Is APAP Working Correctly? Prescribed Pressure Range Wrong?

Hello all, I just joined today, after reading several posts as a guest. My apologies, I have a rather long post, but I wanted to explain what has been going on, and led me here.

On holiday a couple of years ago, I noticed my Mom, who is 83 yrs. old now, stopped breathing several times during the night. So, finally after 2 yrs, she agreed to see the doctor about her sleep. Her initial sleep study confirmed she had OSA, very mild on her side, severe on her back; I believe the AHI= 33. So, the doctor told her to sleep on her side, and she should be fine. She did train herself to stay on her side most of the time. However, a couple of months later, on several occasions, when I went into her room to wake her for breakfast, I noticed she was not breathing, despite being on her side. So, 5 months after the initial sleep study she had a CPAP titration in the lab. She said she did not sleep well during the titration, because her restless legs were bothering her, and she had to take her TMJ mouth guard out, because she kept opening her mouth during the titration; they were using a nasal mask. Following the titration, they sent her home with a one month CPAP trial with a nasal mask, and the pressure set to 8 cmH2O.

After much trial and error, they eventually let her try a full face mask, and then she had no problems with CPAP compliance. When it came time to purchase the machine last month, I asked the doctor to prescribe her an AirSense 10 AutoSet for Her, as it would allow more flexibility for her therapy going forward. Because her OSA was very positional, I asked the doctor to change her prescription from 8 cmH2O CPAP, to a suitable APAP prescription. So, he set the range from 5 to 10 cmH2O. She was fine on this prescription for several days, then one morning she said she decided to sleep on her back, and did not have such a good night. So, I checked myAir, and sure enough the AHI was much higher than usual. This led me to download OSCAR. Up until now, Mom had been trying to sleep on her side since the doctor told her to 5 months ago; but the CPAP provider told her she could sleep how she wanted now, as she was on therapy. So, she sleeps on her back from time to time.

Long story short, over the past 9 days the pressure has been changed by the doctor to 5 to 12, then to 6 to 15, and now 10 to 20 cmH2O. Last night Mom slept predominately on her back and her AHI=34.77, with no central apneas. Now she could go back to trying to sleep on her side as much as possible, which is the obvious thing to do; but if PAP therapy is set correctly, shouldn't the majority of the apneas be controlled even if she is on her back? Even if she does go back to trying to stay on her side, there will be times when she ends up on her back. Apart from the OSA, and controlled high blood pressure, my Mom is very healthy and active for her age. She has a BMI =24. As strange as it might sound, she has never really felt tired prior to PAP therapy, and even today.

I have attached screen shots of 3 nights of sleep below. The assumption is that the first attached screen shot is of her sleeping predominately on her side, the 2nd with some sleep on her back, and the 3rd with her predominately on her back. I intend to contact her doctor next week, but any thoughts/insight/help would be much appreciated.

Your mom needs more pressure, and the machine won't deliver that in 'for her' mode, switch it to regular autoset mode.

Thank you for your reply. I just downloaded the clinical manual, I will try your suggestion.

I switched the machine from autoset 'for her' to the regular autoset mode before my Mom went to bed last night. She went to bed lying on her back. About 20 min. later, she called me to tell me something was wrong; the pressure felt too strong, it was blowing her cheeks out, and it felt like she was swallowing air, although she had no abdominal pain. So, I turned on the auto ramp, which started at 5cmH2O. Apparently she was okay for about 30 min. She did not want to call me again; so she lay awake on her back until about 3:15am with the same problems, of the pressure feeling too strong again, and her cheeks were blowing out, and again it felt like she was swallowing air, but she had no abdominal pain. She said about 3:15am she turned over on her side and went to sleep no problem.

I have attached a screen shot of last night. Cheyne Stokes Respiration occurred, this is something that has never happened during previous nights of therapy.

Any ideas on what is going on, what I should do? Would switching the comfort setting 'response' from standard to soft make a difference? Or should I just switch the machine back to autoset 'for her', and tell her to sleep on her side, which she is okay doing most of the time?

Phil66 wrote: ↑

Mon Jul 22, 2019 8:28 am

Any ideas on what is going on, what I should do? Would switching the comfort setting 'response' from standard to soft make a difference? Or should I just switch the machine back to autoset 'for her', and tell her to sleep on her side, which she is okay doing most of the time?

Well, like I said, she needed more pressure to alleviate all the obstructive apneas, and 'for her' mode won't allow the machine to increase the pressure enough.

So you turned it to autoset mode, and, it increased the pressure.

Leave it as is, and tell her to sleep on her side if she can, let the machine respond to needs when she isn't on her side, she'll get used to the pressure.

There are foam wedges, towel-stuffed backpacks, all kinds of ways to not back sleep, but I imagine it won't be easy at her age to change.

Thanks palerider for your quick reply. I was going to tell her to try and stay on her side; and I'll leave the machine setting as you suggest.

Also thanks Julie for your comment about the wedges, stuffed backpacks, etc. She has something like that she used to use, so if she needs to she can use it again. Actually she is good at staying on her side, but the CPAP provider told her recently she should be able to sleep in any position, so she started to go on her back again, which led to the her AHI going way up. I'm sure if she goes back to side sleeping she should be fine.

Phil66 wrote: ↑

Mon Jul 22, 2019 12:00 pm

but the CPAP provider told her recently she should be able to sleep in any position, so she started to go on her back again, which led to the her AHI going way up. I'm sure if she goes back to side sleeping she should be fine.

Well, I'd the CPAP is working as needed for a person, then they can sleep in varying positions, but, gravity has an effect on pressure needs with most people, ... So if she's on her back, she'll n|d more pressure to hold the airway open.

Something the CPAP provider no doubt neglected to cover.

Phil66 wrote: ↑

Mon Jul 22, 2019 12:00 pm

Thanks palerider for your quick reply. I was going to tell her to try and stay on her side; and I'll leave the machine setting as you suggest.

Also thanks Julie for your comment about the wedges, stuffed backpacks, etc. She has something like that she used to use, so if she needs to she can use it again. Actually she is good at staying on her side, but the CPAP provider told her recently she should be able to sleep in any position, so she started to go on her back again, which led to the her AHI going way up. I'm sure if she goes back to side sleeping she should be fine.

I would suggest that she stay on her side for now. But once she is used to the pressure, she should be able to sleep on her back again if she wants.