Why Not Auto?

[Sleepless on LI]

WS,

Thanks for the confirmation of my reasoning. I was surprised to get it right, but it just seemed clear after reading your post and what others had to say on this and the snoring post. I, too, wish I could somehow find a way to see if I could get a PB420e from maybe my DME on loan to see how I do with it. I have had my Remstar for just over a month. If it really is not the machine for me, maybe I could sell it and buy myself my own PB420e. But I guess as long as I can tolerate the straight 10 cms of pressure, I shouldn't worry about it.

I was seriously thinking of buying something OTC to take before bed for the gas. It's not a very good thing to feel that pressure in your belly and try to hold it in. Not very healthy either, I'm sure, but that's what I do. I don't find it very ladylike to do anything else. And belching, although not ladylike, is something that would be welcome if it would stop the urge for it to find another venue to leave the old bod here at night. I think you're getting my drift... .

Den,
Glad to hear your AHI's sound as if they're pretty darn good on straight pressure, too. I really could feel the difference, even though it's not a huge increase in findings, with my AHI being higher the past four nights. Today was an all-time high of 1.8, all due to hypops, no apnea. I never had such a bad reading. I was averaging 0.1-0.5 usually. And I know there are some people probably cursing at me for complaining about an 1.8, but it made a difference in how I've felt. And it's not a good difference.

Thanks, all, for your support and information. As always, it is greatly appreciated.

[barbyann]

Just to add why I insisted on APAP.....I have started cardiac rehab and I am losing weight rapidly. I don't EVER want to endure a sleep study in the lab again, so I am hoping to give my doc's the readings and work with them to reset my pressures as time goes by. I am praying that weight loss will lessen some of my medical problems, OSA included.

[Sleepless on LI]

Barbyann,

Good for you, taking your health into your own hands and doing something about it. I hope your medical conditions improve with the weight loss. When I started on therapy, I had ABOUT 25 lbs. or so to lose. When I went to talk to a very well known ENT who I've personally used for the past 15 years or so about the Pillar Procedure and if I might be a candidate for it in the first week of this past July, after telling me he won't perform them yet, he did a thorough exam and said he saw no anatomical reason for my OSA. I explained that I had recently embarked on an exercise and eating right plan to lose the excess 25 lbs. and could that be the cause of the OSA since all my life I was a string bean and now I'm 25 lbs. heavier. He said it could very well be. And although 25 lbs. is not obese, it could be just enough to be causing the OSA. As he put it, it is the right thing to exercise and eat right and this new plan I'm on won't hurt in any way. But it is a possiblity that after Labor Day, if my plan goes well, I should come back and see him for re-evaluation in the hopes of determining if I still need the therapy.
Well, here it is after Labor Day and I've lost 14 lbs. in 8 weeks. I feel so much better, dropped two pants sizes and have about 9 lbs. more to go to be at a very respectable weight. However, although I hate to admit this, as I have witnessed from the results of my trying the auto setting, without CPAP, I have events still that need the therapy. I don't think 9 lbs. would do it for anyone, so I don't see it as being the answer for me.
Now, it's been said that everyone would show some type of events on a PSG, and mine said 4.0 hypops, no apneas and 14.something PLMDs, so they put me on CPAP. I was told that 5 or better was the criteria, and it's the PLMD that put me over that limit. But I also had moderate oxygen desats, so that wasn't good, as my BP and migraines were evidence of.
So although the weight is almost all gone, I still have events. Are they enough to keep me on CPAP? I would think so. I should have my oxygen desat level tested again at least to see what's up with that.
Do what you can to lose the weight. Yes, your overall health and self-image, at least, usually benefit from it. But don't put too much of your hope into that getting you off the CPAP. Even for me, with no anatomical reason as far as this ENT could see but maybe 25 lbs. of excess weight, it doesn't seem to be enough to get me off the therapy.
I just have resigned myself to being on it for life. There are so many other ailments one can have and at least the treatment for this one has enabled me to take my life back and make it better. So I will thank goodness that it's OSA and not some other life-threatening, untreatable condition that wouldn't improve my life no matter what.
Best of luck with your endeavors. Keep positive and you will succeed.

[barbyann]

Though I am hoping for a cure with weight loss, I know it is 50/50 at best. I am 41 years old and can see that the outside of my body is sagging and my muscle/skin tone is not what it used to be. I am smart enough to realize that the same conditions are occurring in my airway. Combining the weight gain and loss of tone in my airway with my genetically narrow passages is what I believe to be the cause of my OSA. I might be the only one on my block to consider a "throat lift" rather than a face lift. Thanks for the frank discussion. I have learned alot from people like you.

[christinequilts]

I think you need to remember that snoring alone is not an obstructive event...there are many people who snore tremendously who do not have OSA...just as there are people who have OSA who never snore at all. Looking at your AHI numbers, yes its true they are slightly higher with the 6-10 range rather then straight 10 but is the difference significant? I don't think most people would consider a .3 AHI difference significant. You are still well under the level of 'normal'- most healthy people can have an apnea or two per hour. It might be easier to look at this another way- if you were shorted 3 pennies, would you return to the store to get the difference?- no, because the difference isn't significant for most people. What if you were shorted 3 nickels, or 3 quarters? What about 3 $1 bills, or 3 $10 bills, or 3 $100 bills, etc? Most people wouldn't for less then a $1, some might at $3, most for $30, and nearly everyone would for $300. Whether you would or not depends on a lot of things including the perceived value, which is influenced by what value society places on each amount- 100 years ago 15 cents was more valuable to people in general- and the personal value you place on it- someone who makes $500 per month would consider 3 cents as more valuable then someone who makes $5000 per month. In addition to the precieved value each person has to look at the pluses and minuses for each level for themselves- is it worth it if it takes 1/2 hour to do it versus 5 minutes? Maybe, but 5 minutes would be too long if it means you miss your plane.

In your situation it might be worth it to have a slightly higher AHI if you have less problems with swallowing air- you have to decide for yourself what is more important. I think you need to consider what your goal of treatment is- do you want to feel better or have the lowest AHI? ...there is no prize for having the lowest number- its not a competition with anyone, not even yourself. What is important is how you feel in the long run...remembering that there are lots of ups and downs in how we feel that are not related to our xPAP usage.

[Sleepless on LI]

I have learned alot from people like you.

Barbyann, thanks so much. That means the world to me. I always hope my verbose way of telling something won't cause someone not to read my post/reply. But I was only trying to give you a detailed look into that I'm going through somewhat of the same scenario you are and I don't want to see you disappointed if you have the same ending as I am. But I appreciate your comment tremendously. Thank you.

Christine,
You are absolutely, one hundred percent correct. I do overanalyze my data, as someone pointed out. One of the down sides to being able to have the software, I guess. However, I have been feeling less energetic, believe it or not, from that difference. And it's not only .3. My averages before were 0.1 - 0.5. Yes, 0.5 to 0.8, I wouldn't make an issue out of. But today was 1.8, which is a bit higher, especially from my low to this new high. But great analogy with the pennies. Puts it in perspective. If only the AHI was an unimportant as pennies have become in today's economy.

I agree with what you say, too, about hearing that non-OSA people would also show some amount of events in their PSG's, too. That was why I was hoping to maybe be able to give up the machine when I lost the weight, but doesn't look too promising. Like you said, the bottom line is how you feel. I don't feel good the past four days and the gassy belly is back. So I guess it was a coincidence that that had eased up.

Honestly? If I didn't feel the way I do, I would stay on the auto because it makes my mask quieter (which is really nice). But other than that, I don't see much value of being on it that way. Everything seems to benefit from my being on the titrated 10 pressure except my flow limitation figure (ther we go with those figures again...).

I know it's not a contest, thank God. I wouldn't win, anyway. I never win contests (LOL). It's just my over-analytical way of dealing with these numbers and the software. Thanks for your input and caring.

[rested gal]

However, I have been feeling less energetic, believe it or not, from that difference. And it's not only .3. My averages before were 0.1 - 0.5. Yes, 0.5 to 0.8, I wouldn't make an issue out of. But today was 1.8, which is a bit higher, especially from my low to this new high.

Lori, just a thought....

You say you've been feeling less energetic, and you're attributing it to one thing - the very small differences your seeing in your AHI. And yes...going from 0.8 to 1.8 is a very small difference. Maybe your body is that sensitive to such small "change" (deliberate pun on christine's extremely good post.).

But... maybe the less energetic feeling could be arising from other factors (those ever present variables in life) such as less restful sleep while dealing with getting used to your new Nose Breathe device, or the diet/exercise wearing you down a bit temporarily, or the PLM flaring a bit, or any number of stresses in a busy daily life.

And that brings me to "the thought" - if you're willing, try this:

Set your autopap into whatever mode and pressure that gives you the most comfortable treatment. Take two seconds to decide that. Don't try to second guess it or "analyze" which mode, which pressure, which results the next morning you thought looked best number-wise, or even whether you felt rested the next morning.

Don't think back on any AHI numbers or data of any kind. Just go with your FIRST instinct...the very first thing that pops into your mind...giving yourself exactly two seconds to think about this question:

"What mode and pressure or pressure range lets me sleep comfortably and wake up without bloating or gassiness?"

Two seconds. What's the answer?

Nope..stop that...don't think about, "But, but, I have to consider this...", or "But, the data showed...", or "Well, I thought it was good at first, but then....."

Start over again. Ask yourself the question again, but this time take exactly two seconds to come up with the first answer that pops into your mind..."What's been the most comfortable?"

Now, do this:

1. Set the machine that way. Don't second guess at this point. Just do it.

2. Do not download it for 4 days.

3. Do not change any settings for 4 days.

4. Do not change any mask or accessory you're using.

5. Keep a brief diary of how you feel when you wake up and how you feel through the day.

Above all, don't look at any data for four whole nights. Keep your mind absolutely untainted by any knowledge of what your AHI was during those four nights. (Bigtime withdrawal symptoms starting already?)

After the 4th night of not looking at any data at all, do the download and see what it says. See if the AHI's correlate exactly up and down with what your diary says about how you felt each morning and during the day.

Could be an interesting lab-rat experiment. Are you up to going on auto-pilot for a few days and doing it just like that?

I can hear you going...."hmmmmm".

A penny for your thoughts.

[Sleepless on LI]

RG,

Now you're scaring me. You are either blessed with ESP, as I wrote in Fifi's thread when you knew she was taking her mask off during her sleep and leaving the machine on, or you are just a very good judge of human nature as you don't know me personally and are really guessing in advance my reactions to what you write!!!

First of all, TOO LATE! Well, not really, but I did go back to 10 straight CPAP last night and my AHI was a 0.5 with only 4 episodes of apnea and zero hypops the whole night. No, the sleep was not restful, but it never, ever is. I am having interrupted sleeps every night of my life. I have maybe slept through two nights so far since the beginning of June. I have come to the level of acceptance that I will never sleep through the night again in my life, but it's okay as long as I have energy the next day. It's better than pre-therapy where I didn't sleep through the night but was a walking zombie.

As far as the gas situation, I bought an OTC chewable tablet and took it before bed and it helped tremendously. No urge to do any unladylike function, thank goodness. That was horrible. And so far this morning, I am feeling pretty okay. My Swift was leaking quite a bit last night which kept me up a bit, but just for a second to reposition and back to sleep. I did order the AURA and hope it works for me. We'll see.

My exercise is really routine at this point. Been just two months now and nothing with that is affecting my energy except in a positive way. I've had the Nose Breathe device for two weeks, even before I started the auto experiment, and although it is causing some trouble on its own in addition to stoping my mouth breathing, that hasn't changed since I got it. The only thing that might be affecting my energy level other than the setting could be PLMD. I don't know. I have just felt so wonderful, truly, and I'm so happy to say that, up until I changed my setting that it's hard to figure out why now I wasn't other than that. But, then again, maybe it's sheer coincidence.

I think I'm going to keep myself FOR NOW on this 10 and wait for the new Aura to arrive. Then I will start off with it for a week or so and see where that takes me. Someone, I forget who, wrote about them not realizing how broken their sleep with the Swift was until she got the Aura and finally sleeps through with it on. I am only praying that should happen to me.

I will try your experiment when I get my energy level back and am feeling like I want to lab rat again. Thanks for the idea. It really is the way to figure that one out. Unfortunately, when you ask me to pick a way that I feel best when I sleep, lately there is none. I just go by how I feel during the day, and that's straight 10 or auto 10-10.

[christinequilts]

Have you ever heard the saying "You can't see the forest for the trees"? It sounds like what may be happening with your daily monitoring of your xPAP stats. I think Rested Gals idea of not checking your data every single day is an excellent one- you may be letting your stats influence your mind as to how you feel instead of letting your body tell you. Its the same as when people weigh themselves everyday- or even worse, several times a day- when dieting. Pretty soon the natural fluctuations our bodies go through daily end up stressing the person out... and we all know how stress can make you crave chocolate- or whatever your favorite food is- and the next thing you've blown your diet. That's why they recommend only weighing yourself once a week, at the most, while dieting. The same thing is true with apneas- you can't 'weigh' them every single day.

I've been on BiPAP ST for almost 2 years now and though I didn't get software right away I do have 17 months worth of full nightly data. My Respironics Synchrony BiPAP ST can hold 6 months of full nightly data so I don't have to download weekly. With BiPAP ST only being able to reduce my central apnea from 65 to 30+ per hour, my situation is different then most here. I would love to be able to figure how to reduce mine more and don't think I haven't tried everything I can think of. Synchrony ST's are used to treat various breathing disorders in addition to CSA so its' data is more focused on respiratory issues like tidal volume, minute ventilation, and such. Between the number of apneas I have and the way it marks them I end up having a solid red bar for the apnea line, except when I'm awake, so I tend to focus on the percentage of patient triggered breaths which ideally would be 100%. My earlier data shows I average around 80% for patient triggered breaths and more recent data shows I'm averaging almost 90%. I can't go in and find the precise date I started to improve- I had a lot of ups and downs but the important thing is that I did improve over time. Every once in awhile when I make some sort of change like changing my sleep schedule or starting a new medication I get the idea to watch my statistics more closely. I almost always notice some sort of change- positive or negative- when I start downloading my data every couple of days and its easy to attribute the change to whatever has been changed. Usually after a few days or so of very close monitoring I relax a little and let a week or so pass before I check my data again...and you know what? The changes I saw in my nightly stats are usually short lived; and if I look more closely its usually a result of the normal fluctuations in my apneas from night to night. To me, what happens one night to the next isn't as important as long term trends. I don't let my nightly stats tell me how to feel- I let my body determine that. There are days I feel pretty good when I had a lot more central apneas then normal and days I feel pretty bad when I had less apneas then normal...how tired/sleepy/fatigued we feel isn't always a direct relation to how many apneas we had the night before.

Our mind is very powerful at influencing how we feel- that's why they compare any new medication or treatment to a control group that is getting a placebo. You can give someone a sugar pill- a placebo- and if you tell them it will make them feel better a lot people will say it does. It also works the other way- if you tell them the pill will make they sick to their stomach many will complain of stomach aches & such and some may even throw up, even though its just a sugar pill. Its funny how the human mind works...they don't find the placebo effect with animals. I guess its' true that a little knowledge can be dangerous. You need to stop worrying about every little thing and be thankful your apnea is so well controlled and you have equipment that works well for you. You're going to drive yourself crazy worry over every little change in your nightly stats if you keep doing what you have been doing, and at some point the stress of worrying could effect you as much as your OSA & PLMD did before you started treatment.

[Sleepless on LI]

Christine,
First off, let me say thank you for taking the time to write such a thoughtful and informative reply. I truly appreciate your input. And you are right that a little knowledge can be a dangerous thing.
I just want to say, I may come across a little more stressed out over this than I am in actuality. And though it's true that perhaps the changes I've made would not cause me to feel less energetic, I can only report how I've felt. I don't know if it's mind over matter, something totally unrelated to the adjustment in settings or if it truly is the change and I'm just very sensitive to what I feel. I have always been very in touch with my own body and health and am overly pro-active in everything that concerns it. I can never just be diagnosed with something without learning as much as I can about the condition and the treatment/alternatives. Yes, knowledge can be a dangerous thing,
I read my software every day because, honestly, I like to see what went on the night before. And you could very well be right, that if I didn't lookat those changes for a couple of weeks, that the numbers could substantially change. All I'm going by is how I feel and the numbers seemed to correlate to it. Whether it's coincidence or not, I guess I won't know unless I leave it like that and take a chance that it's not. Personally, I feel if I know I do well at a certain setting, why play Russian roulette, which is what it's in essence doing.
The auto settings did nothing to improve anything but my leak rate. The first night, I thought it did help with my stomach problems and sleeping. As each night passed, I found that not to be the case unfortunately. If it were, I would definitely have given it more time. But why fix what's not broken, is what I guess I'm fumbling to say here? If I get great results at 10 straight and feel very good at that setting, I should stop lab-ratting and just let it be. Guess that's my personality. Like I just ordered another mask to spice things up a bit. I get bored easily. It's just my nature. RG said it was a good sign that it's boring, as it is to her, too, because it means things are working and we haven't needed to change anything. But I do just to see what would happen if...
I can't imagine going through what you are going through. CSA must be much harder to get under control and I wish you nothing but continuing improvement. You seem to be a strong woman and sensible, too, I might add. I am sure listening to people like myself moan about a 1.8 as opposed to a 0.1 or 0.5 must get you angry. I don't mean to post that information for that purpose or to cause anyone else grief. I can only report what my situation is and how I feel. But, believe it or not, I had a lot of related issues that went along with what was diagnosed as mild apnea, such moderate oxygen desaturations, high BP and migraines, fatigue, exhaustion and PLMD. So it hasn't been mild symptoms along with the diagnosis.
Once again, I thank you for taking the time to write such an insightful reply. I think I'll just behave myself and stop playing around with my settings. I guess another reason why they don't want you to have the ability to know how to do that. So between that and having the software, I'm batting two for two.

[WAFlowers]

I guess the next time around, I will try to PB420e. Maybe if I can find someone selling one,

Come down to Florida on a vacation and you can try mine. You can show me yours and I'll show you mine.

Maybe we'd better not try and explain that last to our spouses. .

[Guest]

We can be bribed to keep quiet.......

[WAFlowers]

Who was that masked man?

[Guest]

Only the Shadow knows........

[Sleepless on LI]

Maybe we'd better not try and explain that last to our spouses.

Hey, you said it, not me. And if we're being bribed now, I'm going hold onto that story!!!

My parents live in FL. Where abouts are you? You know, I am coming down there, whether you like it or not, probably in February and you better be ready...LOL!