HELP PLEASE...

[oneofsevendwarfs]

I believe my doctor to be pretty knowledgable and on top things when it comes to my treatment for OSA. Maybe I'm wrong. I've been on 3 machines (cpap to vpap to bipap). I realize I need to make more of an effort to speed up the process so...I read how many are making changes to their pressure settings and I'm wondering if this is what I should be doing. In my last visit the doc said that based on my last sleep study, the settings he has me at cut my apneas down to 4 an hour. Should I trust this? It's been two weeks on the bipap, and at these settings, and I've seen minimal improvement (which is actually kind of a big deal because I've had NO improvement up to this point). By minimal I mean that I've had 3 somewhat clear-minded mornings in these two weeks. Just this weekend I switched from a nasal mask to a pillow mask. That switch resulted in 1 of those 3 mornings. Is there anything else I should try or keep a watch on to have those mornings grow into full days???

[Julie]

Hi, it can take weeks or more before some people experience good results, and possibly you'll have better ones with your new mask. However, I wonder if you've considered whether or not your mouth falls open when you sleep (you'd need someone else to tell you), because if it does, you're routinely losing all the 'good' air from the Cpap. It seems to happen to a lot of us and we then need to go to a full face mask (e.g. Quattro, Ultra Mirage, Hybrid, etc.) which really does the trick. You can buy 'chin straps' which supposedly help, but in reality most of us find they don't really work.

[Snoredog]

most doctors don't know squat about machine settings and pressures, then they rely on the DME's RT who has strained thoughts of their own.

Best suggestion I can give:

1. Get a copy of that PSG and read every word of it, understand what it says.
2. Go through the programming of the machine to make SURE it is set up correctly.
3. IF your OSA is under control AHI (AHI=Apnea/Hypopnea Index, or AI + HI /60) should be under 5, that number will be the "avg" per hour of both Apnea plus Hyponea. You cannot get Hypopnea down (HI) until you first get Apnea number down. IF your OSA is under control, AI (Apnea Indice) portion will be down at 1 or less, HI (Hypopnea Indice) should soon follow where the avg sum of both is under 5.

SO, do you know if your machine is set up correctly? How many residual AI do you have? That is controlled by EPAP or exhale pressure, with it increased high enough apnea will be eliminated. Once those are eliminated or down to acceptable levels you increase IPAP (Inhale pressure) to eliminate any residual HI or FL.

You cannot rely on the PSG, you can use it as a baseline for initial settings but rarely does the home titration match that, many times it is way off. There are many factors that can influence that, sleeping position, mask type and or if you switched masks after your PSG.

Best thing you can do is get the software and adjust the settings yourself to reduce AHI and base settings on how you feel.

Do you know what mode your machine is in and what the settings are? Do you know your pressure settings?

That would be a start, it is not really that difficult once you understand it.

[ozij]

What they said, and:

The cutoff point for "treated" apnea, or "does not to be treated" is formally 5. That's what insurance companies decided, based on financial considerations, so that's when the system says oh great, we've got you at lower than 5, no need to do anything else. There is no study I know of that compared people's response to lower AHIs.

My personal experience (with myself, that is) is that anything above 2.5 is just not good enough. I am not the only member on the board feeling like that. So yes, I would try to tweak my setting towards a lower AHI.

You also have to check the total hours of sleep you get. Too little sleep, and you'll be tired, even is your sleep apnea is perfectly controlled.

O.

[Hawthorne]

I, too, feel much better when my AHI is lower (below 2). Thanks to people on this forum (Ozij in particular), I am getting an AHI below 1 almost every night. I'm sharper in terms of thinking and can do more in a day, in spite of the fact that I have Rheumatoid Arthritis (fatigue issues of it's own) and feel more like facing the day when I get up in the morning.
Everyone is different but a "lower than 2" AHI works best for me. For some people ,5 or just under may be enough.

Having an auto and the software and reader makes it possible for almost anyone tweak their pressures to get the best therapy they can (with a lot of help from this board!), whether it's AHI just under 5 or a lower AHI.

[oneofsevendwarfs]

Hawthrone, you mention an "auto", what is that?

Snoredog, is the "PSG" my sleep study results? an NO I do not know what mode my machine is in, how can I tell? I'm not sure of all the settings but I can see my EPAP and minimum IPAP are set at 6 and my maximum IPAP is at 16. How do I find out the residual AI?

[sagesteve]

Ditto to what Snoredog said...follow his suggestion(s) to the T! It took me 6 months to get to my 2 and some change AHI. I started at 17 AHI.

[roster]

I am not happy unless my AHI is less than 1.0.

[Snoredog]

Hawthrone, you mention an "auto", what is that?

Snoredog, is the "PSG" my sleep study results? an NO I do not know what mode my machine is in, how can I tell? I'm not sure of all the settings but I can see my EPAP and minimum IPAP are set at 6 and my maximum IPAP is at 16. How do I find out the residual AI?

You have the AutoSV and Encore, that will help, what is it showing you for 90% pressure for EPAP and IPAP?

You must have a mix of obstructive and central apnea for them to give you that machine or a form of Complex Sleep Disordered Breathing (CSDB). If not mistaken and others see that machine differently I see it as a pseudo manual-auto machine. What I mean by that is EPAP is manually set to take care of your obstructive apnea and IPAP is free to move to higher as needed to stabilize breathing and as a result of that stabilization the central apnea resolve on their own.

Sounds like they have your EPAP=6 and the IPAP at 10 cm higher at 16 cm. Depending on the mode that can be a range or a fixed setting.

NOTE: Now that I see the type of machine you are using, I have to ask what problem are you trying to fix?

One thing I'd be suspect of is your selection of mask, the Swift would seem to adversely impact your therapy, in fact the manufacturer of that mask does NOT recommend its use with the type of machine you are using. The reason is it flushes too much CO2 out of your system due to its design where with your disorder you should probably be retaining more to keep the central apnea at bay.

So I would consult the Swift's technical documentation for that recommendation, I know they don't recommend it for use with their own machines of that type.

[oneofsevendwarfs]

Sorry for my lack of knowledge, but where am I looking for that 90% pressure for EPAP and IPAP you're asking about?

and, yes, I was wrong when I said I had OSA...I was started on a cpap for OSA and that seemed to cause the complex so I was moved to a vpap and didnt see any results so now the bipap autosv. and yes that sounds right when you say about the pseudo-manual/auto attributes of the machine.

I wasnt sure about the mask choice just trying something different. I'll go back to my nasal if thats more effective for the machine I have. I'll check the manual

[Wulfman]

If you don't have the software to interpret the data, you would need the following:

https://www.cpap.com/productpage-bundle.php?BundleID=64


Den

[Hawthorne]

You're already using an auto, I see by your profile. Yours is an auto bipap. This means you expiration and inhalation pressures can be set differently (that's the bipap part). Since it is an auto bipap, both your expiration and inhalation can also be set for a range of pressure and your machine will change during each exhalation and inhalation during the night within the set range - that's the auto part)- as opposed to each (inhalation and exhalation) being at one set pressure. It can also be set a set pressure for both inhalation or exhalation, if that works better for you. Having the software is a real help because you can see the details, each morning about your night's therapy. It will show when, what kind and how many events you had, what your leak rate was, what your AHI was (the sum of your apneas and hypoapneas and in your case, centrals). It will show your 90% pressure for both inhalation and expiration (90% pressure is at what pressure you spent 90% or less of your night). With this information you can tweak your therapy and get better results -lower AHI -better control over leaks and better sleep. It takes time and maybe a few changes but you feel better and you reduce your risk of high blood pressure and its' related problems. Others can tell you much more and probably even correct me, since I don't know a lot about bipaps. The more experienced ones on the forum can give you much more than I. I've just been monitoring my therapy since February. Many here have been at it a lot longer than I!
You titled your thread "HELP PLEASE". You'll get lots of help here!