Help with Silverlining Analysis please

Thanks Snoredog, I see you figured out that I had posted the wrong URL.

You're right that I don't feel any better...definitely foggy-headed when I got up this morning.

I will try your new suggestions and see what happens. Out of curiosity, when I had no events between hours 4.5 and 5.75 on the previous night, when the pressure was running at 12, why does that not make 12 the right pressure for me? I thought the whole idea of xpap was to get rid of the events. Patience please, I still have a lot to learn.

And I am using a Hybrid at the moment. When I get the pressures set properly, I am going to try one of my pillows only interfaces to see if I am losing treatment through my mouth.

Bonnie

jabberwock wrote:Thanks Snoredog, I see you figured out that I had posted the wrong URL.

You're right that I don't feel any better...definitely foggy-headed when I got up this morning.

I will try your new suggestions and see what happens. Out of curiosity, when I had no events between hours 4.5 and 5.75 on the previous night, when the pressure was running at 12, why does that not make 12 the right pressure for me? I thought the whole idea of xpap was to get rid of the events. Patience please, I still have a lot to learn.

And I am using a Hybrid at the moment. When I get the pressures set properly, I am going to try one of my pillows only interfaces to see if I am losing treatment through my mouth.

Bonnie

feeling foggy is what I would expect, do that every night and you will feel like the walking dead in a few days.

As for 12cm pressure? This was what I was suggesting, because that was the only pressure I seen that completely eliminated the obstructive events seen and didn't kick up a bunch of mixed or CA events. While the frequency of Flow Limited Runs increased was not a good sign, it was better than seen elsewhere. Flow Limited "Runs" don't cause a drop in oxygen levels so I would rather have an increase in those vs more obstructive events or CA events.

The question is however, can you tolerate CPAP at 12cm? Because it would be interesting to see how you did at that pressure. Changing pressure(s) of the autopap can sometimes trigger that unstable CA's. Try CPAP at 12cm if you feel up to it.

But along with that increased pressure is usually more machine and mask noise, greater risk of aerophagia etc. But if you feel better you have to weigh the good along with the bad.

If you find 12cm CPAP pressure works and stablizes your breathing, then maybe you should look into a Bipap machine to help you tolerate that higher pressure and/or eliminate the aerophagia side effects should they arise.

Well, that was a pretty crappy night! I dropped the minimum pressure to 6.5, set the max pressure at 10, and left the pressure command on FL at 10. The synthesis for last night shows efficiency >90% at 10 cm, AHI of 5.5, and cycles as follows: normal 60%, FL 32% and intermediate 7%. I'm all over the map again on the pressure, the runs are worse, I don't know what to do next.

Should I try using it as a straight CPAP for a few nights?

I am feeling worse instead of better

http://i204.photobucket.com/albums/bb23 ... ne1707.jpg

Bonnie

jabberwock wrote: A little background if it would be helpful for you... Initially dxed with OSA in 2003, RDI of 37. Initial titration was at 6 cm pressure, given RemStar Plus with HH I used it on and off for 6 months or so, then completely gave up.

Retitrated in November 2004 at 7 cm. Never used it at that. Retitrated in November 2006 at 6 cm. In April, I was feeling so lousy that I decided to try using it again. That is when I found this forum, and have been a voracious reader here ever since. I had been using my RemStar Plus at 6 cm, as set by the DME when I took it in in April. I had a terrible time using it, and figured out why when I got my sleep studies from my GP. I have no idea why it was retitrated at 6 cm. During the Nov 2006 study, I had an RDI of 39, while on cpap at 6 cm and 7 cm. When they bumped it to 7 cm, there was absolutely no difference in the # of AHI. The report indicates basically that the study was useless since I didn't sleep long enough to get good results. I have made an appt with sleep doc for June 25 to ask WTF happened!! In the meantime, I adjusted the pressure on my RemStar to 8 cm, and at least I didn't feel like I was suffocating. Knowing how you feel about the medical profession in general, I don't imagine you are too surprised by this.

That is when I decided to get the 420E to figure out for myself what was going on. I thought I had sent the minimum pressure at 8 cm, but I had it confused with the initial pressure. I have now set both at 8 cm, with a 30 minute ramp at 6 cm. Is it noteworthy that during the flatline pressures of 12 cm that show on my graph, I had no AHI events? I have also raised the max pressure to 14 as you suggested. I thought I had disabled the FL1 last night, but apparently not. I have done so now.

Sounds like to me you have had several studies indicating 6 or 7cm pressure but you continue to ignore that. The reason they stuck with those lower pressures is probably the same reason your reports have been a train wreck on June1507, June1607 and June1707.

If they couldn't nail down your settings with 2-3 nights in a lab where they can adjust things on the fly, I don't know how we are going to do any better by making one change and expecting improved results the next. From what I've read above, there isn't a pressure that you will stick with for what ever the reason may be.

At this point:

1. You complain you starve for air at 6cm pressure which was your prior titration pressures, and your DME also tried you up to 8cm pressure. We pretty much did the same here.

2. You did no better on straight CPAP using the Plus so you got a 420e to figure it out yourself. You have done no better with it from what I can tell, but at least you can see what is happening.

3. It is obvious your case is complex. Based upon what I've seen and your adverse response to pressure changes I would suspect you may be a candidate for CSDB. That means you would need to see a doctor rehearsed in that therapy and one hopefully with Adapt SV knowledge.

At this point, I would go back into "Settings" screen, click on Advanced button, then hit Default Settings at the bottom bump Minimum pressure back up to 7cm after pressing the Default Settings button.

That should put your machine back to original settings. which should be:

IFL1 =Enabled (box checked)
IFL2 =Enabled (box checked)

Command on apnea =10 (slider to right of IFLx settings). From what I have read you have not tried lowering the Command on Apnea slider from 10cm to 8cm as suggested.

I have a feeling those CA's seen on your report are real, you can ignore them or use them as an indicator of what is happening with your breathing and sleep.

We haven't talked any about your mask interface, but that would be something I'd look carefully at. At this point I would put the machine at a pressure you can "tolerate" in the CPAP mode and call your doctor about getting titrated on a Adapt SV machine.

In the mean time, go over to talkaboutsleep and Search for a copy of that Harvard study and read up on it.

Thank you for your response Snoredog.

I do have an appointment with my sleep doc next Monday; I was just hoping to get some idea of what is going on prior to that. I was told by the sleep clinic that a sleep study can only be done once a year (not due until November), but I will verify that with the sleep doc as well.

I will reset the machine to its original settings, with initial pressure at 7, and look for the Harvard study you refer to.

Thank you for your help and your time.

Bonnie

well I would go back to the doctor and say:

1. We have had several PSG's and they were unable to find a pressure ideally suited. 6cm is too low, you starve to breathe at that pressure.

2. We have tried every CPAP pressure going from 6cm to 12cm and no better results were seen. Take some of your detailed printouts. Suggest expanding them out first using magnifying glass tool at bottom, clicking the right nav arrow and printing them in "Landscape" format. Also print out your Synthesis pages for those days.

Patients with that syndrome seem to do better at lower pressure than higher. Fixed pressure doesn't work so well because it leaves many obstructive events go untreated. That can result in dropping SAO2 levels and daytime fatigue. If pressure is increased to eliminate those obstructive events breathing becomes irregular and more CA's are seen. Then most auto's have difficulty differentiating those CA's from obstructive.

If I seen a lot of snores on your reports, I'd say pressure wasn't high enough, but if you increase it enough to eliminate those then more CA's are seen.

If I was going to see my sleep doctor in a week I would go with the above info, I would also go with manual CPAP using 7, 8, 9, 10, 11, 12. CPAP is important because it rules out "changing" pressure of autopap from contributing to the condition. Once you get over 10cm you may not sleep very long. But I would try CPAP up to 12cm. There is no harm from those centrals other then they make you wake up at that pressure. Setup a Ramp in the CPAP mode but I wouldn't start any lower than 7cm and I'd set it for 30-minutes. Then when you start out with the CPAP mode, press the Ramp button to help you fall asleep.

Next, if you have another mask to use, preferably a nasal, I would also try that and compare your results. My opinion is that Hybrid is NOT ideally suited to your particular disorder due to its higher intentional exhaust rate and design. For the machine to detect and respond it has to do that at the end of a 5 or 6ft hose. At the end of that hose is an interface with 2 chambers. If you happen to breathe through your nose/nares, it has to detect those events from the nares, then the pillows, then the mouth piece chamber then finally down the hose. A conventional FF mask doesn't have those seperate chambers to dampen those events. One way to rule that out if it is even a problem is by use of another mask with same machine settings and compare. Then you can see how a different mask can impact your therapy. The more of these things you can rule out the easier it becomes for your doctor to assist you.

Once again Snoredog, thanks very much for helping me try to get some good therapy going.

Your plan sounds logical to me, and I like the idea of taking the reports in for my doc to see. In the meantime, I will find out more about CSDB.

As for a nasal mask, I currently have the Activa or an UltraMirage II to choose from. Is one better than the other for me as far as exhaust rate?

Bonnie