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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 6:07 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 6:12 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 6:25 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Pugsy
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 6:58 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 2468
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Did you have a sleep study done in a lab using CPAP to get an idea what pressure you need?

BTW....you can do more than one attachment per post. You aren't limited to just one.

You are using a fixed pressure of 7 all night long and obviously it isn't enough to prevent the OAs and hyponeas.
The CAs could easily be just by products of the OAs and hyponeas causing arousals. At any rate you need to deal with the OAs and hyponeas first and then we worry about any CAs that might remain.

Do you have the clinical manual for your machine? Do you know how to change the settings? Are you comfortable with changing the settings yourself?

Go here to get the manual. It explains how to get into the clinical set up menu are and change the settings. About 2/3 down the page are the instructions for how to request the manual.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

If you are comfortable changing the settings...change the mode from CPAP to Auto and set the minimum to 7 and the maximum to 20 and see what happens. Probably will need further adjustments but gotta start somewhere.

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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 7:06 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Yes, I had a home sleep study and was diagnosed, then I went for an in lab titration to see what pressure I needed. I had a CPAP the whole night that night.

I do have a manual that came with the machine, so I will take a look at what you provided and what I have and see what I can do. I have just started therapy and I need to be in compliance for the insurance company, so if I change pressure or settings, well that affect my compliance?


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Pugsy
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 8:30 pm
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The insurance company doesn't care one little bit about your settings or if you change them or not.
All the insurance company cares about is if you use the machine the minimum number of hours each night to justify their paying for the machine.

The user manual isn't the same as the link I gave you for getting the provider/clinical manual.
There's more good stuff in the provider manual including the secret handshake on how to get to the clinical setup menu area.

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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 9:00 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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That is good to know. Thank you so much for the information.. So, OA's can tend to cause CA's ?


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Pugsy
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Jan 12, 2021 9:42 pm
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No, OAs don't cause CAs directly.
What happens is sometimes the OAs occur and an arousal occurs so the person is awake or half awake and there is an irregular pause in breathing that is actually normal while awake but the machine flags it as a CA.
If you aren't asleep they don't count. So the OAs/hyponeas cause arousals which then might increase the chance of awake breathing false positive flagging.

At any rate we know we have to deal with the OAs and hypones with more pressure...so we try dealing with those first and then we see if we get lucky and with a reduction in OAs/hyponeas that the CA/centrals reduce.
If we don't then we re-evaluate things. It is very possible that the OAs and hyponeas are causing wake ups though...so lets try to reduce them and then see what is left to deal with.

Watch the videos here and you will get a better understanding about what I am talking about with awake flagged events.

http://freecpapadvice.com/sleepyhead-free-software

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DeltaBravo3.8
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Wed Jan 13, 2021 8:28 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 595
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: Required to start over on ResMed AirSense 10 AutoSet.
Humidifier: HumidAir and Heated hose
Pressure Setting: Auto PAP 7-14, EPR full time 3

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Still tuned in. Straight CPAP (as it appears to be) like this makes it a bit difficult to adjust. We see that 7 isn't enough to stop events, so it needs to go up.

Here's what I'm seeing as what you're facing. Pressure will have to go up to prevent the obstructive and hypopnea. It may need to go high enough that comfort is diminished, so keep note of "how you feel". Literally, you may want a notebook to note down events are x and I feel tired, or discomfort or whatever related to PAP therapy. Tell the doc about it. And be prepared to get politely demanding, that treatment that is uncomfortable or not well treated is not going to be accepted by you. Any questions at all can be asked here. We on the forum have seen it and dealt with it ourselves.

It's possible these may be clusters of events, but until pressure goes up, we can't see how the events will respond. Saying so as there may be more things needed to help once we deal with pressures and whether or not the PAP you have can successfully treat and with comfort. Read up on positional apnea and soft cervical collars as supplemental to PAP machines for treatment.

Compliance is just using the PAP for 4 hours per day for at least 21 days of 30, with 3 months to get that goal. You also must have a doctor visit to discuss treatment after 30 but before 90 days. Insurance does not care if pressures are edited or by whom they're edited. You can adjust the PAP yourself without an edited script. Doc and the supplier DME cannot change settings without a new edited script.

FWIW on apnea, medical definition of apnea being treated is 5 AHI. You are far above the treated level. These levels of events are presented by some without a PAP. We do not need zero AHI, it is not realistic or needed, but under 5 is realistic and reasonable. Part of an AHI that is acceptable comes down again onto how you feel.

My suggestion is at least consider seeing what happens if pressure of 7 is upped to 8. I have a problem with the simple CPAP they provided when an Auto PAP is not much more cost. The doctor didn't do you very good service with this selection.

We won't know what your therapy requires, but if the pressure approaches 15, a few things are evident IMO. Bilevel would be much better suited to treat and give much better comfort. An APAP can be close, but again they didn't even give you that. None of these negatives are pointed at you the patient. You didn't know this.

Best case is if you had at least an APAP, my personal choice is that you had been given a ResMed AirSense 10 AutoSet. Philips proves many times to be a lot slower at trying to combat events. And then doc dispenses the supposed straight CPAP that is not set even close to addressing events, if not true, you'd have a lot less events now.

_________________
Duct tape carrying K9; the tape helps quiet stupid.
Dave K9DWB 73s


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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DeltaBravo3.8
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Wed Jan 13, 2021 8:52 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 595
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: Required to start over on ResMed AirSense 10 AutoSet.
Humidifier: HumidAir and Heated hose
Pressure Setting: Auto PAP 7-14, EPR full time 3

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PS it appears I missed a bit of info. Your machine is actually an Auto, it just needs to have you set it as such. We can coach you how to do that. But also it's good to see it in the Clinical Manual so you understand it yourself.

_________________
Duct tape carrying K9; the tape helps quiet stupid.
Dave K9DWB 73s


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Mon Feb 08, 2021 6:22 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Hello,

I have been dealing with other health issues (asthma) and my husband's health issues, so I didn't get a chance to check back in. I have been doing really good wearing my CPAP at night and met my insurance requirement of at least 4 hours a night. But, my AHI just kept staying high and I have been having BOTH OA's and CA's and some periodic breathing (not too bad though). I went to the doctor today for my follow up and she said that she doesn't understand why my home study only show an AHI of 7 and I did not have any CA's in my home study, and the titration was able to keep my AHI to 2.6 with a pressure of 7cm, So that is what they put me on. But, since using my CPAP, it's much worse. So (of course) she raised my pressure to 10cm and raised my humidifier to 5 (was 3) and lowered the heat in the hose. So, hopefully this will work. I have a good feeling about it. I know I could have done it myself, but I didn't want to upset my doctor and do anything wrong. But she knows now that it was not sufficient. I will post an update tomorrow when I see how my first night goes. Below are the last few nights I had so you can see what has been going on.


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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Mon Feb 08, 2021 6:23 pm

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

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Attachment:
February 7, 2021 part 2.png
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Respirator99
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Mon Feb 08, 2021 7:00 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 348
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Hi Raven Lady. The panel showing the number of events is of limited value - please revert to the details tab. Without the details we don't know how your machine is set or what pressures (etc) were achieved. Also, please show the following graphs:
  • Events
  • Flow rate
  • Pressure
  • Leak rate
  • Flow limitations

It's obvious that the pressure setting still isn't right. You should be making use of the automatic features of your machine - set a wide pressure range and let the machine converge to an optimum - that's what an automatic machine is for.

The other issue that jumps out at me is the highly clustered nature of your events. This is often an indication of positional apnea, where something about your sleep posture is causing obstruction. In general it's better to lie on your side rather than your back. It's not uncommon for the head to fall forward, chin on chest, which puts stress on the wind-pipe. Side-sleeping can reduce this. Alternatively, consider an orthopaedic pillow to keep your neck properly aligned (chin slightly elevated) to keep the airway open. If tat fails, then a soft cervical collar may be the answer. There's a detailed write-up here: http://www.apneaboard.com/wiki/index.ph ... cal_Collar

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Raven Lady
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Feb 09, 2021 10:14 am

Joined: Mon Dec 28, 2020 6:16 pm
Posts: 23
Location: Alvin, Texas
PAP Mask: Dream Wear Amara full face mask
PAP Machine: Phillips DreamStation
Pressure Setting: 9.5
9.5 cm

Offline
Thank you for responding Respirator 99. I will work on sending screenshots of the details with the thing you listed below. I did have my first night with my increased pressure of 9.5 last night and it was not really any better. My AHI was 13.3. I have not had the opportunity to upload it to Oscar yet as I am at work today, but my events were 35 CA's, 54 OA's and 20 hypopneas, and my machine showed at least some periodic breathing events, but don't know the details yet. This humidifier was better though as my mouth was not as dry. I actually have tried many different positions, and mostly sleep on my right side instead of my back. Last night I slept most of the night on my right side, and even rolled over half way on my stomach on the right side. Then I rolled to my left side. I could literally "feel" some of the apneas happening and waking me up. :( I have one of those wedge memory foam pillows I use. I will look into the cervical collar. Thank you for the information. :) I noticed that the majority of my events are later in the night/morning as opposed to when I first go to sleep, and I am not sure why because nothing is different. My doctor is going to call me in a few days to go over things to see where we need to go. She is able to pull the report from my machine (I assume through my modem).

Will update soon. Thank you.


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DeltaBravo3.8
Unread post  Post subject: Re: Newly Diagnosed - AHI Question  |  Posted: Tue Feb 09, 2021 12:31 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 595
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: Required to start over on ResMed AirSense 10 AutoSet.
Humidifier: HumidAir and Heated hose
Pressure Setting: Auto PAP 7-14, EPR full time 3

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This bit of info should apply on self advocacy on your pressures and really good whole PAP therapy. I've applied it to me so I know it works.

Example, say we suggest change pressure from x to y and you do it. You'll note that when you change x to y it impacted your therapy in OSCAR. So how to keep doc onboard? This...

Mental checklist or physical pen and paper, doesn't matter but physical method you can show the doc. Something like this... On date x I changed setting Mode from CPAP to Auto. When I did that, I noticed x events were less and comfort was better, well rested feelings improved. And you're telling doc "I did this or that with these results". AND you follow up with, what do you think doc? Result, limited ruffled feathers on doc and he or she is still giving input.

_________________
Duct tape carrying K9; the tape helps quiet stupid.
Dave K9DWB 73s


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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