Help with my husbands apap

[Sam33]

My husband has been on apap for 4 months now..
He has been doing pretty well until recent weeks..
Now he has the machine on and is jumping around and snoring like he did prior to having it..
He was on auto setting that ram from 4-16 now averaging 15.8 each night. Someone suggested the range was to wide. So
I changed it.. To 7-17 now he averages 16.8.. And still
Snores. I'd like to help but being a newbie i don't know what to do to help him other than send him back to the sleep lab.
He often turns on his stomach which leads to leaks ..Which I fix for him because he is so tired and out of it he cant do
It himself. He is back to sleeping on the couch which leads
To the argument about going to bed.. Which takes am hour because he falls a sleep changing his clothes.
His case is very severe.. Any of this sound familiar?? Anyone have some helpful hints..
Thank you..

[Pugsy]

Do you have the software? Either ResScan or SleepyHead?
If not, get one of them. I have information on Sleepyhead in my signature line.
Forum member Uncle_Bob has ResScan in his signature line.
If you do have one...can you post an image of a recent ugly night? The daily details...not the summary..
His AHI....what is the breakdown in the indexes for each event category? Like what is the index for centrals...the index for obstructive apneas and the index for Hyponeas?

If you don't know how to post an report ...I use screen shots and this is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[Sam33]

I don't have any software nor do I have a card as they company requested it and never returned it..
I appreciate the help.. Where do I get software? Is all software created equal? Will they all read his resmed? Does this machine give you information. He was so severe he went for sleep study with in 15 minutes they had a machine and full
Mask on him.. Less than a week later we had a machine.. Originally he has an s8 then they changed it to an s9 so they could give him a range.. Is it possible that the pressure is too high.. During the study he was set to 14 and they said he slept like a baby... I don't think he has ever slept like a baby... His original mask was a disaster.. Especially when they changed the pressure.. Then he got the Quattro which was significantly better.. Until these past nights..

[Emilia]

As Pugsy said, you can download Sleepyhead from the link in post (under signature), or find a post by member Uncle_Bob and get the link for the ResScan software. Both are free to download. Sleepyhead is open source software written by one our forum geeks, and everyone who uses it loves it. You can buy a generic SD card (preferably 1 or 2 GB size) and be sure it is formatted FAT16. I can assure you no one else will be interested in his data... the DME is only interested in the compliance data (hours or use) so they can get their insurance money.

Once you can 'see' a night's data, it will be easy to zoom in on what the problems are. I suspect it is pressure related as he is using a FF Mask so the mouth opening isn't an issue...but the snoring is indicative of not enough pressure to stent open his airway properly.

Get the software installed, collect data on the SD card, and then we can take a look and figure things out with you. Good luck!

[Pugsy]

Go to WalMart (or something similar) and buy a cheap generic Sandisk SD card 1 or 2 GB size. Costs around $10 maybe. Generic will work just fine.

The software will be hugely beneficial to you. It isn't hard to use and there is a lot of information available.

You have 2 choices on software ResScan and SleepyHead. SleepyHead is easier to use and faster and offers pretty much the same data as ResScan.

The S9 Autoset offers full data...assuming you have the AutoSet and not the AutoEscape which only offers AHI.

Is the pressure too high? The Autoset won't increase the pressure unless it feels it needs to do it so there is a reason for the increased pressure. Wide variations in pressure can make leaks harder to manage and some people find that the variations in pressure disturb there sleep. Some people can sleep through a change to hurricane force winds.

My gut feeling is that the minimum pressure is still not where it needs to be to be effective but really need to see what is going on instead of guessing.

Without seeing some reports and getting an idea as to what is going on during the hours of sleep on the machine we really can't do anything more that speculate on what is going on. It would really be helpful if we could see one of the typical reports...
Something like this one of mine from last night. This is a SleepyHead report.
Also need to see the leak graph. Mine has a large leak which is easy to spot. We don't want anything over 24 L/min leak if we can help it.

[Gazhacks]

I dont want to sound stupid here and probably because Im not sure how things work over the water but is it not easier to just contact your sleep center and ask them if you can pop in or is this not possible in the states? Over here one phone call and you can go to the clinic to see the docs and sleep tec's and get an opinion on something that is either worrying you or just get your machines data looked at. On reading post from over there it seems very complicated.

[Sam33]

His machine is the resmed escape auto... That's a problem isn't it??
And just for the record waiting for doctors to do anything is rediculous when you can do it yourself...I personally am more proactive thanks.

[Pugsy]

His machine is the resmed escape auto... That's a problem isn't it??

Yep...that is a problem.

You have only total AHI available on the machine and/or the reports along with average pressure and nothing else.
No leak numbers, no even breakdown...nothing to really help you except the overall AHI and if for some reason he is having centrals...increasing the pressure won't help and might even make things worse.

In the absence of the detailed data.....if AHI is too high...small increment increases in minimum pressure and closely watching the AHI to see if it drops any.
Auto adjusting machines don't respond in a blink of an eye to the event precursors and once an event is actually happening it really can't do much. What we hope for is the the pressure will get to where it needs to be to prevent the collapse of the airway. Starting at a lower minimum sometimes doesn't give the machine enough of a head start and the events aren't prevented well during the time the machine is climbing to the pressure that is needed. Once it does get there it may do a decent job until you don't have any events for a while...then the pressure reduces back down...then event precursors will trigger a climb in pressure and you have the same thing happening all over again.

So generally we tend to go with a minimum pressure on an auto adjusting machine some where in the neighborhood of the 90 %/95% pressure...maybe 2 cm less. This gives the machine a better head start.

Example..for me when I used APAP....I started with minimum of 8 cm....and I was seeing 90% (my machine does 90%) around 12 or 13 and my AHI was around 10 to 12...felt awful.
So I started increasing the minimum and at 9 cm the AHI came down to 7 or 8...at 9.5 cm...came down to around 4 to 5 but I still had a few "clusters" so I went to minimum of 10 cm and AHI was lowered to less than 3 consistently and the clusters were broken up.

Maximum pressure in APAP mode isn't the critical pressure unless it is being maxed out all the time.
The most critical pressure need is the minimum pressure..give the machine a good head start and it does a better job. APAP wide open..works great if a person only needs 8 or 9 cm to deal with the events because the machine can get to that point quickly enough..doesn't work so great if someone needs 14 cm or so..

[Sam33]

His average according to the machines report is: avg use 5.9
Pressure 16 AHI 42.1 for the last week his avg. is 52.3
What is ahi?? Where should it be??

[chunkyfrog]

AHI is considered treated or normal if it is under 5.
With the 'brick' your husband has, there is no way of knowing what part of his AHI is obstructive
or simply caused by excessive pressure from the machine.
He is NOT getting adequate treament.
If the DME wil lend him an Autoset for a few nights, it might be possible to home-titrate him to an effective level.
I suspect the settings are wrong.

[Emilia]

Hi Sam..... your hubby's AHI (Apnea/Hypopnea Index= # if Apnea and Hypopnea events in an hour) is incredibly high even with the machine.... it should be 5 or less...and the closer to 0 or 1, the better. If, by any chance, this Escape machine is a rental, see if you can get it exchanged for either and AutoSet S9 (preferred) or the Elite S9 (straight cpap/not apap). The Escape machine you have doesn't give out any useful information to see how therapy is going... just generic info and compliance data. As you can see in the software report Pugsy posted, if you have a fully data capable machine, you can see the overnight therapy minute by minute and zoom in on any problems or issues that can be remedied. You are working blindly with a machine that gives out so little information. If the machine he is using is not being rented, and you've had it for more than 30 days, you are pretty much stuck with it. So..... working with what little info you have to go on....

1. You say he is now averaging a pressure of 16.8 and you had changed the pressure range to 7-17.

2. Try changing the pressure range up to 10-17.5, and if he uses the Ramp, set that to start at 6 for 15 minutes.... that will give him some time to adjust to getting up to 10 and fall asleep.

3. Snoring tells me the pressure isn't high enough to stent open his airway so moving the low end to 10 may be helpful.... and by getting the higher end up to 17.5, you are a bit above the average of 16 in case it is needed. Once you see if this helps get his numbers down, and I would keep it there for at least 3-5 nights to see if he settles into it, then new adjustments can be done. His machine does not go over a setting of 20 so I hope he can stay down around 15 or so as an average. Bumping the bottom number up, in my experience, is often the trick, but we will see.

4. Sleeping on the stomach is not recommended... it can usually only be done well with certain masks/bed pillows. Side sleeping is the preferred position. Maybe try a pillow between the knees while on the side... this often helps with any lower back issues. Some folks use a body pillow to 'hug' while on their side.

Since software is NOT an option with that machine, you are flying blind for the most part. This will take a time and probably a lot of tweaking. UNLESS you can get the machine exchanged for an AutoSet. Perhaps the doctor can help you lobby for a data capable machine.... but if your insurance won't pay for it, you may be out of luck. If that turns out to be the case, consider finding a used or inexpensive data capable machine on your own. If you have a copy of the Rx, you can buy online. http://www.secondwindcpap.com has gently used, sanitized, and warranted machines.

Start learning more about this condition and all the terms used: wiki/index.php/Category:CPAP_Definitions In addition, the yellow light bulb at the top of this page will take you to the Wiki where you can learn all you need.

Your hubby is a lucky man to have you to run interference and help him with this journey. I cannot imagine how sleep deprived he must be with those numbers. I hope you will be able to get to his 'sweet spot' in therapy soon so he can begin to feel better and recover. Keep us posted and keep asking questions. Best of luck!

[Sam33]

Emilia,
Thank you so much for the advice...
I'm going to adjust the machine before he goes to sleep tonight.
One question... Before I changed it to 17 it was he was set to 16 and averaging 15.8 now I change the highly to 17 and he is averaging 16.8 the very next night is that normal??
I'm taking all of your advice will be on the phone with doctor tomorrow
Trying to get his machine changed..
I need to be able to watch this more carefully...
I'll keep you posted! And I hope narrowing the range does the trick!

[idamtnboy]

I dont want to sound stupid here and probably because Im not sure how things work over the water but is it not easier to just contact your sleep center and ask them if you can pop in or is this not possible in the states? Over here one phone call and you can go to the clinic to see the docs and sleep tec's and get an opinion on something that is either worrying you or just get your machines data looked at. On reading post from over there it seems very complicated.

Generally speaking we have no contact with sleep centers except during sleep studies. Sleep doctors get paid per patient session. Insurance companies and government Medicare mostly do the paying. They won't pay for just any willy-nilly visit to a doctor and won't pay for "excessive" numbers of visits. So no, we don't have the luxury, across the board anyway, of just popping in for a consultation.

[Sam33]

What is epr?? His machine is set to a level one...

[idamtnboy]

What is epr?? His machine is set to a level one...

Expiratory Pressure Relief - From the manual

Designed to make therapy more comfortable, EPR maintains optimal treatment for the patient during
inhalation and reduces the delivered mask pressure during exhalation.

The setting can be from off to 3. In your case the pressure is reduced by 1 cm H2O when he starts to exhale.