive events and not trigger centrals. Perhaps the doctor is still trying to find the compromise??
Would I go about it differently? I honestly don't know because I don't have all the information I might need to offer any ideas.

[Canadianguy]

Hello all,
Sorry if I didn’t explain things well, the DME provider is the one who is a little confused with the results
of the titration study and why the Technician did not try a pressure above 9. Apparently there is nothing
on the study to show that my centrals where going up with the pressure increase and at no time was the
pressure set any higher than 9. The DME said she is concern by the low oxygen levels during the study,
when I was having apnea’s. This is why at this point we( the DME and Myself ) are temporally setting
the APAP machine pressures to min. of 5 and max. of 15, also for the next two days I will be using a
blood oxygen sensor while I sleep. Please note, this is a APAP machine and will adjust to my apnea’s
with the pressures needed to the maximum setting , which will is now 15.
The DME said she will review the data, see what apena’s I am having at what pressures,
leaks as well as the blood oxygen levels and send her report on these findings to the Sleep Dr.
Sorry I don’t have a copy of the titration study to share, and last night’s sleep was restless
so will see how things go tonight before I post a screenshot.
Here are the numbers from last night, and I did use a chin strap.
AHI 2.72
Hypopnea 0.72
Unspecified Apnea 0.00
Obstructive 1.29
Clear Airway 0.72

MIN AVG 90% MAX
Pressure 15 8.40 7.83 15
EPAP 5.0 8.40 7.83 11.46
Minute Vent 2.38 4.95 11.12 18.88
AHI/hr 0.00 2.72 3.50 8.00
Rep.Rate 7.20 12.96 15.40 22.80
Flow Limit 0.00 0.01 0.10 0.60
Leak’s 0.00 1.13 9.60 28.80
Snore 0.00 0.01 0.04 0.08
Tidal Volume 160.00 384.84 830.00 1220.00

My original sleep study showed,
50 events per hour
awakwnings elevated at 11 per hr.
AHI 56.1 events/hr index = 43 events per hr. , supine = 67 events per hr.
O2 desaturations to 62%, 23 % total sleep time with O2 saturation of less than 90%

Conclusion severe obstructive apnea, with mild snoring.

Will keep you all posted, please if you have any advice share it with me.

Thanks for your support,
Canadianguy.

[archangle]

Realize that an auto CPAP will not necessarily auto up to the right pressure. Sometimes you need to up the minimum pressure. You may also feel a little better if you up the minimum pressure a little above the level at which the machine stops recording events.

Of course, you won't want to increase the pressure to a point where central apneas become a problem.

[Pugsy]

OHHHHH, I see now..you and your DME are dial a wingin. I thought it was the doctor.

Here are the numbers from last night, and I did use a chin strap.
AHI 2.72
Hypopnea 0.72
Unspecified Apnea 0.00
Obstructive 1.29
Clear Airway 0.72

These numbers are quite acceptable.

You are in Canada and I have heard it is hard to get an APAP full time, that they are often used like you are using now to find the best pressure. You may end up on straight CPAP.

Let me explain about APAP minimum and maximum...it is the minimum pressure that is the most critical. It has to be high enough to give the machine a good enough head start to prevent events.
It doesn't go from 5 to 15 in 5 minutes.. It starts out at 5 and goes up slowly in stages and testing the airway as it goes up. If the minimum is too low then the machine can't get to the higher pressure needed in time to prevent the event so the event happens and waves to the pressure going up as it leaves..

Maximum of 15 means nothing if the machine doesn't ever go there for some reason.

You might read this little thread. It may help explain what archangle and I mean when we talk about having the minimum set ideally.
viewtopic.php?f=1&t=39869&st=0&sk=t&sd=a

[Canadianguy]

Thanks again Pugsy, it's sure is nice to have people like you here to give us newbie's the encouragement and support we need.
I always like to hear from others who have had or know of similar experiences and give me some direction.

I would like to also request some suggestions for a full face mask, I still have some leaks that go past the red line even with the chin strap.
I tried the Quattro FX Full Face Mask, but the fine silicon seal was burning my skin, after 4 hrs of no sleep off it came.
The next day made a mask pad, but after 2 hrs of sleep it had moved and
the mask was leaking and burning my face again.
I currently use the nose pillows and have no problem sleeping all night with them with little leaks from the mask.
I do like to sleep on my tummy face side ways into pillow, and also on my side. Any suggestions on full face masks?
Have heard some people post about taping the mouth but I am afraid if we loose power I may not wake up.

Canadianguy.

[Pugsy]

Any suggestions on full face masks?
Have heard some people post about taping the mouth but I am afraid if we loose power I may not wake up

I am sorry but I am zero help in the Full face mask market. Only one I ever tried was the Innomed Hybrid and that was a disaster. I am strictly a nasal pillow user. Why do you want to use a Full face mask? Are you thinking you are mouth breathing/leaking? Look at the leak line, it might not be as bad as one thinks.

I did tape for about 2 months because my mouth wanted to come open often but I normally breathe through my nose just fine and I think it was just a habit that mouth came open during sleep from gasping for breath. After a couple of months didn't tape any more and mouth seemed to stay shut (no large leaks on reports)

Side note. I read all the "taping is dangerous" stuff before I ever tried it. Since I had already determined I couldn't/wouldn't use a full face mask (long story as to why not) then I didn't have much choice....so I got out the old blue painter's tape leftover from painting the kitchen. During the day I experimented with the tape. I slapped some on and tried to open my mouth (thinking power failure and needing to breathe)... you know what? It is extremely easy to break the seal with a simple non forceful yawn. I didn't even need my hands. This stuff isn't like cement. So I figured I could easily breathe through my mouth by breaking the seal if need be. So next experiment was.."can I breathe enough through the mask if power goes off and I don't wake up".... So during the day again I sit down and breathe through the mask and not have the machine come on. I got bored after about 20 minutes. With the machine off there wasn't a lot of air movement through the vent holes but there was enough that I was never in distress nor did I feel the least little bit like I was suffocating. So that became a non issue.

So I got the tape out, taped my mouth and the very first night that I taped we had a thunderstorm and we lost power. I woke up thinking "why is it so quiet"....then after a short while I realized that the machine was off. No panic, no suffocation, no nothing except "it's too quiet". So after that, I had no problems worrying about "what if" because I had covered all the bases.

Now if someone was drunk, doped up or completely zonkered out of their gourd...yeah, don't tape because who knows what might happen but I just imagine someone in that state wouldn't bother to mask up anyway.

[dtsm]

Let me explain about APAP minimum and maximum...it is the minimum pressure that is the most critical. It has to be high enough to give the machine a good enough head start to prevent events.
It doesn't go from 5 to 15 in 5 minutes..

Couldn't have said it better. Re-set the minimum to 95th percentile and go from there.

FFM are notoriously leakers. If your leaks are under control, stay with either the tape or chinstrap.

[Canadianguy]

Thanks Once Again Pugsy,

I love the pillows as well, like I said full compliance with them and no real problems. I woke with a headache yesterday that lasted all day, I was not sure if it was the the chin strap. I don't have it to tight but i may need sometime to adjust to it. Last nights sleep almost 8 hrs, had a little higher AHI 4.4, obstructive 3.4 , central 0.3 , hypo 0.6 , leak 0.0 with a max. 18.0 , Pressure median 9.2 , 95% 11.1 , Max. 13.3. I had only one leak that was over the red line to a leak of about 34. a few very minor and then one more at about 16.
I may try the painters tape as you suggested if I need an alliterative to the chin strap, I also heard from someone else that in a few months I may no longer require the chin strap.
This sounds good to me, I really don't like the extra strap around my head and jaw, the pillows are almost like not wearing a mask at all for me.

Hugs to you for taking the time to help me along this road to good health,
Canadianguy.