After one month on BiPap, AHI is higher than sleep study?

[BiPapColorado]

Hey everyone.

I've been browsing here a couple days now and decided to finally post. For some background I was diagnosed through a take-home sleep study with OSA. I've been using this BiPap machine for about a month and a week now (started 11/9).

Vitals: 5' 10" , 295 lbs, 28 years old. I realize my weight is a major factor here... my father was using a CPAP for some time but was recently allowed to stop it after he lost some weight. Couldn't say how much is hereditary.

I'll admit I was slow to start digging into data, but after giving it several weeks and not seeing a difference in symptoms, I hooked up the DreamMapper software. And once I saw the results I really started to get a bit concerned. Seeing an AHI of around 13-18 for the past week or so. I had two days that spiked all the way to 35-40. Admittedly my symptoms were minor to begin with - some inertia getting ready in the morning, but I never struggle with afternoon drowsiness or other major issues once I'm up.

I called my doctor's office today and left some of that information with them. I didn't get a call back. The receptionist mentioned when I asked that the AHI during my take-home was around 13.5 though. So... even on the "good" days it looks like it's about the same? And why should it ever be worse than without wearing the thing? Needless to say I'm concerned... I finally bought a SD card reader today and installed Sleepyhead because I figured DreamMapper wasn't going to cut it. There's too much information to digest here, but I wanted to post a few days' worth of data, and tried to follow the newbie guide for it.

I'd appreciate any advice on small adjustments I could make. I'll try to call the doc back tomorrow... I'm realizing now that I still need to get a copy of that study for myself and not just a single number. But I'll be flying home for the holidays tomorrow night so nothing much will change for a couple weeks. I have my basic compliance follow up scheduled for the 11th but with this data, I'm still concerned. Thanks in advance for any help you can provide.

[Pugsy]

How'd they come up with those settings? Geez...talk about a recipe for a central apnea slug fest. 10 cm PS on a fixed bilevel machine. That will give just about anyone centrals unless they have some sort of lung disease or something weird. Normal people won't need that much....normal people would do just fine with 4 or 5 cm PS.
I am surprised things aren't worse.

Do you want to change it yourself to something more reasonable or wait it out?

[Pugsy]

Couple more questions.

What is the altitude where you live?

You don't have some sort of weird lung disease/problem do you? Any neuro muscular disease of some sort?

[palerider]

I'd appreciate any advice on small adjustments I could make. I'll try to call the doc back tomorrow... I'm realizing now that I still need to get a copy of that study for myself and not just a single number. But I'll be flying home for the holidays tomorrow night so nothing much will change for a couple weeks. I have my basic compliance follow up scheduled for the 11th but with this data, I'm still concerned. Thanks in advance for any help you can provide.

You need *large* adjustments, not small ones.

Those settings are the kind I talk about when I say "the only possible way you might do something bad with a cpap is to ... (have settings like you have).

It's not so much "what's wrong with them" as "what, if anything, is right.

I'd say go with a minepap of 8, maxipap of 25, minps of 2, maxps of 6, and see what happens.

It's worse than no machine because you're being hyperventilated into a hypocapnia situation and your body just doesn't get a signal to breathe... all to often.

[BiPapColorado]

Yikes....

Thanks for the quick answers. I knew something wasn't right, but now I wish I'd started looking at the data sooner.

I was planning to wait and call them back tomorrow, and then start changing things, but with a response like that, I feel like I shouldn't even wait that long.

Maybe I'll compromise and start with the PS change. I don't know how they'll react to me messing with the settings on my own but that seems like a small change. (But then, I guess, if it's that bad do I care?)

Couple more questions.

What is the altitude where you live?

You don't have some sort of weird lung disease/problem do you? Any neuro muscular disease of some sort?

I'm near Denver proper so it's around 5200'. And certainly no diseases like that that I'm aware of... Besides my weight and some Lexapro for anxiety I think I'm in good health.

That being said I will be flying home for the holidays to Vermont for a week, which is a lot closer to sea level. Would it do any harm to make this change right before the trip? I suppose I'll be monitoring it either way, if I can. I don't have a laptop to bring with me.

Thanks again guys.

[Pugsy]

For some people higher altitudes can be a big factor in central apneas (those CAs on your report).
At this point with the PS (pressure support or the difference between inhale and exhale) being so high it's impossible to know if altitude is a factor in your centrals or not.

Won't hurt a thing to make the changes and go to sea level though...no matter what is behind those centrals.

You need to make more than one change and that change being a PS reduction. You need an EPAP increase as well.
Your current EPAP of 5 isn't high enough to hold the airway open and prevent the obstructive apneas from happening.
Just cutting PS in half from 10 to 5 isn't going to do a good job but at least it would likely reduce the centrals.
Won't do anything for any of that other stuff you see on the reports though.

Palerider gave you a good starting point to try but if that's more changes than you are wanting to make..
Stick with fixed mode if you wish...Set EPAP to 8 and IPAP to 12 and see what happens.
Do you know how to get into the clinical setup menu area to make changes?
If not, go here and request the provider/clinical manual for your machine.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
It's all explained in the manual along with some other good useful information.

[BiPapColorado]

I did manage to find that info by a quick search for changing the settings. I don't mind digging into this kind of stuff... as a software dev/qa it's in my nature a bit, I think.

It's more that I didn't want to annoy my dr by changing things. But,I just remembered that I received a letter recently from them, saying my doctor is leaving the practice partway through next month anyways. Though someone else is joining of course. So, even if I struck a nerve with her, I think it wouldn't matter.

I'll try palerider's suggestion tonight and see how things go. It surely can't be worse than what I have now, so I have nothing to lose. Thanks once again.

[Pugsy]

Good luck tonight.

I am leaving for Vegas in the morning and I won't be on the forum as much this coming week so if you don't hear from me...it's not that I abandoned you...I just will be doing other fun stuff and you are in very capable hands with Palerider helping you out. You won't need me.
What short time I might spend here will be for the more critical stuff or someone that I am already in the middle of helping.
The settings he suggested...pretty much what I would have suggested if you were a family member of mine.
The fixed settings... for mainly if you were just too uncomfortable with making the other changes. You desperately needed at least that.

[palerider]

I did manage to find that info by a quick search for changing the settings. I don't mind digging into this kind of stuff... as a software dev/qa it's in my nature a bit, I think.

It's more that I didn't want to annoy my dr by changing things. But,I just remembered that I received a letter recently from them, saying my doctor is leaving the practice partway through next month anyways. Though someone else is joining of course. So, even if I struck a nerve with her, I think it wouldn't matter.

I'll try palerider's suggestion tonight and see how things go. It surely can't be worse than what I have now, so I have nothing to lose. Thanks once again.

People are often wary of offending the godlike doctors (what's the difference in god and a doctor? God doesn't think he's a doctor)... but what you have to keep in mind is that the doctor works for you! though many of them forget that, and want you to forget it too.

A *good* doctor will be happy that you're becoming more involved in your personal care and treatment, and will encourage you in that. If yours doesn't, it's really best to find another one.

[palerider]

Good luck tonight.

I am leaving for Vegas in the morning and I won't be on the forum as much this coming week so if you don't hear from me...it's not that I abandoned you...I just will be doing other fun stuff and you are in very capable hands with Palerider helping you out. You won't need me.
What short time I might spend here will be for the more critical stuff or someone that I am already in the middle of helping.
The settings he suggested...pretty much what I would have suggested if you were a family member of mine.
The fixed settings... for mainly if you were just too uncomfortable with making the other changes. You desperately needed at least that.

Ya know, I'll bet a buck that BiPapColorado's problem is that someone took an auto cpap prescription and screwed up trying to put it on a bilevel.

Bet you it shoulda been Min 5, Max 15...

For anybody following along, cpap auto mode min 5 max 15 is *wholly and completely* different that epap 5 and ipap 15 on a bilevel..

[Pugsy]

Ya know, I'll bet a buck that BiPapColorado's problem is that someone took an auto cpap prescription and screwed up trying to put it on a bilevel.

Bet you it shoulda been Min 5, Max 15...

You know that may well be what happened. I can't imagine any doctor doing PS of 10 on anyone without some really extenuating circumstances.
But I can sure imagine a dumb ass DME doing it.
They may have even given him the wrong machine...he got bilevel auto instead of cpap auto. Or maybe that's all they had on the shelf. Who knows with some of those yahoos.
Sometimes they scare the hell out of me...and they are supposed to know what they are doing because people sort of put their health and well being in their hands.

[zoocrewphoto]

Perhaps it would be a good idea to ask the doctor what they actually prescribed - machine and settings to see if the correct machine was provided by teh DME. If not, best to get that fixed while the doctor can help with that.

[Pugsy]

Perhaps it would be a good idea to ask the doctor what they actually prescribed - machine and settings to see if the correct machine was provided by teh DME. If not, best to get that fixed while the doctor can help with that.

Actually I would keep mum on that for the time being....if apap was prescribed and a bilevel auto was given...it's a plus not a minus.
There are some potential advantages to bilevel over apap/cpap that it doesn't hurt to have available.
And using a bilevel won't hurt things for most people.

He's going to be seeing someone after the first of the year anyway...I would hate to have to give up a bilevel and go down to the apap when we can make the bilevel do as good or even better job than the apap.

[BiPapColorado]

Hey guys.

First off I want to thank you all again for your help so far. Last night didn't subjectively feel too different from normal - maybe I had a slightly easier time getting out of bed this morning? But I know not to expect instant results. The biggest thing I noticed, really, was before I even fell asleep. That 10 PS never felt fully comfortable while awake... things are waaay more comfortable while I'm trying to fall asleep now. Big plus.

Naturally, of course, it's the data that's most important so I pulled another graph this morning. Those numbers don't lie... definitely the best night I've had since I started this thing. I know from other threads here that it can still get even better, but I'll run with these settings for a few days before making any other changes.

screenshot-20181221-081138.png (115.19 KiB) Viewed 14208 times

Mask leak rate is a problem today... but that's probably natural given the new pressures. I'll need a couple days to readjust the straps and such, I think. Everything else is probably better though? Any thoughts?

[Tatooed Lady]

I'm not a help to your settings, but I was diagnosed via home (truck) sleep study, never saw the doctor who supposedly prescribed my machine, when I tried calling him to change the pressure, I got an out of state number, which was disconnected.... got in a screaming and swearing match with the DME (I won) over my changing my pressure...other than the call I made to the DME to tell them that if they used the modem to change the settings, I would yank the modem and they could KMA, I have only had contact to do yearly compliance readings.
They don't like it, I don't care, because I'm the one who is either suffering or not. If my numbers are good, that's what matters. If you're willing and able to tweak settings to improve your health and sleep, go for it! And yep, giving a few days or so to see how things settle is a great plan.