Help with father-in-laws cpap

[gwest1953]

   
help to understand what is going on with my father-in-laws cpap therapy. included is screenshot of most recent nights oscar data.  any insight will be most appreciated. In his original sleep test did not get useful results so he was given  a mask and a dreamstation 1 with cpap setting of 17 cm and left at that.  I helped him change to auto about 4 years ago and that helped him but he needs more insight than I can give. Thanks

[staceyburke]

First thing is has this machine been recalled?  Almost all of them have been so I would check.  Here is a link to a thread in the forum that talks about it.  It is very long but you don't need to read all of it.

https://www.apneaboard.com/forums/Thread...ips+recall

The other thing I can see is he is having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

IF you can control the positional apnea he will do much better.

[gwest1953]

       
Thank your for your reply. He removed the foam from his dreamstation 1 and has replacement dreamstation 1 from Philips but continues to use old unit. I helped him change to auto mode from cpap at 17cm pressure. On looking back to the change date it shows large drop in AHI however he starts having a large number of RERAS. I am going to attach screenshots  of OSCAR data on day before and day of change for example. He complains of having sinus congestion also. He is a hard person to convince to try new things to help his sleep. I certainly agree about position affecting events as I personally have struggled with having to sleep on my back due to rotator cuff injury and surgery.  We are trying to get him to find a sleep medicine physician that will help.

[Phaleronic]

They've been sending out remediated DS1s with the white silicone foam that is better than the black foam, but overall the issues were with folks that used Ozone cleaners or used the machine in a high humidity enviornment.

So, since he's using a foamless motor airchamber there's no issue with his DS1.

To help with his problems though I would disable ramp completely, move from a-flex to c-flex or c-flex + and set to 3.  Lower max pressure to 16cm, keep min pressure where it is at, and see how he feels after two nights and post the new charts

[UnicornRider]

I see from your FIL's Profile he is on a Dreamstation 2, but reading the body of your posts he has Dreamstation 1,   I have no experience with Dreamstation 2, but I do have a Grumpy Mom on a DreamStation, so perhaps I can relate.

When dealing with "Grumpy Old People" like my Mom, definitely refusing to give up her Dreamstation.  It may help to post a screenshot of the last years worth of OSCAR "Overview" and OSCAR "Monthly report mode" of  "Statistics" view.

A little historical view may assist us in providing better support for your FIL. And/or drilling down to an event change that affected his therapy.

I agree with the possibility of "Positional Apnea" that StacyBurk points out. However when dealing with "Grumpy old People" Sometimes it is more effective to have a favored Grandchild "gift" a CPAP pillow or Soft Cervical Collar. But not both at the same time, as you want to make adjustments to the sleep environment slowly, one at a time. With sufficient time between adjustments, to fully apprise the effect of the adjustment.

Like Phaleronic mentioned about pressure adjustments, Your FIL is currently on A-Flex 2, try A-Flex 3. That may assist with a few of the events he is recording, AGAIN I stress only one change at a time to eliminate confusion about what worked & what did not work

If possible remove Ramp, but if that is not feasible, if nothing else, shorten his ramp time from 30 minutes to ~10 minutes, it looks like he is asleep by ~7 or 8 minutes after the onset of therapy.   Then incrementally (1cmH2O every 3 to 5 days) increase his Ramp pressure to eventually meet his starting pressure of 8 cmH2O.

By then we will have a better view of his progress and may be able to give a better assessment of a starting pressure that will better suit his needs. I suspect you will want to increase his starting pressure a little, but the other changes have priority.

Post back with OSCAR Reports frequently, highlighting the changes made, and give sufficient time between changes to ensure we get a good evaluation of effectiveness of the change performed before changing another parameter..

As always if you have any questions, concerns or doubts, please post back.

[gwest1953]

thank you for insight.  I will have to try to get him to change settings and see what happens.  I am going to try to get him to use cervical collar also.

[gwest1953]

He is using Dreamstation 1. Sorry for confusion but my profile is showing on post with ds2. I am going to try to encourage using collar and change to flex 3. It will take some convincing so we will see. thanks for insights

[Sleeprider]

The Philips Dreamstation machines have always been crap for therapy and offer no solution for flow limitations other than more pressure. Your FIL has very high and ineffective pressure. He should talk to his doctor about upgrading to bilevel like the Resmed Aircurve Vauto. It shoot require a sleep test, just his lack of efficacy and comfort on CPA0 is reason enough. The Vauto would work great and feel better.

[gwest1953]

He has the familiar problem of a dr that only updates his rx yearly.  I am hoping he can find a sleep medicine dr that will do a sleep study that will shed light on his underlying problem. If anyone in Athens, Georgia  USA area has any recommendations it would be appreciated.