Results of first 2 weeks using PAP therapy...more questions!

[NightHawkeye]

I've got a friend who's been using CPAP for years and he told me that he woke up from his very first night using it feeling unbelievably refreshed etc, and he's been like that ever since. I guess I've been so desperate to feel better that perhaps I'm a little unrealistic in my expectations......I just thought that surely I'd be feeling a little better after 2 weeks. I'll go back to the prescribed titration of 13cm CPAP and see how it goes for awhile.

Gary, your expectations are not unrealistic at all. You say you don't feel better, and your machine is presenting you with some really AWFUL numbers. Are those numbers bogus? Maybe, but based on what you've written I doubt it. Leaks can affect the machine stats, but my experience is that the leaks have to be really, really bad before that happens. You indicate that your leaks are not.

Based on a statement you made in your first thread, your problem appears to be that your titrated pressure is simply too low to overcome your events.

13 was what the doctor prescribed. Apparently I'd just gotten to 14 during the sleep study when I just had to take the mask off!

Obviously, higher pressures have been bothersome to you. If you need higher pressures to overcome your events then there still may be a solution available to you with the Vantage, simply switch back to CPAP mode, enable EPR and raise your pressure to 14 or 15 to see if that reduces your events.

That's my recommendation anyway. Face it, the stats you're seeing now are AWFUL. Waiting isn't gonna change that. The reason for taking charge of your own therapy is to be able to make adjustments if it's not working well. In your case, it's not working well. Make adjustments.

Regards,
Bill

[zorrro13]

I've got a friend who's been using CPAP for years and he told me that he woke up from his very first night using it feeling unbelievably refreshed etc, and he's been like that ever since. I guess I've been so desperate to feel better that perhaps I'm a little unrealistic in my expectations......I just thought that surely I'd be feeling a little better after 2 weeks. I'll go back to the prescribed titration of 13cm CPAP and see how it goes for awhile.

Gary, your expectations are not unrealistic at all. You say you don't feel better, and your machine is presenting you with some really AWFUL numbers. Are those numbers bogus? Maybe, but based on what you've written I doubt it. Leaks can affect the machine stats, but my experience is that the leaks have to be really, really bad before that happens. You indicate that your leaks are not.

Based on a statement you made in your first thread, your problem appears to be that your titrated pressure is simply too low to overcome your events.

13 was what the doctor prescribed. Apparently I'd just gotten to 14 during the sleep study when I just had to take the mask off!

Obviously, higher pressures have been bothersome to you. If you need higher pressures to overcome your events then there still may be a solution available to you with the Vantage, simply switch back to CPAP mode, enable EPR and raise your pressure to 14 or 15 to see if that reduces your events.

That's my recommendation anyway. Face it, the stats you're seeing now are AWFUL. Waiting isn't gonna change that. The reason for taking charge of your own therapy is to be able to make adjustments if it's not working well. In your case, it's not working well. Make adjustments.

Regards,
Bill

[zorrro13]

Madcow why not post some graphs here? There are some real guns around that may pick up on something you haven't. Check your PM as I sent you instructions a few weeks back

[Maddcow]

13 was what the doctor prescribed. Apparently I'd just gotten to 14 during the sleep study when I just had to take the mask off!

Obviously, higher pressures have been bothersome to you. If you need higher pressures to overcome your events then there still may be a solution available to you with the Vantage, simply switch back to CPAP mode, enable EPR and raise your pressure to 14 or 15 to see if that reduces your events.

I think the only reason the higher pressures were bothersome during the initial titration was because I had no choice of mask type, I don't think the mask was fitted properly as it leaked all night, and nothing was explained to me about what to expect! I think I'd be ok with higher pressures now that I know what to expect and have the equipment that works for me.

Bill, you've also confirmed what I'd been thinking re. pressures might be too low. The whole leak thing just didn't make sense to me as being the main problem when there were nights when the incidence/degree of leaks was negligible, yet my AHI was 27!

And yes, I have the AutoSet Spirit II so I'll use CPAP with EPR tonight with a pressure of 14 or 15 and see what happens. I guess I could also set it to APAP with a range between 14-16 too......I'll see what feels most comfortable.

The only other question I have is this: when using APAP with a range anywhere between 9 and 14, the median pressure is around 11-12 BUT my AHI is still usually high eg. mid-high 20's. If the machine is telling me that between 11-12cm is working for me BUT the AHI is still high, can I safely assume that the machine is most likely incorrect in its pressure calculations and that higher pressures are actually more appropriate in order to reduce the AHI?

[NightHawkeye]

He is not using a Vantage . Hes machine is the Spirit autoset II with easybreath.

I was going with the machine listed in Maddcow's profile. I guess that CPAP.com must not have the newer machines available yet.

Regardless of the machine, the data still suggests that he needs to raise pressure to overcome all those events. If raising pressure is intolerable to him, then it may be time to consider a different machine. A Bi-level which might be able to offer Gary some pressure relief. Bi-levels are, after all, the machine of choice when higher therapy pressures are required.

Regards,
Bill

[Maddcow]

Madcow why not post some graphs here? There are some real guns around that may pick up on something you haven't. Check your PM as I sent you instructions a few weeks back

Which graphs are best to post? (i.e. leak/AHI/pressure etc) And for how many days? How about I post the last fortnight's summary bar graphs and a couple of detailed single days?

[NightHawkeye]

And yes, I have the AutoSet Spirit II so I'll use CPAP with EPR tonight with a pressure of 14 or 15 and see what happens. I guess I could also set it to APAP with a range between 14-16 too......I'll see what feels most comfortable.

I'd recommend against APAP again. That machine, for whatever reason, may not be capable of titrating you properly. (It happens.) If we had access to the data plots then they might provide additional clues as to what's going on.

The only other question I have is this: when using APAP with a range anywhere between 9 and 14, the median pressure is around 11-12 BUT my AHI is still usually high eg. mid-high 20's. If the machine is telling me that between 11-12cm is working for me BUT the AHI is still high, can I safely assume that the machine is most likely incorrect in its pressure calculations and that higher pressures are actually more appropriate in order to reduce the AHI?

The simple way to know for sure is to simply use straight CPAP at the higher pressure, assuming that you can tolerate that pressure, Gary.

Now, the other thing, and I hate to even bring it up now, is the possibility of some central events. Your machine can't respond to them appropriately. If your high AHI is being caused by centrals then that requires a different approach. Was there any indication in your sleep study results that you experienced central events? Forget that for now though. Simply use straight CPAP at higher pressure and see how you do.

Regards,
Bill

[NightHawkeye]

How about I post the last fortnight's summary bar graphs and a couple of detailed single days?

The detailed days first ...

[Maddcow]

[Maddcow]

[Maddcow]

[Maddcow]

Do you want me to post any more pics? For a particular day, maybe?

Bill: I'm at work right now and don't have my sleep study report handy but I have a feeling that it may have mentioned something about central events? I'll check when I get home and post back.

[zorrro13]

The only thing I can think of is that Resmed do not respond to events in Auto mode over 10cm. In that case you would need to set the Minimum at what your doctor prescribed and leave the max at 20 ( works for me). or Go straight Cpap

EDIT
Just remembered if you go EPR your supposed to raise the pressure eg, If you set 14 and select EPR of 1 you would need to raise the pressure to 15 and so forth, someone please correct me if Im wrong.

The easybreath might allow you to stay in Auto mode set at say 14 without too much resistance

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, auto

[Maddcow]

The only thing I can think of is that Resmed do not respond to events in Auto mode over 10cm.

I was wondering how on earth you made that deduction then I looked again at the graphs and noticed the numbers......up till now I had no idea what the numbers meant. Am I correct in assuming that the machine is able to detect the pressure levels of events and this is what the numbers represent?

EDIT: I don't think the numbers represent pressure because I just noticed that the numeric range for the Events graph goes up to 50. And some of my events are as high as 25 and I can't imagine that anyone could possibly need a pressure of 25 (let alone 50) in order to prevent an event of that magnitude. But what do the event numbers mean?

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, auto

[zorrro13]

Mislead you a bit. Its a fact resmed machines don't respond to events over 10cm in Auto mode so you need to raise the minimum. It wasn't a deduction but the machine tries to stop them from occurring under 10. The red arrows are how long the events last for and the left hand side is seconds not pressure. If you set your minimum to what the doctor prescribed (was 14? ) in Auto mode and left the max at 20 it should help. I'm a relative newbie here so hopefully one of the legends here can further comment on what to do or give you better advice than me

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, newbie, auto