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Buschman
Unread post  Post subject: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sat May 11, 2019 5:45 pm

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Hello: I have been battling sleep apnea for about 6 years and switched to a CPAP a year ago from an oral appliance. In the sleep lab my apneas were totally eliminated but at home I was still getting 10-15/hr. About 2 months ago after another sleep study my sleep dr switched me to a BiPap and put my setting at 10/6 and now my apneas are only worse, about 15-20/hr. My dr continues to adjust my pressure settings and I am quite disturbed since it just seems like trial and error at this point. Has anyone else had the same experience? I have full compliance with no leakage so I am quite dumbfounded. Should I try to experiment by setting my own pressures? Thanks for any help. Richard


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sat May 11, 2019 5:49 pm
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People typically get the best results by monitoring their on data, interpreting the results, and making adjustments based on that.

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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sat May 11, 2019 6:48 pm

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Thanks diamaunt. Since I have a very experienced sleep specialist I am dismayed that I need to take over my own treatment. Is it unusual for people to have these problems? My dr says I am an unusual case as usually everyone who can “tolerate” the CPAP does fine after the sleep study! I will do as you suggest! Thanks again, Richard


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LSAT
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sat May 11, 2019 7:08 pm

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Sounds like your "very experienced" sleep doctor is a dud.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Tue May 14, 2019 12:02 pm

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Hi: It turns out I do not have a SD card in my machine so I am going to buy one and then install the Sleepyhead software and check it out. I note there are people on this forum who help evaluate the info as I have looked at the graphs and am pretty clueless how I can use them to help me figure out how to better treat my sleep apnea. It is very frustrating seeing my dr once a month and having him do a minor change based on the info he gets remotely. I live in Santa Barbara and would gladly pay someone to help me determine how to analyze the data. Thanks in advance, Richard


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Tue May 14, 2019 12:11 pm
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Buschman wrote:
Thanks diamaunt. Since I have a very experienced sleep specialist I am dismayed that I need to take over my own treatment.

You should be overjoyed... not dismayed. By taking over your own treatment, you're putting it in the hands of someone who (should) really care about your well being, not just paying a few minutes of attention every few months while awash in a sea of others. Plus, you probably don't have to pay yourself a hefty fee each time you see yourself. An involved patient is a better patient.

Think about people with diabetes, they *routinely* monitor their condition, and adjust their medication dosages, frequently multiple times a day... they don't leave their day to day health in the hands of a doctor.... (at least, not if they want to stay healthy).

Buschman wrote:
Is it unusual for people to have these problems?

all to common.
Buschman wrote:
My dr says I am an unusual case as usually everyone who can “tolerate” the CPAP does fine after the sleep study! I will do as you suggest! Thanks again, Richard

And your dr's attitude is why the failure rate on cpap is so very high....

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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Tue May 14, 2019 12:13 pm
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Buschman wrote:
Hi: It turns out I do not have a SD card in my machine so I am going to buy one and then install the Sleepyhead software and check it out. I note there are people on this forum who help evaluate the info as I have looked at the graphs and am pretty clueless how I can use them to help me figure out how to better treat my sleep apnea. It is very frustrating seeing my dr once a month and having him do a minor change based on the info he gets remotely. I live in Santa Barbara and would gladly pay someone to help me determine how to analyze the data. Thanks in advance, Richard

most of the graphs aren't of any use... the ones to pay attention to are:

flags
flow rate
pressure
leaks
snore
flow limitations.

figuring out the basics isn't that difficult, with a little practice, it just looks intimidating at first.

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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Tue May 14, 2019 12:39 pm

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Thanks again Diamount! My brain is so foggy I have trouble even motivating to get the card and install the software, let alone analyzing the data. But baby steps is better than doing nothing. My case is more complicated as I also have periodic limb movement disorder and need to take both benzos and opiates to treat that, which likely is compounding my sleep apnea problem.

I agree with you about my dr. I don’t think he is a quack and thankfully I have good insurance, but relying on him exclusively at this point is not cutting it.

Keeping my fingers crossed!


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri May 24, 2019 2:32 pm

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Hey all: I finally got my data card and transferred my results into the new version of Sleepyhead called Oscar. Is there any way I can share the data with the group as I have no idea where to start to interpret my results? If so, I will need some instruction as to how to transfer the data and what info to share! Thanks in advance. Richard


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri May 24, 2019 7:35 pm
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These sleepyhead instructions are still applicable to Oscar:
http://www.cpaptalk.com/wiki/index.php/ ... d:Organize

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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun May 26, 2019 10:51 am

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Thanks Diamaunt: I am hopefully attaching a report for a "typical" night...I am not sure this attachment will go through as I could not figure out how to attach it without using imgur (which I have no experience using). I also will be out of town for about 10 days but thought before I leave I could get at least some sleep data to the group and when I return figure out what else is needed. I really appreciate your help! Richard

https://imgur.com/a/lelXcFn


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun May 26, 2019 11:19 am
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YIKES!

First, please update your equipment profile to say 'Aircurve 10 S'

Second, I'd suggest raising your epap pressure to 8 and see what that does.

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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun May 26, 2019 3:22 pm

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Thanks Diamaunt. I changed my epap pressure as you suggested. I assume based on your reaction that my fatigue is not psychological. Was that screen shot enough info? I appreciate your guidance and will report back to let you know what effect the change had on my scores. Richard


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun May 26, 2019 7:03 pm
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I'd like to see a new screenshot after a day or two.

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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun May 26, 2019 8:41 pm

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Thanks! Since I am leaving town tomorrow I will send you the results for tonight before I leave. (I am not very good at getting the info transferred so will rely on a friend to help me before I leave). I am keeping my fingers crossed that this change will reap a benefit. Your continued help is greatly appreciated. Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon May 27, 2019 9:18 am

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diamaunt: well we made a step in the right direction since my score went down to 17, but since my prior scores would range from 10-25, I am not sure the change made a difference. Hopefully you can determine what is happening by viewing last night's results. Thanks for your help! Richard

https://imgur.com/wU9y1K7


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon May 27, 2019 10:26 am

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diamaunt: in looking at my results it is clear that I have "central sleep apnea" which, based on some quick research, is much harder to treat. As I advised I have had neurological problems for years which led to developing periodic limb movement disorder. This requires opiates at night due to leg cramping. I note that opiates contribute, if not cause, central sleep apnea. My sleep apnea only arose in the last 5 years or so.

I note that another option is ASV treatment if the bipap treatment does not work. Any thoughts? I will be seeing my sleep specialist in June and will discuss this with him, but it appears that given the central apneas, I guess his difficulties in getting my sleep problem addressed is not uncommon. I was tempted to go to another sleep specialist for a "second opinion" but I have been seeing this dr. for over 10 years and believe he is very qualified.

Thanks again for any advice as I am hoping with your input I can continue moving in the right direction by modifying my settings. Richard


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon May 27, 2019 11:12 am
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Care to try a little experiment one night while waiting to discuss all this with your doctor?

Switch the machine over to cpap mode, set it to 8 cm and no EPR and see what happens. Just one night .

May or may not change anything but it's something to try that there is a small chance it might improve/reduce those centrals.

If you really do have Complex Sleep Apnea secondary to the pain meds...ASV is probably your best option.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon May 27, 2019 5:18 pm

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Thanks for your suggestion, Pugsy. I will try the cpap option. Frankly I was doing pretty well before I was switched to the bipap 3 months ago at a pressure of (if I recall right) 14. I was averaging about 10 apnea’s/hr and was feeling much better than I am now. I think I will stick with the setting diamaunt suggested for a couple more days, as I felt a little better today, but certainly will experiment with the cpap setting you have suggested.

Diamaunt, if you have any thoughts about last night’s results please advise!

Thanks again to all! Richard


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diamaunt
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon May 27, 2019 5:40 pm
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Pugsy wrote:
Care to try a little experiment one night while waiting to discuss all this with your doctor?

Switch the machine over to cpap mode, set it to 8 cm and no EPR and see what happens. Just one night .

May or may not change anything but it's something to try that there is a small chance it might improve/reduce those centrals.

If you really do have Complex Sleep Apnea secondary to the pain meds...ASV is probably your best option.

I'd set it to 9... but pugsy and I have the same idea.

Either that, or set the ipap and epap to 9... (does the s check for centrals in cpap mode? I don't remember) if so, cpap mode is fine.

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