Not doing well - need help, please!

[lesliegl]

I've been really tired, so I just looked at OSCAR data. Now I understand why I'm tired, but I don't know what to do. Any suggestions? (The following is typical of what I'm doinevery night. Thanks SO much!

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[Pugsy]

Oh man....what a mess.

How long have you been using cpap?
Did you have an in lab sleep study to determine pressure settings?
Did you have a home sleep study for diagnostic purposes? If you did...did you wear a belt around your chest?

Do you know exactly what your diagnosis was?

Do you take any medications that might suppress respiration? Various pain meds mainly...

I don't know if what little I have in my bag of tricks will help much or not but might as well try them.

First thing to try if you can....turn off EPR....if you can't go totally without EPR try setting of 1.
See what happens.

Second thing to try....set the machine to regular autoset mode ...it's in the for Her auto mode right now.

Don't do both at once though...for tonight just try the EPR change...let's see what happens and most likely tomorrow night we change the mode to regular auto mode.

Do take the time to answer the above questions...it's important to have some past history to help us out.

[Pugsy]

I see you have been using cpap for many years.
Can you look back in OSCAR and see if you can spot when this change in AHI happened?

[lesliegl]

I looked back - the numbers were never really good (I knew that), but my AHI was stuck in the mid-to-upper teens. Around the 2nd week of January this year, they started going haywire. This was 2 weeks BEFORE I underwent gastric bypass for acid reflux relief. I've been on no pain meds. BTW, although I've had in-patient sleep study, but it was many years ago. I don't even know who my sleep doc is - if I have one.

I'll definitely try your suggestions, and I'll post my results. Thanks so much!

[Pugsy]

Okay....we can try the easy stuff first and see what happens. Might get lucky.
If we don't get lucky will cross that bridge later once we get to it...if we get to it.

Can you look back on one of your past detailed data nights before things got this bad and see if your AHI was primarily CAs/centrals or OAs/hyponeas?

[lesliegl]

It's so weird. One night, it's mostly obstructive, the next day (with far worse numbers), it is Central. It flops around dramatically, day to day.

[Pugsy]

That's about par for the course...just to confuse us.
Add in the fact that sometimes the machine might give us the wrong label and we are thoroughly confused.

I want to first see if EPR is a factor or not. Sometimes it is...sometimes it isn't and sometimes when it is all we need is a minor change to achieve markedly improved results. It's a quick easy experiment to try. EPR is essentially pressure support or the difference between inhale and exhale pressures. I have seen as little as a 1 cm change make a huge difference in the number of centrals.

Second experiment is the change in auto adjusting algorithm to the regular auto algorithm. This one is a new one for me so I don't know how much, if any, impact it might make. The for HER algorithm might be establishing a new minimum in response to the OAs it is sensing and that higher minimum might be a factor if we determine the centrals are related to pressure itself.
It's a long skinny limb to go out on but it's there and worth investigating. Sometimes there is a fine line where above so and so pressure we have centrals being triggered and below that line we don't.

So lets go do some experimenting and see if we get lucky or not.
EPR off ideally...if you just can't handle having it totally off...reduce it as much as you can.

[lesliegl]

Thanks! EPR adjustment tonight! We'll see how it goes - fingers crossed!

[zonker]

Thanks! EPR adjustment tonight! We'll see how it goes - fingers crossed!

when you report back, please do so in this thread.

it'll help the experts kep track of you and how you are doing.

thanks!

[lesliegl]

Hi again,
I waited 2 days, here's the data - 1st day, no EPR, I was really unhappy with the leak rate, so I changed to a smaller pillow size for day 2. This AHI is about as good as I've ever gotten. Should I try for (or expect) lower? Thanks again SO much.

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[Pugsy]

Keep the current settings again tonight and lets see what happens.
Tomorrow night lets change from the for Her mode to regular autoset mode for pressure. Keep the settings the same though...same minimum and no EPR.

There is a large CA/central cluster right at the end of the night last night which is elevating your AHI. Were you maybe laying in bed awake for that period of time and then decide to just get up?

[lesliegl]

I will! Thanks again!

I know the central isn't from lying awake with the mask on, as I was awoken by a phone call.

[lesliegl]

I don't think I've every scored an AHI so low - and with leaks, no less!

[Pugsy]

Some of those large leaks were so deep in large leak territory the machine might have just missed them.

Try again in the regular autoset mode tonight and lets hope the leaks aren't quite so bad. This time try 10 cm minimum.

Also...can you omit the mask pressure graph and instead show the flow limitation graph? No need to redo these reports though.

[Janknitz]

Are you losing weight because of the gastric bypass? How is your mask fitting? Those leaks make me wonder if there's a problem with the mask. When I lost weight, I seemed to lose it in my face first (actually inflammation goes out of your face first).