How to improve?

Hiya

What would you change to improve?
Somehow I still feel so tired, not sure what to do.
(the time is off on the screenshots, didn't noticed before, sorry)

TruckedInTheFace wrote: ↑

Sat Apr 13, 2024 6:52 pm

Hiya

how long have you been on the machine?

zonker wrote: ↑

Sat Apr 13, 2024 8:15 pm

Ook! (thank you for showing how to add images!)

how long have you been on the machine?

Sorry if I left out details, not sure what is important and what is so normal it happens to everyone.
A few months of fighting so far. Doctors, DME (local version of them), they first gave me a nasal (pillow?) mask, but all the air escaped by the mouth, so now with a full face mask, like in the alien movie
the hospital set the pressure 5-20, AHI was 10, I could not sleep with it, but the doctor says it is good enough (without cpap at 86 AHI).. But thanks to this forum I understand a little bit now, and increased the pressure every week. But hypopnea will not go away, snore will not go away, central stay the same.
But now already at pressure 14, not sure if it is safe to increase more?
Maybe add helium, it will be like a balloon

TruckedInTheFace wrote: ↑

Sat Apr 13, 2024 8:47 pm

But thanks to this forum I understand a little bit now, and increased the pressure every week. But hypopnea will not go away, snore will not go away, central stay the same.
But now already at pressure 14, not sure if it is safe to increase more?
Maybe add helium, it will be like a balloon

It's actually not bad looking... some desats... would like to see the O2 graphs. You don't have much FL's going on... your pressure spikes up, but it doesn't flat-top... more pressure is not going to help you here... in fact, less pressure might be good for those CA's.

SleepHQ is free for one machine (I pay so I can put my O2Ring in). If you upload to SHQ we can zoom in on your graphs and get an idea what your breaths look like during your events. Here's a recent night of mine, some leaking going on:
https://sleephq.com/public/0887426a-439 ... 5f9fc6c538

I'm feeling like you're over-treated and you could bring that min pressure down from 14 to 12 or even 11... your call. Increasing your max above 16 won't change anything I see in the two nights posted.

In case you sleep mostly on your back (though your hypopnea result isn't especially high) you might want to try side sleeping for a few nites to see if there's any change.

Thank you for taking the time to look at the data. I will upload zooms and O2 also.

Why overtreated?
If I put the pressure down, events go up. First hypopnea, then obstructive.

If it is important, I don't see it on the screenshots, but it is with "soft" algorithm. With the normal algorithm pressure changes all the time like a saw.

Julie wrote: ↑

Sun Apr 14, 2024 6:11 am

In case you sleep mostly on your back (though your hypopnea result isn't especially high) you might want to try side sleeping for a few nites to see if there's any change.

Thank you for the advice.

I think I turn all night, like a kebab

Hi, after the resmed autoset didn't work well, my dr switched to a Lowenstein Prisma. However it is not working very well either:




It will take months to get a new appointment again sadly. And I don't understand what is happening. At first the pressure was 11 to 20, but it just jumps up to the top and stays there, and at 20 I blow up like a balloon.

Does anyone have any recommendations please?

TruckedInTheFace wrote: ↑

Wed Jul 24, 2024 10:32 am

It will take months to get a new appointment again sadly. And I don't understand what is happening. At first the pressure was 11 to 20, but it just jumps up to the top and stays there, and at 20 I blow up like a balloon.

Does anyone have any recommendations please?

You need to call the doctor's office and tell them you need to speak with a doctor, PA, or nurse practitioner as soon as possible specifically because things are getting worse. You need to report that even though you are using the machine every night, you are not feeling any better and that in some ways you are feeling worse than when you first started CPAP. You need to stress that you feel like you are being blown up like a balloon every night and that the feeling is painful and/or annoying and/or interfering with your ability to get to sleep and stay asleep. You need to stress that the change in machine from the Resmed AirSense 10 AutoSet to the Lowestein Prisma Smart has made things worse. In short, you need to convince the person on the phone that you are not calling to set up a routine follow-up appointment in several months because you don't think you can continue using this machine with these settings for several months because this machine with these settings is blowing you up like a balloon and you cannot cope with that for several more months.

After telling the person on the phone all of that subjective, but important stuff first, then you can mention that the data from the Lowenstein looks far worse than the data on the Resmed did: The AHI is higher and the pressure is rising to 20 and sitting there all night. And request a call back as soon as possible from the doctor, a PA, or a nurse practitioner because you need some real medical advice on what to do in order to continue using the machine as prescribed.

If you prefer to, you could also report this through the patient portal (if they have one), but sometimes the phone call can get the message across that what you need is a "semi-emergency" appointment worked in and around the routine appointments.

Once you get a chance to speak to a doctor, PA, or nurse, tell them honestly that things have gotten worse after being switched to the Lowenstein. And ask them for some specific ideas of what they think should be done, including the possibility of switching you back to an AirSense. Or (given the pressures and the aerophagia---i.e. being blown up like a balloon every night) whether a change to a bilevel machine might be warranted.

The one thing you should not accept is "we can't possibly see you or even talk with you for several more months". If that's all that this sleep doc's office can do, you need to call your primary care physician and report the situation and your frustration with not being able to get a proper follow-up while you are having significant adjustment problems. And ask for a referral to a different doctor with your PCP working on expediting the initial appointment.

Best of luck.

I don't believe your condition is getting worse, I think it's because the Lowenstein's algorithm is not treating you properly.

It's increasing your pressure and you're (likely) responding with Central's and Hypopneas (that are likely Central in nature). Notice how the clusters of apneas are present when the machine is at higher pressures.

While you were using the ResMed, your Apnea was actually being treated pretty good. Not perfect, but pretty good. However, you still felt tired and believed that the solution was still going to be solved by the ResMed. I don't know why your doctor switched you from the ResMed to the Lowenstein, but it was a mistake.

All to often, new CPAP patients have this idea that CPAPs will solve all their sleeping ails, and no it won't. It will address apnea, and hopefully that is the root cause of your sleep problems.

You should:

• Switch back from the Frank(low)enstein to ResMed
• In the mean time, cap you max pressure at 15, to see if the CAs and Hs go down and stop clustering. (Not sure how to with a FrankenStein, another reason to use ResMed)
• Investigate other causes of your tiredness

Thank you for the help and for noticing the patterns, will try.

I still have the resmed autoset somewhere, but not sure. The numbers are better, but the feeling also not very good.

Feeling even worse with the lower pressure



This is zoomed in. It's only one night but any suggestions?

DS has given you good advice. Make it a priority to find the ResMed machine and use it tonight. Then post a chart tomorrow.

Miss Emerita wrote: ↑

Thu Jul 25, 2024 11:12 am

DS has given you good advice. Make it a priority to find the ResMed machine and use it tonight. Then post a chart tomorrow.

And why?

For the reason he gives. The sooner you do that, th sooner we can try to help.