Newbe with Complex Apnea - Best ASV to get?

[racprops]

OK For the first time I seem to making some progress:

I have tied my CAs to my EPAP setting.

By lowering my EPAP MIN to 6.5 I have been able to go from 33.37 to 6.90, and twice, first time for about 2 hours in bed and the second was 3 hours in my recliner.

This also checks with a couple of days ago when I set the EPAP Min to 7cm which I only had 10.25 CA events.

The other days with 8 to 10cm for my EPAP has given me: 10cm=30.45, 8cm=32.3, 8cm=33.37 CAs

My AHI Has run: 10cm=36.61, 7cm=23.83, 8cm=48.08, 8cm=46.19 and 6.5=20.88

It will be interesting to see what my Doctor says today when he reads these reports.

Rich

[Sleepster]

Rich, if you go back and read this thread you'll see one piece of important advice that's been given repeatedly. Set the machine back on the settings that it had when you got it. If you have questions about these settings being the correct ones for you, call your providers and ask those questions.

Data-capable machines are wonderful but you have to leave them with consistent settings for a period of at least a week or two before you can get any data that's meaningful enough to interpret.

Sleeping in your recliner may help your apnea but it's no substitute for a CPAP machine. You can do both if you like.

[racprops]

So your saying I should allow my body to have 30+ Central apneas per night (or is that per hour??) and NOT take action to make things better and lower not only how many CAs I have but also how long they run??

Also I should allow my AHIs to read in the serious side when I can lower them to only bad??

PS I was taking about using my machine and sleeping in my recliner...

At this point it seemed to make no difference.

Rich

[Sleepster]

So your saying I should allow my body to have 30+ Central apneas per night (or is that per hour??) and NOT take action to make things better and lower not only how many CAs I have but also how long they run??

Also I should allow my AHIs to read in the serious side when I can lower them to only bad??

Not at all. I think it'd be better if you discussed any changes you make with your doctor before you make them.

[vsheline]

So tonight I will return to my recliner and see.

Has anyone found they do better in a near chair like sleep position?

My heart surgery caused my sleeping in my recliner, it is a side effect from this surgery, and while I waited for my sleep studies we SEEMED to see less apneas when I sleep in a more upright position.

Hi Rich,

Yes, it is well known that obstructive apneas happen less often when our head is elevated, as in a recliner, compared to in a bed flat on our back. I suggest sleeping in the recliner until your therapy is more successful.

Here were the original settings you reported your machine had when you received it:
Min EPAP: 10.0
Max EPAP: 15.0
Min Pressure Support: 0.0
Max Pressure Support: 15.0
Max Pressure: 25.0
Flex Setting: 2
Backup Rate: Auto

You said you changed the pressure to 9/15.
I suppose the 9 was the EPAPmin. What was the 15? EPAPmax, or what? IPAPmax?

I hope you did not set the IPAPmax to 15. If you did, your machine will not be able to adequately treat your central apneas. In any case, I recommend putting the IPAPmax back to 25, the doctor's original prescription. (The machine will never go there unless it needs to, to prevent central apneas.)

From the SleepyHead data you posted, it looks like your machine is not adjusting the Pressure Support high enough to treat your centrals. You can see from the bottom two plots, "Mask Pressure" and "Pressure" that around 3:00 your EPAP adjusted itself to around 13 (to treat OAs). At this time you are having many CAs (this is shown in the Event Flags time plot) but the PS (which is the difference between lower and upper pressures) is small, just a few cmH2O. To treat the CAs the PS would sometimes need to go nearly to 10 cmH2O, but for some reason it doesn't. (Maybe this is somehow related to the small PSmin you are using, since you reported earlier that the machine reponded to your breathing more strongly when the PSmin was set to 2.)

In the statistics section it says your PSmin was 13, PSmedian was 39, PS95% was 68, and PSmax was 90. This is obviously impossible and looks like a SleepyHead bug. None of the other statistics look unreasonable or obviously impossible.

Keep an eye on your minimum respiratory rate (8 breaths per minute). That is a little low. Probably should be closer to 10 or 12.

Does SleepyHead allow you to zoom in on the time plots to see more detail?

Take care,
--- Vaughn

[SuperSleeper]

How did it go at the doctor's office, Rich?

[racprops]

Current settings are:

Min EPAP: 6.5
Max EPAP: 15.0
Min Pressure Support: 0.0
Max Pressure Support: 10.0
Max Pressure: 18.0
Flex Setting: 2
Backup Rate: Auto

As I was unable to have a good talk with my Doc:

In fact at one point he said if I was not going to do as he tells me to do I can find another Doctor…

When he saw I was not falling apart and crying "forgive me please" he then tried to convince me he was right and I loved this one."You cannot come in here with one night's results and say you settings are better… "

Funny as he prescribed from one nights study and from one 18 minute run at the pressures he prescribed, where I had 6 + hours of data. And I had 6 days of data clearly showing a lower EPAP pressure caused a lower CA events.

As well as all the other events. AND my CA were of much short duration to boot. As were the others.

We left things at: I am to not change anything for 60 days and see him then....???

Well that was for only two nights, things fell apart last night:

AHIApnea / Hypopnea Index 53.54
HypopneaHypopnea 10.01
ObstructiveObstructive Apnea 3.88
Clear AirwayClear Airway Apnea 39.64
RERAResp. Effort Related Arousal 0.00
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 14.51
PB/CSRPeriodic Breathing 10.10%

So unless you see something really wrong or bad for me I plan on leaving the settings alone for at lease a week.

Rich

[racprops]

I am hoping for some feed back...

[Sleepster]

I'm not convinced that anything you did had any effect on your AHI. The AHI changes when you do nothing, especially if you're new to CPAP therapy. The only way to determine if a setting has an effect is to keep the machine on that setting for at least a week or two.

[racprops]

I am learning that and will do so.

Rich