My CPAP-to-APAP Experience

[BleepingBeauty]

I've been running the machine in Auto mode between 11-13cms since Monday. I'm pleased to report that the numbers look good, and the pressure fluctuations (small as they may be) are not disturbing my sleep.

The data is very interesting to me. I never paid attention to the chart at the bottom of my nightly data before, since I was always at fixed pressure, and it simply repeated the info on the graphs. But now, seeing how I'm doing at the differing pressures shines a whole new light on things. I know it's early in my trial, but I'm encouraged. My data, so far:













Lots of pressure variation, and my leak line isn't quite as flat as when I'm at a fixed pressure, but I'm seeing the possibilities of improved therapy (dare I hope). Comments, suggestions?

[KatieW]

I have Resmed, but am enjoying looking at your graphs. Just trying to understand about the leaks--I found a chart that says the Hybrid leaks are 50.5 at 11 cmH20, and 54.9 at 13. And your average leaks seem to fall within or under that range. You said that they are more flat-lined with straight cpap. Are you seeing a correlation between events, and the peaks in leaks, and does that concern you?

Your AI, HI, and AHI numbers are excellent. How does this compare with your previous numbers? Do you feel better?

My Resmed data doesn't show Vibratory Snores, are yours significant?

I'm glad you're feeling encouraged by these results, and hope to keep learning, by following your progress.

[GaryG]

BB, Looks like on 12/7 and 12/8 you were spending most of the time at your max pressure, while 12/9 was divided and 12/10 was skewed towards the lower pressure. Now depending on how you're feeling, you might be ok where you are, but if you're game, you might want to increase the upper range a little or decrease the lower a little to see if that will bring down the AI a bit.

I think though you probably need to collect a bit more data to see what happens over time.

But as a ResMed/ResScan guy, these charts are interesting and different to me. I'd be curious if one of our veterans chimed in here.

I think its cool that you're trying APAP, while Katie and I, as regular APAPPers are trying CPAP. This is an interesting exercise.

[BleepingBeauty]

I have Resmed, but am enjoying looking at your graphs. Just trying to understand about the leaks--I found a chart that says the Hybrid leaks are 50.5 at 11 cmH20, and 54.9 at 13. And your average leaks seem to fall within or under that range.

Hmm. According to the graph in the Hybrid's booklet, my leak rate should be 42 lpm at 12cm. (Unless i really goofed in reading it, which is entirely possible. ). I'll have to re-check that.

You said that they are more flat-lined with straight cpap. Are you seeing a correlation between events, and the peaks in leaks, and does that concern you?

I mentioned the "more active" leak line just as an observation, as it makes perfect sense to me that it would be a little more variable with the different pressures. Even though the machine is only set with a 2cm window, the pressure seems to vary quite a bit through the night. In fact, it's so variable that I find it a little challenging to determine what pressure I was at when.

None of the leaks is unreasonable so, no, I'm not concerned. As to seeing the correlation between leaks and events, unless it really jumps out at me (like a big cluster of events and a corresponding high leak), no. The granularity of the graphs isn't detailed enough for my eyes to note the one-on-one match-ups and determine what happened first (leak, apnea, pressure change). I'd have to blow up the image in order to make that call, and I haven't done that. Yet.

Your AI, HI, and AHI numbers are excellent. How does this compare with your previous numbers? Do you feel better?

Your question prompted me to run some averages on my Excel spreadsheet. I've been using the Hybrid for about 10 weeks now, minus the three weeks of my surgery recovery (when I was wearing a sling 24/7 and was not sleeping well). Here are the averages for about seven weeks' time:

Leak - 41.72
AI - 2.97
HI - 1.44
AHI - 4.42
NR - 0.00
FL - 1.9
VS - 45.62

So yes, there's a little improvement over my previous average AHI. But this is only four nights of data, so I'm not exactly convinced yet, but I am hopeful. I can't say I feel any different, but I don't feel any worse (and that was my big concern).

My Resmed data doesn't show Vibratory Snores, are yours significant?

Since "snore" is sometimes recorded by the machine when it's actually just noise generated by the hose moving around (rubbing against the bed or the headboard), I don't give the number too much credence. Significant? Here's one of my nights of high snore:





It doesn't seem to correlate with anything else, so I don't think snoring (real or misinterpreted by the machine) has any substantive effect on my therapy and, as long as things are going relatively well and I feel good, I don't worry about it.

I'm glad you're feeling encouraged by these results, and hope to keep learning, by following your progress.

Thanks, Katie. I'm keeping an eye on your thread (and Gary's), too. It's fascinating to see how the various options work for different people, and it serves to hammer home just how personally-tailored our therapy needs to be. It's an adventure.

[Hawthorne]

I can see that each night your data improves. You have fewer events, your VS has gone down and your leak like looks better each night.

I am thinking though, that your 90% is your maximum pressure. Maybe you need to open up that top end to see where your 90% really would be if it had the chance. I do see though, that you are spending less time at 13 cm each night so you may be still adjusting to your current settings of 11-13.

My maximum pressure is 13 cm and I only get there for a very little amount of time and not every night. My 90% is always 12 cm.

I don't see any centrals (NR) in your data at all so a raise of the maximum to 15 cm would not be a problem, unless you begin to see those NRs.

If you set it at 11-15 cm for a few nights, you might get a better idea of just how high your pressure needs to go for parts of the night. You MAY eventually raise your minimum also when you see those results for a few days or a week. You may also see the events become even less and the AHI lower. My AHI is almost always less than 1 with the maximum of 13 and a 90% of 12 and,as I said, I very rarely get to 13 cm.

It just seems to me that your 90% should not be your maximum pressure. You may need a little more for some of the night.

Just my thoughts as I compare it with my situation!

Great experiment you have going there!

[BleepingBeauty]

BB, Looks like on 12/7 and 12/8 you were spending most of the time at your max pressure, while 12/9 was divided and 12/10 was skewed towards the lower pressure. Now depending on how you're feeling, you might be ok where you are, but if you're game, you might want to increase the upper range a little or decrease the lower a little to see if that will bring down the AI a bit.

Hi, Gary. I'm finding my APAP results quite interesting. I could very well end up with a somewhat wider range of pressures when all is said and done (as was discussed in another thread), but it's too early to make any changes. As I said in response to Katie's post above, I don't feel any different (yet), and that's okay, because I don't feel worse. I feared the pressure changes would really mess up my sleep quality. But so far, so good.

I think though you probably need to collect a bit more data to see what happens over time.

Definitely.

But as a ResMed/ResScan guy, these charts are interesting and different to me. I'd be curious if one of our veterans chimed in here.

Me, too.

I think its cool that you're trying APAP, while Katie and I, as regular APAPPers are trying CPAP. This is an interesting exercise.

Agreed.

[BleepingBeauty]

I can see that each night your data improves. You have fewer events, your VS has gone down and your leak like looks better each night.

This place is like magic! Ask for a veteran's opinion, and ya get one!

I am thinking though, that your 90% is your maximum pressure. Maybe you need to open up that top end to see where your 90% really would be if it had the chance. I do see though, that you are spending less time at 13 cm each night so you may be still adjusting to your current settings of 11-13.

I noticed that I'm spending a lot of time at the ceiling pressure, so I'm with you there. Still, I think it's too early in my trial to change anything (although I'm sorely tempted , as I have very little patience and hate to wait). I also see that I've spent some time at 11 and wonder if my end result might be a range of 9-14 or so. Only time will tell.

My maximum pressure is 13 cm and I only get there for a very little amount of time and not every night. My 90% is always 12 cm.

I don't see any centrals (NR) in your data at all so a raise of the maximum to 15 cm would not be a problem, unless you begin to see those NRs.

Aside from the one night when I tried A-Flex, I've never seen a NR event on my data, although my initial sleep studies were loaded with them. Only the two most recent APAP trials (of the four I experienced at the hands of my ex-doctor) include NRs on the printouts, and I see that some centrals were recorded on 8 out of 10 nights. (None of the data - my very jagged leak line and high leak rate, the high AHI every night, the centrals - was mentioned; not one word about the possible need for a chinstrap or a different mask. Office visits, APAP trials, new sleep studies - CHA-CHING! )

One trial was done at 4-20cms and the other was set for 7-14cms. I don't know what kind of machine I used for the first two trials, which produced less data and didn't include NR events. Looking back at how my treatment was so poorly handled makes me mad as a hatter, knowing what I know now. I guess I've adapted to therapy since finding the forum and parting ways with that jerk. But yes, centrals are definitely an aspect of my data that I keep a close eye on, especially now that I'm "playing with fire."

If you set it at 11-15 cm for a few nights, you might get a better idea of just how high your pressure needs to go for parts of the night. You MAY eventually raise your minimum also when you see those results for a few days or a week. You may also see the events become even less and the AHI lower. My AHI is almost always less than 1 with the maximum of 13 and a 90% of 12 and,as I said, I very rarely get to 13 cm.

That's the goal!

It just seems to me that your 90% should not be your maximum pressure. You may need a little more for some of the night.

I agree. I just have to give it some time before I can determine where the max should be. But I'll get there, and the "ride" sure is interesting.

Just my thoughts as I compare it with my situation!

Great experiment you have going there!

Thanks, Hawthorne! I appreciate your input.

[jules]

I believe you need MAX - MIN to be at least 3 to have a NR show up on the report. I don't see them on mine with a narrow range or on fixed pressure.

[KatieW]

I have Resmed, but am enjoying looking at your graphs. Just trying to understand about the leaks--I found a chart that says the Hybrid leaks are 50.5 at 11 cmH20, and 54.9 at 13. And your average leaks seem to fall within or under that range.

Your source is probably more accurate. Not knowing the leak rate for the Hybrid, I googled it, and found this chart.

http://www.internetage.com/cpapinfo/leak-rates-1.html

[BleepingBeauty]

I believe you need MAX - MIN to be at least 3 to have a NR show up on the report. I don't see them on mine with a narrow range or on fixed pressure.

Really? I didn't know that, jules, so thanks. When I do expand the range, I'll be sure to keep an eye out for any NRs (not that I don't do that, anyway ).

Not knowing the leak rate for the Hybrid, I googled it, and found this chart. Perhaps it's not accurate?

http://www.internetage.com/cpapinfo/leak-rates-1.html

Thanks, Katie. I'm familiar with that chart (it's DSM's).

I'm pretty sure I got my figures from the booklet, itself. But like I said, I'm going to double-check it.

[Hawthorne]

Even though I have been on cpap since 2002, I am only a 2 year veteren at reading and trying to interpret data! Hardly an expert!

Since you are heading (definitely) in the right direction, I agree that you don't want to move too quickly. Another night or so though, and you may want to up that maximum for a few nights to a week. This is based on the fact that you spent a lot of time at your 90%.

On the other hand, the amount of time you are spending at the maximum each night is decreasing so a couple more nights, right where you are may well be a good idea.

You are certainly heading in the right direction and, wisely, taking your time.

[Wulfman]

I believe you need MAX - MIN to be at least 3 to have a NR show up on the report. I don't see them on mine with a narrow range or on fixed pressure.

Not disagreeing with Jules, but his post made me think of how the algorithm works on NR events. It will make 3 attempts to clear an event by raising the pressure (one cm. at a time) before backing off and lowering the pressure if it detects what it believes to be one. Now, the thing I wonder about is what happens if it is too near to or already at the maximum pressure at the time it detects an event and starts incrementing pressure.....but doesn't have 3 cm. more to go...... (same scenario could happen at 18 or 19 cm., too)

http://sleepapnea.respironics.com/techn ... logic.aspx


Den

[Wulfman]

One more thought about your reports......

If your previous CPAP pressure was 12 cm. (and you were used to that), you might want to try a range of 12 - 15.


Den

[BleepingBeauty]

My anal tendencies prompted me to take the Hybrid's flow chart from the booklet and blow it up so it was at least readable (:roll:), and then graph it out with a pencil and a ruler so I could see exactly what the LPM should be for the varying pressures. I know, I know... heh heh

Anyway, here it is, for anyone who might find it useful (with apologies for my poor excuse for a scanner):

I believe you need MAX - MIN to be at least 3 to have a NR show up on the report. I don't see them on mine with a narrow range or on fixed pressure.

Not disagreeing with Jules, but his post made me think of how the algorithm works on NR events. It will make 3 attempts to clear an event by raising the pressure (one cm. at a time) before backing off and lowering the pressure if it detects what it believes to be one. Now, the thing I wonder about is what happens if it is too near to or already at the maximum pressure at the time it detects an event and starts incrementing pressure.....but doesn't have 3 cm. more to go...... (same scenario could happen at 18 or 19 cm., too)

http://sleepapnea.respironics.com/techn ... logic.aspx

Den

That's very interesting, Den, so thanks for your additional input. I'll definitely be watching for NRs when the range is expanded to allow that 3cm (or more) differential.

One more thought about your reports......

If your previous CPAP pressure was 12 cm. (and you were used to that), you might want to try a range of 12 - 15.

Den

Hmm. I'm tempted to go there, but I fear it's too soon. I also question why I would want to make the minimum 12cm (notwithstanding the fact that that's been my fixed pressure for so long) if I'm spending a decent portion of the night at 11. Wouldn't it make sense to also set the minimum a little lower? Or am I getting into a range that's too wide to be very effective by doing that?

[BleepingBeauty]

Even though I have been on cpap since 2002, I am only a 2 year veteren at reading and trying to interpret data! Hardly an expert!

But definitely a veteran, and one who offers solid advice.

Since you are heading (definitely) in the right direction, I agree that you don't want to move too quickly. Another night or so though, and you may want to up that maximum for a few nights to a week. This is based on the fact that you spent a lot of time at your 90%.

On the other hand, the amount of time you are spending at the maximum each night is decreasing so a couple more nights, right where you are may well be a good idea.

You are certainly heading in the right direction and, wisely, taking your time.

Thanks. I feel good about it.