newbie but not new

[duhmom]

Afternoon - I am not new to CPAP therapy - been at it since 2014 but just found the site looking for the clinical manuals to 'work' on my cpap machine.  Last week had my annual sleep doc visit.  The overly friendly NP made some changes to my pressures - now as far as I was concerned they weren't broke but then I did not argue.  my setting was 10 to 20 which seemed to be ok - she told me my average pressure was 14.  She stated that at my sleep study - 9 months ago my type of apnea went from obstructive to central - she recommended changing to a constant pressure said it was better for central apnea.  ( I did know about the change in DX) 

now, I have no idea why I have central apnea - no history of anything neurological.  OSA was discovered in work up for bariatric surgery in 2014

but anyway, the NP told me my 'average' pressure was 14 - Since the change was made I have not slept due to the excessive pressure - ending up with a belly full of air and more leaks than good! - so thank you to this board I downloaded SleepyHead and installed it and looked at the data myself.  I am actually quite angry - IF - I am reading my stats correctly.  It appears the average pressure is 11ish.  I am going back to variable with a max of 14.  Would appreciate your thoughts on the stats if anyone wouldn't mind.

[DavePaulson]

From the data you posted, it looks like you have been getting good results all along before and after the change. Your 90% pressure was 14 that must be what they meant. It wouldn't be unusual to raise it based on that but if it raises other problems then it is not a good solution. Could you post some of your daily charts from SleepyHead from before and after the change if possible? Do you have a copy of the sleep study that showed a lot of central apneas because they are not showing up in the sleepyhead data? There are a couple of guides on how to post and organize your charts here. Posting an Image in 5 Easy Steps
 Organize your SleepyHead Charts. If you need more help with any aspect of posting data don't hesitate to ask.

Best of luck,

Dave

[trish6hundred]

Hi duhmom,
WELCOME! to the forum.!
Hang in there for more responses to your post, good luck to you as you continue CPAP therapy.
You have come to the right place for help.

[DeepBreathing]

Hi duhmom. Welcome to Apnea Board.

It looks like your therapist has broken something that didn't need to be fixed. Your central apnea has actually got "worse" since she made the change. And when I say "worse" I mean it went from an insignificant amount to a slightly less insignificant amount.

As Dave mentioned above, we need to see some representative daily charts to be totally sure, but if it was me I'd just change the settings back to exactly what you had before.

[tmoody]

She stated that at my sleep study - 9 months ago my type of apnea went from obstructive to central - she recommended changing to a constant pressure said it was better for central apnea.  ( I did know about the change in DX) 

now, I have no idea why I have central apnea - no history of anything neurological.  OSA was discovered in work up for bariatric surgery in 2014

Welcome to the club...the complex apnea club, that is. The fact is, the causes of central apnea are not well understood. There are some conditions known to cause it but there appear to be many cases where it just shows up--like yours and mine.
I never heard the claim that constant pressure is better for centrals. I'd like to say that my own centrals only appeared when I went from CPAP to APAP but that would be misleading, since my CPAP that I used for nine years didn't have the ability to monitor centrals. So I'll never know. I tend to agree with DeepBreathing that your therapist seems to have meddled unnecessarily. On the other hand, it's only a week in, and there can always be an adjustment period to a major change; and going to constant pressure is pretty major. But you were doing very well before, so it's unclear why she decided to change anything at all.

[duhmom]

Hi all, and thank you so VERY much for your responses.  I am posting a couple of days of pre-change graphs.  I have studied them and understand a minuscule amount.  I did change the machine back to APAP at 8 to 14.  pre 'doctor' change I was on 10 to 20 and in looking at the graphs I may need to go to 16 as the upper limit but will look to you guys expert opinion.  As for the sleep study - I don't have a copy - but will be calling them today to have them send it over. I'll share it too once I get it. 


-- I just thought I was going to attach it... getting a message that the file is too big - 512kg limit and I have a 540 and 795 kb.  I am going to see if I can figure out how to get the graphs out instead of pdf.  will search on the boards for an answer too

[OpalRose]

duhmom,
New folk are somewhat limited in size of attachment.

Once you have at least 4 posts, you can follow the tutorials in my signature line.
This will show you how to take a screenshot, organize the graphs, and use Imgur to post here.

[duhmom]

Here are a couple of examples of my graphs


you all are so helpful! thank you. both of these examples are pre-change

this one is after the change and the leak is so bad from the pressue I don't even see the point of cpap.


I said this earlier - I have changed setting back to previous setting but capped it at 14 initially and changed the cap to 16 for tonight. will pull another set of data in a couple days. It appears, my S9 only keeps a weeks worth of FlowRate data.

[Sleeprider]

I have to agree with DB, your therapy was not broke. Your earlier results look great. CA events in low numbers are not meaningful, and can often be reduced by cutting back on the EPR. You have been using an EPR of 3, and I would guess a setting of 2 or 1 might help with the CA events. Your event rate is excellent, and I think the NP greatly over-reached when she said your Dx has changed from OA to CA.

Hopefully you get more comfortable and those leaks get back under control If anything, I'd suggest a slight reduction in EPR, but that's about it.

[Gideon]

duhmon, I totally agree with SleepRider here, you are good and were good before the change, VERY GOOD.  Many here would love your numbers.  Should the frequency and or number of CA event significantly increase (or whenever you are questioning it) please post your dailys and ask if you should do anything about it.


Tmoody:  You handle differently with bilevel then you do with APAP or CPAP.  For some reason with an APAP a constant pressure (simple CPAP) frequently works better than other combinations of pressure, that and minimizing or eliminating EPR.  Not always, but frequently.

Fred