Problems since cpap auto shut off

[seamusv]

Hi All,

I could use some help figuring some things out.

Background:  I've been using CPAP for about 15 months.  The beginning was really rough, but after some research, hiring a consultant, and trial and error things are better.  I still have some bad days, and I don't ever wake up feeling like I had a great nights sleep.  I'm currently using a constant pressure of 13, a foam collar and a mouth guard.    Getting ready for bed is a process.

A couple of weeks ago my machine started turning off repeatedly during the night.  Auto off was always disabled.  I've disable auto on now.  The machine hasn't oshut itself off since disabling auto on. The problem was always sporadic, so  I'm not 100% sure I've solved the problem.  

Since then I've had almost entirely bad nights.  I'm asleep for most of the night but have fatigue, headache and brain fog the next day.  I don't see any red flags in the charts, but I'm not very good at reading them.

I'm thinking about either increasing the pressure to 14, or turning flex back on with a minimum pressure of 13.  

Any help would be appreciated.  

Thanks,

Seamus

[OpalRose]

The Auto On/Off feature hasn't been known to work consistently, so it's best to leave it to off.  Since you stated you turned this feature off, I'm at a loss as to what would cause your Cpap to stop during the night.

Have you utilized the Auto Mode instead of Cpap Mode?  I would try putting this machine in Auto mode with a minimum setting of 12 and a max setting of 15.
Set AFLex to 2.  

You really could use some pressure relief (Flex) as you are experiencing Hypopneas and Reras.  These can cause sleep disruptions you're not aware of.

I don't see Flow Limitations on your chart, but this may show up once set in auto mode.  

Also, you are using OSCAR 1.2.0, you should upgrade to 1.3.0

And when posting charts, please follow the Organizing link in my signature line for guidance in layout of chart.  We need to see the following graphs:  Events, Flow Rate, Pressure, and leak rate.  Your DreamStation won't show a Flow Limitation graph.  Keep the left sidebar, minus the pie chart and calendar.

Finally, are you using the DreamStation 1 or 2. I assume you're aware that the DS1 has been recalled.

[cathyf]

Is it possible that you are having power failures? I have no experience with a PR machine, but a ResMed has very distinctive behavior if you cut power to it and then power is restored as opposed to tuning it off and on. (On a resmed machine if you turn it off and back on, it goes back to minimum pressure on power on, and ramp if you've got that on. If you pull the plug and plug it back in -- simulating a power failure -- it starts back up at the pressure it left off at.)

You can experiment a little and see if you can figure out what happened. If you actually pushed the power button without being aware of it, well you've got ramp on and you would see in the data that the ramp restarted. (You should probably turn ramp off or at least shorten it. That's a lot of time without therapy. Also, if you turn auto on, the machine will adjust the pressure according to your needs, as opposed to ramp which is just a timed increase whether you need it or not on its set schedule not necessarily when you need it.)

[seamusv]

The machine has not shut itself off since I disabled auto on, so I think that is resolved.

Yes, I know my machine has been recalled.  I'm working on getting it replaced.  

I've attached my chart for last night.  Today is a pretty good day; mild fatigue and headache.  My problems have always been inconsistent, so it will be interesting to see how these settings work after a week.  

There's a large chunk of time where the pressure is at the maximum setting.  Does this suggest the max. pressure should be set higher?

I think I have the chart set up correctly for the forum, but let me know if I missed something.

Thanks,

Seamus

[OpalRose]

The snores and Reras are driving the pressure to max setting.  

I wouldn't raise the max pressure, but to help with snores, that can be as simple as turning off the ramp.  This way you're starting at a higher minimum pressure.  

If that doesn't help, sometimes it just takes a small adjustment to minimum pressure.  Instead of 12, try 12.4 or 12.5.  Can't remember what increments Respironics allows, but turn off ramp first.

[seamusv]

I stopped using ramp, and bumped the min. pressure to 12.5.  My AHI doesn't always correlate to how I feel, but my AHI went up and I feel like crap today.  I can see pretty clearly where the apneas woke me up.  I'm not sure where to go from here. Thoughts?

[OpalRose]

Around 4:00, the cluster of Obstructives woke you up.  This is a good example of positional apnea, where you are allowing your chin to tuck into your chest, which then cuts off your air.  This can occur sleeping on your side or back.  

If this happens just a couple times and it's not a trend, then it's not an issue.  Take some time and look back through some of your graphs to see how often this cluster of apnea's occur.

You can correct this by using a "soft cervical collar" or even try a flatter pillow.  
A thicker pillow can tilt your head/neck forward into your chest.

http://www.apneaboard.com/wiki/index.php...cal_Collar

My AHI doesn't always correlate with how I feel either.  I don't like chasing numbers, but would rather focus on how you feel.  Waking up with headaches is concerning.  Do you monitor your oxygen levels while you sleep?  Possibly look into purchasing an overnight recording oximeter to watch that.

If your using AFlex2, keep the setting there.  With a Respironics machine, the only thing you can try is to inch up the minimum pressure a little at a time and watch results.  

If you don't see a history of positional apnea, then you can raise maximum pressure too.

[seamusv]

Last night (attached) was a good example of a really low AHI followed by a day of fatigue.  I've been using a soft cervical collar every night for about a year.   I've used an overnight oximeter in the past, but never saw any dips.

The obstructive apneas don't typically cluster, and I can't find any that are as dramatic as the one in my last post.  The hypopneas are a bit more likely to be in clusters.  

What's weird to me is that things were OK, not great, for a long time running a constant pressure of 13.0.  Ever since the machine started shutting itself off I've been feeling like hell even though I fixed the problem of it shutting off. 

I'll try another 0.5 bump tonight.

Thanks so much for your help.

Seamus

[OpalRose]

I went back to your first post and looked at your chart again with a fixed pressure of 13.  You actually had almost no FL and you didn't use the Flex feature.

Your numbers are good either way, so we should only be looking at what makes you more comfortable, and how you feel. 

It might be a good test to go back and use the fixed pressure of 13 or 13.5 and see how it goes.  This way, your pressure won't bounce up and down responding to Flow Limitation. I think that doesn't equal a restful night.  

So go ahead and set it to Apap mode, but use 13 minimum and 13 maximum.
If you keep it to Apap mode, with 13-13, then we can still see if there are FL.

You can set Flex to 2 or 1.  Try to gauge what feels better.

Definitely leave that auto on/off feature to OFF, since we have no idea why you machine was turning off.

[SarcasticDave94]

FWIW Respironics should have pressure adjustments in 0.5 increments. These Respironics are infamous for needing higher Min. pressure and as noted you had good results on 13. But that doesn't mean tweaking can't make it better. Flex of 1 or 2 might help, you'd just need to try it and see what you think.