New here, introduction and some newbie questions...

[FrederickRose]

BTW, given the point you are at now, I think a sleep lab titration would be a waste of time, money and energy. Many of us have used the sleep lab prescribed machine settings only as a starting point. We use Sleepyhead to find the optimal machine setting.

This may be a dumb question, but is there any chance - based on the graphs I showed - that I'm wrong about having OSA?

[Pugsy]

This may be a dumb question, but is there any chance - based on the graphs I showed - that I'm wrong about having OSA?

Not a snowball's chance in hell of you not having OSA. IMHO

If you want to get an idea of just how much stuff the machine is preventing...set the machine to 4 minimum and 4 maximum (or the least amount you are comfortable with) and see how many flags you end up seeing.

[FrederickRose]

This may be a dumb question, but is there any chance - based on the graphs I showed - that I'm wrong about having OSA?

Not a snowball's chance in hell of you not having OSA. IMHO

LOL. I like how you tell it to me straight .

[Pugsy]

LOL. I like how you tell it to me straight .

No sense in pussyfooting around.

I screened my sister and her husband using my apap machine a few years go.
Her pressure never increased all night long...her husband's went to 9 and stayed there.
The machine didn't sense anything to fight in my sister's case and come to find out her fatigue issues were related to her BP meds. She changed meds and the fatigue issues went away.
Now in the BIL...the machine sensed something it didn't like and it only responds to obstructive stuff (OAs, hyponeas, snores, Flow Limitations) but he has/had OSA. Typical symptoms yada yada yada. He blew it off though.

The fact that your pressure goes up and pretty much stays up...and the residual AHI even with the pressure being elevated and the clustering....all points to OSA.
No doubt in my mind.
Now as to how severe...you would need a sleep study because even at 4 cm there is some therapeutic value.
Now a sleep study might be useful down the road if once you get your therapy optimal (at least on paper) and you have no improvement in your symptoms...maybe something else is going on that might be spotted on the sleep study but I think you know that sleep studies just tell us that we sleep poorly and they can't always tell us why we sleep poorly if the reason is something besides the data sleep studies gather.

I see it all the time...people have crappy sleep and the numbers are good and think that a sleep study will tell them WHY they wake up often and sometimes it does but most of the time they can't tell why we have arousals unless the arousals are related to breathing issues or leg movement issues.
Spontaneous arousals...means they don't know why.

Now a sleep study would tell you about potential desats but even that comes with a caveat. Not everyone will have significant desats with even severe sleep apnea. I have a friend who has "severe" with over 60 events per hour and her desats never really dropped below what would be a normal drop during sleep. Baseline during the day was 97% and the lowest it went to during the sleep study was 94% and not very long at that.

[Pugsy]

Oh, forgot to mention a sleep study would also tell you if you had a strong positional component to your OSA or the REM thing.
For some people it is really important that they know all this.
For me not so much. It's like being pregnant...you either are or aren't and with OSA you need some sort of therapy or you don't.

Besides the in lab study is one night in a foreign setting with all those wires and stuff. Not exactly conducive to reproducing the sleep you get at home in your own bed.

That was part of the problem I had with the titration sleep study from hell...I couldn't sleep for various reasons even with Ambien and out of an 8 hour night I got 186 minutes of sleep. It's no wonder they got my pressure wrong.
If I had it all to do over again...I would have bypassed the sleep studies and gone straight to DIYing it.
Saving the in lab stuff if the DIYing it didn't work out so great.

[DreamStalker]

Very interesting. If you can get equal efficacy with less pressure, that seems like a win.

Your sense of breathe against pressure adapts given sufficient time. I found it weird for the first couple of weeks and then it became quite normal.

As for the ResMed vs Repironics APAP algorithms faster vs slower response to change pressures ... I started off with the ResMed APAP and then got a Respironics APAP as a backup machine and also to specifically compare the two machines for myself (the ResMed vs Respironics debate goes way way back). I found that for me, I got more restful sleep with the slower Respironics ... perhaps the more rapidly changing ResMed would wake me out of REM, I don't know. I eventually sold my ResMed and got a Respironics BiPAP seeking out that perfect pressure machine algorithm that would get me as close to zero AHI as possible with as much comfort as possible. After a couple of years of experimenting, I nonetheless discovered what forum member Wulfman (Den) had always said ... and that eliminating all the comfort bells and whistles and using the correct straight CPAP pressure ended up working best for me because I think I am a light sleeper and somewhat easily awaken by the slightest disturbance. But as most folks around here will agree, we are all different and we each need to find what works best for us with regard to this therapy ... that includes the mask interface, the blower unit make and model, the type and level of humidification if any, hose management, and any other of the numerous tips and tweaks from mattress to pillows to other sleep habits and accoutrements.

[FrederickRose]

Very interesting. If you can get equal efficacy with less pressure, that seems like a win.

Your sense of breathe against pressure adapts given sufficient time. I found it weird for the first couple of weeks and then it became quite normal.

As for the ResMed vs Repironics APAP algorithms faster vs slower response to change pressures ... I started off with the ResMed APAP and then got a Respironics APAP as a backup machine and also to specifically compare the two machines for myself (the ResMed vs Respironics debate goes way way back). I found that for me, I got more restful sleep with the slower Respironics ... perhaps the more rapidly changing ResMed would wake me out of REM, I don't know. I eventually sold my ResMed and got a Respironics BiPAP seeking out that perfect pressure machine algorithm that would get me as close to zero AHI as possible with as much comfort as possible. After a couple of years of experimenting, I nonetheless discovered what forum member Wulfman (Den) had always said ... and that eliminating all the comfort bells and whistles and using the correct straight CPAP pressure ended up working best for me because I think I am a light sleeper and somewhat easily awaken by the slightest disturbance. But as most folks around here will agree, we are all different and we each need to find what works best for us with regard to this therapy ... that includes the mask interface, the blower unit make and model, the type and level of humidification if any, hose management, and any other of the numerous tips and tweaks from mattress to pillows to other sleep habits and accoutrements.

Great insights and information here. It seems that everyone here agrees that different people can need very different solutions for optimal results.

[WearyOne]

Very interesting. If you can get equal efficacy with less pressure, that seems like a win.

Your sense of breathe against pressure adapts given sufficient time. I found it weird for the first couple of weeks and then it became quite normal.

As for the ResMed vs Repironics APAP algorithms faster vs slower response to change pressures ... I started off with the ResMed APAP and then got a Respironics APAP as a backup machine and also to specifically compare the two machines for myself (the ResMed vs Respironics debate goes way way back). I found that for me, I got more restful sleep with the slower Respironics ... perhaps the more rapidly changing ResMed would wake me out of REM, I don't know. I eventually sold my ResMed and got a Respironics BiPAP seeking out that perfect pressure machine algorithm that would get me as close to zero AHI as possible with as much comfort as possible. After a couple of years of experimenting, I nonetheless discovered what forum member Wulfman (Den) had always said ... and that eliminating all the comfort bells and whistles and using the correct straight CPAP pressure ended up working best for me because I think I am a light sleeper and somewhat easily awaken by the slightest disturbance. But as most folks around here will agree, we are all different and we each need to find what works best for us with regard to this therapy ... that includes the mask interface, the blower unit make and model, the type and level of humidification if any, hose management, and any other of the numerous tips and tweaks from mattress to pillows to other sleep habits and accoutrements.

I've always wondered if the faster-changing pressure with ResMed would bother my sleep, which is why I've always used Respironics. (I'm a very light sleeper.) They had to take it REALLY slow upping my pressure in my titration because if they didn't I would start to wake up.

My husband and I are SO different it what works best for our xPAP setups. We like the same type of machines, but it ends there! Pressure relief, humidification, heated hose/no heated hose, type of mask . . . completely different from each other!

[zoocrewphoto]

My husband and I are SO different it what works best for our xPAP setups. We like the same type of machines, but it ends there! Pressure relief, humidification, heated hose/no heated hose, type of mask . . . completely different from each other!

Sounds like my mom and me. We both have the Resmed S9 Autoset and Quattro FX mask. Hers is set to 10-15, and mine is set to 11-17. We are both unaware of the pressure changes. Very similar. Ends there

She does not use the humidifier at all. I have mine set to 5 out of 6. The highest I can go at a low temp without rainout. (BTW, we both live in the same house.) She can sleep through major leaks (tons of loud hissing), and I can't stand a single tiny leak.

Our actual sleep apnea is different, too. We both have OSA. Untreated, I snore loudly and gasp for air. She is totally quiet and looks dead. My ahi is super high with minimal oxygen desats. Her ahi is much lower, but much lower oxygen desats. I have very short events, mostly 11-15 seconds. She has clusters of events that are over 30 seconds each.

[Arlene1963]

Welcome to the fascinating world of sleep disordered breathing!

As you can see it really is quite diverse, from who has it, what symptoms we have (or don't) and what leads to optimal XPAP treatment.

This forum is an absolute gold mine of information. From current topics to the searchable archives. When I started I spent hours reading current and old posts and it really helped me to adjust and figure how to deal with almost every problem I encountered.

[FrederickRose]

Thanks, Arlene. Yes, the information here is amazing!

I didn't have a great night last night at all. 1st half was okay, but after that I kept waking up with my nasal pillows not seated correctly. Tonight I think I'm going to try the small size, which seems to be a much better fit for my nose. Am also planning to try a pressure range of 10-15 since lower doesn't seem to prevent events, and higher seems to wake me up. Also turned on Smart Ramp since I don't easily fall asleep with a pressure of 10 (yet).

Here are the graphs from last night:

[FrederickRose]

I just switched from the DreamWear Gel Pillows to the DreamWear Nasal Cushion. Wow, so much more comfortable, and so much easier to get a good fit without leaking!

It's amazing how much difference these different masks make. As a diabetes doctor, I often ask patients whether they have been tested for sleep apnea. A lot of the time they answer that they tested positive but can't stand the mask.

Up until now, my answer has always been that there are different machines and masks out these days and that it's work going back to the sleep doctor to see if there is a better solution for them. Now I can speak from experience!

[DreamStalker]

I just switched from the DreamWear Gel Pillows to the DreamWear Nasal Cushion. Wow, so much more comfortable, and so much easier to get a good fit without leaking!

It's amazing how much difference these different masks make. As a diabetes doctor, I often ask patients whether they have been tested for sleep apnea. A lot of the time they answer that they tested positive but can't stand the mask.

Up until now, my answer has always been that there are different machines and masks out these days and that it's work going back to the sleep doctor to see if there is a better solution for them. Now I can speak from experience!

And you can send them to this forum because the sleep doctors for the most part are still incompetent about how to get their patients to make their CPAP therapy work.

[ChicagoGranny]

Here are the graphs from last night:

----------------------->

Next time you share and image could you omit most of your graphs shown and make the others shown larger so they are easier to view and evaluate?
So it looks more like this image below...
graphs on the right...need
Events
Flow Rate
Pressure
Leaks
If we end up wanting one of those others we will ask.

[FrederickRose]

Oops, sorry I missed that.

Here it is again: