Had a rough time with it

Hi All. Thank you for all the info that's on here. I've been a reader for a while but haven't posted until now. I've learned quite a bit though on individual problems/questions from this forum.

The short version is:
I had my first sleep appt and was told I needed to do a sleep study (standard). I went in for that and was told I definitely had sleep apnea. The doctor said he had been skipping the second sleep study and setting people up on a machine based on the info he got from the first sleep study. I was setup with a company that gave me a PR CPAP machine with humidifier. I had extreme trouble adjusting to this machine mainly due to dry mouth. The company swapped the normal humidifier for an upgraded model with a heated tube. This was better, but just didn't help my sleep. I had several Dr appts but he basically said it took time to see results and asked what I thought would help. I know nothing about this...I was shocked the doctor was asking me...that's why I'm going to him.

I requested to go back for a second sleep study and was told I needed a bipap machine. After waiting to see if my insurance company would buy a second machine, they actually approved it. I went back to the sleep machine company and got a PR Auto Bi-pap with Bi-Flex machine. I would like to say that has helped, but so far it really hasn't. My doctor has been useless telling me that I will have to adjust to sleeping in the mask and it will take time. I've had a machine for over 6 months...he seems to forget this is not my first one. Over the past few weeks or so, I've experimented with different pressures and settings with no improvement.

They started me at 11/6 on the Bipap. I've slowly increased the pressure over the last few weeks to see if there was any improvement. My AHI has consistently stayed around 40 for the last two week average. Last night it was 69.4. I have no leaks on the mask and have been using the machine about 3-4 hours per night. I have a ton of clearway apnea events each night and usually fewer than 10 obstructive events. Last night, the data shows for 4 hours of use, I had 107 clear airway events. I've been told by the doctor that I may need a different machine to deal with central apnea. My question for him was shouldn't that have been something that the sleep study showed instead of buying three different machines??? I'm surprised they covered the second one, I'm pretty sure they won't buy a third machine.

More pressure doesn't seem to help. Does anyone have any suggestions I can try to improve my sleep with the auto bipap machine I have? I can post data from sleepyhead if needed. Thank you all in advance for any suggestions. I just want to sleep...

Hi and welcome. You didn't mention what type of mask you have and that's usually 90% of the problem people have with things not going well. Unfortunately too many doctors are unfamiliar with equipment and why some of it works for certain people, and why not. If you have not tried a 'full face' mask (just like a nasal one that extends to cover your mouth as well) it would be an idea for you to look into as you seem to be a mouth breather once asleep and this style of mask - there are many of them - allows you to mouth breathe without losing the Cpap air that way. Others try chin straps or tape their lips shut, but those are not as effective. You'd need to be fitted of course, for your size in a given mask and see how things go. You might want to look at Cpap.com under Masks, then FF ones, to get an idea of what's available (e.g. the Quattro FX is very popular). You could also look at a Hybrid, because it covers your mouth, but not your nose... small 'pillows' or 'cushions' do that extending from the mouth part.

jeaves726 wrote:They started me at 11/6 on the Bipap. I've slowly increased the pressure over the last few weeks to see if there was any improvement. My AHI has consistently stayed around 40 for the last two week average. Last night it was 69.4. I have no leaks on the mask and have been using the machine about 3-4 hours per night. I have a ton of clearway apnea events each night and usually fewer than 10 obstructive events. Last night, the data shows for 4 hours of use, I had 107 clear airway events. I've been told by the doctor that I may need a different machine to deal with central apnea. My question for him was shouldn't that have been something that the sleep study showed instead of buying three different machines??? I'm surprised they covered the second one, I'm pretty sure they won't buy a third machine.

Sounds like you have complex sleep apnea
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
Your insurance will likely want special documentation but if the medical need is there....they will buy it.

If you do indeed have CompSA...increasing the pressure won't help and actually makes things worse because the added pressure will create the breathing instability and thus more centrals.
You might do better with lower pressures.
If your obstructive apnea can be contained by lower pressures..maybe the centrals won't be so apt to pop up in response to the pressures.

Can you post an image of a detailed report from when you were using EPAP 6 and IPAP 11?
Don't know how? Discussed in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779

Hi Julie. Thanks for your reply. That shows how badly I'm sleeping...I knew that was vital information and meant to include mask type, but totally forgot (I'm exhausted today from my 69 AHI and over 200 clear airway events). I have a full face mask for exactly that reason...I can't keep my mouth shut, lol. I tried the nasal pillow thing and it really irritated my nose/sinuses. I seem to be super sensitive to increased pressure in my nose.

I have the PR FullLife Cushion mask. It is great for me. No leaks because of the extra cushion and comes with sm, med, and large seals. It's been the absolute best I've tried so far (I've tried quite a few over the last 6 months or so). It's actually somewhat comfortable and doesn't bother me through the night.

jeaves726 wrote:They started me at 11/6 on the Bipap. I've slowly increased the pressure over the last few weeks to see if there was any improvement. My AHI has consistently stayed around 40 for the last two week average. Last night it was 69.4. I have no leaks on the mask and have been using the machine about 3-4 hours per night. I have a ton of clearway apnea events each night and usually fewer than 10 obstructive events. Last night, the data shows for 4 hours of use, I had 107 clear airway events. I've been told by the doctor that I may need a different machine to deal with central apnea. My question for him was shouldn't that have been something that the sleep study showed instead of buying three different machines??? I'm surprised they covered the second one, I'm pretty sure they won't buy a third machine.

Oh, they might kick and scream, but if the doctor documents it clearly (and the progression through the different units is part of the accepted process), then the insurance company will cover it. Sure they might tell you to wait until next year. But they will cover it.

Failure to do provide medically necessary (and generally accepted) treatment would open them to all sorts of liability issues. Imagine if you have a fatal car crash and they refused to pay for medically necessary treatment. Lawyers would have a field day with that. And they know it. Of course, that doesn't mean they won't apply normal stall tactics. But they will pay.

Pugsy wrote:... Sounds like you have complex sleep apnea ...

While I agree with Pugsy, please understand that doctors know from experience that SOME people find relief from lower levels of treatment. If a CPAP device would work, then they prescribe that. If a BiPAP device will work, then they will prescribe that.

Think of a person that cuts their hand. It's not all that bad. They might first try a simple adhesive bandage to see if that does the trick. But because of where it's located, the wound does not heal as it should. So, they go do a doctor, who tries another type of bandage trick - a butterfly bandage. This acts as a stitch and helps hold the cut together so it can heal. But darn it, it just doesn't seem to do the trick. You go back to the doctor, who tells you that you need some stitches to hold the skin together.

Why not just jump to the stitches first? Well, if a simple bandage would do the job, then the cost of the stitches would overkill.

So it is with xPAP therapy. If a CPAP works, then great. It's cheaper. It takes less adjusting. You have more choices. It's a simpler path.

Pugsy wrote:... You might do better with lower pressures. ...

Something else that can help is turning off the EPR or BiFlex setting. Sometimes those "relief" settings allow apneas and hypopneas to start. Turning them off, once you adjust to sleeping with the pressure, helps avoid those unnecessary apneas. And that can sometimes make all the difference.

Here's hoping you find relief soon.

Thank you all for your replies! I reverted back to my original pressure 11/5 and tried it again last night. Total time was about 5 hours. Here is the info from sleephead:





I did turn the bi flex off which seemed to help some. I felt the machine was kind of stuttering before. Turning off the bi flex helped with that issue.

Wonder if that PS of 6 is affecting things???
The next image of the detailed graph you do can you turn off the AHI graph? It's redundant information and not needed (go to Preferences/Graphs tab and remove check mark).
Also we need pressure and leak rate more than the minute volume and respiration stuff.
How about trying IPAP at 9 or 10 and see what happens? Sometimes that big difference between inhale and exhale creates a little breathing instability...sort of like hyperventilating. I have seen it happen on more than one occasion.
What model machine are you using? 660 or 760?

Here's an example of one of my reports below. You can resize the graphs by hovering mouse along the bottom of the graph till you see a short little double line then click and drag to resize. SH will remember the changes so you only have to do it worse.

These are the graphs that I find helpful
Events graph on the top
Flow rate graphs
Pressure graphs if using auto adjusting pressures...otherwise if using fixed pressures they aren't going to change so not needed
Leak graphs.

I don't really care about snore graphs because snores are shown on the top events graph.
You can turn off the Piechart in the Appearance tab of Preferences. This brings into view a few of the Statistics numbers on the left.

Oh, once you went to sleep the second time last night around the 03:00 mark...did you sleep soundly or wake up often?

When you have time and know for sure which machine you are using could you please add it to your profile so that we don't have to ask each time. See how I have mine as an example.

Ok, here is more relevant information. My AHI has been extremely high, but the last two nights it's dropped considerably. I still feel awful in the mornings and don't feel rested at all.



Hopefully this is more the info needed. The guy that manages my machine said he thinks my EPAP pressure needs to be higher. I did bump it up a little last night from 5 to 7.5. Over the past few weeks, I've slowly increased the IPAP pressure from 11 (where they started me) to 22 (AHI was 69.4 that night). I usually walked it up about 2 per night so there wasn't a major increase. I kept thinking that when the numbers fell to where they should be, I would feel better. However, I've had two nights of AHI under 10 and still feel the same.

Could you please do the detail tab on the left instead of the Events tab so we can see pressure settings?

jeaves726 wrote:I've slowly increased the IPAP pressure from 11 (where they started me) to 22 (AHI was 69.4 that night)

Mostly Clear airway events??? What was the EPAP when you were using IPAP at 22?

2 nights of barely decent AHI is not going to work the miracle you are expecting...it doesn't work that way except for a lucky few.

Did you happen to wake up around 6 AM last night? Or did you sleep straight through the night?
Or did you have lots of little awakenings during the night?

Honestly, I'm not sure if I woke up or not. I guess it's just restless sleep or something. I don't remember waking up, but I might have.

When I was in the 20's on Ipap, the Epap was set at 8. That night I had over 200 clear airway events and felt like a zombie the next morning. My AHI was 70 that night too. I learned there that more pressure isn't necessarily a good thing.

here is the new image with the detail graph.

Pugsy wrote:Mostly Clear airway events???

I've noticed I seem to have mostly clear airway events. I'm assuming that most have obstructive events and clear airways events aren't as normal?

jeaves726 wrote:

Pugsy wrote:Mostly Clear airway events???

I've noticed I seem to have mostly clear airway events. I'm assuming that most have obstructive events and clear airways events aren't as normal?

You're right. Most people don't have as many clear airway events as you do---particularly in periods when they are pretty sure they're asleep.

Your RERA numbers are also pretty high. Whether those numbers mean anything is a different question since it's not at all clear how accurate the RERA detection algorithm is.

Has your doctor examined any of your daily data reports in an Encore report in your presence? If so, what's the doc said about them? If not, that's the next step. Take an official Encore report to the doc (maybe one printed out from the DME with the last seven days of daily detailed data) and insist that the doc look at the detailed data and tell you whether s/he is worried about what s/he is seeing in it.

Like pugsy and JohnBFischer have said, it looks like you probably have a problem with Complex Sleep Apnea. And as John has written, it is not unusual that insurance companies require documentation that CPAP/APAP and BiPAP/BiPAP Auto fail to resolve the problem before moving a patient with Comp SA to an ASV machine. The reason why is simple: As John has already said---some patients with mild Comp SA problems have the Comp SA resolve with a bit of time on either a CPAP/APAP or a BiPAP/BiPAP Auto, and hence there's no need to jump immediately to the most expensive machine that is also a machine that can also be a very difficult machine to adjust to sleeping with. But in your case, you've been sleeping with a BiPAP for six months and the problem has not resolved. Hence it is unlikely to resolve on its own. So you may be in that unlucky minority of folks who were originally diagnosed with simple OSA who went on to develop Comp SA that simply would not resolve on a CPAP/APAP or BiPAP/BiPAP Auto. And hence the next step is to move you to either an ASV machine or a BiPAP ST running in "T" mode

Good luck