Newbie Greetings, findings and sadly, questions

[TedVPAP]

Hi, thanks for all of the advice so far, as i had very little sleep the other night i thought i'd post last nights result before i venture to the hospital in 10 mins. I had more sleep, only waking briefly at 3am before going back to sleep to awake properly at about 6am. I'd value your opinions.

This figure is a perfect example of your minimum IPAP pressure being set too low. Your machine was set to a minimum ipap of 6 and a maximum ipap of 20. As your data shows, the automatic algorithm lets the pressure go too low and then you get a lot of issues so the machine raises the pressure up to handle the problem. Then the machine allows pressure to drift down again causing problems, then you get a lot of issues before the pressure is high enough to help you. You need to set the minimum IPAP pressure higher - closer to where your needs are.

You subsequently mentioned the ramp being raised to 10. Ramp is different from the minimum IPAP pressure. Ramp is a comfort feature that increases pressure from zero to the IPAP minimum over time to help you ease into treatment. I suspect that your tech raised the minimum IPAP pressure to 10, closer to what you need, so you will now ramp up to a MINIMUM IPAP pressure of 10.
Post your data tomorrow so we will know what the new setting is and how you responded. Until the minimum IPAP pressure is set close enough to where it is needed, your therapy will be off. Then you will have turned the corner on your treatment.

[SolisQuaesitor71]

As requested here's the data from last night. I was back at the hospital today to have the results of last nights Sp02 which came back as normal.
The nurse said that i only dropped about 6 points (which i didn't understand) and commented that i was doing really well.. hope he wasn't just saying that lol. I requested that he upped my low pressure level so he took it upto 8 (double what it started at).

Someone near the start of this thread mentioned that someone had posted a comprehensive fitting guide for the Quattro mask and depite searching on here cannot find it. If someone could point e in the right direction.

[Pugsy]

Is this the Quattro fitting guide you meant?
https://maskarrayed.wordpress.com/tamin ... e-quattro/

Don't be disheartened about needing more minimum pressure. It's actually very common.
I had reports similar to yours with an 8 cm minimum starting point and they only cleared up decently when I increased the minimum to 10 cm.
Some people need even more...like 14 cm minimum or higher.

[SolisQuaesitor71]

Hi Pugsy and many thanks for replying. Did you make anything of the last chart i posted? I'd be interested if you noticed an improvement or otherwise from the one before.
The post for the mask fitting was something that Rick mentioned near the start and was by someone called Robysue, however i can't seem to locate the guide that he refers to despite searching.

[Bertha deBlues]

Best of luck to you.

[Pugsy]

I don't know of any mask fitting guide from forum member RobySue for the Quattro. She's like me...never used the Quattro ever. She uses nasal pillows.
Now the one I gave the link to is from forum member Janknitz and she has used the Quattro and that's the fitting guide we often point to and the one I always link to.
I have no idea what Rick might have been talking about because RobySue has never done a full face mask fitting guide of any kind that I know of.

Your report last night....did you sleep or were you awake very much during the night?
How long do you think it took you to go to sleep?
I need those answers to better know what to think of last night's report.
On the surface minor improvement but not much and to be honest...if you are asleep when these events are being flagged...you won't ever see much improvement in the numbers until your minimum is up at least in the neighborhood of 10 starting point and very well might even need to be higher. At this point you aren't even close enough to what you need to get much of an idea where you will end up.

[SolisQuaesitor71]

Your report last night....did you sleep or were you awake very much during the night?
How long do you think it took you to go to sleep?
I need those answers to better know what to think of last night's report.

Thanks for your reply Pugsy, i'll check back later and have a look at the fitting guide.. i have been rather naughty though and hope that i'm not at risk of getting into trouble. I cut out a mask liner from a template from an old cotton towel. Tried it with the machine but understand that at it's starting pressure of 8cm won't reflect when the machine ramps up to 15 or 20 to control the apneas... and i think this is where the problem is. So i manually changed the start pressure to 15cm so that i could fit the mask based upon that as i'm sure that's why i'm waking up. I've changed it back however i'm now rather scared as it'll have written this to the SD card and i don't want to get into bother with the hospital.

As for last nights sleep.. well it woke my wife for the first time as well as myself. I went to sleep quite quickly but i do drink a good deal of alcohol before going to bed daily. The mask was farting and whistling a few times throughout the night. I always seem to wake about 3am though and i can't understand why as i can usually go back to sleep again to reawake at 6am.. after that it's lying in bed waiting an hour until i take the mask off and try to drift off naturally again (which sometimes i can, sometimes not).

hope this helps
regards

[Pugsy]

Okay, the laying awake and trying to go back to sleep explains what happened at the end of the night when the pressure obviously dropped..

I don't remember if I asked this or not but do you usually go to sleep laying on your back or your side?

Don't worry about changing the pressure for the mask fitting. Won't hurt a thing and really won't be reflected in the data to the point where they will slap your hands for messing with things but there is a mask fit feature on your machine that can get close to that higher pressure and do the same thing if you want to use it.

How much alcohol are we talking about? Any other drugs or medications? Do you feel you need it to get to sleep?

The 3 AM awakening really isn't all that uncommon. Did you know that it is common for us to wake after a REM cycle? Most of the time we don't remember it but it's not unusual if we do. Those wee hours of the morning is when we have more REM so more chances to wake up. Obviously we don't like to not be able to go back to sleep though because that's where the term sleep maintenance insomnia comes in.

[Jay Aitchsee]

I went to sleep quite quickly but i do drink a good deal of alcohol before going to bed daily.

Could be a good bit of your problem. Alcohol can exacerbate apnea and lead to late night insomnia. See here for an overview: https://www.webmd.com/sleep-disorders/n ... ol-sleep#1

[SolisQuaesitor71]

Okay, the laying awake and trying to go back to sleep explains what happened at the end of the night when the pressure obviously dropped..

I don't remember if I asked this or not but do you usually go to sleep laying on your back or your side?


How much alcohol are we talking about? Any other drugs or medications? Do you feel you need it to get to sleep?
in.

I do drink far more than I'm supposed to. Probably about 4 double mixers a night. I don't tend to get drunk but more tired.
Meds are 100mg Losartan daily for blood pressure (I used to also have bendroflumathiazide but since starting cpap my bp has dropped).
I used to sleep on my side however find it easier now just sleeping on my back to lessen the effects of leakage.
Now one thing I have noticed but do t know if it's coincidental is that I never have a good dream, always a nightmare of sorts.
I haven't found a mask fit feature on my machine.

[Pugsy]

Go here and request the provider/clinical manual for your machine.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
The mask fit feature is explained in the manual.

Supine sleeping often will make OSA worse...and need more pressure...though I do understand the need to want to sleep on one's back for leak management but a properly fitted mask can be used in any sleeping position.

You are using the ramp...I suggest you change it to the Smart Ramp setting in your machine (explained in the manual) or don't use ramp at all because you seem to be going to sleep fairly quickly and having a truckload of events when you do right off the bat. The combination of the ramp and the lowering starting pressure is allowing the airway to collapse and that's why the large cluster at the beginning of the night.
It wouldn't be so bad using the ramp if the minimum was more optimal.

I would work on sleeping on my side if at all possible and see if the pressure needs would reduce. If the pressure needs were reduced the mask might not leak so much when on your side.

[Pugsy]

As mentioned (and you already know)....alcohol is bad when in excess in terms of sleep quality/architecture and OSA in general.
Maybe consider no alcohol for 2 hours prior to bedtime????? Or less alcohol????

[SolisQuaesitor71]

When i was in the settings menu the ramp number was I think set to 5

[Pugsy]

Yeah, ramp minimum is 4 but can be changed....not that big of a difference between 4 and 5.
I know you would like to think that there is a big difference between 4 or 5 or 7....in the grand scheme of life and cpap treatment...the difference is very minimal.

[RicaLynn]

I do drink far more than I'm supposed to. Probably about 4 double mixers a night. I don't tend to get drunk but more tired.
Meds are 100mg Losartan daily for blood pressure (I used to also have bendroflumathiazide but since stadying cpap my bp has dropped.

I'll echo the admonishment to cut back on alcohol. My psych explained that while it does help you *fall* asleep, it cam prevent you from *staying* asleep, as the BAC falls through the night. Add in that it affects your bp and it can confound the effects of those meds and further disrupt your sleep.