[Health] sleep study results and setting pressures

[MastiffMom]

Results from sleep study show ipap 13 and epap 11 with 6 hypopneas and index of 20.8 and O2 of 76. He was at this setting for 18 minutes. This is best index number. Hubby got resumed auto vpap with no limits set. Given fiasco on auto Cpap with it over inflating his lungs so badly we are setting max ipap ourselves. All we hear from DME is that machine can't over inflate lungs ... well it did no matter that they keep saying it can't. His next best index was 23.8 at ipap of 14 and epap of 12 and O2 of 79. He was at this setting for 29 minutes. He sees doc on Wed but needs to use machine before visit. Would a max ipap of 14 be a good place to start? Anything under a ipap of 13 had indexes ranging from 43 to 77. Is the index what we should be looking at when deciding what to set the machine up at? Or should we be looking at # of hypopneas per minute and ignore the index? He only had 1 apnea at minimum pressure at beginning of test. His lungs are apparently very sensitive to the pressures so we want to take baby steps to get things right but also want to set pressures where it actually helps too.

[retired_guy]

Max 14, Min 9 would seem to me to be a good place to start. You don't want the max too far removed from the min. It'll just make the machine cranky. Actually, if it was mine, I'd set the Min on about 11 with an EPR value of 2, and the Max on 14.

The other thing and probably more important at this point is the sleeping arrangement. He needs to be sleeping with his head elevated. Maybe even in a comfy recliner chair until this gets sorted out. Otherwise, in bed, elevated a bit, sleeping on his side. The reason for the high scores while under pressure could very much be because of sleeping on his back.

[retired_guy]

Mom, I was thinking about all this while getting ready to start my day..... (Go Ducks!)

I do remember the problems he had when you first began, but I don't know or recall whether or not he has any COPD issues.

I ask because I have what they playfully call "severe emphysema." What that amounts to is I can breath in but I have trouble exhaling. So air can build up in my lungs making me think they're going to pop, and make me think I cannot get enough air. The reality is I get enough air I just cannot get rid of it.

So for me with cpap, the EPR is very helpful. It makes it easier to exhale by reducing the pressure a dab on the exhale vs inhale. So that's why I end up suggesting you try him with the EPR turned on. Not necessarily because I think he has any COPD issues, but because of his experience with the feeling of being "over-inflated."

I don't know for sure what caused all his issues in the beginning, but I do know he easily could end up concluding he has "sensitive" lungs and that they were "over inflated" by the cpap pressure. In this case they might not have been over inflated, he just could not get rid of the air he was breathing in.

That's why so many of us emphysemiacs end up on oxygen. The idea is if we can get oxygenated with a smaller amount of air being taken in, we won't have so much air in us to get rid of. Which is also the reason I do not allow oxygen in the house. If my emphysema is going to get me down, it's going to have to work for it.

So, even if he doesn't have COPD, you might investigate breathing exercises for him, such as "pursed breathing," and others that encourage him to fully empty his lungs between breaths.

[MastiffMom]

Hi Retired-Guy

No COPD or other breathing issues we are aware of. He was unable to tolerate the exhale pressures on the CPAP even at EPR of 3. BiPap pressure support is set at 4. During the test he was able to exhale with a EPAP of 8 without it bothering him. When I set the max IPAP I will adjust the pressure support a bit as well.

When he had the issue with his lungs he said his chest felt phycially pumped up like he had been lifting weights all day and that his lungs felt like they were filled up and he could not get all the air out yet he felt dizzy and lightheaded and that needed to get oxygen.

we don't know what caused the problem, whether it was his inability to exhale properly or whether the autoset, while it may have been giving him pressures he "needed" the pressures were too much for his lungs to handle right out of the gate. He seems to have a very long exhale so it is possible that with his pressures on the auto cpap running as high as 19 his exhale with an EPR of 3 would have been 16 and he just couldn't get all the air out before the machine was forcing air in again.

We've been told the autoset vpap is much more sensitive with breathng patterns and there are different adjustments that can be made. Hopefully it is true.

Thanks for you help

[retired_guy]

When he had the issue with his lungs he said his chest felt phycially pumped up like he had been lifting weights all day and that his lungs felt like they were filled up and he could not get all the air out yet he felt dizzy and lightheaded and that needed to get oxygen.

Yes. Exactly what I was trying to describe. I know that feeling a lot. Doesn't mean I think he has COPD, don't know about that one way or the other. But it does mean you are on the right track in trying to reduce the resistance to his exhale.

Did they teach him any of the breathing exercises to try to clear up that congestion before? Just sitting around for a little while and doing the pursed breathing to help get as empty as possible should really help.

[MastiffMom]

Of course not ... they just look at him like he's an idiot when he tries to tell them what happened. They just keep repeating "the machine is automatic, it won't give you any more pressure than you need ... it can't over inflate you lungs ... it can't do that" over and over and over. We might not be using the right words but something happened and it was darn scary.

Maybe they are right, maybe he needs the inhale pressure the cpap was giving him maybe it was as simple as he wasn't able to exhale enough ... can't understand why the docs and rt's can't figure that out and just say so. Actually that would be much less scary because with the bilevel we can keep the exhale to something he can tolerate and raise the pressures slowly to what he may ultimately need to clear the apneas and hypopneas.

Thanks again.

[retired_guy]

Yes, it sounds like they were trying to impress you/him with their vast knowledge rather than treating the patient before them.

Here's a nice article about "pursed lip breathing" you might find useful. You could also google and get a lot more info.

This might not stop him from having a problem, but might make it much easier for him to get past it if he does. As an exercise regime, it can improve the inhale/exhale functions rather considerably.

[Sleepster]

Results from sleep study show ipap 13 and epap 11

That's a difference of only 2 (pressure support equal to 2). That's pretty small. You can get that much with the EPR feature on the Autoset.

It sounds to me like you need a new doctor. Someone who specializes in CPAP therapy and sleep apnea.

[MastiffMom]

[It sounds to me like you need a new doctor. Someone who specializes in CPAP therapy and sleep apnea.

Yeah, well, the new doctor is certified in sleep medicine ... sigh. Hubby has appt on Wednesday and I plan to print reports to take with us. They don't even want to start giving me a hard time about monkeying with the machine settings.

We changed the settings ourselves to an IPAP of 14 and a PS of 6. He did pretty well the first night but the pressure seemed to bother him a bit so we dropped it to 13 last night. I haven't seen the data yet but he slept with the mask on all night which is a first. The other nights he ends up waking and removing the mask for a short period each night. At an IPAP of 14 he would still snore when he was on his back. Last night, with an IPAP of 13 I didn't hear any snoring even when he was on his back. I'm anxious to get home tonight to check the data.

He is also 2 days compliant for insurance purposes ... wooo hooo! That is more than I hoped for.

Something weird that happens. When he first comes to bed and puts the mask on the ipap immediately goes close to max IPAP. We aren't sure why. he is awake and breathing fine. The data shows a lot of mask leakage but the mask really is not leaking. Even weirder is that when he finally does fall asleep the pressures dropped and he had zero mask leakage. Any idea why? We are going to set the ramp tonight to see if that helps some.

He is also a classic example of sleeping on his back his pressures rise and sleeping on his side his pressures drop, so that is a work in progress.

As always, thanks to everyone for sharing your knowledge and support.

[Terry]

Something weird that happens. When he first comes to bed and puts the mask on the ipap immediately goes close to max IPAP. We aren't sure why.

Respironics has a feature called "mask check" or "fit check" (don't remember) that lets you look for leaks by jacking the pressure all the way up when you first turn it on. I'm guessing it's on yours too.

You should be able to turn it off.