Tomkk - Therapy Advice Request

[Tomkk]

Hi, I'm new here and have only had CPAP for about two months. The doctor set my pressure to 18x10 and it was impossible to sleep like this, the pressure lifted the mask and a terrible draft woke me up. What I found out:
1. So far, the maximum pressure I can bear without waking up is approx. 15.
2. I changed the pressure rise from 0 ms to 300 ms so that it does not make such shocks.
3. The original Aifrit F20 mask did not suit me, the pressure of the hose tilted it at night and air escaped. I bought a mask with a forehead rest, it fits better on my face and the hose doesn't tilt it.
4. I put earplugs in my ears to dampen the sound because I find that the sound of the draft wakes me up more than the blowing on my face.

I try to gradually raise the pressure values to the doctor prescribed, I sleep with an oximeter and sometimes an ECG and monitor the benefit. Unfortunately, I have combined severe apnea.
 (excuse my poor english)

[Crimson Nape]

Tomkk - In order to prevent hijacking another member's thread, we prefer that you use one thread for all your therapy posts. I have moved your post into its own thread and renamed it to be more inclusive.

I will be confirming this post with a PM to you as well.
- Red

[Sleeprider]

Tomkk, what is the therapy mode on your Lumis 100? 18/10 pressure suggests a fixed pressure with a pressure support of 8.0. That's a lot, so it will help to now if this is in S or ST mode or something else. Without a timed backup, this setting would result in a great deal of discomfort and likely CA events. The Aircurve 10 S (Lumis 100 VPAP S) is supported by OSCAR. Be sure to download and install OSCAR software, and use a SD card in the Lumis as you sleep. That will let you see detailed therapy data and post graphs and charts on the forum. Do you have any idea why your doctor would have prescribed 18/10 pressure? For complex apnea with centrals, you need a device with a backup rate, and the Aircurve 10 ASV, (Pacewave CS ASV, or Lumis 150 ASV) is the correct device for that condition. As far as I know the Lumis 100 does not have a backup rate to resolve central apnea, and you are being mis-treated.

[Tomkk]

PAP Mode: BiLevel-S/T is set on the device.
Doctors don't know exactly my problem. The fact is that I have myasthenia gravis, a herniated cervical disc with spinal cord compression, overweight and age 53. (My medication is triplixam, concor cor and 4 mg medrol)
The ENT did not find a problem in the airways even with a camera, but the fact is that during operations (thymoma, gall bladder) they have a problem intubating me, "their tubes burst". I have a problem with breathing even during the day when I am at rest, so often I stop breathing automatically, I start suffocating and I have to breathe by myself. The doctor says this is not related to MG.
Here are the SPO2 reports before and after CPAP (and before concor) with the 14x6 setting. CPAP has corrected the deep dips by inflating the airways, but has not yet resolved the low average saturation.

[Tomkk]

I am also attaching today's report from the Oscars, when I slept pretty well. (I don't know what format is best to export the data here, so I'm sending a picture.)

[Sleeprider]

Our preferred format for posting charts is shown in this wiki http://www.apneaboard.com/wiki/index.php...ganization

Including the Daily Sidebar (left column F8) lets us see respiratory statistics, and settings. Your SpO2 results show a significant improvement. The Oscar Report shows a relatively stable tidal volume and minute vent, but occasionally erratic respiration rate. Using the zoom feature in Oscar, you should look at the flow rate where the respiration rate drops to verify that a breath is not delivered or what is going on. There should be timed breaths in those places. Since the oximetry report and Oscar report are from different nights, we can't really make comparisons. With the Oscar chart we can see the effect of of a timed backup in maintaining the flow rate.

I suggested ASV might be a good answer for your, and I have to say, it would be worthwhile to attempt ASV titration to verify it is effective. The difference is, it does not push a high pressure support all the time, but instead adapts to your needs, allowing spontaneous breathing when possible, but then providing even more pressure support to maintain the respiration rate and volume as needed. I don't know that it will improve your SpO2, and you are borderline for using supplemental oxygen to increase your fraction of inspired O2 (FiO2) to generally raise your baseline oxygen.

[Tomkk]

Thanks for the reply. In the in the previously attached image from OSKAR, the corresponding graph from the oximeter from the same night is also imported below. The record from the oximeter is longer because I measured the saturation even after removing the mask.

It's a bit strange that even a small pressure with a small breath support 7x6 gave practically the same results as 14x6, that is, it expanded the airways, removed those sharp dips to 80% saturation, but the basal saturation was the same, around 91%. Does this mean I can keep the low pressure if I don't see significant improvement with higher breath support? I am worried that with high breathing support my breathing reflex will become even more "lazy". I read in medical treatises that this happens. That is also why it would probably be better to try the ASV mode you recommended, which would help only when necessary. Unfortunately my lumis 100 only has CPAP/S/ST/T/PAC modes.

If these are short-term outages, they typically look like the attached picture.

[Sleeprider]

We normally see better base oxygenation with higher EPAP (positive end expiratory pressure PEEP), not IPAP. Basic rule is EPAP for oxygenation, IPAP for ventilation (blows off CO2).