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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun Jun 09, 2019 10:19 am

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Hey Pugsy: I’m 61 and was fortunate enough to largely retire and move to Maui a couple years ago, but then started having multiple health issues, starting with needing a hip replacement, then getting edema from drinking too much (Maui is not a smart place to move if you have a drinking problem) and then developed a kidney disorder that resulted in me putting on 35 pounds which led to a worsening of my sleep apnea. Now I am in Santa Barbara and haven’t had a drink in a year and my kidney disorder is in remission, but losing the weight caused by the prednisone I was on has been a real hassle. With the fatigue it is hard to motivate to exercise. I am moving to Todos Santos in Baja Mexico in the fall, and want to try to address all my health issues before then, although they have very good and inexpensive medical care, especially in Cabo (which is an hour south from TS).

Anyway, last night was not as “productive” as I hoped, as I was so fixated on not starting my machine until I was about to sleep that I didn’t get to sleep until real late! I also was waking up a lot more than usual and shutting off my machine, and then forgetting to turn it back on! So it shows I only had 5 hours sleep which is inaccurate but at least there should be fewer false positive apneas in my report. I checked my score after a couple hours of sleep and my AHI was only 3! It went up to 6 after 4 hours of sleep, but ended up at 8. But this is a whole lot better than the 15-20 scores I was consistently getting, and while I can’t say I feel like running a marathon, I certainly am not in the constant brain fog state I was mired in, and as you say, I know that the hidden dangers of sleep apnea due to insufficient oxygen are largely being addressed!

I know apneas increase in the last hours of sleep, but I really don’t understand how the score could almost double. Anyway, I will send you my data once I have my daughter download it and hopefully it will be more “accurate”.

Thanks for any advice you can provide once you get the chance to review my data...it is so great to have this forum where everyone understands what I am going through. Sleep apnea is such a hidden condition, as I look “normal” and no one in my family/friends (even a brother who is a MD) understands what I am going through nor why I don’t want to go out at night.

Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun Jun 09, 2019 10:30 am

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Pugsy: here is my info! Let me know if you could use other info from the screen that I have not copied! Richard

https://imgur.com/a/L9asovX


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun Jun 09, 2019 11:21 am
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The bulk of that AHI is central/clear airway and I am betting the bulk of those are related to arousals.
When you have time watch the videos here and you can learn how to sort of tell if you were asleep or not by the pattern of your breathing.
http://freecpapadvice.com/sleepyhead-free-software

For now continue with current settings. Let's get you so that your body is more in tune with the current new settings. There is some truth to the "give it time" thing.

The centrals we can't do much about them except watch them anyway.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Sun Jun 09, 2019 2:09 pm

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Thanks again Pugsy. I will check out the video! I think I am going to not bother worrying about my scores for a couple days and just keep the machine on before I go to sleep and when I go to the bathroom, as my sleep was disrupted fiddling turning the machine on and off. As you say it may be beneficial getting used to the setting, especially with my new mask. If the central apneas are the main problem, I assume I should explore with my dr the potential of getting the ASV machine? I will keep you posted! Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon Jun 10, 2019 7:01 am

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Hey Pugsy: I ended up sleeping well and only really woke up and went to the bathroom once (I woke up suddenly probably 5 times but just went back to sleep within a minute) so here is my report, which is still not "ideal" at 8 but is consistently much better than before. I note it seems to show that my central apneas were lower. I don't want to waste your time but if you have a chance to look and think there is anything worth noting please advise. Otherwise I will continue to see how things are going and report back in a week or so! Richard
https://imgur.com/a/Pi2cYhw


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Mon Jun 10, 2019 8:20 pm
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I don't like AHI of 8 and the bulk of it is obstructive.

Increase EPAP 1 cm and lets see what happens


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Tue Jun 11, 2019 10:07 am

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Thanks Pugsy. I had a better night last night as my score was 6.2, with obstructive being 2.7 and centrals being 3.2. I forgot to insert my memory card in so I don't have details. I will increase to 10 on CPAP setting. Thanks for your help...it sure is nice to have lower scores! Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Wed Jun 12, 2019 9:14 am

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Hi Pugsy: you are becoming a miracle worker! My score was 4. I did notice more of a leak rate than before, but we are making progress. Here is the results. I am tempted to increase my pressure to 11 and see what happens, but will wait for your sage advice. Thanks Richard
https://imgur.com/a/n0IVwyt


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Wed Jun 12, 2019 11:53 am
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Your AHI was 4.26 and of that only 2.13 was related to obstructive stuff (those OAs and hyponeas).
The 2.0 ClearAirway/Central apnea index we have to set on the back burner because what we are doing with the pressure isn't really going to deal with obstructive stuff.

Go ahead...1 more cm EPAP to 11 and then be prepared to stick with it for a few nights to let the body adjust and let you be able to get a handle on leak management.
You are really close to optimal pressures. Time to slow down the changes and give each change ample time for the body to adjust to.

Do expect some variation every now and then. We simply don't always sleep the same each night.
So don't go into panic mode if you have an off night. We all have them from time to time. Even someone like me who has been on cpap for over 10 years now.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Wed Jun 12, 2019 1:55 pm

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Thanks again for your input Pugsy. I will set my machine to 11 and see what happens. Do you think there might be some benefit in setting the IPAP differently from the EPAP? I am frankly unclear why it makes a difference, but since my dr prescribed the bipap machine and put those settings a couple numbers apart (I think my last setting after I saw him was 9/6), maybe that may be worth exploring? I am thinking the new mask may be making a big difference too.

Regardless I sure hope these results continue consistently...I still am not feeling "on top of the world" but am hoping that now that I am getting better sleep I will recover a lot more energy over time. I sure am a lot more optimistic than I was before I joined this group! Thanks again for your help! Richard


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Wed Jun 12, 2019 3:52 pm
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You are in CPAP mode....so there is only one single pressure and you don't appear to have EPR turned on.
I can't see the statistics to confirm.
Next time you post a report hide the calendar and let more of the statistics move into view.

So with one single pressure and no EPR...EPAP equals IPAP.
If you want to go with dual pressures we can either add in EPR or change over to S mode.

Now if you want to go to dual pressures...we can sure do it and it won't hurt to try. All depends on what you want to experiment doing.
I would do it if it were me but then I love to play around with stuff.

I can see where 6 EPAP and 9 IPAP would not have been nearly enough pressure for you though....
maybe 9 exhale and 12 inhale or in that neighborhood if you were adding in an actual different inhale pressure.

The difference between inhale and exhale in bilevel mode is called PS or pressure support.

Only caution about having dual pressures...a very small (very small) percentage of the population who do bilevel will have centrals increase simply because of the bilevel situation. Odds are you won't have that happen but I did want to caution you about it.

So if it were me...I would change over to bilevel S mode.
EPAP 9
IPAP 12
and that will give you 3 PS...a nice comfortable number to start with and see what happens.
Or if you want to try 4 PS...then IPAP at 13.

Having a little IPAP might even help reduce those OAs.
Normally I would look at it for hyponeas but it does some OA reduction also.

Up to you how adventuresome you want to be...and the beauty of it...you have lots of time to plan out your experiments and I will be here to help no matter what you want to do or when you want to do it.

I personally really like having separate inhale and exhale pressures.
You might try it first just to see what you think about it. You might hate it and decide it's not an experiment you want to do.
You might love it and be like I was the first time I actually slept with a real PS (I did 4 cm PS) and after the first night I was totally in love.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Wed Jun 12, 2019 4:19 pm

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I'm not too good at getting the screen shots to eliminate the calendar but will try to work that out tomorrow. I think it is worth a shot at EPAP 9 and IPAP 12. Since I have the bipap machine I might as well experiment with its features. (I am not sure what EPR is but assume since I have the ability to have separate inhale and exhale with my bipap machine that is the same thing.)

I am really stoked to have the scores down for couple days straight! Thanks again. Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Thu Jun 13, 2019 4:35 pm

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Hi Pugsy: here is my data with the new pressures. FYI I was largely up until past midnight with my machine on so really the only data that is "good" is likely the info from about 1 am on. I was actually expecting to have a much higher score than 6, so I was pretty surprised to see the score when I got up. Anyway I will continue with this setting as it might be much lower once I get used to the pressures and get to sleep more quickly. Thanks Richard
https://imgur.com/z0Oy2cs


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Thu Jun 13, 2019 7:46 pm
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If you didn't sleep solidly some of those flagged events may not be real asleep events.

Give yourself a few nights to get adjusted to the new pressures.
Mainly it's the centrals that is messing with your AHI.
See what happens once you can say you slept fairly solidly for most of the night.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Thu Jun 13, 2019 9:03 pm

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Thanks again Pugsy. You really have helped me tremendously. To see you (and the others in this group) helping so many people, spending your valuable time and experience for no gain, makes me realize there is a lot more good in this world than you realize if you just watch cable news! I was really feeling quite helpless, and you and Diamount gave me hope! After a year of no progress to have my scores improve so quickly was literally beyond my highest expectations. It must feel really fulfilling for you guys to know how many people you have helped! If you ever need a lawyer in CA let me know! Richard


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri Jun 14, 2019 12:10 pm

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Pugsy: I had a better night as I went to sleep shortly after I put on my mask. However, I woke up and turned off my machine and must have forgotten to turn it back on for an hour or so (as can be seen if you look at my results). The real issue is my AHI is getting higher (around 9 last night...with mostly clear airway apneas) and my leaks are also getting worse. I think I need to either reduce the PSI or tighten my mask. The best score I had was when I had an AHI of about 4 with a 9 setting in CPAP mode, so I am tempted to switch back to that or maybe just go up to 10 and see what happens as this hopefully will resolve the leaks problem? Any suggestions would be appreciated, obviously! Thanks again, Richard
https://imgur.com/a/0UpHz5S


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri Jun 14, 2019 12:44 pm
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Sometimes PS can trigger centrals in some people. Not sure if you are one of those people yet...

Anyway, go back to cpap mode and proceed with that experiment for now since PS isn't a factor right now in that mode.
Once you get that experiment completed then revisit the bilevel mode experiment.

Once you have the centrals down to a nice minimal level and OAs also reduced....then revisit bilevel mode with PS and see if the centrals come back and if they do then you know you are one of those people.
It's not very common but it can happen...using PS or EPR will trigger centrals.
Bummer because having a difference between inhale and exhale is actually kinda nice and comfy for most people.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri Jun 14, 2019 4:12 pm

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Thanks again for your input Pugsy. I have found that I tend to suffer uncommon side effects, so I would not be shocked if PS triggers centrals in me. I will go back to CPAP mode and report back! I hope you have a great weekend. Richard


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Pugsy
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri Jun 14, 2019 5:45 pm
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Will be a working weekend for me....lots to do and not enough time to do it.
Got the mowing all done between yesterday and today...we mow over 7 acres and some of it in the pasture was pretty ugly because we don't do the
pastures every week and we've had more than our share of rain last 6 weeks or so.

Tomorrow...building a deck...me and my husband. Should be interesting because neither one of us knows what we are doing and I am a light weight and can't lift much.

Oh...a note about PS causing centrals. Sometimes there is a very fine line between how much PS causes centrals and how much doesn't.
I have a friend who gets about 15 centrals PER hour with PS of 4....but with PS of 3 she doesn't even make 1 per hour central.
She needs PS too so she is lucky that she can simply just use PS of 3....her pressures on her bilevel start with 16 EPAP and often go over 20 cm...so that PS really comes in handy helping her with the exhale and makes it so much easier for her.

So if you do finally determine that PS of 3 is a problem....doesn't mean that you can't try PS of 2...might get lucky like my friend.


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Buschman
Unread post  Post subject: Re: Problem with apenas after one year of CPAP and BiPap use  |  Posted: Fri Jun 14, 2019 6:32 pm

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Pugsy: It is great that you have the energy to do all that yard work etc. I used to have incredible energy and I am hoping it is not gone for good...I have assumed that the sleep apnea was the main reason I lost my energy, and reading all the success stories from CPAP users gave me a lot of optimism. Now that my scores are getting better I am have renewed hope! I am about to move to a 2 1/2 acre property in Mexico I just acquired so I need to start getting more energy whether I like it or not!

Your taking me on as a "project" is so appreciated, and I feel guilty as I know you likely feel an obligation to write back and review my scores even though you have more important things to do. I will not write again until Monday and hopefully report that I have gotten my scores back to 4 or below! I do hope that I can go back to the bipap function, but last night was pretty tough on me so a little break will help.

Again you are so kind and generous to help me...at least you know your efforts are appreciated! Richard


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