Cpap not doing it's job? My saga

[General C1]

I have had a cpap for 1 year now. After my sleep test, since my APH were so bad (among the 2 worst the technician has ever read), I was outfitted with a "temporary/loaner" cpap until my new one arrived. I used this old machine for 2 weeks. Upon receiving my new machine I immediately noticed a difference. The new machine, although achieving the correct pressure output, appeared to me to not direct the air onto my throat like the loaner did. In the past year I have noticed that there are times my APH is relatively low, and other times that my APH is extremely high (as high as 30 on some occasions). Additionally, the cpap does not always eliminate my snoring. I also question the accuracy of the information I get from the cpap. Sometimes I notice the pressure rising when I'm only sitting in bed reading with the cpap on. When I've gone into the app to see what is going on, it will state that I have had several apneas or hypopneas while I've been just sitting. Has anyone else had these issues?

When I initially told my doctor of the issues, he raised the starting pressure from 5 to 8. That raise also came from my complaint to him that upon putting the mask on at night, the machine wasn't giving me enough air to breath to start.
The equipment dealer checked out the machine and determined that it was putting out the correct pressures.

As a side note, my original equipment dealer has had a number of issues, such as failing to provide me with timely replacement parts, so I have moved on to another supply company. I am scheduled to go in to them in 2 weeks for a proper mask fit test and to have them check my machine. I will ask the same question of them as to why I have so many APH while on cpap.

[avi123]

What is APH?

[General C1]

Oops, I meant AHI.....was thinking apneas per hour, lol (APH)

[LSAT]

APH??? I think you mean AHI...Apnia Hypopnia Index
The machine does not direct the air...It blows air into the hose
The machine cannot tell if you are sleeping or awake..that's why it reports events while you are up.
It's rare for a machine not to put out the correct pressure.

[Guest]

However, my main question is why am I having so many apneas while I'm on the cpap?

[Pugsy]

What kind of apneas are you having? Clear Airway/Central or Obstructive apnea or Hyponeas?
Where are you getting the AHI numbers? From the machine LCD screen or the software?
As to why so many??? It depends on what kind of apneas they are and what your settings are.
We need a lot more information to hazard a guess as to why the therapy is not optimal.

[Wulfman...]

From your posts and comments, I don't think you understand how these machines work or the principles behind their functions.
Are you using some software to monitor your therapy.......like Sleepyhead?
What are ALL of your settings?
Pressure (range or single)?
Exhale relief?
Humidity?

As has been stated already, these machines don't know whether you're awake or asleep and if you are awake, may not react in the way you think they should.
They're supposed to provide enough air to "splint" your airway open (nose or mouth) to allow you to breathe normally and not "force" (direct) air into your throat.
If your machine is set to a range of pressures, it is likely that the settings are not effective.
In other words, you may have been wasting a year with poor therapy.
If your doctor thinks these machines automatically find the proper pressure setting, then your doctor is clueless.
Take control of your own therapy as soon as possible and learn how this stuff is supposed to work.


Den

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[General C1]

Thank you all for your engagement on my issue. My apologies if I seem uninformed, as I am still learning. To answer some of the questions posed;

-I am viewing the result via the Philips app which communicates with my Dream Station via Bluetooth
- my pressures are 8 to start, with a maximum of 18. The machine is supposed to auto ramp as it sees a need for increased air.
- I do not use any additional humidity.

Please let me know if anyone has additional questions which I can answer to provide more clarity

[Wulfman...]

Thank you all for your engagement on my issue. My apologies if I seem uninformed, as I am still learning. To answer some of the questions posed;

-I am viewing the result via the Philips app which communicates with my Dream Station via Bluetooth
- my pressures are 8 to start, with a maximum of 18. The machine is supposed to auto ramp as it sees a need for increased air.
- I do not use any additional humidity.

Please let me know if anyone has additional questions which I can answer to provide more clarity

Sounds like your pressure range may still be to wide open.
My suggestion would be to get Sleepyhead software and take control of your own therapy. You'll get a better picture of what's going on during the nights and become more knowledgeable faster.
Nobody is going to care more about YOUR therapy then YOU.


Den

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[Pugsy]

SleepyHead software information
https://sleep.tnet.com/equipment

Some examples of what you can see can be found here
viewtopic/t103468/Need-help-with-screen-shots.html

Without knowing what your AHI is made up of all we are doing is guessing as to what could be wrong or the cause for the sub optimal therapy.

The online app leaves a lot to be desired in terms of level of detail available. It's okay when everything is going fine and dandy but not so okay when there's a problem that needs to be fixed.

[kteague]

- my pressures are 8 to start, with a maximum of 18. The machine is supposed to auto ramp as it sees a need for increased air.

It would be helpful for the data gurus here (not me ) to see actual data from your machine. The Sleepyhead charts previously mentioned can often help identify treatment issues. Any advice without seeing or at least knowing more data would be a generality without a way to tell if your case is perhaps an outlier. I encourage you to continue down this path of discovery. I was 5 months into treatment and failing miserably when I showed up here and in no time my treatment was optimized and I began to experience a turnaround.

If a person has garden variety OSA and their pressure has to climb a lot to meet needs, it is often suggested to increase the starting pressure so as to more quickly reach a therapeutic pressure when needed. A wide gap between where the machine starts and what one needs can mean it takes too long. Increases are incremental over time - it doesn't just shoot up there immediately. However, that general advice which can work miracles for some can cause more problems for those individuals who have pressure induced centrals as increased pressure could result in more central events. Just saying all this to let you know how important detailed data can be in avoiding trial and error and getting straight to the meat of the matter. Good luck with everything.

P.S. I see while I was typing others have already reinforced the data thing. Consider this a co-sign.

[OceanBlue]

I'm sorry to hear this. The same thing happened to me. The insurance trial machine worked great-I started feeling much better and refreshed in the morning. When they switched out the trial machine with the one I had to purchase, same model and mask, but it never worked for me again. I've been struggling with this for 3 years now, but no one can help. The medical company told me it was psychological. I wonder if they sell refurbished ones as new or lemons.

I called ResMed and spoke with an engineer, who told me many other things can be wrong with it, things that can't be detected with the limited testing done at medical equipment companies (example-the 1-2 or 3 comfort breathing setting-I wonder if that could be the problem). So, I went round and round in circles, and got worn out as everyone gave me the runaround, include the pulmonologists. I mean, I am/was exhausted every day and gave up. In my case, I moved to a different state, and home medical companies here will not ship it to ResMed for me, because they are not the 'owner'. The original medical equipment company who sold me the machine in my former state said they can't do anything about it now after I moved because they can't "practice medicine" across state lines. And-the manager told me there's nothing in my record about having any problems with the machine! Yet, I had numerous calls and visits with them about this, and have at least 2 personal emails to the tech who told me the problem was 'psychological'. The whole has been devastating because i felt better for the first time with that trial machine, and have been tired every day of my life since then. I cannot afford to pay cash for a new one. But I shouldn't have to either.

If I did this over, as now it's been years, I would have sent the medical equipment company a certified letter asking them to send the machine back to the manufacturer to thoroughly check it's function. That's my advice. Don't go through the same thing I went through. And they do wear you down.

[Guest]

Thank you all. There is still much I don't know as I thought all I had to do was switch on the cpap and forget about it. I will take a look at the software as my app currently lists lots of obstructive apneas and hypopneas, with a few clear apneas

[Uncle_Bob]

The machine is supposed to auto ramp as it sees a need for increased air.

Ditch the ramp, thats just for kids.
What was your titrated pressure? Have you tried just a set pressure on CPAP at that pressure?
Your machine has no ability/algorithm to detect and deal with clear air/central apneas as the better machines do.

[LSAT]

Thank you all. There is still much I don't know as I thought all I had to do was switch on the cpap and forget about it. I will take a look at the software as my app currently lists lots of obstructive apneas and hypopneas, with a few clear apneas

Please define "lots". Are you talking about AHI? or total for the night?. You keep talking in generalities. How about specifics.