New User looking for analysis of Data

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
rotts4u
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New User looking for analysis of Data

Post by rotts4u » Wed Oct 08, 2014 4:52 pm

I have been on a Resmed CPAP S9 for a little over a week and thanks to reading here I learned how to download my data and look at my info but am still learning what everything means. I am 51 years old and after my wife advising about long periods I had a sleep study where my AHI was 29. The Dr put me on a Cpap and I already sleep and feel better for sure. I know my pressure settings are 6 on low and 18 on high. With a start up of 4 and a 20 minute ramp. Before my snoring was so bad my wife usually left the room. Now its basically gone. Its seems to me my 6 start up pressure is a little low and I am still having obstructive events. Here is my summary for the first 10 days.

I know how to adjust everything in the clinical settings menu so if there is advise I think I can follow thru.

Thoughts?
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Wulfman...
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Re: New User looking for analysis of Data

Post by Wulfman... » Wed Oct 08, 2014 5:19 pm

Just going by that data, it would appear that you need to move your minimum pressure up to around 10 cm. That way, it will have a head start preventing events.......and should lower your AHI.


Den

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rotts4u
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Re: New User looking for analysis of Data

Post by rotts4u » Wed Oct 08, 2014 5:36 pm

Thanks Ill bump that up tonight and see if it helps. If I look at the nightly data it was really good the first few nights like an AHI of 1.XXX then its been gradually going up to 4.XX

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Pugsy
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Re: New User looking for analysis of Data

Post by Pugsy » Wed Oct 08, 2014 5:41 pm

The AHI isn't bad at all. Less than 5. Right now it's showing averaging a little over 3 per hour and last night not quite 5 per hour.
Before changing anything I would make sure the bulk of that AHI is Obstructive OA or hyponeas. We can't tell from this statistics page.
Often newbies spend considerable amount of time awake while wearing the mask with machine on and the machine sometimes mistakes awake breathing irregularities for some sort of apnea event which can give us falsely elevated AHI.
Often the breathing irregularities will get flagged as centrals (ClearAirway events in SleepyHead) and we don't treat centrals with more pressure.

So before you go increasing anything....make sure that what you want to fix is fixable with a little more pressure.

It's hard to get a feel for what pressure might be a little better for you from just this statistics page.
Can you give us last night daily detailed image and be sure to include the AHI breakdown on the left and these graphs on the right
Event
Flow rate
Pressure
Leak

You can turn off mask pressure and AHI graphs (Preferences/graphs tab and remove the check mark) so you that you can get all of this on one image. The graphs will resize...but don't make them too small or we can't see the numbers.

Assuming all the AHI is obstructive in nature and not central then a little more pressure would probably reduce it down a bit. I don't know that I would go with 10 but it might be best. What I would do is increase the minimum 1 cm every couple or three nights and watch the reports and see where things start to improve to your satisfaction.

In my experience I have often seen the overall averages and 90/95% pressure numbers actually decrease with a little more optimal pressure. Worth a try and besides going from 6 starting to 10 in a single move is going to be a harder adjustment than going up slowly. And you might get lucky and not need as much as we first though.

So look at the AHI event categories first...make sure that what you want to reduce is reduceable with more pressure.
If your AHI is 5.0 and your centrals are 3.0....that leaves 2.0 for obstructives and that doesn't really need improving and increasing the pressure may not even reduce them from 2.0. While not impossible to get 0.0....it's not all that common either and an unrealistic goal that will drive you crazy.
If your AHI is 5.0 and your centrals are 0.5...that means the obstructives are 4.5 per hour and those could likely stand a little reduction.

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Pugsy
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Re: New User looking for analysis of Data

Post by Pugsy » Wed Oct 08, 2014 5:43 pm

rotts4u wrote: If I look at the nightly data it was really good the first few nights like an AHI of 1.XXX then its been gradually going up to 4.XX
So what is increasing in that AHI?
Might just be more deep sleep and thus more REM where we might see our OSA worse but it might be centrals which we don't increase the pressure for and actually could potentially make the centrals worse.

Don't go changing anything until you understand what you are fighting.

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Julie
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Re: New User looking for analysis of Data

Post by Julie » Wed Oct 08, 2014 6:01 pm

Have you tried not using the ramp? Or at least shortening the time of it, raising the starting ramp pressure and getting yourself to therapeutic levels faster? Most of us, once into things by a short time, don't bother with it at all... it's only if your set pressure is very high e.g. 15, that it becomes more necessary.

rotts4u
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Re: New User looking for analysis of Data

Post by rotts4u » Fri Oct 10, 2014 9:06 pm

I went ahead and raised the min pressure to 10 and have had it there for 2 nights. The data looks pretty similar both nights in terms of AHI,. I took a bunch of screen shots so hopefully I captured everything needed to get some additional help.
ImageImageImageImage

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Wulfman...
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Re: New User looking for analysis of Data

Post by Wulfman... » Fri Oct 10, 2014 9:25 pm

Do you sleep on your back? (supine)

Would you be willing to try setting the minimum and the maximum both to 12 cm. for a few nights?
Looking at your reports, the areas where there are fewer events seem to be at around that pressure. When the pressure goes up, I'm not sure whether the increases are causing some of the events or whether it's responding to events. The clusters seem to be when your pressure is higher (15 - 17)......but taper off when the pressure goes back down.

The other part of my thought is that it also wouldn't be responding to snores or flow limitations by using the same pressure.


Den

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(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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rotts4u
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Re: New User looking for analysis of Data

Post by rotts4u » Fri Oct 10, 2014 9:30 pm

I usually start on my back but roll to one side then the other during the night. I know its better on my side from a OA point of view but I can't always get comfortable there.

I am open to trying anything as I seem to tolerate the machine fine with no problems and I already feel better so if that is the general consensus I will give a 12-12 a try. Just for curiosity sake does the insurance monitor just the usage? They can't tell that I am changing stuff can they? I know the Dr can see if when he looks at m y data I just don't want insurance to have an excuse not to pay for machine.

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Wulfman...
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Re: New User looking for analysis of Data

Post by Wulfman... » Fri Oct 10, 2014 9:37 pm

rotts4u wrote:I usually start on my back but roll to one side then the other during the night. I know its better on my side from a OA point of view but I can't always get comfortable there.

I am open to trying anything as I seem to tolerate the machine fine with no problems and I already feel better so if that is the general consensus I will give a 12-12 a try. Just for curiosity sake does the insurance monitor just the usage? They can't tell that I am changing stuff can they? I know the Dr can see if when he looks at m y data I just don't want insurance to have an excuse not to pay for machine.
Correct. The DME and insurance just care that it's being used for the required amount of time so they get paid.
Besides, it's YOUR therapy and whatever YOU can do to optimize it benefits YOU. They're not the ones sleeping with it.

The doctor shouldn't care either as long as you're able to corroborate your improvements in your therapy.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

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Wulfman...
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Re: New User looking for analysis of Data

Post by Wulfman... » Fri Oct 10, 2014 9:46 pm

By the way.......what mask are you using?
Is it comfortable? Good fit? If it's a nasal mask, are you aware of any mouth-leaking or mouth-breathing........(dry mouth?)


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

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Pugsy
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Re: New User looking for analysis of Data

Post by Pugsy » Sat Oct 11, 2014 4:41 pm

For future posting of your graphs...you included graphs that really aren't particularly useful and omitted the leak graph which might be useful.

You can also turn off the pie chart which is not particularly useful and that lets some statistics come into view which might be useful.
You can also hide the calendar which will bring up even more statistics on the left.

The graphs on the right side..these are the main graphs I like to see.
Events
Flow rate
Pressure
Leak
with the S9 sometimes the flow limitation graph if it is very active.
Those graphs can be resized so 4 will fit on one image and lessen the screen shots that you need to take. It's nice when we only have to evaluate one image that has everything we need on it.
Also for further images can you expand them horizontally? The blue thing on the right isn't needed but having 7 hours scrunched up so closely together makes it a little more difficult to evaluate any pattern that might be developing.

Those events might be related to REM stage sleep.
First REM sleep stage usually happens around 90 minutes (give or take 30 minutes) after sleep onset and then as the night progresses REM comes more often and lasts longer with the greatest amount of REM happening in the wee hours of the morning. It is common for pressure needs to change during REM...I have seen the need for 8 cm more when I was probably in REM sleep and my sleep study confirmed that my OSA was worse in REM.
Of course supine sleeping can also significantly change the pressures needed.
Sometimes we can do something about supine sleeping and sometimes we can't but we can't ever do anything about REM stage sleep short of not getting it which isn't something we want to do because we need those sleep cycles each night for sleep to work its magic restorative powers.

I can't tell from the graph what your minimum pressure is with this most recent report.
Looks to be around 10 cm with EPR being used but can't tell how much EPR. If those statistics were showing I could see those numbers.

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rotts4u
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Re: New User looking for analysis of Data

Post by rotts4u » Sat Oct 11, 2014 8:53 pm

10 was the min pressure for the last couple of days and last night was about the same as above too 4.87 AHI 3.5 OA. The mask is a Mirage Quattro full face and yes I find it to be comfortable. It adjusts top and bottom with a strap and also has the adjustable height on the forehead.

Ill make the changes suggested to the graphs and post again

rotts4u
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Re: New User looking for analysis of Data

Post by rotts4u » Sat Oct 11, 2014 9:11 pm

The big leak was after getting up to go to bathroom around 7 or so. I didn't turn it off I just unhooked it from the mask and left it running


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Pugsy
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Re: New User looking for analysis of Data

Post by Pugsy » Sat Oct 11, 2014 11:08 pm

Thank you for the larger and clearer image.
Looks like EPR is 3. I think Den's idea of 12/12 is a good idea to start with if that is what you want to try. If you make a pressure change don't go changing the EPR at the same time. Keep your variables to a minimum.

Leaks aren't an issue. Your leaks are well controlled and below the red line for the bulk of the night. Short spikes above the red line aren't the end of the world and this report doesn't really have much time over the red line anyway and it's easy to spot the really big line when the mask was taken off and the machine ran for a short period of time.
Now if leaks wake you up then you want to deal with them but because they are disturbing your sleep.

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.