Is this odd or what? APAP woes

Fatigue Fighter · Post by **Fatigue Fighter** » Thu Oct 27, 2005 7:51 pm

Hi all,

I just received my new Respironics Auto-PAP with C-Flex set for 12-18 cm H20. I tried it last night. Didn't feel well this morning. Dizzy. I tried it again this afternoon during a nap...but I didn't sleep...I just rested. In less than an hour the APAP went all the way to the maximum pressure of 18 and I wasn't even asleep! It just stayed there too. Now my chest hurts (I started with a BiPAP at 17/14). Has this relatively sudden increase to pressure happen to anyone on an APAP machine? It never went down...just kept going higher and higher until it reached the set maximum.

I am scheduled to see an ENT physician on Monday so I hope he has some solutions (if the problem is with my nasal turbinates).

FF

neversleeps · Post by **neversleeps** » Thu Oct 27, 2005 8:16 pm

If you've been using a bipap at 17/14, I'm not sure how a max pressure of 18 (vs. 17) could make that much difference in how you're feeling. Perhaps what you're missing is the decrease to 14 on exhalation. Make sure you have the c-flex setting at 3 for maximum relief upon exhalation.

Maybe you'll want to try a setting of 14-17 (and c-flex at 3) on your new auto for a night to see if you experience the same difficulty. If so, my layman's guess is you may need the relief that your bipap provided because you're at a relatively high pressure. (The c-flex "relief" is not a 1cm drop per setting. It is an indistinct drop and may not be getting you low enough for your comfort.)

What does the software indicate? Did your AHI go up last night?

Fatigue Fighter · Post by **Fatigue Fighter** » Sat Oct 29, 2005 8:05 pm

If you've been using a bipap at 17/14, I'm not sure how a max pressure of 18 (vs. 17) could make that much difference in how you're feeling.
The reason my sleep doc suggested this is because the last titration I did eliminated most of the apnea and hypopnea at this level. He thought an APAP would be more comfortable because he thought maybe the high pressure was waking me up too much.

Maybe you'll want to try a setting of 14-17 (and c-flex at 3) on your new auto for a night to see if you experience the same difficulty.
I tried this and it didn't make much difference for me. I did increase the max pressure to 20cm and I woke up at that level in the morning. I am beginning to wonder if I have something else (in addition to sleep apnea) that is causing the pressure levels to go so high. It gets to 18 cm while I am awake!

I did not buy the software yet because I wanted to see how this worked for me first. Thanks for your response Neversleeps. I'll just keep trying different things. Meanwhile, I see an ENT specialist tomorrow to see if there is anything that might be causing a problem.

FF

neversleeps · Post by **neversleeps** » Sun Oct 30, 2005 11:57 am

So, let me see if I've got this right. You've been using a biPAP at 17/14, which means your inhalation pressure is a constant 17cms. Your last titration study indicated 18 gave you the best treatment, so your doc suggested the pressure be raised to 18 and that you try switching to an auto because he thought the high pressure (17) on the BiPAP was responsible for waking you up too much. I don't understand his logic, but then, I'm not a doctor.

In addition to my first theory (needing the exhalation relief of your biPAP), I wonder if it's now the 'zooming up' withing the set pressure range of the auto that's bothering you.

Also, I'm thinking my idea of setting cflex to 3 was a bad one. Initially I thought it would more biPAP-like for you, but at higher pressure levels like yours, it's possible C-Flex is just not helpful... it would take a really strong exhalation to get it to make any difference and it probably wouldn't last long enough before the full force of inhalation pressure kicked in. I think that would make me dizzy!

Maybe try using your auto in straight CPAP mode at 17 or 18 and turn off the CFlex feature to see what happens. If you can't stand it (if the biPAP woke you up less and didn't make you feel dizzy and exhalation was markedly easier) perhaps the biPAP is a better machine for you!

BETTER YET, you sound like the PERFECT CANDIDATE for the new Auto BiPap from Respironics. Tell your doc the auto isn't the solution and that you'd like to try the new Respironics Auto BiPAP. Then you'll be able to utilize all the functions, independently or all at once!!!

Once you have the software you'll be able to tell what's happening as you conduct these experiments... in addition to how you feel.

Good luck and hang in there! You WILL get it figured out!

george45 · Post by **george45** » Sun Oct 30, 2005 12:41 pm

I have had a similar problem with the Respironics Auto with Cflex. Every 2nd or 3rd night it would awaken me with a high pressure (max of 13 so far) and then would just stay at that high pressure even though I was wide awake. Finally after 15 minutes or so, I'd push the ramp button and the pressure would go down to 4 and stay around 4 or 5. This is my second machine as I thought my original one was malfunctioning since it acted the same.

I haven't used my machine for 5 nights now and notice no change in my daytime tiredness. In fact one night of no cpap produced one of my best days in years. I have mild OSA.

ufo13 · Post by **ufo13** » Sun Oct 30, 2005 12:42 pm

Fatigue Fighter:

neversleeps has given you excellent advice IMO. The analysis above is right on in my estimation!

Best to you!

Steve,
ufo13

Guest · Post by **Guest** » Sun Oct 30, 2005 12:46 pm

george45 wrote:I have had a similar problem with the Respironics Auto with Cflex. Every 2nd or 3rd night it would awaken me with a high pressure (max of 13 so far) and then would just stay at that high pressure even though I was wide awake. Finally after 15 minutes or so, I'd push the ramp button and the pressure would go down to 4 and stay around 4 or 5. This is my second machine as I thought my original one was malfunctioning since it acted the same.

What is your titrated pressure? What is the pressure range you have your auto set to?

george45 · Post by **george45** » Sun Oct 30, 2005 12:49 pm

My titrated pressure is 6.5, My cpap currently has the full range of 4 to 20 but Ihave experimented with 4-9 up to 16.

Guest · Post by **Guest** » Sun Oct 30, 2005 12:53 pm

george45 wrote:My titrated pressure is 6.5, My cpap currently has the full range of 4 to 20 but Ihave experimented with 4-9 up to 16.

I've read that full range doesn't work as well as a narrow one. Have your tried raising the lower pressure to 6 (to your titrated pressure) and max at 9?

Do you have the software to see the results of your experiments? What happens to your AHI at the higher pressures?

george45 · Post by **george45** » Sun Oct 30, 2005 1:52 pm

No I have no software to check current results. From my first week of use I did have some interesting results, though. During one 3 minute period when I was at a pressure of 8, the software showed that I had 20 apneas and 40 hypopneas. This was with my original machine. Also, I checked my titrated pressure and it is not 6.5 but 5.7.

neversleeps · Post by **neversleeps** » Sun Oct 30, 2005 2:44 pm

Have you decided to stop CPAP therapy?

george45 wrote:I haven't used my machine for 5 nights now and notice no change in my daytime tiredness. In fact one night of no cpap produced one of my best days in years. I have mild OSA.

If you're still going to attempt to use CPAP to treat your OSA, it would be well worth your while to get the software and card reader so you can examine your results. You'd be able to zero in the best pressure range (if your self-titration experiments indicate auto mode works best for you) or your best set single pressure, should your experiments show straight CPAP works best for treating your apnea/hypopnea events.

I have found that once you get it right, you shouldn't be awakened by unnecessary high pressures requiring you to hit ramp. In the meantime, in the absence of having the software (and if you plan to give it another try), maybe you should try setting your machine in straight CPAP mode at 5 or 6 (with CFlex off). Certainly this would relieve the soaring pressures you've been experiencing, but again, without the software it's impossible to know just exactly what's going on. It would be nice if your titrated pressure was precisely the correct one for the optimum treatment, but often that turns out not to be the case.

So, if you're going to keep experimenting, IMHO, try straight CPAP, or at least narrow your APAP range to keep a lid on the high pressure end.

Good luck!

Fatigue Fighter · Post by **Fatigue Fighter** » Sun Nov 06, 2005 5:59 pm

Hi all,

I have been away from the board for a few days and what did I find? Lori no longer has to use CPAP???? Way to go, Lori! That is such good news. I started the same time you did (on therapy) but it doesn't look like I will be getting off XPAP treatment because of the high amount of apneas/hypopneas and my 62% o2 desaturation. Oh well... I am so happy for you, though

As an update to my condition, the ENT found nothing wrong with my nares or turbinates or throat. So, since I could not tolerate the APAP (exhaling is pretty darned hard at such high pressure numbers), I went back to the BiPAP (at 17/13) and switched to a full face mask for most of the time. I also turned of the Bi-flex feature and instead increased the rise time so it fits better with my slow breathing pattern. That helps me tolerate it better. I don't feel more energetic but I am still hopeful. The sleep doc said he didn't know what more he could do for me so this has to work!

FF

Sleepless on LI · Post by **Sleepless on LI** » Sun Nov 06, 2005 6:08 pm

FF,

Thanks for your kind words. I hope your therapy goes easier for you now. I would really like to hear you're starting to get some real relief from it after all this time. But don't give up, not that I think you will. One of these days, you will be writing a wonderfully positive post about how great you finally feel. Look at Barb from Seattle who after eight years finally is getting some results. Hopefully, you won't have to wait THAT long.

elliejose · Post by **elliejose** » Sun Nov 06, 2005 9:53 pm

FF,

Glad to hear that you are at least sleeping better. Hope you will soon start to feel better over all.

I have the Remstar auto and I also have found that if I don't go to sleep soon after donning the mask or if i leave it on in the am, anticipating another nap, that it always rises over a period or time to whatever setting is highest be it 16 or 20. Why this happens, I don't understand either. I've watched it and it may drop a bit but it always goes back up. I have been very curious about this. I asked DME but of course he had no answer. So if y'all have any ideas, I'd like to hear them.

Is this odd or what? APAP woes

Is this odd or what? APAP woes

update (and congrats to Lori) Yahoo!