Evaluate me! Also - my provider and his hogwash...

[matsarge]

First of all, I'm posting my OSCAR study.  I've been at this for 4 nights.  I wrote my provider, and he first told me not to change the settings on the Dreamstation Auto, that only a licensed pro can do that (bologna, I know.)

But he also told me "From your therapy on the 6th I see your mask leak is at 18.4, which is a very good fit. I would stick with that size. Your AHI has dropped from 93.7 down to 13.8. Which is exceptional and very good therapy. With severe apnea, you should not expect you AHI to drop into the normal range of 5 or less."


Are you telling me i'll never have a good AHI range then?

Attached are my results from last night.

Total hogwash. My supine AHI was 98 and my average AHI from the last 2 months using the Dreamstation Auto has been about 4.5. Since being on the forum and getting advice on the pressure, I have it down to around 2.5 AHI. You have lots of room to improve.

[Dormeo]

Thanks, jaswilliams. Ramp was on Sleeprider’s list so I wanted to flag it. Sounds like that shouldn’t be necessary.

Ministerman, about the message from your provider. I’ve been reading apnea posts for some months now, and it is simply not true that a person with severe apnea should be resigned to an AHI above 5. It is also not true that you are barred from changing your pressure settings or that the machine will somehow be thrown off if you do.

[Sleeprider]

Also - here's the reply from my provider, John Knotts, RPSGT, Somno Services, LLC., who can be found at www.somnosvc.com

"I have reviewed your therapy data and I am seeing one nights use so far on the 6th, it does take a day or so to send data over and you do have to open the app in order for it to send.

 
From your therapy on the 6th I see your mask leak is at 18.4, which is a very good fit. I would stick with that size. Your AHI has dropped from 93.7 down to 13.8. Which is exceptional and very good therapy. With severe apnea, you should not expect you AHI to drop into the normal range of 5 or less.
 
You should not attempt to adjust any clinical settings such as pressure on your CPAP. Your PAP machine is an APAP, Auto Positive Airway Pressure and it adjust the pressure for what you need and learns you breathing patterns and events and will make adjustments as needed. If you attempt to adjust pressure you will throw the computer off and it will not know how to react. Not to mention pressures can only be changed by a licensed professional.
 
The feeling of not getting enough air and having to much pressure to exhale against, in most cases is a psychological issue. I always recommend practicing when starting out with PAP therapy. While watching tv in the evenings or on the weekends. Practice taking slow controlled breaths, don’t let the PAP Device dictate when you inhale or exhale, many people feel they have to increase their breathing rate, Just breath normally.
 
All in all for your first week everything looks really good. Give it some time to learn your respiratory rate and your OSA / sleeping habits and lets see how it goes and I will look back in on the data near the end of May.
 
Let me know if you have any other questions."

Although your provider is trying to be encouraging, and point to the significant improvement of your therapy compared to yoru untreated test results, this is complete crap.  With auto CPAP therapy, my expectation for new users with unoptimized machines is an AHI less than 5. With optimization I expect consistent results less than 3 and generally less than 2.  Your results are 100% obstructive, yet your machine does not move above 8-cm.  I have not seen this in a properly functioning machine, but have rarely seen this behavior in machines that were eventually replaced under warranty.

Obviously, we have seen results similar to yours, but we can count on the machine to properly react, increasing pressure. When obstructive apnea fails to respond to higher pressure, we have other tools in reserve. So far, your machine has not done its job, and unless it responds much differently with teh changes we have suggested, you need to replace it. My advise is that you don't replace it with another Philips Dreamstation Auto, but a Resmed Airsense 10 Autoset.  At this point, your results are among the worst I have seen with CPAP therapy. I have posted examples of similar high obstructive AHI in the Wiki article on Flow Limitation, where obstruction was found to be positional in origin. http://www.apneaboard.com/wiki/index.php...Limitation  Take a look at the similarity of the "before" positional apnea image here to your own, but at much higher pressures. the AFTER image is using positional therapy:



AFTER:

[Ministerman]

I'm up and moving this morning - i'm a preacher and I have studying to do before my sermon. Thought i'd quickly share my dreammapper results - don't have time to do the OSCAR stuff this morning.

Usage - 6:06 hours
Mask fit - 100% (although, didn't feel like it with the pressure higher!)
AHI - 9.9
Min pressure - 7.5
Max pressure - 20
90% pressure - 12.4
Total clear airway apneas - 27 (highest of these it's been)
Total obstructive apneas - 21
Total Hypopneas - 13

So, that's the best AHI i've had since I started. And the 90% pressure FINALLY seems to have bumped up. I started off with my full face mask, but just can't get used to it. I switched back to just the nasal mask - and it seems to be better.

I could tell the pressure was higher last night.

Can you all tell me - how do you usually feel while the machine is working? I don't know how else to ask that question, and I don't know if it makes sense. I always envisioned a cpap machine forcing air into your throat like a leaf blower -- but that's definitely not the feeling I get.

[Gideon]

Please post your OSCAR charts when you get the chance..

You can feel the Leaf Blower effect if you disconnect your mask from the hose. That is the blower trying to achieve your set pressure. If you put your hand over the end of the hose you will here the blower immediately slow down. The pressures, even the "very high" pressures your machine generates are in reality very low. An experiment for you to generate the maximum pressure a CPAP is designed to generate. Get a tall glass of water. I mean 8 inches tall. Now grab a straw and with the straw at the bottom of the glass blow through the straw. That is the maximum pressure your machine can generate.that is a setting of 20.

Clear Airway events are not uncommon while awake and we can ignore events that occur while awake. Typically these occur when we hold our breath while changing position, tossing around in bed.

[Sleeprider]

For me, CPAP and Bilevel therapy "feels" like my airway is being expanded. There is no sense of flow, just light pressure that keeps the nasal passages and upper airway open. If you feel flow or a blower effect, that would be an indication of a leak. Remember CPAP stands for continuous positive air pressure. It is not a blower, and once the pressure is achieved, the amount of flow is only enough to maintain the pressure, and support the intentional leak at the mask vent. Think of inflating a tire. Once the pressure is reached, there is no airflow at all. The flat tire is inflated, and as long as pressure is constant, it will stay that way without additional air.

Many of us have little or no perception of the pressure and airflow. Moving the mask away from your face results in a rush of air as the machine increases flow to compensate for the loss of pressure, but the instant a good mask seal is achieved, the flow slows to very low levels. Many members describe pulling the mask away just to know the machine is working. Once you have adapted to the therapy, you feel nothing at all other than your airway is no longer obstructed and you are free to breathe through your nose. I am chronically congested, especially in allergy season, and the CPAP inflates my sinuses and airway allowing easy breathing.

[Ministerman]

Okay - so i'm posting my OSCAR charts from Sat. night and a Sun. afternoon nap.

My Sat. night actually looks better than I thought -- I got up and turned the machine off to go to the restroom, so my first part of the night is labeled part 1 below.

The second part is labeled part 2.  The combined is labeled combined.

Then I also posted my Sun afternoon nap as well.

The first part of Sat. night I actually had an AHI of 6.75 - wow!  And it also looks like raising the minimum pressure really helped.  Oddly enough, I didn't think it went so well, but that's because I was having issues with my mask.

The second part of Sat. night was much much worse.  AHI of 19.  I switched masks from the full face to the nasal.  But it looks like the pressure never climbed up to what it needed to be.

The Sun. afternoon nap - AHI of 7.9.  My assumption - looks like I need to bump the minimum pressure even more --- but i'm still new at this.  What do you all think?

All in all - I really feel like I turned a corner.

[ajack]

If it was my chart, I'd move the min pressure to 10. It may need a bit more as you go along. I wouldn't worry about the CA till after the first 12 weeks. It often happen with new users and your machine can't treat them.

I think your main problem could be positional, tucking your chin to chest and constriction your airway. When there is a large difference and clustering, it is often the case.

[Ministerman]

If it was my chart, I'd move the min pressure to 10. It may need a bit more as you go along.  I wouldn't worry about the CA till after the first 12 weeks. It often happen with new users and your machine can't treat them.

I think your main problem could be positional, tucking your chin to chest and constriction your airway. When there is a large difference and clustering, it is often the case.

Well -- I do sleep on my back some, with my chin tucked to my chest, because i'm overweight.  Working on that as well.  I always start out on my back,  and then to my side.

I changed my pillow today too. My other one was too thick, I believe.

[ajack]

Yes, you want your neck supported and the chin up, head back, think like CPR. Some use a $10 foam cervical collar or one of the other travel or snore ones. Once the airway is open, it's just a matter of how much min pressure is needed.