confused as to what's happening - 2 weeks on cpap

I have been using the intellipap for 2 weeks - something got screwed up when I used the smartmodule so it's missing 2 days of data so it should be 9 days of compliance instead of only 7 and I didn't write down all the smart codes. I am having problems still w/ the mask - had to switch to a nasal mask because my sinuses still can't take the air being blown on them from the nasal pillows. But, I continue to wake up panicked and ripping the mask off because I feel like I can't breathe. My sleep study AHI was 11.9. My pressures are between 6.5 and 10. This is the data I have in order by date (oldest to newest):

95th Percentile Pressure 7.5
90th Percentile Pressure 7.0
AHI 4.0
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 0.00
EPI 1
While Breathing Hours Last Day 3.6

I don't know if I should bump up the starting pressure to 7.5?


95th Percentile Pressure 7.0
90th Percentile Pressure 6.5
AHI 10.0
Pressure Plateau Time 0%
High Leak Flow Time 1%
NRI 0.50
EPI 2
While Breathing Hours Last Day 4.5


95th Percentile Pressure 8.5
90th Percentile Pressure 8.5
AHI 7.0
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 3.50
EPI 1
While Breathing Hours Last Day 2.7


95th Percentile Pressure 8.5
90th Percentile Pressure 8.0
AHI 7.5
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 0.25
EPI 1
While Breathing Hours Last Day 4.8


95th Percentile Pressure 9.0
90th Percentile Pressure 8.5
AHI 10.0
Pressure Plateau Time 0%
High Leak Flow Time 1%
NRI 2.00
EPI 1
While Breathing Hours Last Day 4.8

95th Percentile Pressure 13.0
90th Percentile Pressure 11.0
AHI 12.0
Pressure Plateau Time 0%
High Leak Flow Time 1%
NRI 2.00
EPI 1

95th Percentile Pressure 13.5
90th Percentile Pressure 13.0
AHI 8.5
Pressure Plateau Time 2%
High Leak Flow Time 0%
NRI 0.50
EPI 1

95th Percentile Pressure 8.5
90th Percentile Pressure 7.5
AHI 6.0
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 1.25
EPI 1

mgrunk wrote:But, I continue to wake up panicked and ripping the mask off because I feel like I can't breathe.

Did you have a titrated pressure? What is your humidifier setting?
My instinct is that either your pressure is too low or your humidifier setting is too high......or both.


Den

no titrated study - she just set me up w/ auto - I've been increasing the lowest pressure number up gradually from 4 - felt like I was suffocating!!!! to 6.5 now. My humidifier is at 2 - I just had sinus surgery, so I am not wanting to send up dry air through my sinuses. But, it's not even using the water because I live in humid Atlanta

I think your tech set your machine up wrong (or you may have misunderstood her) because the 'starting slowly at 4' is about the ramp feature, to ease you into things each night until your scripted pressure is reached, but most of us don't use the ramp at all now, and let the machine go straight to the pressure it's supposed to be at, like 8 or 10 or 15. You must have a prescription with the pressure your MD set, and you need to find out what that number is, then go from there. If it's an autopap then you'd set the range at e.g. 8 and 12, if your MD's number was 10. If it actually is 6.5, I think that may be an over cautious MD at work - barest minimum to do the job and I'd want to be able to raise it at least a bit so I could really breathe easily.

I second the suggestion to try 8-12. From what I know of this machine (used one for 9 months) and what I see here (flat top number must be part of new software-- nice addition), your minimum pressure is still too low. Most people here report problems below 7 cm.

Ok, I'll try that range. What I meant is originally, she set it for 4 - 10 and we've been moving the lower number up based on the 90 / 95th percentile.

but, the other issue, Is I'm waking up swallowing air - lots of chest pressure that I assume is from the air. I am too freaked to tape my mouth, but w/ the nasal mask, my mouth is popping open at time and then I have a mini-panic attack from the air rushing feeling.

I have to say, this is really miserable - I'm sleeping so badly at this point, I about dread going to bed.

I wish I could wear the nasal pillows, but the feeling of the air is just too much - I've tried the optilife and the swift LT for her. I also have a hybrid but it's nasal pillows, and a nasal mask but it's painful and keeps popping the seal about 5 or 6 times at night (on top of my mouth popping open). I have a comfort gel mask coming - hopefully it will be more comfortable. I know I could try a chin strap.

I realized I hadn't added last night's data:

95th Percentile Pressure 13.0
90th Percentile Pressure 11.0
AHI 12.0
Pressure Plateau Time 0%
High Leak Flow Time 1%
NRI 2.00
EPI 1

Hi
I am somewhat new to CPAP and this forum however I am learning as well. I am interested to understand from people on the forum why it is suggested that you should increase your lower pressure when your AHI results are getting worse than the AHI of 4 in the first reading, or am I missing something. By raising the lower pressure and getting worse results seems to suggest perhaps that there is an increase in Central events which can come from pressure that is too high as suggested in other posts by those with knowledge of this forum. Apart from overcoming the suffocating feeling at very low pressures, your unitial 90 and 95 percentile pressures are suggesting that these pressures are dealing with your events at least to get below the AHI of 5.

I would suggest you may consider going back to 6.5 as the lower and say 9.5 as the higher which is 2 above the 95 percentile you had initially and try this for a number of days (say two weeks) to get some trend in your results. If this gets you below AHI of 5 for a while that is at least an outcome that gets into the "normal" range. Perhaps look for adjustments from there. Maybe that is as good as you will get as these things seem to vary a lot from person to person.

As an example I had a study with AHI of 46. My titrated pressure was 8. Using 4 minimum and 12 maximum which was obviously and arbitrary setting by my supplier, I was getting AHI results of 1 to 2 with a median pressure of 5.3 and 95 percentile of 8. I found a pressure of 4 uncomfortable so changed it to 5 which was better. It appears that higher pressures are not perhaps appropriate for all. I am getting by very well with lower ones even with an reasonably severe AHI of 46 without CPAP. I started to take anti-depressants about the same time as I started CPAP and have been increasing dosage as happens with those drugs. I have noticed that my AHI scores have increased progressively but not yet got above 4 but if you are taking medication that needs to be considered in the possible AHI results.

As I said I am just learning by reading a lot of info on this forum and other web sites etc. I would also appreciate hearing from others with more knowledge to help you to a good outcome.

W

journey wrote:Hi
I am somewhat new to CPAP and this forum however I am learning as well. I am interested to understand from people on the forum why it is suggested that you should increase your lower pressure when your AHI results are getting worse than the AHI of 4 in the first reading, or am I missing something. By raising the lower pressure and getting worse results seems to suggest perhaps that there is an increase in Central events which can come from pressure that is too high as suggested in other posts by those with knowledge of this forum. Apart from overcoming the suffocating feeling at very low pressures, your unitial 90 and 95 percentile pressures are suggesting that these pressures are dealing with your events at least to get below the AHI of 5.

I would suggest you may consider going back to 6.5 as the lower and say 9.5 as the higher which is 2 above the 95 percentile you had initially and try this for a number of days (say two weeks) to get some trend in your results. If this gets you below AHI of 5 for a while that is at least an outcome that gets into the "normal" range. Perhaps look for adjustments from there. Maybe that is as good as you will get as these things seem to vary a lot from person to person.

As an example I had a study with AHI of 46. My titrated pressure was 8. Using 4 minimum and 12 maximum which was obviously and arbitrary setting by my supplier, I was getting AHI results of 1 to 2 with a median pressure of 5.3 and 95 percentile of 8. I found a pressure of 4 uncomfortable so changed it to 5 which was better. It appears that higher pressures are not perhaps appropriate for all. I am getting by very well with lower ones even with an reasonably severe AHI of 46 without CPAP. I started to take anti-depressants about the same time as I started CPAP and have been increasing dosage as happens with those drugs. I have noticed that my AHI scores have increased progressively but not yet got above 4 but if you are taking medication that needs to be considered in the possible AHI results.

As I said I am just learning by reading a lot of info on this forum and other web sites etc. I would also appreciate hearing from others with more knowledge to help you to a good outcome.

W

By having a higher minimum pressure, the time to respond to events is cut. It's desirable when using an APAP to have the minimum pressure high enough to eliminate almost all of the apnea and hypopnea events......like a straight CPAP setting.
APAPs have to detect "events" in order to increase pressure.......the further it has to go, pressure-wise, the more events that are going to occur before the pressure gets to where it needs to be.......those untreated events count in the AHI and are detrimental to one's sleep and health.

Statistically, pressure-induced Central Apneas are rare and don't start to show up until you reach a pressure higher than 10 cm.
If a person is not prone to Centrals (and that should be noted in a sleep study report), then there should be no problem with pressure settings.


Den

Wulfman wrote:

journey wrote:Hi
I am somewhat new to CPAP and this forum however I am learning as well. I am interested to understand from people on the forum why it is suggested that you should increase your lower pressure when your AHI results are getting worse than the AHI of 4 in the first reading, or am I missing something. By raising the lower pressure and getting worse results seems to suggest perhaps that there is an increase in Central events which can come from pressure that is too high as suggested in other posts by those with knowledge of this forum. Apart from overcoming the suffocating feeling at very low pressures, your unitial 90 and 95 percentile pressures are suggesting that these pressures are dealing with your events at least to get below the AHI of 5.

I would suggest you may consider going back to 6.5 as the lower and say 9.5 as the higher which is 2 above the 95 percentile you had initially and try this for a number of days (say two weeks) to get some trend in your results. If this gets you below AHI of 5 for a while that is at least an outcome that gets into the "normal" range. Perhaps look for adjustments from there. Maybe that is as good as you will get as these things seem to vary a lot from person to person.

As an example I had a study with AHI of 46. My titrated pressure was 8. Using 4 minimum and 12 maximum which was obviously and arbitrary setting by my supplier, I was getting AHI results of 1 to 2 with a median pressure of 5.3 and 95 percentile of 8. I found a pressure of 4 uncomfortable so changed it to 5 which was better. It appears that higher pressures are not perhaps appropriate for all. I am getting by very well with lower ones even with an reasonably severe AHI of 46 without CPAP. I started to take anti-depressants about the same time as I started CPAP and have been increasing dosage as happens with those drugs. I have noticed that my AHI scores have increased progressively but not yet got above 4 but if you are taking medication that needs to be considered in the possible AHI results.

As I said I am just learning by reading a lot of info on this forum and other web sites etc. I would also appreciate hearing from others with more knowledge to help you to a good outcome.

W

By having a higher minimum pressure, the time to respond to events is cut. It's desirable when using an APAP to have the minimum pressure high enough to eliminate almost all of the apnea and hypopnea events......like a straight CPAP setting.
APAPs have to detect "events" in order to increase pressure.......the further it has to go, pressure-wise, the more events that are going to occur before the pressure gets to where it needs to be.......those untreated events count in the AHI and are detrimental to one's sleep and health.

Statistically, pressure-induced Central Apneas are rare and don't start to show up until you reach a pressure higher than 10 cm.
If a person is not prone to Centrals (and that should be noted in a sleep study report), then there should be no problem with pressure settings.


Den

However, some people do get central apnea below 8, and journey is quite right when he points out that mgrunk's data is getting worse as the pressure rises. Furthermore, at the higher pressures, mgrunk is getting NR's which in DeVilbiss lingo are non-responsive apneas, meaning central ones.
The DeVilbiss has a tendency to zoom up sometimes, for no know reason - limiting the max is therefore a good idea.

And all these changes have been going on within 2 weeks.

For all these reasons, I think following advice by journey is spot on:

journey wrote: I would suggest you may consider going back to 6.5 as the lower and say 9.5 as the higher which is 2 above the 95 percentile you had initially and try this for a number of days (say two weeks) to get some trend in your results.

Well, last night's numbers were even more interesting - I set the lower limit to 7.5

95th Percentile Pressure 13.5
90th Percentile Pressure 13.0
AHI 8.5
Pressure Plateau Time 2%
High Leak Flow Time 0%
NRI 0.50
EPI 1

So, the AHI came down a bit, but I hit my top limit.

I did have 4 or 5 times waking up w/ puffing. I tried three different masks last night - a liberty hybrid, the swift lt for her, and a generic type nasal mask. So, it's just a very fragmented night.

I can try setting it back to 5 - 10. I didn't have any centrals during the sleep study - but I wasn't titrated there. My REM period didn't come until the end of the sleep period. I had 29 hypopnia's during the 16 minutes of REM sleep.

True, but I did say "statistically".
However, in my opinion, using an APAP in a range of pressures when you are one of those "statistics" (one who has Centrals) is not the smartest thing to do.


Den

Michelle,

I would strongly suggest using a straight pressure (CPAP mode).

Do you have the software? Where are these numbers coming from? (LCD or software reports?)


Den

It's a smart code system - so I take the code and input it on the website.

Wulfman wrote:Michelle,

I would strongly suggest using a straight pressure (CPAP mode).

Do you have the software? Where are these numbers coming from? (LCD or software reports?)


Den

I agree that could also be a good way of finding out you best pressure.
I would start out at 7 or 7.5

O.