AHI jumping to scary levels with new machine.

[Barb (Seattle)]

Pugsy...just want to say I really appreciate you. All your advice for everyone is very helpful.


that is all <3

[Barb (Seattle)]

Feel free to delete my posts, moderator. I just thought the OP would appreciate the fact he wasn't alone and i identified with the fact someone elsehad problems with the dream machine. You all are rude.

We do appreciate that fact.
A few rude and clueless people combined with some truthful but tactless ones make it appear that we are all rude.
(Oops. I think I insulted all the regulars except Pugsy)

should have said ya'll (meant just the one person) as opposed to you all...I was saying it different in my head.

I'm out.....finally lol except to say I'm impulsive sometimes and when I saw Dreamstation in a thread I got carried away :O

[Ron AKA]

I give up trying to reason with some people who just won't listen.
Might as well be arguing with that stump in my back yard.

To Barb...you know what you need and why. That's why you had the most recent sleep study and did indeed confirm the presence of central apneas and you already know full well that plain bipap/bilevel isn't the answer in your situation which is why you had this recent repeat sleep study done in the first place.

To the OP here...Sleepingbettercpap...see my post directed at you.

To everyone else...Ron is the most scary kind of dangerous newbie...best to just ignore him because he won't listen to reason because in his mind he knows it all already. Scary thing...he's got it wrong about some real important stuff and is potentially dangerous in his advice and unwilling to learn.

I apologize. I didn't appreciate that you were responding to somebody other than the original poster.

[palerider]

should have said ya'll (meant just the one person) as opposed to you all...I was saying it different in my head.

Actually, y'all, which is short for "you all", a collective noun.

Pale, in Texas, where y'all is part of the lexicon.

[Ron AKA]

So I adjusted my mask a little and leak rate was really good and then I had a horrible 4 hours of sleep. AHI 23 concluded with a central (can't remember last time I had that) + waking up gasping. Really at my wits end here. I'm willing to try pretty much anything. If someone says sleeping on the floor will help, I'll do that.
No idea what was going on with all the PB and the obstructions. I went to sleep on my side but I don't know what position I was in when that stuff was going on.

If you are interested in accepting advice from "the most scary kind of dangerous newbie" who has actually been doing this stuff for over 3 years now, here is what I think. From the posted daily screenshot there are two obvious issues. Your machine has run out of pressure to deliver. It is maxed out at 20 cm. And to me the leaks look high. That said my experience is with ResMed and certainly if the machine was a ResMed that would be high. Big leaks can cause false flags to be set. I would suggest putting your cursor over the area of all the events and pushing the up arrow repeatedly to zoom in on that area. You may also have to push the left and right arrow keys to keep the zoom area correct. Zoom in to the point you can clearly see the flow rate cycles. There may be something in all that noise that gives some clue as to what is going on.

The suggestions for a neck collar are good ones. The other thing you could try is a memory foam shaped pillow that controls your head and neck position better than a standard soft pillow. You want to keep the neck extended and the chin up. See inserted image below.

Pillow.JPG (22.7 KiB) Viewed 2091 times

[palerider]

If you are interested in accepting advice from "the most scary kind of dangerous newbie" who has actually been doing this stuff for over 3 years now, here is what I think.

Bear in mind, Ron can't make his OWN therapy work, just because his wife doesn't have problems, he thinks he knows everything.

[Pugsy]

And to me the leaks look high.

They would be too high for a ResMed machine. Not high at all for a Respironics machine.
It's because ResMed reports excess only leak and Respironics reports total leak which is of course vent rate plus any excess leak.
And since vent rate goes up as pressure goes up...not unexpected to see a seemingly high total leak number but most of it is vent rate.
Respironics large leak territory...way up there and if the machine didn't flag LL...it didn't get to large leak territory.
Respironics never gives a set large leak threshold like ResMed does the 24 L/min red line...they don't because it varies as the pressure varies.
Large leak territory at that 20 cm pressure...probably right up around 100 L/min total leak if not a little more.

The only LL flag that I can see is the one right at the end of the night. Leaks not an issue here in terms of therapy effectiveness. Now if they wake a person up that's a different story and it doesn't matter how big or how little because anything that wakes us up is unwanted.

[palerider]

I apologize. I didn't appreciate that you were responding to somebody other than the original poster.

Hmm, faint signs of humanity...

[palerider]

. And to me the leaks look high. That said my experience is with ResMed and certainly if the machine was a ResMed that would be high. Big leaks can cause false flags to be set.

Unfortunately, that's more ignorance talking.

The leaks are not high, and high leaks don't cause false flags, if anything, they may mask some flags, and (primarily) cause the machine to be unable to differentiate obstructives from centrals.

[Ron AKA]

And to me the leaks look high.

They would be too high for a ResMed machine. Not high at all for a Respironics machine.

That would be bad news then. The machine is maxed out on pressure and flow. I thought the machine may be up to the job, but not when it is feeding leaks.

[Pugsy]

What happens when a Respironics apap mode machine happens to get very far into large leak territory....
It functions like a cpap mode machine...pressures don't vary...looks like the machine is broken.
It will still try to flag real events until if someone goes deep into large leak territory...like 140 L/min and then it just blows air and reports nothing. It picks max pressure and stays there until the leaks are reduced to a more manageable level and this doesn't happen with just barely going into large leak territory...it's deep in large leak territory before it can't do a fairly decent job.

Past experience with Respironics machines and reports and deep into large leak territory to really mess up the auto adjusting algorithm so it becomes a fixed pressure....40 L/min past large leak territory line.

This report shown above...leaks no where near causing the machine have problem reporting anything.

The most common problem when deep in large leak territory for any machine isn't false flags...it's the machine being clueless and not reporting events because it can't sense them.

[Pugsy]

That would be bad news then. The machine is maxed out on pressure and flow. I thought the machine may be up to the job, but not when it is feeding leaks.

It's not feeding the leaks. These machines don't feed leaks and in fact Respironics machine reduce pressure if it senses a large leak (remember it's the machine's large leak territory it uses).

The machine isn't up to the job at this point because obviously 20 cm isn't holding the airway open well enough.
Now why it seems to now not be working well when in the past it did work quite well...that's an unknown at this time.
It's too long of a bad cluster to blame it on REM since most REM cycles don't last for 2 hours.
Something changed...don't know what changed but something changed.

If it can't be sorted out with something simple...like maybe a cervical collar or making absolutely sure no supine sleeping...he's going to for sure need to see his doctor.

I suggested the cervical collar because its cheap and easy and sometimes it works...and it's a lot cheaper than a doctor visit, a new sleep study which I pretty much can guarantee the doctor will want to do and the cost of a new machine.

Will it work? I have no idea but it's worth trying because it's obvious this isn't working.
I suspect he will eventually need to be seeing his doctor but this is one situation where I hope I am wrong. Nothing would make me happier to find out that a $10 cervical collar makes a huge difference.

[Pugsy]

Questions for Sleepingbettercpap.

I meant to ask but I think I forgot between time I thought of it and fingers responded...

Are you taking any medications...if so what?
Have you added something new in terms of meds or changed dosage or had anything else maybe change in terms of your health.

You never answered by nasal congestion question...just how much nasal congestion are you having? Is this something new or something that's been around for a long time?
Just how much congestion???
Any history of allergies?
What humidity setting are you using?

[palerider]

That would be bad news then. The machine is maxed out on pressure and flow. I thought the machine may be up to the job, but not when it is feeding leaks.

It's not feeding the leaks. These machines don't feed leaks and in fact Respironics machine reduce pressure if it senses a large leak (remember it's the machine's large leak territory it uses).

What kind of ignorant babble is 'feeding leaks' anyway?

[Pugsy]

What kind of ignorant babble is 'feeding leaks' anyway?

I kinda got lost on that one too.
If it was because more pressure equals more vent rate and vent rate being included in total leak...well...that's all masks and all machines do it. ResMed is the only one to report only excess leak but that's just the report...it still has to use a vent rate number of some sort to subtract so it can report excess only leak . Just because we don't see that side of the leak calculations doesn't mean it doesn't exist.
It has to exist because vent rates vary. Might not vary much but they vary.

I am still here scratching my head as to what changed to give such a drastic difference in results so quickly and isn't it obvious what changed.
There are a couple of other medical conditions that could maybe be involved but I don't want to go there until we exhaust ruling out all the other usual culprits.

Anyway, crossing my fingers that dumb luck might just drop by and bless us here so that we can stumble on the cause and maybe an easy fix.