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Permalink Reply by Chris on May 11, 2009 at 5:44pm

Rock Hinkle said:

Me again, I donn't believe anyone has mentioned yet. Chris have you had problems with allergies in the past? Sometinimes when you are new to Pap therapy it can and irritate your sinuses and or allergies. It does not always have to be a technical issue. Headaches can be caused by many things as the others have mentioned.

Yes major problems with allergies. They said I had polyps in my nose because of it but when they did the surgery to remove them they were gone.????? Strange but they had to fix a deviated septum so all is well and I am doing the allergy shots to keep things in check.

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Permalink Reply by Chris on May 11, 2009 at 5:57pm

j n k said:

They don't make you do the math anymore if you get a recent machine and use the software. ResMed does a good job of giving a lot of information from the screen, too, I think. But it takes time to figure it out, that's for sure. It took me weeks of reading and meditating to finally figure out what the heck the clinician's manual was saying!

I think we forget sometimes how new these machines are, relatively speaking. To a medical professional who has been around this stuff for years, and understands the history, it might seem more intuitive than it does to us--I don't know. They may understand that what ResMed did is to put bilevel functionality on top of an auto algorithm written for auto-CPAP. So the machine reports the pressure that the algorithm uses, since the algorithm thinks it is an auto-CPAP. The blower takes that info and adds and subracts pressure in order to give pressure support. We humans think of it as starting at one pressure and raising to another. But the machine apparently thinks of it as starting at an imaginary midpoint pressure and adding to that and subtracting from that. Doing things the way ResMed did was a way to put out a bilevel using an already proven approach from its auto-CPAPs. The A10 algorithm has proven its effectiveness, so ResMed was doing us a favor by constructing an autobilevel on the same platform.

The approach is meant for RTs to understand it. Not us. And ResMed has yet to put out customer-friendly software, in my opinion. But at least the newer machines (like the 25) do give the IPAP and EPAP numbers in the software charts so that the math doesn't have to be done now. But if you use the screen, the math still has to be done.

Sorry I made that add 2 subtract 2 so difficult to understand before. But imagine if pressure support had been at 5! Then we would have been adding 2.5 and subtracting 2.5 to get our real numbers! I HATE MATH!!!!

Yep, I hate the math too. I did orderd the software a few days ago hoping it would make things a little easyer . Now if they would only get a spell check on this site i would be set. LOL O yea by the way I just started pap a week ago.

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Permalink Reply by Daniel on May 11, 2009 at 11:15pm

One of the contraindications for using xPAP is if you've had a skull fracture or surgery which involves drilling a hole into your skull. The pressurized air could get into your brain, which would not be good. I imagine it would cause headaches. That may be why the manual suggests seeing your doctor. I can also imagine that if you don't have the settings right with the humidifier, you may wind up with congestion that could cause something like a sinus headache.

I certainly hope its nothing serious, but don't dismiss talking to your doctor about it.

Daniel

Chris said:

j n k said:

As for the headaches I just found some warnings in the manual that say If you get SERVERE headaches to cal a doc immediately. The headachs are not that bad so I just might mess with the settings including the humidifier.

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Permalink Reply by Chris on May 12, 2009 at 12:04pm

Daniel said:

One of the contraindications for using xPAP is if you've had a skull fracture or surgery which involves drilling a hole into your skull. The pressurized air could get into your brain, which would not be good. I imagine it would cause headaches. That may be why the manual suggests seeing your doctor. I can also imagine that if you don't have the settings right with the humidifier, you may wind up with congestion that could cause something like a sinus headache.

I certainly hope its nothing serious, but don't dismiss talking to your doctor about it.

Daniel

Chris said:

My brother always says I have a hole in my head but I dont think thats it. LOL

These are just like the headaches I woul wake up with once in a blue moon before I started pap. It happend for about four days in a row right after I started. Has not happend again but I will look in to things like machine settings and talk to the doc.

Thanks for the help

j n k said:

As for the headaches I just found some warnings in the manual that say If you get SERVERE headaches to cal a doc immediately. The headachs are not that bad so I just might mess with the settings including the humidifier.

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Permalink Reply by Mike on May 20, 2009 at 2:42pm

Hi Chris, I see that your current bilevel pressure is 15/5, leaving your AHI a little high. Your HI (hypopnea index) seems to be the problem, since the AI (apnea index) is fairly low. You might want to get your doctor to prescribe a setting of 16/8 or 14/7, and see if things improve from one of those starting points. I would try one or the other for a week each. This should lower both your HI and AI. Just one patient's viewpoint.

Chris said:

j n k said:

That AI is a little high for a ResMed. Generally it is good for AI to consistently be below one, whenever that is attainable. If you are just starting out, I wouldn't worry about it right now. But if you have been using your machine over a month, it is my opinion some tweaking of your pressures should be done to see if that AI can get below one. I would ignore the AHI number until AI is below one.

It may be your doc is going to check your numbers later and adjust your range. So work with the doc on that if that is the game plan.

Here is what the settings mean, if that hasn't been explained sufficiently to you. Your Min EPAP is the lowest your exhale pressure can go. Your Max IPAP is the highest your breathe-in pressure can go. Your pressure support is the difference between the experienced breathe-in pressure and experienced breathe-out pressure with any given breath, and that difference between inhale and exhale is a constant on a ResMed autobilevel.

So, in practice, with the settings you have now, you start out the night with 9cm pressure for inhale and 5cm pressure for exhale. It stays there until your "settling" time is up. Then the machine algorithm kicks in to try to prevent events and raises your pressure. With your Max IPAP at 15, your pressures never gets above 15cm for inhale and 11cm for exhale, since the difference between inhale and exhale stays at 4 all night. Does that make sense? If not, let me know.

The reported 95 centile autoset pressure number of 12.8 shows that your machine is giving you pressures of 14.8 on inhale and 10.8 on exhale, or below that, for 95% of the night. So your pressures are likely hitting the 15cm ceiling on that machine momentarily, as it is set now. The reported pressure of 12.8 is a number given you to figure out your 95 centile IPAP and EPAP. If your pressure support is at 4, you add 2 to the 12.8 to get your 95 centile IPAP, and you subtract 2 to get your 95 centile EPAP. That math works out to 14.8/10.8 for your 95 centile IPAP/EPAP. That isn't important to grasp right now, but I explain it in case you are the kind of guy that likes to know. :-)

If your doc doesn't mind you tweaking the numbers a bit, you can slightly adjust them in an attempt to get your AI consistently below one. I would start by seeing what happened if I raised my Min EPAP. The Min EPAP of 5 is pretty low. In fact, many find it hard to breathe when the pressure is that low. That machine is so comfortable to use that you should have no problem at all starting out the night at a higher pressure during settling. You could raise your Min EPAP to 6 for a week or two and see if that gets your AI below one. If it doesn't, you can try raising it to 7 for a week or two after that, and so on. (Do not, however, raise Min EPAP over 11. You need a distance of at least 4 between Min EPAP and Max IPAP, since your pressure support is set to 4. There is no reason to even think about getting the Min EPAP that high any time soon. I think you would see that AI drop below one long before that.) Any adjustment should be tried for a week or two before trying another one. That is the slow, methodical, scientific approach to minor self-titrating.

If your AI is still above one after playing with your Min EPAP setting, you may want to ask your doc about permission to raise your Max IPAP. I would not do that without the doc's permission, myself, since that would be actually affecting the delivered pressure, not just the range (which is all that changing Min EPAP is, changing how low you start out). Your titration study may have shown a reason to keep your IPAP below 15 at all times.

Nevertheless, all that being said, I very much doubt any of that is the reason for the headaches. The humidity would be where I would start for that, along with giving your body time to adjust to PAP therapy, if you are relatively new to it.

jeff

I never had a sleep study to set the pressure. My doc went with the bi level machine because it sets the pressure to what you need. When I went to my first study to find out what the pressure should be I had such a bad case of congestion the nasal mask was useless. Not sure why they did not try a full mask but any way you said they may of had a good reson to set my machine up the way they did but it looks to me like they are doing some gueesing so what I am going to do is get the tech to download the info and send it to the doctor and take it from there. I might try to tweek things a bit while I wait for my appointment.

And yes, I am the kind of person who wants to know everything about my treatment so thanks for taking the time to explain all the math involved with how the Vpap Auto comes up with the results. As for the headaches I just found some warnings in the manual that say If you get SERVERE headaches to cal a doc immediately. The headachs are not that bad so I just might mess with the settings including the humidifier.

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