New user seeking guidance optimizing settings

[kmelman]

Hello, folks! I'm back and my cup overfloweth with OSCAR data and - gasp! - a titration report. 

The combination of a higher minimum pressure and sleeping without a pillow (inspired by SarcasticDave94's remarks re kinking my neck). My pillows are fluffy as heck. Comfortable, yes, but clearly not in my best interest. At least not for the time being. 

First, the OSCAR data:  


   
   
   

[kmelman]

May 29:

   
   


June 7:
Something went wrong here, and I don't believe related to pressure settings. Including anyway.

   

[kmelman]

June 7 (continued):

   


Second, the titration report, which I received a few hours ago:


  Titration Report_AB.pdf (Size: 157.5 KB / Downloads: 11)


Tonight, I plan to try the following settings: min pressure 10, max pressure 15, EPR 1 (full time), and no pillow.

[SarcasticDave94]

Hmm... Any word yet on the diagnosis and suggested actions from Dr. McQuack? Page 1 on the Respiratory Events where there's 40 CA events, and Page 3 under Titration Chart almost all events are Central, with there being 0 of any events at a CPAP setting of 10. For that night only. I'd say if I'd read this accurately, you'll need ASV, a special BPAP with backup rate. Central Apnea is very much consistently inconsistent. You may not be able to repeat 0 events on the pressure of 10 for a while. Zero events really isn't the goal or my point. CPAP may or may not treat you consistently due to these CA.

[kmelman]

Dave,

Straight from my doctor: 

"You will see, that at the lower CPAP settings you had a lot of central events, back to back.  However, once the pressure was increased up to 8- 9 cm H2O range, centrals have drastically decreased. Pressure of 11 cm of water was well tolerated in the 2nd half of the study. I would suggest increasing your settings to 9-12 range, you will still be able to use the ramp feature."

I've asked about switching to bipap. No response. It doesn't help that, up to this point, my doctor only seeing patients virtually. I have an appointment in 15 minutes and have a long list of questions. Switching to bipap tops the list, especially since I've had two extremely disruptive nights. See attached June 9 OSCAR data. To my (admittedly novice) eyes, looks as problematic as June 7. 

I'm trying to find another medical provider for a second opinion, possibly multiple second opinions. In addition to pulmonologists, I'm considering specialists such as neurologists, and oral and maxillofacial surgeons. Money and physical location are complicating factors, but I'm doing the best I can.  

Tired and frustrated! Thanks for your assistance. 

Kate

   

[jaswilliams]

Kmelman, the problem with CA’s are they are consistently inconsistent and the pressure change may not have contributed to the CA reduction. Only monitoring and tracking your data over many nights will provide a set of data to move forward.

[SarcasticDave94]

FWIW I've had very high CA on a diagnostic for BPAP due to not tolerating CPAP. And they couldn't find a pressure that didn't have any CA during my titration. THEN they put me on the DreamStation Auto BPAP. CA went through the roof and I returned that machine within a month and told them point blank I need an ASV. I used their own diagnostic detailed pages with the CA highlighted.

I got it after a new titration including ASV. Then about 2.5 months for approval and another 2-3 weeks for ASV delivery.
You'll need this ASV Titration IMO.

[SarcasticDave94]

Take a look here for my noob thread in '17, chart is on the linked post.

http://www.apneaboard.com/forums/Thread-...#pid199507

[sheepless]

higher and variable pressure can trigger ca. reducing ca by raising pressure is not logical. in fact you had plenty of ca at - what - something like 11-18 cmw. your ca events may have nothing to do with pressure - presence and frequency of ca are known to be inconsistent.

if ca is a problem for you, you don't want a vauto anyway. if lucky, a high or very high trigger setting can help reduce it but like apap, the vauto is not designed to to treat ca.

it looks like you haven't been at this very long, however. treatment emergent & pressure induced ca are common and often settle down within about 90 days so waiting a bit might pay off.

[SarcasticDave94]

I'm thinking for now EPR and Ramp may both need to go to off, especially the EPR even if it's only on 1. Your high CA count is requiring this edit.