First time PAP user. Need help interpreting graphs.

[kayblitz]

Hi folks,

I am helping my dad with his PAP treatment. He recently got a Lofta take-home test with these results:

• Obstructive Sleep Apnea (G47.33) - Severe based on pAHI=60.5 and O2 nadir of 69%
  
• Central Sleep Apnea (G47.31) - Moderate based on pAHIc=20.2
  
• Cheyne-Stokes Respirations 18.3% of recording time
  

His AHI is 60.6, so his apnea is pretty bad.

I am uploading information from his first night. The reported AHI is 12.11 which is better, but I think it is still high. We want it < 5 right? Zero is ideal but I am not sure how feasible it is.

He is still not very comfortable with the treatment, but he is willing to continue trying after I showed him the Youtube video you guys have on the wiki. He realizes the harm the apnea is causing on his body now.

One side effect that he says he noticed is that his mouth is dry. Not sure if I need to increase the humidity or not.

We use an AirCurve 10 VAuto BiPAP with ClimateLine and the F30i hybrid mask.

Any suggestions or recommendations based on these graphs?

   
   

[Sleeprider]

Kayblitz, Your dad is fortunate to have a really great bilevel machine, and you to help him. You can certainly see his apnea are clustered into groups. This is the signature of positional apnea, where the patient becomes obstructed by his sleeping position. That is usually caused by chin-tucking from pillows being too tall, or using multiple pillows which is really preventable. Sometimes it happens due to sleep positions that are better corrected with a soft cervical collar. I want you to read our wiki articles on positional apnea and the soft cervical collar. There are some example charts there of past members that have had similar problems, and they show how correcting positional apnea can resolve the apnea.
Positional apnea: https://www.apneaboard.com/wiki/index.ph...onal_Apnea
Soft Cervical Collar: https://www.apneaboard.com/wiki/index.ph...cal_Collar

There are also a few central events. We can wait for him to correct his positional issues, but I'm going to suggest a change in his "trigger sensitivity" settings. These are in the clinical menu and need to be changed from medium to high. This allows the machine to trigger inspiration pressure (IPAP) with less flow and effort to stimulate a breath when a central or hypopnea might otherwise occur. If your dad will tolerate turning off ramp, do that, otherwise change to Auto. For settings, he needs more EPAP pressure for the obstructive apnea. His current median pressures are 16.36/12.36. Clearly his set minimum of 6.0 with PS 4 is not cutting it. I'm going to recommend his settings be modified to EPAP min 9.0, Maximum Pressure (IPAP) 18.0 and PS 4.0 with trigger sensitivity on "High". This along with correction of the positional issues should give him much more comfortable and effective results. So we are reducing maximum pressure, increasing minimum EPAP and putting his Ramp on Auto and increasing trigger sensitivity. Can you handle that? We are not exposing him to any pressures he has not already experienced, and will achieve lower pressure overall if you can set this up.

[kayblitz]

Thanks for the detailed response sleeprider. I am already familiar with the clinical menu, so I can make the changes in there. I will look into the wiki and getting a cervical collar for my dad. It never occurred to me that chin tucking could be a cause for apneas, but it does make sense now that you mention it. Let's see if this helps with his AHI and overall sleep.

[Sleeprider]

Speaking from personal experience, age allows the throat to relax more. If the head and neck position is not aligned, it can result in airway obstruction. None of us sleep as well as we age, but I think you will see a big difference with these position and setting modifications.

[kayblitz]

I have ordered a cervical collar that should be coming in soon. Last night we used the settings you suggested Sleeprider. The only difference being I lowered RAMP to 20 minutes from 45 minutes (there was no AUTO RAMP setting).

There is one question I have about the max IPAP. 18 seems to be too low right? Last night the graph shows 95th percentile he was at the max 18, meaning the machine wanted to go higher but couldn't because we limited it. The night before (my original post), P95 is 21.68 and P99.5 is 23.44. Since it can get as high as 23.44 would it make sense to just leave max IPAP as the default, 25?

What do you think?

[Sleeprider]

This is all positional and will clear up when his head and neck position is resolved. You can return to max pressure 25, but I'm not confident pressure sill fix this. What ever maximum pressure you use, the machine will go there in response to the persistent positional apnea. How many pillows is he using? What is his sleeping position?

[kayblitz]

Got it. I will set the max IPAP back to 25 for now. Once the brace comes in, I will post new results. If the brace works, the positional apnea will be reduced and the machine will no longer compensate for it with higher pressure. When that happens I will move it back down to to 18 or whatever the new results may show. Thanks for the help so far

To answer your questions, he uses a pillow about 3 in high. The original post was with the pillow. Last night I asked him to sleep without the pillow. Only one pillow is used. He sleeps mostly on his back.