Need some good advice - sleep crisis I think

[quote="Wulfman"]
Most frequently, clusters of apneas like those are seen when the person is sleeping on their back.

I also believe that for some people, pressure increases can create subconscious resistance, which tends to cause the pressure to further increase until the max pressure is reached or something causes the pressure to drop.

Did you ever have a titration? What is/was your prescribed pressure? Any Central Apneas in your sleep study?

Many times, APAPs can create more problems (or the appearance thereof) than they solve. If you don't know the nature or cause of your obstructions, you probably won't know how to treat them. If "more pressure" was the answer to all of our treatment, we'd all be using CPAPs at 20 cm. or Bi-Levels at 25 cm. [/quote="Wulfman"]


I was titrated at 12. And there were no centrals. Thank you for the link explaining the algorithms- very helpful information. Also increased pressure creating subconscious resistance would apply. I will lower the max pressure to 13 or 14 tonight and no ambien. I wear a backpack to stay off my back but maybe it needs to be snugged up some more.

My sincere thanks for all the help.

Hello All,

Here are the charts from last night using Bipap settings 9-14. Not great looking. I have to go to office so all I have time to do is post the charts. Some of the clusters at the end are when I am laying in bed awake and same thing at beginning of nite when I am awake.

Looking at my above chart "summary of data events" it shows my OA on the exhale breath EPAP. At EPAP level 12 the OA is 38.2. My OA was only 2.0 with a EPAP pressure of 9.0 . Why would the machine adjust to take the EPAP pressure higher when the results are better with a lower EPAP of 9.0?

I think I need to lock the machine EPAP (exhale) level to 9.0 and see if this brings down the OA's.

Am I interpreting this data correctly?

Since you switched machines, it's now somewhat like comparing apples and oranges.
But, your AHI is still about the same......just different time patterns.

I presume the person who loaned you the machine will be advising you on how to tweak your therapy from here on.


Den

In one night I feel better on Bipap than I have on CPAP/APAP which I have tried on/off for over 2 years. I also tried dental appliance and dental appliance along with full faced mask CPAP/APAP. I believe I need more difference from inhale to exhale than is what provided with CPAP/APAP - difference in pressure of 3 only. In just one night I could feel the Bipap was more relaxing for me. Yes, the AHI is not good but as I said most of the OA came when I was already awake and just breathing into the mask while awake.

Thanks Den, but please try to help other folks -- like you did so diplomatically for another poster when you gave the helpful advice : "That mask is a piece of crap. I'd recommend a ResMed Ultra Mirage Full Face (UMFF)"

For those that have experience with Bipap and can help interpret the data I appreciate your advice.

I don't have sleep apnea but I live with someone who does. I love him dearly and have lived with him for years.

Unfortunately, the doctors are not that much help. From the looks of things, some of the people posting are not, either.

The bottom line is that the patient has to figure it out him or herself. That's not saying much for the medical profession. So, if someone gets a chance to try a bi-pap, so be it.

If someone is at their wits end, they are going to do everything they can and hope that others will help them, too. I thought that is what this forum was for.

Trying 2 Help wrote:I don't have sleep apnea but I live with someone who does. I love him dearly and have lived with him for years.

Unfortunately, the doctors are not that much help. From the looks of things, some of the people posting are not, either.

The bottom line is that the patient has to figure it out him or herself. That's not saying much for the medical profession. So, if someone gets a chance to try a bi-pap, so be it.

If someone is at their wits end, they are going to do everything they can and hope that others will help them, too. I thought that is what this forum was for.

I'm a little confused by your post. Are we supposed to be helping people or do we just let them figure it out for themselves?

We try to help people and give them enough knowledge to figure out as much of this for themselves as possible.

It almost sounds like you're bashing us for trying to help.


Den

Ah Den, we hoseheads get a bit testy when we get lousy therapy. Tom's had issues for years and still had found solutions. I'd be waay more irrational if I were in his situation.
EDIT: NOT found solutions...sheesh!!!

Whether you choose to use cpap. apap, or bipap, you will find people on here who are knowledgeable and able to point you to good information about optimizing the treatment of your choice. When someone has had poor results the lure can be to call in the big guns. And that's fine if one is sure there is a need. However, it seems prudent to sort thru the known factors before muddying the picture by introducing new ones, to simplify rather than complicate. I'm just saying, if you're buying a bipap because of high pressures that may only be high due to leaks, seems resolving the leaks then evaluating the data would have given you a better idea of the next needed step. Maybe that step is a bipap. I certainly don't know. Just wondering if any of the data you're basing your decisions on is valid or reliable. Leaks make it all suspect. However you go forward, I hope you find the effective treatment and good sleep you need. Even with effective treatment, you're right, it might take your brain a while to relax and trust the treatment enough to sleep well. But with ineffective treatment, meds to sleep aren't going to be the answer. Your efforts to get your treatment to work for you are your best bet. Once that happens, then you will know how much of a sleep issue you have left to deal with. Maybe you'll be pleasantly surprised. By the way, you must be quite a guy to have had a lifetime of the ravages of sleep apnea and still be the kind of brother who a sister can speak so highly of. Best wishes in resolving your sleep issues and putting her mind at ease.
Kathy

Not only am I a CPAP user, I have been doing sleep studies and titrations on people for 10 years. From my lab experience, it looks like your mouth may be dropping open during REM which would lead to apneas and hypopneas which leads to increased AutoPAP pressures. What I do in the lab is add a chin strap which fixes mouth leaks easily. Another thing it may be is your mask. Maybe it is not fitting you properly or else it shifts while you sleep. Check out my blog at http://sleepandcpap(dot)blogspot(dot)com/ I just started it, but it has a couple topics on there so far. I'll address topics as they come up on there.

The only other thing I can think of for you is that you need to go in for another sleep study. Maybe you need to be retitrated. You may be able to qualify for BiPAP too. Really I think you may just have a leak problem.

sleepmba wrote:Not only am I a CPAP user, I have been doing sleep studies and titrations on people for 10 years. From my lab experience, it looks like your mouth may be dropping open during REM which would lead to apneas and hypopneas which leads to increased AutoPAP pressures. What I do in the lab is add a chin strap which fixes mouth leaks easily. Another thing it may be is your mask. Maybe it is not fitting you properly or else it shifts while you sleep. Check out my blog at http://sleepandcpap(dot)blogspot(dot)com/ I just started it, but it has a couple topics on there so far. I'll address topics as they come up on there.

The only other thing I can think of for you is that you need to go in for another sleep study. Maybe you need to be retitrated. You may be able to qualify for BiPAP too. Really I think you may just have a leak problem.

He's using a full face mask. (stated in his first post and listed in his profile)


Den

Thomas F. wrote:Hello All,

Here are the charts from last night using Bipap settings 9-14. Not great looking. I have to go to office so all I have time to do is post the charts. Some of the clusters at the end are when I am laying in bed awake and same thing at beginning of nite when I am awake.

Can someone explain the leaks that correspond with the apnea clusters at beginning and end if Tom's awake as he states? I agree that adding a Bipap to the mix may be adding to the confusion. Last year when we purchased another M Series Auto/Cflex to use as backup(our original is the same but an Aflex),Mike's data is different on each one, the backup gives lower leak rate but higher AHI and I had to discover by watching the trends, that with our original he does better on cpap=12cms but with the backup he sleeps better on auto=10.5-13cms. Don't ask me why,but it's all good either way. Tom, I really hope you find the answers here, and you have a wonderful sister! Keep us posted. Dori

Wulfman wrote:

sleepmba wrote:Not only am I a CPAP user, I have been doing sleep studies and titrations on people for 10 years. From my lab experience, it looks like your mouth may be dropping open during REM which would lead to apneas and hypopneas which leads to increased AutoPAP pressures. What I do in the lab is add a chin strap which fixes mouth leaks easily. Another thing it may be is your mask. Maybe it is not fitting you properly or else it shifts while you sleep. Check out my blog at http://sleepandcpap(dot)blogspot(dot)com/ I just started it, but it has a couple topics on there so far. I'll address topics as they come up on there.

The only other thing I can think of for you is that you need to go in for another sleep study. Maybe you need to be retitrated. You may be able to qualify for BiPAP too. Really I think you may just have a leak problem.

He's using a full face mask. (stated in his first post and listed in his profile)


Den

Thanks for the clarification Den. I should have looked more carefully.

Tom, you may want to look around for a new style of mask. On some of the sleep studies I have run with a full face, I've seen the same pattern. When somebody goes into REM, the mask will lose its seal for various reasons.

sleepmba wrote:
Thanks for the clarification Den. I should have looked more carefully.

Tom, you may want to look around for a new style of mask. On some of the sleep studies I have run with a full face, I've seen the same pattern. When somebody goes into REM, the mask will lose its seal for various reasons.

thank you sleepmba for the tips. Yes, looking at the chart the average mask leak of 41 is not too bad but at time with more pressure it climbs to 70 or so. I've tried other FF masks and got best results with the quattro but still not good enough for REM sleep. Good Insight on my jaw dropping in REM. When my jaw drops my airway seals off. That is why I used FFM with dental applicance. DA held my mouth closed. I was getting decent results that way but then started to feel lousy again - could be because of mask leakage. I also have papcap and used that at times w/o dental appliance + FFM.

Tonight at 8pm I go to sleep lab to be titrated on Bipap. I will strongly bring the issue up of mask leakage with FFM. If technician sees this happening and it's impossible to make better seal I will switch to nasal mask in hopes that I get better seal at high pressure. I lost confidence in nasal pillow mask awhile back draw drop, air escape, and not big fan of taping. But if that is what it takes to get better I will do it.

Good news. I think you are doing the right thing.

From my experience I've found that new xPAP users are in the habit of opening their mouth or letting it drop open. It takes a little time for your body to get back to nasal breathing. I almost always put nasal masks on patients and if I have the mouth opening issue, I'll add a chin strap. The chin strap is usually only needed temporarily. Perhaps you are ready to switch to a nasal mask.

Let us know how it goes!

http://www.sleepandcpap.blogspot.com