New with two weeks on CPAC

[Windsurfing_Steve]

My husband has been using his CPAP machine for two weeks with amazing results as far as how he feels, he feels much more rested, however last night he had three obstructive apneas. He is getting much needed rest and has had no problem with using his machines. When he was young he took up scuba diving and I think this has made using the mask system easier.

The Doctors report says the following. "He is currently undergoing evaluation for frequent PVCs and right bundle branch block. The question has been raised whether sleep apnea is the cause or contributing to this problem".

We believe that his heart is traumatized by his sleep apnea and have high hopes for this treatment. In two weeks he will be seeing the sleep doctor for the first time since getting his machine. Last night he had three occurrences of Obstructive Apnea. I woke up and witnessed one of these and it was not good. He was not breathing and so I touched his arm and he woke enough to start breathing again. I know this is not good for his heart arrhythmia and want to make sure the doctor takes this very seriously.

My questions right now are about his still having three Obstructive Apnea even though he is diligently using his machine? Some nights he only has one, but last night three along with a few apnea and hypopnea. Even though he feels better he still has those PVCs to worry about and wants to get everything he can out of this treatment.

Thank you in advance for any help. I hope I have provided enough information as we are still on a high learning curve.

[Pugsy]

A handful of events through the night is normal. We all can have them...even people without the OSA diagnosis.
Having 3 throughout the night...actually extremely excellent results. It is hard to eliminate all of them and not really necessary.

Welcome to the forum. Sounds like the machine is doing its job. Don't worry about a handful of events here and there through the night. Most of us have them. If I only had 3 all night...it would mean I had an extremely good night.

[Windsurfing_Steve]

Thank you for the prompt reply. Our concern is the reaction of his heart to even one event. If the CPAP is not going to work I guess we need to know that before we see the doctor. His total AHI according to our sleepyhead report from last night was 7.9 with 7 hours of sleep. When he had the sleep study before the CPAP treatment his AHI was 9.5 with only 5 that were obstructive so I guess we made some progress.

When he has these obstructive events it causes his heart problems. He has ventricular tachycardia at a rate of 150 beats per minute when he stops breathing. Perhaps you are saying this is not going to work?

[BlackSpinner]

You gave his AHI but not his pressure settings. It maybe that his pressure is too low.

That AHI of 7.9 is not good. It should be well below 5.

Since it is an autoset it has probably been left wide open. Look for his 95 percentile and set the lower level to 2 cm below that.

[Pugsy]

Your first comments said the reports showed 3 obstructive events...over an entire night that is not a big deal.

My questions right now are about his still having three Obstructive Apnea even though he is diligently using his machine? Some nights he only has one, but last night three along with a few apnea and hypopnea.

Now you say AHI of 7 something that means an hourly average over the night of 7 or more events.
That is not acceptable level of reduction of events.

What pressure is being used? What is the event category breakdown? Minor obstructive and hyponea count and predominately central? Makes a big difference as to how we look at things. What you say now with the AHI completely contradicts your first statement.

You can't realistically expect zero events of any kind though some people are lucky enough to get it. It depends on what kind of events they have, what pressure they use, how long the night is and how lucky they are.

[osako]

...Our concern is the reaction of his heart to even one event. If the CPAP is not going to work I guess we need to know that before we see the doctor.

I'm no expert, but I feel confident in saying that if you're expecting CPAP to consistently eliminate all obstructive events, then no, it is not going to work. There are many people on this board that can work with you to reduce the number of events per night to what is considered a "normal" level, but it won't be zero every night. Only your husband's doctor can tell you what the risks of a single OSA event are given his underlying condition. If you are concerned that even a single event may jeopardize his health then you need to get medical advice immediately.

[Windsurfing_Steve]

So sorry for my miss information, I am uncertain how to proceed. Yes, last night the AHI was 7.9. I am trying to figure out how to attach a report from sleepyhead, but so far that did not work so here goes from last night:

Hypopnea 1.48
Apnea 0.86
Obstructive 0.37
Clear Airway 5.18
95% Pressure = 12.00

The pressure range on his ResMed was set at 4-14 by the technician at the start.

I realize that he will not be able to reduce his total apnea to 0. I am concerned about these Obstructive apneas like the one I witnessed last night where he stops breathing for a long time and not until he wakes up does he start breathing again.

[osako]

I realize that he will not be able to reduce his total apnea to 0. I am concerned about these Obstructive apneas like the one I witnessed last night where he stops breathing for a long time and not until he wakes up does he start breathing again.

OK. Just wanted to make sure you had realistic expectations. Looks like BlackSpinner is correct in that the pressure range is too open. The 95% pressure is 12, yet the APAP range is set from 4-14. The starting pressure of 4 is really too low. The APAP won't increase the pressure until it senses apneas/hypopneas. You're trying to prevent events, not react to them. Also, it takes a while to increase pressure from 4 all the way to 12, which can lead to longer events. Increasing the starting pressure can help prevent apneas/hypopneas in the first place. For what its worth, my 95% pressure is also around 12 with a maximum of 14.6. I set my APAP from 11 to 15.

[Windsurfing_Steve]

Thank you Osako. This is absolutely what we were hoping, that we could prevent rather than chase events. We will work on getting those settings changed. I have been reading this forum since we started and do believe there are directions somewhere to change the settings. His heart Doctor is also hopeful that CPAP will be the answer for his heart arrhythmia since his heart is in great shape. We want to keep it that way and so for now everything hinges on getting this right. Thank you for the help!

I also wish to say that apnea is a very serious condition as you all know and I am finding out.

Donna and Steve

[BlackSpinner]

Thank you Osako. This is absolutely what we were hoping, that we could prevent rather than chase events. We will work on getting those settings changed. I have been reading this forum since we started and do believe there are directions somewhere to change the settings. His heart Doctor is also hopeful that CPAP will be the answer for his heart arrhythmia since his heart is in great shape. We want to keep it that way and so for now everything hinges on getting this right. Thank you for the help!

I also wish to say that apnea is a very serious condition as you all know and I am finding out.

Donna and Steve

There are manuals online that will allow you to change anything in five seconds flat. In your case I would not hesitate to experiment.
However I would keep an eye on the clear air way events. Sometimes they increase with the pressure. If they only appear on sleep onset and first thing in the morning then no problem.
I would start by increasing the lower number to 7 - watch the results for a few nights, then increase slowly until you achieve what you want.

[osako]

...However I would keep an eye on the clear air way events. Sometimes they increase with the pressure...I would start by increasing the lower number to 7 - watch the results for a few nights, then increase slowly until you achieve what you want.

Great point.

[Windsurfing_Steve]

Thank you BlackSpinner. We were able find directions easily and got into the settings, but were uncertain how much to change. We will try the bottom number at 7 as you suggest and see how he does. This is exciting and thank you so much for the help.

[BlackSpinner]

Thank you BlackSpinner. We were able find directions easily and got into the settings, but were uncertain how much to change. We will try the bottom number at 7 as you suggest and see how he does. This is exciting and thank you so much for the help.

If you get any flack from the doctors, ask them about diabetics, if they suggest that diabetics not test their insulin levels. They test and adjust their insulin levels all the time. You can kill people with insulin, you can't kill people with air, you can however damage people if their settings are to low to treat their OSA.

[Tino2You]

Here is a how to link to post images from sleepyhead

Oh and welcome to the forum!

[Tino2You]

I really hate when I forget the attachement

Here is the link viewtopic.php?f=1&t=75678&p=692431&hili ... ad#p692431