cpap and apap not effictive

[Ezil71]

Hi - I'm new to the board, having read a lot of very useful information before joining.

I've been on apap/cpap since April and have never been able to get my AHI down to below/near 5 over a night (although I do have some periods early in the night that can be down at 3.5-4).

I've looked at sleepyhead data and see that early in the night a pressure of 9-11 keeps things OK, but later in the night/early morning even going up to 17 doesn't stop my hypopnea/apneas.

Over the last several months I've tried many, many settings. My initial setting from April was 6-16 apap and a later titration came to 10 on cpap.

I've had an extremely difficult time with aeorphasia. No matter what my settings, or which of many types of masks I've tried (nasal pillows are the worst, a full face is a bit better, but not much).

At the moment I have my apap set to 10-18 with no flex (flex seems to make my aerophasia worse, either c-flex or a-flex (or c-flex plus when on straight cpap).

When on a wider range of apap (6-14), I tended to be around 11.5 for 90%. The issue I see is more clear apneas. Going 8-14 helped some of the clear apneas and bumped my 90% to 13, making the aerophasia much worse. Oddly, at 10-18 there were more clear apneas.

I can post some data, but having changed settings many times over many months I don't know how useful it is. I cleared my data on the machine and started over last night (saving my original data in sleepyhead).

I'm going to try to stay on 10-18 for a while to see where the data is but find it very, very odd that my dreamstation seems to always go up to just under my max setting, no matter if it is set 5-12, or 10-18.

I should add that even after so many months it is only recently that I could tolerate having the machine on for more than a few hours a night. I can now keep it on 6+ hours most nights.

Thanks in advance for any advice or suggestions.

-Ed

[surferdude2]

If at all possible, avoid sleeping on your back! It can make a huge difference... in both the pressure required and the number of events.

Dude

[Ezil71]

I'm pretty much never on my back.

Almost always a side sleeper, on a firmer bed I tend to be on my stomach. I tried sleeping on an incline on my back but can't do it at all. I always end up on my side.

[trish6hundred]

Hi Ezil71,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, hang in there for more responses to your post.

[Sleeprider]

What happens with a CPAP pressure of 10 with no Flex? Have you tried setting min and max pressures both to 10?

[Ezil71]

At a straight cpap, no flex at 10 I was generally around 7-9 AHI, sometimes closer to 11.

The entire time since April I've never felt rested except for maybe 3-4 times I've woken after a few hours and felt like I slept a week.

I would add that the time I had my titration I had taken some trazadone to make sure I actually slept (since I barely did during my first study). I've noticed that when I take it my pressure can be lower relative to the ahi I see without it, but I hate taking it because it always makes me feel bad/tired the next day no matter what my ahi was.

My theory in setting my apap to 10-18 right now is that at 10 my early sleep is still showing ok (might be able to bring it down to 9), later sleep is pretty much always bad ahi.

I haven't tried both set to 10 on apap, only cpap at 10. Wouldn't that be the same thing?

[justMongo]

My theory in setting my apap to 10-18 right now is that at 10 my early sleep is still showing ok (might be able to bring it down to 9), later sleep is pretty much always bad ahi.

Are you looking at that graph of AHI by the hour?
I ask becuase we may be talking "Apples and Oranges" here.

We really need to see some plots of events, pressure, flow, and leak for the night.

As a noob, we'll let you post images to an external site like Photobucket or imgur; then put a broken link in your post.
We only limit links for noobs to discourage spammers. As long as it's non-commercial and related to your cpap therapy, the boss says broken links are OK.

[Ezil71]

I'm not sure exactly what to post but here are two screenshots from last night. I have my older data from before I reset it on another machine.

Other than really bad aerophasia, about as good as my numbers ever get for a night.

[attachment=2901]

[attachment=2902]

[Sleeprider]

The daily chart is more useful since the Statistics consist of only one day. The OA is not responding to increases in pressure. There is no flow limitation and low snore index, but a couple casual snores during the OA events. These two pieces of data indicate the events flagged as OA are not preceeded by normally present obstructive precursors. That explains why the machine does not increase pressure until you are already into a series / cluster of events. Aside notes are you have good tidal volume and are another person with much longer inspiration than expiration which, I haven't figured out yet, but it's a good predictor of problems like you are experiencing.

If you can zoom in on a set of events so that the breathing wave-form is clearly visible, we might be able to figure out something. Aside from the events, how are you feeling in terms of energy, restfulness, concentration? Also, have you discussed this with your doctor? Your results don't suggest the level of success that should be expected. Anyone discussed bilevel?

[Ezil71]

I'll see if I can figure out some more screen shots. Any particular type of event I should be zooming in on?

I don't feel more rested, actually I feel worse than without the machine on most days, but I've felt those handful of really restful few hours over the last several months of trying and I know that kind of sleep is in there somewhere!

My doctor, and provider, have basically given up. The doc has said that I know more about the machine and the settings than he does, and my provider has said I'm more determined than anyone she has seen, but without much more help.

He did mention bi-pap but said "well with flex on cpap you are basically on bi-pap at 3" and since I tend to feel more aerophasia with flex turned on, he said it wasn't worth trying.

I just went back over my old data on the other machine and my 95% is closer to 12.5. Should I try setting my min pressure to 12.5 or 13? I'm not sure if I can tolerate it, but I'll try anything for a few nights.

I'll post a screenshot shortly.