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New User - Oarsman50 - 07-06-2020
New to CPAP and this Forum,
Diagnosed last year with severe sleep apnea. Finally got the machine last month and have been using it for just about 30 days. The AHI has been fairly low in most cases but there are still clusters of events. Just wondering if someone could give me a sanity check on my data to see what is really happening.
Thanks in advance,[attachment=24294]
RE: New User - mesenteria - 07-06-2020
Hi, and welcome.
Your upper pressure setting is substantially higher than where your pressure chart says you like to be. However, it’s only the one night you’re showing, and there might be a lot more variance.
Generally, clustered events, if they are otherwise sporadic AND of the “open airway” or “central” apnea (see the summary index at far left of all the charts), mean you are either dropping your chin and being aroused enough to hold your breath, or you are just forgetting to breathe, something that we see in some people using PAP.
You have clustered events, so you might do better if you were to try a soft foam cervical collar. It would help to reduce the arousals or real obstructions if they happen as well.
I believe you will be asked to provide an expanded view of one or more of those clusters showing at most a minute before those events. Would you mind terribly?
RE: New User - Sleeprider - 07-06-2020
Do you have an example of the clusters of events? Are they obstructive or Lear airway? With the BiOAP Pro at 22/17 (PS 5.0) pressure your events appear to be mostly CA. You seem a bit over-ventilated with a tidal volume of 740 mL which probably accounts for the CA events. We don’t know how you arrived at your current pressure and pressure support but it is relatively high although not unheard of. A closer examination of flow rate or your titration study might offer some insights. I assume you have not experimented with lower pressure which might be possible from what I’m seeing in this example.
RE: New User - Oarsman50 - 07-06-2020
Thanks so much. What kind of detail would you like me to provide and where does it reside in the data. I will check into the collar. I was also told that I have substantial periodic limb movement during the night. Not sure what all that means and the tech did not address it. I guess the arousals could come some from that also.
RE: New User - Oarsman50 - 07-06-2020
Thanks so much. Most of the events are clear airway. The pressure setting was designated by the VA tech. I had two in hospital sleep studies done and each time the results indicated the high pressure was needed to reduce the events substantially. The VA does not give you much info so you are pretty much on your own. That is why I went to this forum. I could not believe that something as critical as this would be a set it and forget it. I have not tampered with any of the pressure settings. I would not know where to begin.
RE: New User - Sleeprider - 07-06-2020
Oarsman50, while the VA is certainly bureaucratic, it is still bound by US HIPAA Law to provide you access to your records https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html You have the right to request copies of any studies, lab results, prescriptions and other medical records. In this case you want the detailed reports for your diagnostic and titration sleep studies. Ask for them and keep them for your records. If you want to try something a bit difference, we can start conservatively and see where it takes us.
You are currently using settings of 22.0 IPAP and 17.0 EPAP. Based on your chart, I will suggest changing settings to 20 IPAP and 16.0 EPAP. This will be lower in total pressure and less difference between IPAP and EPAP (pressure support). This will reduce CA events and should not greatly affect obstructive apnea. Your results in OSCAR will tell us. This quick tutorial shows how to access the settings https://www.apneaboard.com/dreamstation-clinician-setup-instructions
RE: New User - Oarsman50 - 07-06-2020
O.K. changed the settings as recommended. I will repost with the new data. Thanks again.
RE: New User - Oarsman50 - 07-07-2020
[attachment=24309][attachment=24309]Here is the new data with the settings changed from 22/17 to 20/16. Looks like the data got quite a bit worse as to the types of events and frequency. What do you recommend?
RE: New User - Sleeprider - 07-07-2020
Interesting that the vents are nearly all central when what we did was reduce pressure and pressure support which would more likely increase obstructive events and decrease centrals. I think the more important question is how did the lower pressure feel to you? I'm doubtful the setting changes is what caused the increase in CAI. You have slightly lower tidal volume and minute vent which, unless you're a giant is getting closer to normal. If you're okay with the change, i would continue for second night.
RE: New User - Oarsman50 - 07-07-2020
The lower pressure felt more comfortable from the beginning. I usually have to concentrate early on to get used to the high EPAP. I will let it ride and see what happens.
Thanks,