Assistance with wife's CPAP issues

[Hammer641]

My wife has been on CPAP almost one year now (I have been on CPAP for several years).  She is using a ResMed 11 with a P10 (she has a bleep but is not using it right now).  Her AHI is still running in the single digits (started over 50) and she is still tired a lot of the time.

When looking at her OSCAR data when her flow rate is flat (OA) her mask pressure seems flat.  Mine is far more consistentant even around an OA. 

Comparedaring to mine - mine is far more flat without the peaks hers has (not sure if this is an indication of anything or not).  I will put a few screen shots with the message.  

Please let me know what would help to see.

Any help would be greatly appreciated.

Thank you

[Phaleronic]

Welcome to the forum Hammer641

She is having way too many obstructive apnea events, mainly because she's using EPR @ 3 and a min pressure of 5cm, please turn min pressure up to 7.6cm but she will need higher pressure, that will help for now, please have her try this new pressure before bed tonight, and also lower minimum pressure to 19cm. Her 99.5 percent pressure is 19cm (which is high), she likely needs bilevel therapy but for now let's gradually turn up minimum until those OAs are knocked down.

[OpalRose]

The first thing I see are the "clumps" of apneas (Obstructives).  When we see apnea clumped together, this indicates
Positional Apnea.  She is sleeping in a way that is cutting off her air.  Could be from "chin tucking".   Is she using more than one pillow, or a too tall of a pillow which could cause her head to tilt forward into her chest, cutting off air... sort of like a kink in a hose.  This needs corrected, as other pressure changes/adjustments may not help much.  

Change to a flatter, but firmer pillow.  This will help keep her head and neck aligned.  Some folk use a soft cervical collar to help.  Read through this link so you have a better understanding:

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Second, she is using the "For Her" mode.  She probably would be better off using the regular "Auto" mode.

Next, I'll suggest some changes to settings which may or may not help until she can overcome the positional apnea.

Her median pressure is around 13cm, so let's change her starting pressure at that point.  Continue using EPR set at 3.
So....
Minimum set at 13 (IPAP)  
EPR set at 3.  This will give her an EPAP of 10.  (We need to keep her Epap around 10 to help keep her airway open.)

Repost after a couple days and let us know how she is doing.

[quiescence at last]

Her chart shows that OAs are happening even at 13, and setting 13 as a minimum has little chance of reducing the OAs.  I'll be interested in the next graphs.

I wonder if you can provide a 12 minute close up view of the period between 02:08 to 02:20 from the Aug 30 night. I anticipate she transitioned to REM sleep during that period.

It is highly likely that she was in REM Sleep to nearly 3:30.

Her machine stops at 3:30, suggesting that she woke up.  Did you happen to hear her say she was dreaming?  Can you ask her if she does recall having dreamed?

QAL

[Phaleronic]

Well, the issue is we can't just ramp her pressure up from 5cm to 13cm or more without her having major issues with keeping the mask on, a nearly 3cm jump in one night is enough to begin with, we know she needs more pressure but to move from 5cm to 13cm in one pressure change (or more) is asking quite a bit of person that is normally on 5cm, we don't want her to curtail therapy.

[quiescence at last]

The chart you posted shows a machine reaction that raised the pressure from 5cm to 19cm rapidly. That whole night the pressure was well above 12, so she really didn't enjoy 5cm breathing (and sleeping).

Getting her to 13. You can ramp starting at 7cm and running 10 minutes. 7.0 is likely to feel alot like starting at 5.0. The increase during the ramp is gradual enough that it may not be noticed.

Best of luck, whatever you choose.

QAL

[OpalRose]

Well, the issue is we can't just ramp her pressure up from 5cm to 13cm or more without her having major issues with keeping the mask on, a nearly 3cm jump in one night is enough to begin with, we know she needs more pressure but to move from 5cm to 13cm in one pressure change (or more) is asking quite a bit of person that is normally on 5cm, we don't want her to curtail therapy.

Well, if you studied her pressure graph, you would see that within a  wry short period of time, her pressure jumps up to over 12cm and stays there for most of the night.  So, essentially, she is already using high pressures.  

I've did explain that yes, she needs higher pressure, but that my recommendation for raising pressure probably won't make a difference until she addresses her Positional Apnea.  We have seen this problem many times on the forum.  

The positional issue needs to be addressed first.  

https://www.apneaboard.com/wiki/index.ph...onal_Apnea