1. You need detailed access to your data
2. You need to be able to study and understand your graphs
3. This won't work for everyone but it will most likely work for Obstructive Apnea's/Hypopneas and might work for some Central Apneas
4. These tests were conducted on an APAP, it could work on a CPAP but not necessarily as well and I don't know about a BIPAP (possibly not)
5. This is not a miracle cure
6. Make changes to your machine at your own risk, I suggest you speak to a doctor first before even contemplating this
7. If your doctor or DME asks to read your data they will see differences in your machine configuration, so be prepared to explain it (and it could get you into trouble)
8. I am not a doctor
9. Make subtle changes, not big changes and document them.
10. Ensure you know what your original settings were so you can go back to them at any stage
Know your Titration pressure
Find out if you don't know what your titration pressure was, e.g. 10cm. This will help you work better with the graphs.
Study your graphs
It's very important to check your graphs. You can see what the pressure you are receiving on your machine throughout the night minute by minute, with an APAP you'll have a Min and a Max pressure that you can set as well as a RAMP pressure. You need to look at how many Apneas and Hypopneas you have per night. Look at the areas where you don't and check what your average pressure is. For me I had my ramp pressure set at 6cm as it's more comfortable to get to sleep with, the min pressure is 8cm and the max pressure is 20cm. This is too wide a gap but is how a lot of machines are configured. If you purchase your machine from a manufacturer then it is likely that your machine will not be configured to your settings.
Know how you sleep and improve it
If you suffer from Obstructive Apneas and know you sleep a lot on your back, force yourself to sleep on your side. Roll the duvet up behind you or prop a pillow up behind you to stop you rolling over. Also ensure you don't drink Alcohol as that can induce more Apneas, likewise over eating or a snack before bedtime can have the same effect. Also make sure as much as possible that your nasal pathways are clear. If you're congested uncongest yourself. If you can't uncongest yourself switch to a full face mask that will help in the comfort level. Also contain your leaks, try to reduce your mask leaks as much as possible. Lastly try to go to bed at regular times so your body clock also gets used to it.
Having the knowledge
So now you should see what your average pressure is on the graphs when you don't have any events and likewise what your pressure is when you do have events. You also know how to try and improve your sleeping patterns to get a better night sleep and suffer from less Obstructive Apneas.
If you look at the increase of pressure around your apneas, for me the pressure would go up to around 10.6 on average but sometimes could exceed this and raise to 12.5 in more severe events.
Once you know at what pressure you don't get 90% of apneas or hypopneas with and what your upper pressure limit raises to you can then start working out how to change your figures.
1. For the sake of argument, let's say there's only a difference of around 2cm then set your min pressure to the point where your lower Apneas/Hypopneas are, e.g. if your pressure is 10.6 to simplify things you can can round off to 10cm. The APAP's can cope and respond with a 0.6cm increase pretty easily and quickly.
2. You can leave the RAMP pressure as it is as this is only set for the first 30 mins of starting the machine for most machines.
3. Continue to make small tweaks until you think you are improving over continuous days and it's not one-offs.
How will this help?
1. Ensure that most of your lower Apneas and Hypopneas are resolved by giving you enough pressure to stop your upper airway to collapse.
2. Give you a small difference between your lower pressure and what will be required for the upper pressure to quickly adapt and reduce the time for the apneas and hyopneas to occur. This will then have the effect of stopping additional apneas and hyopneas but can also have the effect in reducing the amount of time you see an apnea for and possibly turn it into a hypopnea or remove it altogether.
For me tweaking the above settings carefully over several weeks has helped reduce my AHI further.
Here's what my events were like prior to making changes
Here's the results after gradually increasing the min pressure
Here's the results after further increasing the min pressure
Here's the results after further increasing the min pressure
On a really good night here's what my events now look like
*Note graphs are for an 8 hour period
I do not want to suggest everyone goes out and starts messing with their machines, you need to understand what changes you are making and why, the risks involved which could impact your health further or cause problems with your doctor/DME but what I will say for me is this has started to help me to reduce my events even further than I had imagined.
Some of you will be reading this and think that it's not rocket science and it's just common sense, and this may have been discussed on lots of other threads before and you are correct. Others will look at it and think why try to reduce your AHI by only 1 or 2 - is it really worth the effort? Others will also think why would you want to risk it? Making these changes are really up to you to decide, but I thought I'd show you some graphs as to how my graphs have gradually improved after making gradual tweaks.
Not every night is like the 4th or 5th graph, there are some nights where my AHI will go back up, e.g. sleeping on back (more prone to creating Obstructive Apneas), drinking alcohol, other Sleep Based Disorders like RLS, PLMD etc.
The other way to reduce your AHI for Obstructive Apneas is to lose weight (although it's not a 100% guaranteed way of reducing Apneas and can still occur).
Thanks
Dave
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| Additional Comments: Running AirSense 10 AutoSet CPAP, previously S9 AutoSet and S8 AutoSet Spirit | ||||
