Three weeks into treatment

[jolycu]

My husband was diagnosed with mild Sleep Apnea based on a home study of 2-1/2 hours duration. These are the results:

AHI/RDI 9.1
Analysis:
Total Apneas: 1
-Obstructive Apneas: 0
-Central Apneas: 1
-Mixed Apneas: 0
-Unclassified Apneas: 0
Total Hypopneas: 22

Snoring Events: 91
% Flow Ltd. Br. w/o Snore: 29
% Flow Ltd. Br. w/ Snore: 1
Total Flow Ltd. Br. w/o Snoring: 728
Total Flow Ltd. Br. w/ Snoring: 17
Number of Breaths: 2553
Avg. Breath per min.: 16.95

Spo2: Duration: 7:00:43
O2 Desat Index (ODI): 10.8
Avg. Saturation: 91%
Lowest Saturation: 82%
Baseline Spo2: 90%
Avg. Pulse Rate (bpm): 61
Max Pulse Rate (bpm): 93
Min Pulse Rate (bpm): 40
Total Desaturations: 76
Lowest Desat Event: 82%
Spo2 <= 90%: 180 min.
Spo2 <= 89%: 108 min.
Spo2 <= 88%: 34 min.
Spo2 <= 85%: 2 min.
Spo2 <= 80%: 0 min.

He is a truck driver, so based on these results, he must use a CPAP machine if he wants to keep his job. He's mad about it but accepts that this is how it's going to be as long as he's driving. He does have Hypertension and Type II Diabetes which are both controlled with oral medications.

We are using a Respironics RemStar Auto with A-Flex (560P) that belonged to my sister. He's been using it for three weeks now. The DME (Lincare) set the machine at 5-20 as recommended by the sleep study. They told him he would have to buy something from them anyway even though we already had the machine, so he bought the Dreamwear Nasal mask. We had already purchased the Aloha Nasal Pillows, and have also purchased the SleepWeaver Elan nasal mask which he likes best so far.

Now it's time to try to zero in on the best pressure ranges for him. His AHI avgerage over this time is hovering around 4. His Min pressure is 5, Max pressure is 16.7 and his 90% pressure is 9.3 for the three week period but has been 8.5 for the last week. I think it's time to bump up the bottom pressure from 5 to about 7 or 7.5. What are your opinions? Most of his events are caused by Hypopnea and he has quite a few VS2 snoring events. He is now using a Ruby adjustable chin strap which is better than the Respironics one the DME sold him.

If you would prefer charts/graphs to look at, let me know which are the most informative and I'll be glad to post them.

Thanks for taking the time to read my long post! There is so much information available here that it is daunting at times, but I am so glad it's here. I want my husband's CPAP experience to be a minor annoyance instead of this great big pain-in-the-posterior it's been since he's been forced into this. TIA

[OpalRose]

Hi jolycu,
Agree that the minimum pressure should be raised at least to 7, but seeing pressure and event graphs would help. Curious how often or why his max pressure goes up to 16.7.

The APAP will respond to snores and raise the pressure to ward off apnea events.

If you can do a screenshot of the event, pressure, leak rate, and flow rate graphs, also the info to the left of graph, then someone can better advise.

[PaytonA]

I agree with bumping up the minimum pressure setting. I would do that and let it run for a while. Good job so far.

[Ghost1958]

Yep min needs to come up. 7 to 8 min.
If i were you id change DMEs. You"ll wind up changing anyway. May as well get that over with.
They already lied to you telling you you had to buy something from them.
You didnt, and you dont.
If he likes nasal mask better than pillows the Eson is one of the best.
Loose fit, great seal.

[trish6hundred]

Hi jolycu,
W ELCOME! to the forum.!
I hope your husband adjusts to CPAP well, it would make it easier.
It’s great he has you to help him through this, GREAT JOB.!
Hang in there for more suggestions and answers to your questions and much success to your husband with his CPAP therapy.

[DumfriesDik]

Hi Jolycu, your husband and I have some things in common. Diabetes II, hypertension and SA!

I have been using the CPAP for over five years now and its second nature to use a mask. I have a full beard and use a nasal mask now. Hope he gets on okay with things.

[PoolQ]

If I read the OP correctly, the OP had a machine that they did not purchase from the DME and then asked the DME to adjust the machine, in return the DME asked them to buy something. Personally I would not expect anything less from my DME

[jolycu]

Thanks for all your responses and encouragement. PoolQ, you are right. We didn't have a problem purchasing a mask from the DME since we weren't buying a machine from them. They were very reasonable on the Dreamwear mask. We paid $92 for the setup of the machine, the Dreamwear mask, and a Respironics chin strap, so we don't have any complaints about that. The girl my husband worked with was very nice. She even promised to download the information required for his next DOT physical and fax it (it has to be faxed over, he can't carry it in hand) to the doctor at no charge. The place that does the DOT physicals charges $25 bucks to download the card!

As far as changing the DME, we don't plan to purchase much from them anyway. My husband has a $3000 deductible on his insurance before they'll pay anything anyway. But his company gives him $250 a month on an HSA card to cover the deductible and we use that to pay for any medical stuff we need. It's much easier to purchase stuff on the internet than to try to schedule an appointment then have to wait if they don't have it in stock.

[jolycu]

Here are a couple of screenshots of my husband's data as suggested by OpalRose.

This first one is the night his pressure went up to 16.7. He was using the Aloha mask at that time.


This is from the last night he was home. He was using the Sleepweaver Elan mask.


As I said previously, I think it's time to bump up the pressure to about 7 or 7.5. I'm not too worried up the upper number because it won't rise unless needed. I'm hoping by raising the pressure we can get rid of some of those hypopnea events.

[OpalRose]

In the first graph, the flow chart looks goofy. Can't figure what's going on with that.

It's looks like your husband had a better night with the Elan mask in the second graph.

A couple of leak "blips" caused the pressure to rise as the APAP can't accurately respond to leaks.

But there should be no issue with raising the minimum pressure. I would start with 7.5 or 8 and lower the top pressure to 15. Watch this for a week to 10 days and see how he feels. Hopefully that will bring down the Hypopneas.

If your husband has trouble exhaling with a higher start pressure, then use one of the flex settings.