Trying CPAP one last time... AHI looks really bad

[gsilver]

It's been about 6 years since I last tried a cpap machine, and my problem with excessive daytime sleepiness and fatigue have persisted (even though I'm generally sleeping more than I was last time). Before I got the machine, I've tried a number of medications to stay awake during the day, as well as a mandibular advancement device. The device helped somewhat, but I was still pretty tired during the day. My doctor recommended that I try a bipap machine, which I got this week. It's data-capable, so I took a look at the data from Sleepyhead, and I'm rather concerned.

I've used it for three nights, and the AHI numbers are 45.8, 48.5, and 60.8, of which is almost entirely CSA.
My latest sleep study showed an AHI of about 22, of which is mostly obstructive apneas but some central apneas are present.


I feel really awful and had to take today off of work (and took a half-day yesterday)
I called the doctor's office yesterday, but he won't be back until Tuesday of next week.

[Gideon]

OK, starting from scratch.
Mode "S"
EPAP = 4
IPAP = 6

Let's see what that does.
High Pressure Support Yours is 7 and that is fairly high, can cause central apneas
High Pressure, your IPAP is 12, not that high but I want to see a dramatic difference so the reduction to 6

My goal is to simply have you breathe comfortably. This is the largest change I have ever recommended. I have no idea where we will end up but it will be a good start.
The intention its to see where those new settings put you and then to titrate from there. We may even try vauto mode later

Fred

[mesenteria]

It almost doesn't matter what your previously assessed AHI might be/might have been at one time....with those AHIs you report, you are badly untreated.

Bonjour is a knowledgeable person who is keen to offer guidance, and I think you should heed what he offers you.  At this point, with an AHI above 10 even, you have little to lose.

One other thing, if he's even close, you'll see a dramatic improvement on the first night....BUT...it may actually take three or four nights before you settle into a true 'reveal' about how well his suggested regimen is really working.  My point is that one night often isn't enough to make a determination of how well you are being treated.

[gsilver]

It almost doesn't matter what your previously assessed AHI might be/might have been at one time....with those AHIs you report, you are badly untreated.

The latest sleep study was a month ago, so I'm about 100% sure that the vastly increased AHI is from a misconfigured machine.

K. Got the settings updated. I'll try it tonight.

[Sleeprider]

Edit: missed that new settings based on Fred's advice are implemented. Those are as good as it gets.

[gsilver]

Here are the results with the modification that I made last night. Still almost all central, but much lower than before.

[Gideon]

Much better.
I'd like you to try changing your IPAP to 5, keeping EPAP at 4 and remaining in "S" Mode.  We will see if we get a good reduction.  Be aware, this is getting into an area where many have trouble on inhalation.  I'm assuming you had no problems with IPAP at 6.  If you have issues reset to 6 and get a decent nights sleep.  Right now that is more important than awesome numbers.

By reducing IPAP we are again reducing both pressure and pressure support, both of which should help reduce your centrals.

It is VERY important for you to report your impressions on the therapy and the changes that are made, and any and all symptoms that you are feeling.  The final choice of settings will be determined more by how you feel than by your numbers.

It is possible that you may need a different machine, but it is far too early for that.  Post your diagnostic sleep study, the full study, not just the summary.  That will give an indication of the prevalence of centrals without CPAP, important for determining your future direction with regards to which machine is most important for you.  The first step down that path is to eliminate a temporary treatment-emergent central apnea which typically diminishes in 2 to 3 months,

[Sleeprider]

It almost doesn't matter what your previously assessed AHI might be/might have been at one time....with those AHIs you report, you are badly untreated.

The latest sleep study was a month ago, so I'm about 100% sure that the vastly increased AHI is from a misconfigured machine.

K. Got the settings updated. I'll try it tonight.

If you have the results of that study, it would be ideal if you posted it with personal information redacted. Specifically we want to see whether central apnea are present or if you're treating obstructive apnea.  You would be amazed how many people show up here with a diagnosis of obstructive sleep apnea that actually have central or complex apnea.  I suspect that your doctor prescribed the bilevel machine because he already knows this.  The way your machine was setup with very high pressure support was about the worst situation you could have had.  If you do have complex or central apnea, the solution is a bilevel machine that has a backup rate that switches to higher pressure to cause you to take a breath when you have central apnea. That machine is call an adaptive servo ventilator (ASV) and we have many members that use them.

If you don't have a copy of your sleep study, you should request a copy for your personal records.  These studies are very important to maintain, because the need for treatment generally does not go away and retaining copies can avoid the need for studies in the future.

[Diotima245]

Have you tried Autoset mode with a range such as  8-20?

[Gideon]

Have you tried Autoset mode with a range such as  8-20?

Why?  Pressure changes increase central apnea whether they are from algorithmic changes from a range of 8 - 20, or EPR.  I am willing to listen to reasons.

The OP showed a EPAP of 5, IPAP of 12 with an AHI of 60, mostly centrals.  We have him down to just over 7.  If we didn't have an immediate history of very significant centrals I can see a trial  of a tight range in auto.