confused over settings

the sleep lab titrated me on 18/14- I weigh about 180 now at BMI 24 and at 18/14 I have 97% O2

the new sleep doctor told me she has a theory that I have OSA and I was wrongly titrated too high. apparently the high pressure was giving me central apneas. so they are going to switch me back to bipap auto from bipap st and to some 15/5 setting? how do I set this on the machine?
I also got some resmed masks, but I like the gels on the philips better. resmed full face mask has this screw you can tighten to close off leaks near the eyes.
the sleep doctor also told me that my energy and blood levels should improve.

I'm not sure though if my memory will return or I have permanent brain damage?

anyway my energy still fails me and I can't do complex mental tasks

sickwithapnea17 wrote:does OSA change to hypopneas if you are on the wrong pressure? I have hypopneas on 14/10 on bipapst but the sleep doctor thinks I have OSA

A diagnosis of OSA is based on the total AHI, not the break down between hypopneas and obstructive apneas. Many of us here on the board have OSA diagnoses based either solely or primarily on the number of hypopneas scored during our diagnostic sleep study test.

The difference between an obstructive apnea and a hypopnea is just a matter of degree: With an obstructive apnea, the airway is completely blocked for at least 10 seconds while the effort to breathe continues. With a hypopnea, the airway is partially blocked for at least 10 seconds; since the blockage is only partial, some air can still get in on every breath. But the blockage is severe enough where the amount of air getting into the lungs is significantly less than normal: Under one scoring criteria for hypopneas, the air flow must be reduced to less than 50% of the base line airflow. In other words, during each inhale, you are taking in less than half the air that you normally take in. And this severely restricted intake of air on each inhale can lead to O2 desats and arousals in the same way that obstructive apneas do. Hence they can be just as disruptive of your sleep as full apneas are.

I went to see the new sleep doctor and she told me that I have OSA and I was wrongly titrated too high. apparently the high pressure was giving me central apneas. so they are going to switch me back to bipap auto from bipap st and to some 15/5 setting? how do I set this on the machine?

Some folks do indeed develop central apneas from being put on CPAP/BiPAP with too high of a pressure. And folks with very high CPAP pressures (above 15) may be more apt to have this happen.

It appears that you have some doubt about the new settings. You really ought to ask for a written copy of your prescribed settings for your own records. And there should be any question in your mind about what the settings are supposed to be.

As for how you set this on your machine: I'd recommend having the doctor give you a written copy of the prescription and fax a copy over to the DME. Then take the machine into the DME and have them change the settings for you. And ask them exactly what the IPAP and EPAP settings are. And ask them to confirm that the machine was put back into Auto BiPAP mode instead of BiPAP ST mode.

thanks for your message!
the sleep doc told me that my settings should range from 5 to 15 on auto pap but that I need to change from bipap st to the biflex philips machine. does this mean I should set min EPAP to 5 on max IPAP to 15? the problem is on my machine if I set Epap 5 the IPAP seems to get stuck on 7cm.
maybe she is just being kind by saying my memory damage is temporary? I read one study where long term the short term doesn't return to normal with OSA
my BMI is about 24, I weight 180 pounds but maybe I could lose 10 pounds or fat in the neck area.

maybe the resmed asv has better programming to match your breathing

sickwithapnea17 wrote:thanks for your message!
the sleep doc told me that my settings should range from 5 to 15 on auto pap but that I need to change from bipap st to the biflex philips machine. does this mean I should set min EPAP to 5 on max IPAP to 15? the problem is on my machine if I set Epap 5 the IPAP seems to get stuck on 7cm.

You need to clarify what the doctor wants by getting it in writing. Guessing about the pressure settings is not going to do you any good. And since you are having real problems processing verbal information, I think it would be best for the doc to fax your prescription to the DME and have you take the machine in for the DME to change the settings for you.

I can tell you this about the Philips System One BiPAP Auto:

If your settings are:

• min EPAP = 5
  max IPAP = 15
  PS = ??? (This needs to be set too)
  

then at the very beginning of the night, your EPAP = 5 and your IPAP = 7 because at the beginning of the night, the System One sets IPAP = min EPAP + 2.

But your IPAP is not "stuck" at 7cm: During the night, the IPAP pressure will increase when the machine detects hypopneas and flow limitations. The EPAP will increase when the machine detects OAs and snoring. IPAP and EPAP will both go up together if EPAP needs to increase and IPAP-EPAP = 2. IPAP and EPAP will also both go up together if IPAP needs to be increased and IPAP-EPAP = PS. Neither the IPAP nor the EPAP will increase when the machine detects CAs.

For now you need to follow Robysues advice and have a DME change the machine settings. Once your mind starts to clear from the fog you can try setting things yourself. You also need to stop reading all these studies. You are having problems processing information, so the less un-needed information you take in right now the better. You need to do what the doctor says for now and give the machine a chance to help. Once you start understanding more you will be able to try different things to optimize treatment.

Brenda

wow I had the worst night in months- my sa is getting much worse and I really sleep worse on the bipapst on 11/9 then I do on bipap auto on higher settings like 15/11. the sleep lab gave me a setting of 18/14 on the last study which showed 97% O2 so maybe this is the most reliable data I have and not my sleep docs opinion
it's strange I read my card today and while I didn't sleep all night on the machine I had only central apneas and hypopneas. think it's 8 centrals and 1.5 hypopneas.
0 osa's. I still wake up with the swollen throat, mucous. maybe there's a chance the machine is misreading my osa's as centrals?
so maybe this sleep doc is incorrect. it was strange she didn't give me any meds when I asked for restoril. and then she completely ignored my request to review my data card. I took some gufalsein, valerian root, and sleeping pills (sominex I think OTC succinate) so maybe that could have caused problems. but I can't function at a high level like this or take advanced classes

I still don't know how I could have centrals since I'm not that old and I don't have any heart/brain problems? I have high blood sugar and low testosterone
don't I have the classic signs of mixed apnea which becomes centrals on cpap?

1st- Everyone will have some nights that are worse than others.
2nd-Where did the pressure of 11/9 come from?
3rd-It's not so strange that the doctor didn't give you any meds, She may think you already self medicate too much.
4th-gufalsein, valerian root, and sleeping pills (sominex I think OTC succinate - Just what did you take?
5th-Age does not cause centrals
6th-You may not have heart problems but I would have to argue that your brain is not functioning normally

Brenda

I tried the 18/14 pressure and it worked! I feel rested finally- I had to tape an oven mitt to my hand.
The sleep study said I have 97% o2 up from the dangerously low 75% at 18/14 pressure
no this sleep doc seems bad, like she is changing the settings without any oxygen readings- they need to send me back to the lab for a study since I am waking up with these hugh hot flashes and brain fogs
anyway this person was beating me at home

Why are you telling me to not read STUDIES? do you not want me to get better?

sickwithapnea17 wrote:I tried the 18/14 pressure and it worked! I feel rested finally- I had to tape an oven mitt to my hand.
no this sleep doc seems bad, like she is changing the settings without any oxygen readings- they need to send me back to the lab for a study since I am waking up with these hugh hot flashes and brain fogs
anyway this person was beating me at home

Why are you telling me to not read STUDIES? do you not want me to get better?

Have you ever read Darwin?

does restoril or other meds work? see these docs they will just string you along to make money and not give you medicines you need
don't you see the information on these forums is not always reliable depending on the source especially if they choose to ignore SCIENTIFIC STUDIES

sickwithapnea17 wrote:Why are you telling me to not read STUDIES? do you not want me to get better?

Congratulations on having a good night, I hope you have many more.

However one note: a lot of people have had a lot of patience taking up their own personal time to try and help you even though you have repeatedly asked the same question many times in many threads and often have ignored a lot of the advice given (my own included).

So I think a 'thank you' to those members who took time out of their day to try and help you without asking for anything in return would be a lot more appropriate than jumping all over someone by saying something stupid like 'do you not want me to get better'. I read that post and that person is actually trying to help you out but you choose to ignore that.

Some folks have already given up on trying to help you, and if you don't show a little appreciation, then those who are still here will also give up and go help someone else and you'll find yourself both sick and alone.

I don't understand why this doc is changing my settings when she doesn't have any O2 data?
the sleep lab test showed that my O2 goes up to 97% on 18/14 so it seems like I should keep it that way rather than switching to this 15/5 setting. I seem to be only sleeping 2 hours a night on the machine though because of the high pressure and waking up several times

ask her -

she told me that she had this theory that I had OSA but my machine readouts show only central apnea and mostly hypopneas when I do sleep on the machine
the graph is broken up though the x axis goes up to 8- usually there is only a small fragmented line for 2 hours a night (it says 12pm though at the top)
ok I will try again

I don't see how the doc can possibly predict what my O2 level will be on a new setting without a sleep study- I think it's best to get another study at a different place