Advice re: changing CPAP settings

[fyrfyter43]

Good morning! I am back with some more data. 

Monday night I set my machine to auto, min 6.5, max 6.5, as suggested by Sleeprider. I also switched back to the P10 mask. I noticed that I was waking up quite a bit more than usual. I think it may have been some discomfort with the mask since I have become pretty comfortable with the DreamWear I've been using for the past month or so. 




Since I think the mask may have been part of the problem Monday night, I switched back to the DreamWear last night. I definitely slept better, only waking a couple of times. I also noticed that the added humidity and larger cushion still seem to help with the congestion, so it probably is not just a fluke that it helped Sunday night.



I think tonight I'll increase pressure to 7.0 and continue with the DreamWear mask and see if I have any further improvement. 

Oh, one thing I should have mentioned, although I don't know why it would have a long-term effect. The elevated AHI also corresponded with a surgery I had in late January. The surgery was tarsal tunnel release (for neuropathy in my foot). I'm sure the percocet I was taking for the first several days played a role, but I don't understand why the trend would continue for more than 2 months.

[xxyzx]

Good morning! I am new to the forum and am looking for some advice regarding changing my CPAP settings.

I started CPAP therapy almost 1.5 years ago. My initial pressure was 13 cmH2O. I did fairly well at that pressure, but still didn't feel quite as good as I should. My average AHI during that time was 2.90, with very rare nights where it went above 10. I also found that I was still up 3-4 times every night.

 After a year of therapy, my doctor ordered another sleep study. My pressure was lowered to 6 cmH2O. Since then my average AHI has been 8.47, with several nights above 30. The majority of events are hypopneas. 

My first thought is to call my doctor and have him change my pressure back to 13 cmH2O. However, I am not very comfortable with this doctor. To my knowledge, he has never reviewed any of the therapy data. I found out that he has an undisclosed financial interest in the sleep center, so I suspect that his answer if I contact him will be to send me for yet another sleep study. Since the sleep center is out of network for my insurance, it has been a fight to get each of the past sleep studies paid for, with the sleep center telling me that the portion of the bill which I am responsible for will be written off once I schedule my next study. I still haven't seen a bill for the most recent study from December, although my insurance is denying it as not medically necessary.

I have found the clinician setup manual for my machine. My only concern is about the compliance data sent to my insurance company. I have read the part in the Wiki about changing your own settings, and the fact that it is not illegal to do so. But I don't know whether or not I could have an issue with my insurance company if I do change the settings, or if they would even know. My thought, since my machine is an auto CPAP, is to set it to auto with minimum pressure at 6 cmH2O. 

Also, is there any reason I need to continue seeing this doctor? What happens as far as my prescription if I were to switch to another doctor?

i would tell him things are worse and ask him to change the pressure
he sends in order they do it 

otherwise i would see another doctor

afaik insurance only cares about your usage level not whether it works right for anybody

why did he lower it
people change
different studies get different numbers depending on the gear they use, the gear you have, and your condition during the test
i dont know enough to say it is safe to increase without knowing why they changed it down 
i would guess it is probably safe but i would make changes 1cm at a time over a two week period before increasing again to be safe

[Sleeprider]

Fyrfyter, the fixed pressure seemed to help once you got the mask issues sorted out. I agree with the increase in pressure to 7.0 based on what we're seeing. What we're looking for is less sleep disruption, and that escalating pressure that just seems to end in higher events. I'm glad you pushed through to a second trial as the results look more promising there. Any thoughts on what causes the therapy interruption at 23:45 to 00:20?

[fyrfyter43]

Fyrfyter, the fixed pressure seemed to help once you got the mask issues sorted out.  I agree with the increase in pressure to 7.0 based on what we're seeing.  What we're looking for is less sleep disruption, and that escalating pressure that just seems to end in higher events.  I'm glad you pushed through to a second trial as the results look more promising there.  Any thoughts on what causes the therapy interruption at 23:45 to 00:20?

Yes, the disruption from 23:45 to 00:20 was because of 2 trips to the bathroom because of some latent intestinal issues. (Without going into too much detail here that's not relevant, I'm missing about 1/3 of my colon.)

[Sleeprider]

Well I hope you find it before I do...yuck!

Understandable break, and just checking it was unrelated to the machine therapy, which is looking pretty good.

[fyrfyter43]

After a decent night at 6.5 cm, I tried increasing pressure to 7 cm. I gave it 2 nights to make sure it wasn't just a bad night. My AHI was higher, as were my CAs. 






Finally, to try to satisfy myself, I tried returning to my original pressure of 13 cm last night. I found that I woke up much less often than I do at lower pressures, but my AHI (and CAs) were again high. The first time I woke was after about 5.5 hours, and I felt as if I had been sleeping very well. However, the numbers tell a different story.




Looking back over the past few months, my troubles started with the decrease in pressure from 13 to 6, but then became worse after my foot surgery. I'm not sure why the surgery would have made a difference, especially once I stopped taking the pain medication. The only thing I can think of is that the change in my sleep routine is the source of my problems. I will soon find out, though, as I am finally back to work on Monday, and will be back to my normal routine.

[Sleeprider]

Your pattern of AHI and response to pressure has some characteristics of complex sleep apnea, although it is a bit on the mild side to qualify for ASV. No doubt most of your events could be resolved by ASV. You might try a return to the lower pressure, combined with turning off all AFlex and CFlex comfort options. This sometimes will reduce the CA and H events.

[fyrfyter43]

Last night I went back to 6.5 cm with flex turned off, but it was one of the worst nights I've had. The only thing I can think of is that I was using the medium DreamWear cushion, rather than the large that I used the last time at 6.5 cm. (I had used the medium when I jumped up to 13 cm because the large leaked at that high of pressure.) Tonight I will switch back to the large and see if there is any improvement.

I'm hoping that after I return to work and my normal schedule tomorrow, I regain some control over my symptoms. Although even when my AHI was much lower I still had many of the symptoms I was originally complaining of that lead to my sleep apnea diagnosis.

[Sleeprider]

Did you have centrals during any of your sleep studies?

[fyrfyter43]

Did you have centrals during any of your sleep studies?

Honestly, I don't know. All I was told was that I averaged 55 events an hour. 

I think if I don't see any improvement in the next couple of weeks, once I get back to my normal routine, I am going to have to find another doctor who is interested in my treatment, rather than in just making money sending me for yet another sleep study. I've been trying to avoid that because there is still an outstanding bill for the last study which insurance has denied.