[CPAP] 'mild' apnea but increasing. Can anybody provide tips?

[Willem1978]

From this data I get the impression that the CPAP certainly has it's limits in my case: on relatively low pressure it is not that effective, and on high pressure even less.

[Sleeprider]

I think when AHI is fairly low as suggested by your diagnostic baseline of 7.2 then the benefits of CPAP are going to be harder to demonstrate, however it's also true that the effectiveness of the different brands of CPAP are very different from one another. My wife had a similar mild apnea of mainly hypopnea, and have found very consistent efficacy and comfort using the Resmed Airsense 10 Autoset. The difference between her machine and yours is the ability to provide bilevel pressure support in the form of EPR. This makes breathing much easier and more comfortable as the pressure support follows the inspiration upward and the pressure relief of expiration lasts until the next inhale begins. It is very hard to treat hypopnea with the Philips machine using Flex because the pressure does not follow respiration, but transitions to lower exhale pressure before you being exhale and returning back to inhale before expiration is complete. Some people do fine with that, but others just don't see the degree of improvement expected. We have see time and time again where members have switched machines and had transformative results. You may be one of those if you stick with it. I share your frustration on how difficult it is to get comfortable and improved results using the Philips Dreamstation. It is a challenge for those of us that try to coach members to better results to have to deal with the significant limitations of the Dreamstation CPAP vs the Resmed devices.

With that said, I think your pressures are too low to keep your airway patent against the airway restriction that is the root cause of your hypopnea, and consistent with the limitations of the Philips, the auto algorithm simply does not respond appropriately to prevent those kinds of events, and must be set to higher minimum pressure to work correctly.

[Willem1978]

I have tried the increased minimum pressure (6.5 instead of 5) for 10 days now. And it does help a bit. I have had nog AHI 6 nights anymore. But overall I am still not happy with how the machine is not helping me very much.

Thank you very much for your response Sleeprider. I have an appointment with my doctor next monday and going to request looking into (a) trying the resmed, (b) an operation: what would be advantages/disadvantages/risks.

Also many thanks to the others who have responded. I really helped me think about what to do.

[Willem1978]

Ok I have an update 

I managed to convince my doctor to let me try the Resmed Airsense 10 Autoset instead of the Philips Dreamstation, even though she didn't believe this would change anything. Well, it did!

Last month of Dreamstation: AHI 4.37    (O 0.71, H 3.61, CA 0.67, 95% pressure 9.40)
First month of the Resmed: AHI 0.95     (O 0.27 H 0.33 CA 0.34, 95% pressure 7.66)

So my scores are over 4.5 times as good as with the Dreamstation! Although I do believe both machines could measure/calculate AHI differently. I see in the graphs (see attached) that the Resmed prevents hypoapneas in particular, by raising the pressure immediately when there is a flow limitation. And the machine needs less pressure to be effective. And most importantly ofcourse: I feel great.

I did have to get used to the new machine in the first 2-3 weeks. I completely woke up a couple of times a night. This dissapeard by setting the algorithm to 'soft' instead of 'standard'

I anyone would like more graphs/data let me know.

[staceyburke]

Looks a lot better. Good for you to find out the difference between machines and standing firm on what you needed with the Dr. to many of us just take what we are told and don’t advocate for ourselves.

[Sleeprider]

Told you so.

[SevereApnea]

Willem, uitstekend!

I do want to know why / how you so quickly decided to switch Soft Mode? Was this instinct/something you read about or been advised about?

This is also something I want to look at trying soon.

Looks like you have the Flow Limitations under control but more importantly you are feeling great.

I was also amazed at your high Max Tidal Volumes and Minute Ventilation on the Philips as compared to the Resmed.

For a moment there I was quite impressed (windmills?!), but I see your values are more in line with my own now that you are the Resmed.

Is this a Philips thing? Anyone?

[Willem1978]

Why I switched to soft mode?
In the first weeks I noticed my scores were great but that I still felt tired. But it was a different kind of tired. I was feeling tired because I woke up more than before (i.e. the Dreamstation) during the nights. I was consicous of that. And I had read somewhere (on this or another forum) that people can experience awakenings when they are getting used to the Resmed, because it is aggressive when it comes to pressure changes, and that a 'soft mode' exists. So I figured I could give it a go. My scores remained the same but my awakenings went from about 4-5 per night to about 1-2. And the 95% pressure dropt from above 8 to below 8.

I don't really know what Max Tidal Volumes and Minute Ventilation mean/implicate.