OSA have increased significantly in very short time-Cause?

I was raising the question from the standpoint the he be notified that there is NOW a problem where there didn't seem to be one before.
I understand that the AHI went up after you got back from the trip, but did the AHI go up before or after you went to the chiropractor? (I guess that question is "what was the timeframe between getting back and going to the chiropractor").

I'm wondering whether the AHI rise was related to the neck/arm muscle spasms or the visit to the chiropractor.....
(I guess you answered that in your last post.....I just re-read it.)

Den

You are using a nasal interface, are you taping, can you rule out mouth leaks 100%. Jim

Thanks Wulfman,

The AHI went up only after return. During my trip, I woke up with really bad shoulder pain. The pillows were really bad at the hotel. Since then, the AHI was significantly higher than my average. It did go up a bit with the chiropractic treatment. Could be just a coincidence but I think there is correlation between my pain and the increase in AHI.

If I had major mouth leaks (not likely), how would that increase my AHI index? If anything, wouldnt that increase the APAP pumping out more pressure?

Justin_Case wrote:If I had major mouth leaks (not likely), how would that increase my AHI index? If anything, wouldnt that increase the APAP pumping out more pressure?

If you have major mouth leaks then your pressure is not being maintained to keep your airway open which results in increased AHI.

If you have mouth leaks you will know because you will have dry mouth when you wake.

- r

Justin_Case wrote:If I had major mouth leaks (not likely), how would that increase my AHI index? If anything, wouldnt that increase the APAP pumping out more pressure?

If you're losing air out your mouth, you're not getting "therapy" pressure to keep your airway open......which would cause your machine to raise pressure AND cause increases in your AHI (due to lack of therapy pressure).

I think somehow that question got overlooked in the initial responses. Leave it to Jim/ Goofproof to finally come up with it.

Den

Good guess. However, in my case I have been using an oral appliance most of the time which effectively prevents me from losing air through the mouth. Without the appliance, the AHI index is not significantly different.

Furthermore, the APAP adjusting to the events is consistentl. Even though I am having a lot of events, say, at pressure 8, I have 25 HI triggers (sleep flags) in one hour. The pressure still didn't rise. It only raised the pressure at the 4.5 hour mark when there were 13 OA events. This is during a 4 hour period. But, I am usually comparing my AHI index over a 7+ hour period. I am attaching a link to the PDF for the 4 hour period:

http://www.freefilehosting.org/public/17353/7a.pdf

On your posted chart, at the bottom: Daily Events Per Hour. Your pressure graph numbers are all messed up, for some reason.

If they are wrong, maybe something is wrong with the machine or Encore Pro, It doesn't look like leaks are too bad, always can be better... Jim

Jusin,

Please go through the setup on your machine. From looking at your chart, I'm wondering if the "Ramp time setting" (in item C. below) is set to like four hours or more. With an APAP mode, it should be set to 0 (zero). It is also called a "Split night" setting. Looking at your chart, nothing happens with the pressure change until after 4 hours......which could be what is causing the high numbers you're getting.

Please copy and save the instructions below to a file on your computer.

Den


REMstar Auto w/C-Flex Setup

When in the Setup Menu, the humidifier ^ and ramp v buttons operate as up and down keys to change the settings, the left/right user buttons < > allow you to go to the previous/next question or setting, and the pressure start/stop button is used to exit the Setup Menu. Holding the humidifier or ramp buttons down will cause the values to change more quickly.

To enter the Therapy Setup Menu, hold the two top user buttons < > down while plugging in the power cord.
Continue holding the buttons down until the REMstar Auto w/C-Flex beeps twice.

Note: The word "setup" will appear on all of the screens indicating that you are in the Therapy Setup Menu.
(If you press the Pressure start/stop button, you will exit the Setup Menu.)

A. Compliance hours/nights: (recommend leaving alone, but CAN be cleared at this point)
Select next setting with >

B. Therapy mode: (CPAP/CFLE/APAP/AFLE) select with ^ or v
Select next setting with >

B1. If CPAP or CFLE select pressure setting: Select with ^ or v
Select next setting with >

B1a. C-Flex mode (if you chose CFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

B2. If APAP or AFLE, select minimum pressure setting: Select with ^ or v
Select next setting with >

B2a. If APAP or AFLE, select maximum pressure setting: Select with ^ or v
Select next setting with >

B2b. C-Flex mode (if you chose AFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

C: Ramp time setting: Select with ^ or v
(ramp time will be turned off with a setting of 0)
(if using APAP or AFLE mode, Ramp setting MUST be set to 0)
Select next setting with >

D. Ramp pressure setting: Select with ^ or v (use only in CPAP or CFLE mode)
Select next setting with >

E. Patient disconnect setting: 1 = on 0 = off Select with ^ or v
Select next setting with >

F. Buttons lights setting: 1 = on 0 = off Select with ^ or v

(Last setting. Use On/Off button to exit Setup)

Goofproof, yes. In converting the PDF and removing my personal information, the columns are a bit messed up iafter I removed my personal info.

Basically, with the Daily Events, the Pressures starts off with 4, then it should be 5,6,7,8,9. 01 is actually 10, 21 is 12. The first column digits are reverseds after that. 90% of the time the pressure was at 8. The numbers in the subsequent rows are correct. In the PDF, you should look at the graph instead of the chart.

As far as leaks go, that's been my average ~35, with the lowest at 20. The Respironics machine's valve, as I call it (where the dehumidifer connects to) has a bit of leak coming from it. I told my DME about it and he said that's normal that the seal is not 100%. I would be curious to see what the leak index for others on the same machine. I read somewhere that 35 is normal.

Wulfman, you're exactly right. The ramp setting was 4 hours. I was told there was no ramp setting in AFLEX mode. Then, you can only change it to 2,3, or 4. That's very strange. What happened to 1?

I will see the data tomorrow morning and post my details.

Cheers,
Justin

Justin_Case wrote:

The Respironics machine's valve, as I call it (where the dehumidifer connects to) has a bit of leak coming from it.

That IS your problem, the silicone coupler is leaking!

Push down on the tank and slide it back from the machine, then lift up the back of the machine and remove it from the humidifier. Insert your index finger in the silicone coupler (metal ring should be outward side). Pull the coupler out so it just hangs on the fitting.

Once the coupler is pulled out, put the machine back on the humidifier base, once the machine is seated, then push the tank in towards the coupler, let the tank push the coupler on the machine.

This should STOP the leak, you cannot have that fitting leaking. It is just like a large mask leak and will skew all your AHI data and how the machine responds to events.

Once you seat that coupler correctly, the machine should return to normal operation and be much quieter.

Justin, shoulder pain is a common signal of serious cardiac events, and I do think you need to either see your GP again and ask for an EKG, or go to a local hospital for the same thing. Chiropractic won't help and you could be on the verge of larger trouble than OSA. If your GP has tunnel vision, or is misled by your focus on OSA rather than anything, ask for a referral to someone else (or make your own appt.). You need to be evaluated by an objective person at this point and not be concentrating on CPAP alone, or a sore shoulder, in isolation from possibly more serious overall trouble.

_________________

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

_________________

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

Wulfman wrote:Jusin,

Please go through the setup on your machine. From looking at your chart, I'm wondering if the "Ramp time setting" (in item C. below) is set to like four hours or more. With an APAP mode, it should be set to 0 (zero). It is also called a "Split night" setting. Looking at your chart, nothing happens with the pressure change until after 4 hours......which could be what is causing the high numbers you're getting.

Excellent catch, Den!!!

Justin_Case wrote:Wulfman, you're exactly right. The ramp setting was 4 hours. I was told there was no ramp setting in AFLEX mode. Then, you can only change it to 2,3, or 4. That's very strange. What happened to 1?

The 2:00, 3:00, and 4:00 (hours) are for split night mode therapy. Meaning the machine will use only the lowest pressure in the range during that many hours. Gathering data, but not behaving like an autopap...not varying the pressure until the timer's number of hours is finished. Then it will begin doing its "autopap thing".

You're right, Justin...there's no "1" for "one hour". I suppose they figure having a split night consisting of only one hour to begin with would not be very useful. There is, however, a "0:00". That is the important figure. It should be set for 0:00 to keep "split night" from happening at all when using APAP or AFLE mode.

The M series Respironics REMstar Auto with C-flex has a true ramp the way we think of a traditional ramp -- start out easy, build up to prescribed pressure slowly over a matter of minutes. The M series ramp timer can be set to operate for x number of minutes, up to 45 minutes. Even in APAP or AFLE mode.

However, the older REMstar Auto with C-flex does not offer a true ramp feature when operating in either of its auto modes: APAP or AFLE. If either of those modes have been chosen, then when you continue on through the setup menu and see a screen that says "Ramp", that timer MUST be set for 0:00 to avoid putting the machine into split night therapy mode.

Den, you nailed it! Good detective work.

Justin, you mentioned having read that 35 is normal for a leak rate. That was probably talking about leak rate from a mask while using a Respironics machine. The normal leak from the exhaust vent of a mask. I don't think there should ever be an air leak coming from the connection of the humidifier to the cpap machine, however.

As snoredog said, be sure you have the humidifier and machine coupled together securely. If you look at the silicone coupler, there is a metal ring inside the silicone, closer to one end of the coupler. That's the "short" end of the coupler and should be closest to the humidifier, as snoredog mentioned, when you put it all together. That was a great description of "how to", snoredog!

Page 2 of the thread below has more discussion about the coupler ends:
viewtopic.php?t=11219

Excellent catch, Den. Justin's Obstructive apneas werent' being treated, 4 hours every night - no wonder they're on the rise!

The shoulder pain may have come from the hotel pillows -

And it may also have been the result of the non-treated apneas: my neck and shoulders use to scrunch up badly before apap therapy.

Which doesn't preclude Julie's caution: Have yourself evalutated to be on the safe side, Justin.

O.