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I previously posted 3 nights each of two different CPAP settings. I was thinking my new knowledge of my Airsesnse 10 Autosense APAP capability and new Board membership using Oscar would work better for me using the APAP mode. I was a longtime user at a fixed pressure of 11 with an EPR of 3 who looked for a CPAP solution to a possible medical problem with daytime dizziness. I am going in tomorrow to my family doctor to rule out any other medical condition and intend to ask for a referral to an ENT if that looks OK
Now my issue is I was completely surprised by the results of my titrations last step. I posted 3 nights at APAP 11-16 EPR 3 which showed better results than the 3 nights of fixed CPAP. I only had 1 night with about 20 minutes of dense pressure limits and high density of OA and H tags. The APAP pressure tracked potential problems each night and maxed out at 16 before coming back down again. Bonjour asked me how I felt and I said I felt rested in the morning but felt a little groggy the one night that I had the cluster,. Sleeprider gave me a good explanation of the value of pressure support using higher levels that BPAP can support. I also got the paper by Dr. Barry Krackow wrote about Flow limitation/UARS and BiPap. Great article and it caught my attention for some of the anxiety that some individuals feel in their sleep.
Since I was maxing out on the APAP setting of 16 and still not fully controlling the one significant apnea cluster in the 3 nights, BTW the soft neck collar was on all the time now so no chin tuck. I was recommended to take the upper limit to 18, still with EPR of 3. The 3 nights at 11-18 were almost without an episode and didn't max out the upper limit of the APAP setting even though it was tracking something each night. I was ready to declare victory. I felt rested in the morning. Then the anxiety episodes hit me. At first it started a couple of hours after waking up and lasted all mornining. Then it lasted all day starting a couple of hours after waking up. It was very uncomfortable and added to that my BP also went up.
Last night I thought about what could be causing this. I figured it must be the large expiratory pressure what much more that what I was used to and it was catching up with me. Last night I lowered the APAP setting to 11-14. Another surprise. APAP didn't max out, my numbers were good, but I only got 3.5 hours of sleep and had high anxiety for most of the day. Just coming out of it now.
I posted here the one night with the 11-16 episode. One night with 11-18 (out of 3) and last nights 11-14. All at EPR 3. Does anyone think I need to start over with titration at a lower level? I do have nasal breathing problems, deviated septum and long time ago got turbinate reduction surgery --not too effective. I stopped using Flonase but started in again last night. I was thinking 9-14 EPR 3. Also I was a very heavy snorer before my first CPAP about 12 years ago so I do need inhale pressure to open me up.
The results look fine, with the December 3 looking best of the examples above. November 27 shows an obstructive cluster, but it seems to be resolved more recently. Flow limitation is a significant feature of your therapy, and I think you will be much more comfortable with additional pressure support from bilevel, but with very good AHI, it's unlikely your doctor will prescribe unless he is very open minded, and insurance is unlikely to pay. Good used bilevel machines are widely available through resale channels.
I have not seen anxiety as a consequence of therapy, whether it is good or bad. I would look at other factors than CPAP use. For some reason, it seems once people start using CPAP, the therapy becomes the solution or gets blamed for everything in their life. It's just a matter of getting better sleep with fewer arousals.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Do you find it difficult to exhale against the pressure? You might have done better on Max 14 because it was easier to exhale, your flow limitations are also lower on Max 14.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
My thoughts as well Sleeprider on the anxienty as well as the dizziness issue. I was just hoping the anxiety reference in Dr. Krackow's paper might also apply during the day. It would be nice to get a universal solution as sometimes things have more than one cause and are related. Thanks.
(12-04-2019, 03:59 PM)JoeyWallaby Wrote: Do you find it difficult to exhale against the pressure? You might have done better on Max 14 because it was easier to exhale, your flow limitations are also lower on Max 14.
I seemed to have settled in to all the pressures and didn't feel uncomfortable until after waking up. I wasn't sleeping long that night and assumed I was still recovering from 3 nights at 11-18.
It's been a over a month since I last posted on my issues with setting my APAP after using fixed pressure of 11 for 12 years. I went back to my general physician who is not a sleep specialist about the dizziness and rise in blood pressure. I was still in the middle of adjusting APAP settings and had a problem with 11-18 setting--at least I thought so. It was not with the OSCAR results but with the hours long anxiety attacks afterward. Dr. recommend bloodwork and an echocardiogram. When those came back OK, he prescribed an additional BP pill, a water pill for blood pressure and Zoloft (centraline) for the anxiety. I showed him my Oscar charts and he said they looked fine becaise AHI was under 5. I even told him reluctantly that I had changed the pressure myself with the boards help. He didn't seem upset even though he is the doctor of record for my DME. He though my machine was already set for APAP and his opinion was that it could self titrate with a large range of settings.
A couple of weeks later I saw a sleep specialist Dr that I hadn't met before. He wanted my original sleep study results, which I didn't have and couldn't get. I still wasn't certain that my issues weren't related to the CPAP settings. I went prepared with some OSCAR charts of the settings I had been using for a couple of weeks at 11-17. I also had some earlier charts with a fixed 11 pressure and a couple with 9-14 APAP that showed the dense apnea clusters of about 20 minutes in length once or twice a night. He looked at them and when he realized I knew how to change the pressure, I explained about the Apnea Board user group and my recent awareness of how much the technology had changed since my last sleep study.
After I got a scolding about how I shouldn't have changed the pressure, I knew I had the wrong doctor. I offered to bring the chip in and that was fine but he wouldn't allow me to change the pressure myself to what he recommended. He wanted me to do 4-16 for two weeks and then maybe a sleep study. I had just finished two weeks at 11-17 with what I thought was good results. When I asked him if he thought the charts showed I had achieved good results he just said no but didn't give me an explanation. I thought that encounter was interesting, maybe not a surprise from what I have read here about others expeiriences.
Fast forward to my current situation. My BP is now controlled and I have not experienced any more anxiety attacks. I have nearly a month on the 11-17 pressure with EPR 3. The results do vary night to night, but I am never over about 1.5 and most nights under 1 on the AHI. I still have a problem with stuffy nose that isn't related to seasonal allergies. I use Nasacort spray and it does seem to help. The F20 airtouch full mask seals wonderfully and I rarely have to open my mouth to breath. I still have a psychological problem going back to the "quiet air" elbow. I had been used to hearing the venting from the mask and think I may have panicked when I reallized the new elbow had replaced the old one and now I couldn't feel any venting. It is truly is quiet. I modified the quiet air elbow by removing the plastic diffuser and can feel the comforting sound of the vent air. I still have one quiet air that I will eventually try again.
I attached 3 recent charts. I want to thank the Board for just being there and providing such helpful advice. Special thanks to Bonjour and Sleeprider. I do feel more rested and can go back to not worrying about CPAP again. I must admit though that I still read my charts every morning.
Congrats on your victories. Hopefully it'll continue. Seems like sleep Duck quacks a bit IMO.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Congratulations on your perseverance and success. Recognizing that xPAP is just air to stop events and can’t solve the world’s problems is a big step in pursuing other medical areas that might need some attention.
As for the elbow, I bought a standard non-quiet F20 off eBay for less than $20. This is the first elbow I have ever purchased in years of xPAP, but I did so because there have been posts about the quieting foam developing dark spots. I haven’t used it yet, but I don’t think I’ll need to buy another.
Looks like your doing well. You may want to increase your min pressure t0 12 0r 13 since your median is over 13. Also, flow limitations are driving your pressure to the max. You may want to try a max of 20 and see what happens. It may be a positional issue that can be resolved with a soft cervical collar (See the link below).
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(01-09-2020, 03:24 PM)Melman Wrote: Looks like your doing well. You may want to increase your min pressure t0 12 0r 13 since your median is over 13. Also, flow limitations are driving your pressure to the max. You may want to try a max of 20 and see what happens. It may be a positional issue that can be resolved with a soft cervical collar (See the link below).
Thanks for the comment. I have been using a soft cervical collar at the suggestion of people here on the board. It isn't uncomfortable and the dense clusters I was originally seeing were similar to others who were having chin tuck issues. I didn't know it was a common problem. I eventually want to take it off and see if it changes anything. I was also worried that my pillow might be blocking my vent when I was on my stomach, but now that I have been paying attention to it, I don't think it is.
As far as the minimum pressure I have quite a few nights that don't max out at 17. I was worried about increasing farther than 17 becasue of comfort. The lower limit of 11 is comfortable. The nights I posted were ones that I was having some nasal stuffiness, I believe. I'll continue to monitor especially during spring when pollen starts kicking in.
