No one seems to get my settings right

[jeffm591]

I have been on CPAP for years. The dr I was seeing was always adjusting pressures. Rarely has my AHI been under 12. Over the years I have had CPAP, BiPAP. I changed drs again thinking a new set of eyes may help. New doc did yet another sleep study. Doc ordered a new machine, an ASV. I tried that for about two weeks, made no difference. My AHI was constantly over 20, on occasion maybe 15. They kept moving pressures around. They said ASV not working and put me back to BiPap 15,12. My AHI jumped to 42. I felt like I didnt sleep at all. I have several machines over the years, ready to give up, decided the best thing to do is go back to CPAP set at 10. The first night my AHI was 20, but I was able to sleep 7hrs straight. Im still not sure everything is right but I remember when using straight CPAP at least I felt better and there were occasional nights under 12 AHI. I would kill to have it under 5. I am just asking someone elses opinion on this board. It seems all these pressure changes, no one knows where to set it. Ive had at least 5 sleep studies the last 10 years. I remember at one time my BiPap was set at 24. Drs had it on auto for a while. Now on the third dr I would think someone would be able to tell me something. No matter how I go to sleep, I always end up on my back. Tried the tennis balls pinned to my back, no help

Im not that computer saavy but I can try to get OSCAR downloads if needed. Im using full face mask. Air leaks practically 0. Im on aircurve 10.

[Pugsy]

You need to get OSCAR and lets see exactly what the high AHI is composed of to have any chance of being able to offer any ideas.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

[zonker]

I have been on CPAP for years.

Im not that computer saavy but I can try to get OSCAR downloads if needed. Im using full face mask. Air leaks practically 0. Im on aircurve 10.

jeff, here's your post from last year-

http://cpaptalk.com/viewtopic.php?f=1&t ... 6#p1363856

so it looks like you can get the oscar reports and post them. what you need to do is arrange them so that they show the information needed for folks to offer suggestions on.

the chart you post should look like this-



if you need help getting the charts arranged, don't hesitate to ask.

good luck!

[bwexler]

Jeff, learn to post your charts here.
I also use an Aircurve 10. My untreated AHI was 84.
When I made adjustments per Sleep doc recommendations I could stand it for an hour.
When I adjusted opposite the docs recommendation things got better.
The experts here have guided me for over 10 years. Beats every doc I have seen.

[jeffm591]

OK I think I got what you may need here. This is my worst night - I was on BiPap

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Hope I did this right - last time I posted my son helped me. They changed me back to cpap the last few nights. I had one really good night ith an ahi 1.5 I also tried a cervicl collar and seems to help . If you cant read these please let me know. I appreciate all you help. I am at my wits end.

JM

[Pugsy]

Still not quite right with the images but close enough to get some ideas.

Where did you get the OSCAR version you are using? It wasn't from the link I provided.

First of all get this version of OSCAR....it's a newer version and it defaults to a better viewing format which turns off the calendar and pie chart so we can see the statistics better.
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Or you can manually hide the calendar and turn off pie chart ...Preferences/appearance and uncheck the show pie chart line.

Compare your reports to examples here
viewtopic/t158560/How-to-post-images-for-review.html

Don't zoom in on anything unless requested to zoom in.

Find the night with the AHI 1.5 report....post the detailed report for that night.
Lets see what the settings were that night.

[jeffm591]

ok i download the new version of OSCAR

here is the low ahi night

screenshot-20210228-085710.png (82.75 KiB) Viewed 1527 times

[Pugsy]

Well...that's a very acceptable result so it makes us wonder what changed between that night and last night.
The settings were the same...so we know they can work at least some of the time.
Something changed though....now to figure out what.

How was your sleep quality last night? Did you spend much time awake with mask and machine on?
What position did you sleep for the bulk of last night?
Do you ever curl up in a position where you tuck your chin to your chest?

[jeffm591]

First I am definatley a mouth breather. No matter where I start sleeping, sometime during the night I always end up sleeping on my back. The night with the ahi of 1.5 was the first night with the cervical collar. I thought sure I found the problem. But the last two nights I was at 15 ahi again. Even with the c collar I do find myself waking up with my mouth somewhat open. My wife did tell me the last two nights I snored a bit .
So now I usually start sleeping on my back. The docs told me to put a tennis ball in a sock and pin it on my back and sleep on my side but I just wake up in the morning on my back with a tennis ball jabbing me. There were a few nights that the "positional therapy" did a little good but it wasnt lasting. I am very tired lately. I have no problems falling asleep. Usually I awake for some reason about 1:30 every night for a bit, then usually I can go back to sleep.

I am getting a little wordy here but this has been a long road.

[Pugsy]

Sleeping on one's back seems to create a recipe for the jaw/mouth dropping open.
Sleeping on one's back also is a prime recipe for making OSA worse and needing more pressure to prevent the airway from collapsing.
Your docs seem to want to use a fixed pressure which doesn't work so great when something happens to cause a person to need more pressure.

Can you go back to the OSCAR software and get me a screen shot of the "Changes to Machine settings" at the bottom of the Statistics page?
I want to see what all changes have been made along with results and this will give me an idea as to what has been tried with this machine.

Are you gutsy enough to change the settings yourself? It's easy.

As for the old tennis ball trick. I have always thought that was the stupidest idea I have ever heard of....insert a variable that causes a person to wake up often due to discomfort when we are trying to use a machine that prevents wake ups.
I had better luck figuring out a way to stay on my side with something comfortable that let me stay asleep.
I put a buckwheat pillow behind my back to support me better (and it's so heavy it doesn't slide out easily) so when I did end up trying to roll onto my back I ended up being sort of at a 45 degree angle with the pillow supporting my back and it's quite comfortable so no wake ups due to discomfort.

I don't know how much of your OSA is sleep position related but it is VERY common for OSA to worsen when supine and need lots more pressure compared to side sleeping.
Working with a woman right now who needs around 18 cm when on her back but only around 8 cm when on her side.
I suspect your issues are likely similar.
REM stage sleep can also worsen OSA and cause a need for higher pressures. I have this myself.
Supine sleeping was never a real problem for me but REM sleep sure was.

[jeffm591]

I can changes settings - they had me do a lot along the way - especially recently as you will see - they also changed them - even daily -

screenshot-20210228-094816.png (125.29 KiB) Viewed 1517 times

[jeffm591]

My history is long - Im not sure what REM issues are but the way I was diagnosed with sleep apnea is I had a lot of parasomnias. I did a lot of sleep walking and night time activities and they said it was because of sleep apnea would not let me get to REM sleep. Does that sound right? I was on clonazepam for a few years at bedtime. After the cpap the parasomnias eventually stopped and I came off the clonazepam but my ahi never was able to get under control.

[Pugsy]

OMG what a friggin mess of experiments. Your most recent Monday the 22nd report shows a truckload of UAs and it's totally weird because we don't normally see UAs with this machine unless the leaks are really bad and your leak graph shows minimal leaks. Makes me wonder how much of those apnea flags were maybe central in nature and just confused the machine.

I don't know where to start except back to the basics.
I don't know how much the cervical collar is helping or not...but whatever you choose (with or without the collar) don't change it.
When doing experiments remember Science 101...keep your variables to a minimum so we have a better chance to know which change did what.

What I would like to try is a small auto adjusting range without a difference between inhale and exhale if possible. If not possible then as small of a range as is comfortable.

So...change to auto bilevel mode.
Minimum EPAP 9 cm
PS ...0 if at all possible or 1 or 2 if 0 isn't possible because of comfort issues.
Maximum IPAP 15 cm

Sleep in any position you want for now.
If you want to wear the cervical collar...that's fine but continue wearing it especially if you find it helps with jaw drop that causes wake ups. We want to do everything we can to make sure that you stay asleep and don't have awake breathing irregularities potentially messing up evaluations.

What we are going to do is a prolonged version of what is often done during an in lab titration where they attempt to find optimal pressures.
I full expect we will need to adjust the settings but we have to start somewhere.

The reason I want to eliminate having a difference between inhale and exhale is sometimes that difference can cause unstable breathing which sometimes causes central apneas. It's a small subset of people who have this happen but the UAs seen on that one ugly night...make me scratch my head and wonder.
I noticed on the history of settings that at one point your PS (pressure support which is nothing more than the difference between inhale and exhale) was 10 cm...that's a recipe for almost for sure triggering central apneas....and that's your worst AHI night...Aug 29

Any questions?

[jeffm591]

Ok I will set it up like that -we'll see what happens - thanks for your help

JM

[jeffm591]

Not a bad night - Thank you!!!! I slept on my back - I wore the C collar. What next?

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