Doing my own sleep study - surprising results

[Jerry69]

Don't you have to report your results to a Dr or DME? I have to send my card in every month or so, and they will know if I tamper with my pressure, but thanks for letting me know! I was curious and now at least I know if everything else fails, I can try on my own if I have to.

The DME was here at my house and he noticed on my machine that the pressure was at 8. He mentioned that it was higher than my prescription. I told him that I had increased it and invited him to my computer to look at My Encore report results showing a diminished AHI and SI. He was impressed with the reports and my involvement in my own treatment. He suggested that I tell the sleep doc. I said I would when I see him in 5 months. He also suggested that I take copies of my reports to show him. His body language told me he thought the doc would be impressed and maybe awed [my interpretation].

Anyway, I'm currently at 10 cms and practically no A/H's or snores all night. What's to protest? My sleep doc does not seem particular involved with my treatment. He has hundred's of patients with all kinds of breathing problems, not just SDB. He will be relieved when I tell him my therapy is fruitful and he won't care that I've increased the pressure from 6 to 10 cm, I'm betting. Besides, I may reduce it to 9 in a couple of more nights to see if that works almost as well. I ain't hurtin' nothin'.

Jerry

[snoredog]

Jerry69 wrote:

I have begun to mouth exhale, some. Don't know if that has to do with the slightly increased pressure 8>10. But, I'm going to search the posts for remedies. Jump in if you have a good one. I'm allergic to the adhesive on medical tape, so I can't use that remedy for very long.

I think 9cm might be your magic number, your numbers are probably not going to get any lower and as you can see you start seeing problem reappear with increased pressure(s).

If you find you need to tape your mouth and are allergic to the tape adhesive, look for the 1" wide "paper" medical tape from Johnson & Johnson, it will say "hypoallergenic" on it, don't know if you have tried that one or not. It doesn't stick as well as other tapes so it is even easier to remove.

[Colorado Jan]

Okay, you've got me wondering. Am I too complacent? My AHI's are around 4.8 or 4.9 every night. Like a .8 AI and 4.0 HI sort of mix.

But I started out at 85 AHI, so that is a huge improvement. And it is within normal guidelines.

I have the PB420E and the software. But I am really, really not a graph person. Can't stand them. So I don't look at the results too often. And actually right now I'm using the Resmed Spirit and just glancing at the readout on the machine real quickly in the morning to see if I'm doing ok.

Should I get myself worked up over this and get my AHI down?

Jan in Colo.

[Jerry69]

Okay, you've got me wondering. Am I too complacent? My AHI's are around 4.8 or 4.9 every night. Like a .8 AI and 4.0 HI sort of mix.

But I started out at 85 AHI, so that is a huge improvement. And it is within normal guidelines.

I have the PB420E and the software. But I am really, really not a graph person. Can't stand them. So I don't look at the results too often. And actually right now I'm using the Resmed Spirit and just glancing at the readout on the machine real quickly in the morning to see if I'm doing ok.

Should I get myself worked up over this and get my AHI down?

Jan in Colo.

85 down to 4.8 sounds like a great improvement to me.

I have no experience except my own, however. Untreated my AHI's were 9.5 and now I'm varying my titrated pressure, 6 cm, to see what results:

6 cm = ave. AHI of 2.6 with 1 apnea event per night of 12 sec. (on average)

8 cm = ave. AHI of 1.9 with 1 apnea event per night of 12 sec. (on average)

10 cm = ave AHI of 0.4 with 0 apnea events (two-night study)

From what I've read on this forum, AHI's under 5 are okay. So, I may be just playing a numbers game considering the low AHI's I'm getting. Percentage wise, the reduction is significant, but therapeutically, maybe not significant. But, since I don't know, I think I might as well, go with a slightly higher pressure to get the AHI reductions I'm seeing.

I realize that this doesn't answer your question. You are wondering if you should raise your pressure a little to see if you get a reduction. Does your doctor know what your treated AHI's are? If so, I don't recommend that your change your pressure, without consulting him.

My doctor doesn't know what AHI's I am getting off of my machine. In fact, he didn't know that my machine would report AHI's. I saw him a couple of weeks after going on PAP and I'm not sure why. Maybe, so he could ask me how I was doing and I could say, "okay." At the time I saw him, I didn't know I could get reports from my machine. I'm not scheduled to see him for another 5 months, so he's not worried about me. Maybe with untreated AHI's of 9.5, he didn't consider me to be at much risk? And, just maybe, he knew that the titrated pressure of 6 cm would give me all the improvement I needed. And, in fact, my machine reports average AHI's of 2.6 at 6 cm, so maybe he is giving me appropriate treatment. And, maybe, just maybe, I'm being a little obsessive about all this? Another reason, Jan, not to worry about your treatment. You must feel like a new person to get your sleep disturbances reduced as much as you have?

Jerry

[rested gal]

Many people seem to believe that AUTOs *instantly* adjust their pressure to correct events that may occur at a cms lower than their titration recommended level when this is just not the case at all.

You're right about that, dsm. We see that mistaken notion perpetuated by some doctors and DMEs who talk about how "the changing pressures will wake people up" when they refuse requests for an autopap as if the machines have a yo-yo built into them.

An AUTO is usually in a 'react' mode, rarely, in anticipate & control mode

Well, yes, but isn't that a good thing? Isn't that what we want an autopap to do? To sense subtle changes in wave form characteristics and react only as much as needed to correct the throat condition, and keep subtle changes (like limited flow) from turning into a "event" -- an apnea or hypopnea.

Maybe it's semantics, but when an autopap "reacts" gradually with half cm or 1 cm increases in pressure to changes in air flow that are not yet impeding breathing significantly, I think of that as a preventive action rather than as a "reaction".

Yes, it is technically a reaction. But, you can also think of those small reactions to small flow changes as being exactly what autopaps have to do in order to perform their most important job right... prevent apneas.

Of course there are people whose sleep disordered breathing events can hit so hard and heavy all the time, or in certain stages or sleep positions, that an autopap could be playing catch-up too much. That's true for some people especially if the low is set considerably below the person's prescribed pressure. All the more reason for those people to set the low pressure of their autopap up fairly close to their prescribed pressure in the first place.

No autopap can do a perfect job all the time. But a straight cpap single pressure isn't necessarily perfect all the time, either. There are soooo many dynamics affecting breathing while we sleep. I believe the "love affair" many of us have for autopaps is justified in most cases. Not all. Just "most".

The point Wader makes is a good one... "considering an APAP can always become a CPAP, what do we have to lose?"

[rested gal]

My AHI's are around 4.8 or 4.9 every night. Like a .8 AI and 4.0 HI sort of mix.

But I started out at 85 AHI, so that is a huge improvement. And it is within normal guidelines.

---snipped---

Should I get myself worked up over this and get my AHI down?

If you're feeling pretty good I wouldn't worry about an AHI under 5. You've made an enormous improvement!

[MikeSus - Guested]

APAPs are good, but often misused. How often do we hear of someone with theirs set at 4-20?

I think Perry made an excellent observation. When an APAP has a smaller range, it has less ground to cover to get to the "ideal" pressure. Simply getting an APAP and leaving it at 4-20 is not better than a straight pressure IMHO...

When the range is narrowed, it handles the slight increases we might need, but not at the expense of missing events.

[Jerry69]

I've got to be careful here. Rather like having a very good round of golf. Makes you think you've finally mastered the game, only to go out next time and be really disappointed. [You never master golf.]

But.... I'm going to show you some charts you want believe. First, I'll just tell you:

• 1) I used my new Aura/Everest last night, all night, after bending the wires in the 'nasal seal' to make it seal well. Extremely comfortable. Nothing on the cheeks. I could turn my head to partially bury the 'nasal seal' in the pillow. I am going to order the extra-large nasal seal that Lori found, however, because I get some slight leakage that I had to fix while semi-asleep.
  2) One snore, all night! My snoring often disturbed my wife prior to CPAP
  3) No apneas!
  4) Three hypopneas. I'm convinced that two of these were recorded as a result of a snort I made after awakening. I saw the two tic marks on the Encore Pro See them at about the 8 hour point on the graph.
  
  
  
  5) My libido has been restored

First, is the My Encore Daily Report:



Note the 1 snore and 3 hypopneas.

Next is the ME Daily AHI Report:



Those last 3 days are the results at 10 cm. Really low!

Next is the AHI Index vs. Pressure Report which shows how dramatically the AHI's are reduced by increasing pressure to 10 cm. [Thanks, Wulfman]



Next, is the Snore Index vs. Pressure Report which reflects, practically, no snoring with an increase of pressure to 10 cm, only 4 cm above the titration pressure.



And, finally, the Daily Snore Index Chart which reflects the non-existent snores for the last 3 nights at 10 cm CPAP pressure.



But, the best thing is that I woke up truly refreshed, and as I mentioned, with a restored libido.

Couple more things:

• 1) I used the heat on the humidifier at 1 last night and noticed some condensation in the nasal seal and had some leakage of condensate from the seal during the night. First time ever, but I don't usually heat the humidifier. Doesn't bother me. Makes me feel like a pro.
  2) I had no mouth breathing last night. Just a couple of 'puffs'. I poured over a lot of forum topics about mouth breathing, taping, and training to use the tongue to seal against mouth breathing. I went to sleep with a new understanding of the role of the tongue in preventing mouth breathing. Did some practicing and went to bed confident that I could implement and control the mouth breathing.
  3) I love the Aura. Thanks to Rested Gal and others that recommended it. I'm going to order the extra-large nasal seals (thanks, Lori). I hope that they will prevent the slight leakage I got last night.

I'm ready to take on the world...after some fried Spam and eggs over easy, OJ and more coffee. The best to all of you.

Jerry

[Snoozie]

The DME was here at my house and he noticed on my machine that the pressure was at 8. He mentioned that it was higher than my prescription. I told him that I had increased it and invited him to my computer to look at My Encore report results showing a diminished AHI and SI. He was impressed with the reports and my involvement in my own treatment. He suggested that I tell the sleep doc. I said I would when I see him in 5 months. He also suggested that I take copies of my reports to show him. His body language told me he thought the doc would be impressed and maybe awed [my interpretation].

Ok, now you have me psyched about all of this. DME is coming today to change my setting. If it doesn't work, I may try on my own, since my Dr. seemed genuinely impressed with the fact that I can pull up my own results.

Besides, I am very disgusted with the DME's in this group anyway, and I have a great Dr. who will listen to me.

Keep up the good work, Jerry.

[Jerry69]

The DME was here at my house and he noticed on my machine that the pressure was at 8. He mentioned that it was higher than my prescription. I told him that I had increased it and invited him to my computer to look at My Encore report results showing a diminished AHI and SI. He was impressed with the reports and my involvement in my own treatment. He suggested that I tell the sleep doc. I said I would when I see him in 5 months. He also suggested that I take copies of my reports to show him. His body language told me he thought the doc would be impressed and maybe awed [my interpretation].

Ok, now you have me psyched about all of this. DME is coming today to change my setting. If it doesn't work, I may try on my own, since my Dr. seemed genuinely impressed with the fact that I can pull up my own results.

Besides, I am very disgusted with the DME's in this group anyway, and I have a great Dr. who will listen to me.

Keep up the good work, Jerry.

Talk to your DME about changing your pressure, yourself. Ask him to let you watch. Tell him you might like to tweak it sometime, yourself. If he is reasonable, he will say, "You know I can't approve of your changing it, yourself. But, if you want to, it is up to you." I don't know if they bill for each visit to your house, or not. If so, he may volunteer to come back as often as you want. But, if I were you, I'd rather do it myself. It is very simple to do. If you do it yourself and find a setting you like better, you can inform your doctor. He will probably just note it if you tell him the results you have achieved. You seem to be on good terms with him. The only person left out of the loop is the DME, but all he does is adjust the setting on the machine, which you can do.

It's fun to get involved in your own treatment. I've had a great time with the little study I've been doing, and this morning, I'm really feeling good about my treatment. Whether I've accomplished anything really significantly therapeutic, or not, I don't know, but I FEEL GOOD.

Jerry

[Wulfman]

It's fun to get involved in your own treatment. I've had a great time with the little study I've been doing, and this morning, I'm really feeling good about my treatment. Whether I've accomplished anything really significantly therapeutic, or not, I don't know, but I FEEL GOOD.

Jerrrrrrryyyyyy.......wasn't it you who called ME a "numbers guy"?????
(just had to give you a little good-natured ribbing )

I'm sure seeing those numbers drop like a rock has a positive psychological effect, too.
Aren't you glad you're monitoring your therapy with software?

Now I'm REALLY jealous!!!
(but SO darned glad you're numbers have had good results from the pressure increase)

Hope it improves your golf game, too. (Well, ya never know....... )

Best wishes for a Happy New Year.

Den

[Colorado Jan]

Okay, Jerry, you inspired me.

I made the big move (big oohs and ahhs are appropriate here!)...of changing my setting from a low of 8 to a low of NINE (my titrated pressure), lol. I kept the high at 15 because I had hit fifteen the night before..

I spent half the night with the Breeze....and unless I am imagining this...my Resmed Spirit had a readout of "Excellent fit *****", which I have never in my life seen before. I think I must have dreamed that one.

But my nose thought differently and I was up in the middle of the night doing a little repair job on my Swift and finished the night on that.

And....no apneas and hypopnea index of 2.0. Well, who knew.

I kind of thought the idea was to keep the pressures as low as you could...but if that is only for comfort and leaks, well, I'm confortable with slightly higher pressures, lungs are fine, exhaling against it doesn't bother me in the least...and it doesn't seem to leak all that much in the 9-10-11 range anyway...

Hard to tell if I feel better....and that is such a subjective thing anyway with things that influence it other than apnea as well....

Just learning something every day, aren't we? Thanks, Jerry!

Jan

[Jerry69]

Okay, Jerry, you inspired me.

I made the big move (big oohs and ahhs are appropriate here!)...of changing my setting from a low of 8 to a low of NINE (my titrated pressure), lol. I kept the high at 15 because I had hit fifteen the night before..

I spent half the night with the Breeze....and unless I am imagining this...my Resmed Spirit had a readout of "Excellent fit *****", which I have never in my life seen before. I think I must have dreamed that one.

But my nose thought differently and I was up in the middle of the night doing a little repair job on my Swift and finished the night on that.

And....no apneas and hypopnea index of 2.0. Well, who knew.

I kind of thought the idea was to keep the pressures as low as you could...but if that is only for comfort and leaks, well, I'm confortable with slightly higher pressures, lungs are fine, exhaling against it doesn't bother me in the least...and it doesn't seem to leak all that much in the 9-10-11 range anyway...

Hard to tell if I feel better....and that is such a subjective thing anyway with things that influence it other than apnea as well....

Just learning something every day, aren't we? Thanks, Jerry!

Jan

The Breeze can be a nose tugger. And, since it is top heavy, it seems to undergo a lot of movement, which increases the tugging. I find it quieter than the Swift or Aura, however, and I haven't' given up on it. I will get some x-large pillows for it and give it another try.

WRT to your pressure change: you must have an APAP? You talk of 'low' and 'high' pressures, which I suppose are the limits you can set on an APAP. Some have suggested that the range be reduced on an APAP, so it doesn't have to 'travel' so far to quell a disturbance. It might be that the disturbances that were quelled at 15 would be quelled at a lower pressure if the starting pressure was higher? But, that is what you are going to find out. There are some APAP experts on this forum, and I really mean 'experts'. So, maybe they will provide some guidance. You can probably do a search on 'APAP' and find enough topics to read for hours. And, you may want to start your own topic to have a better chance of attracting the 'experts'.

The AHI's of 2.0 sound really good to me. Probably good enough. But, if you have been following my 'study', you know that I've been on a quest to see just how low I can drive the AHI's and Snore Index by increasing pressure, moderately, as it turns out. But, I've confessed that I don't know that it is necessary to drive them lower than 2.0, for example. But, if I can do it with moderate pressure increase, why not? Don't be confused by the fact that I am talking about pressure increases. I have a CPAP, not an APAP. I wouldn't suggest that you increase the pressure upper limit on your CPAP. Get some input from an APAP expert.

Funny thing is that when I started my study, I reduced the pressure to 4 cm. My titrated pressure was 6 cm. I thought that if could show that AHI's were acceptable at 4 cm that I would have shown that I didn't need PAP, at all. Reasoning being that I thought 4 cm was not therapeutic. But, several posters cautioned me that 4 cm might be therapeutic for me. So, I gave up on that tact. Besides, I was snoring like a son-of-a-gun at 4 cm and, even at 6 cm, according to the machine reports.

Jerry

[Jerry69]

Hope it improves your golf game, too. (Well, ya never know....... )

That would be a 'miracle' not 'medicine'.

Yes, I'm so thankful my DME (or Doc, not sure who is responsible) supplied a machine that has reporting capability. I really couldn't stand not knowing when I knew that some machines had it. And, I'm further thankful for the free software to take advantage of the reporting capability.

Happy New Year and happy CPAP'n, to you, too,

Jerry

[Colorado Jan]

Thanks for your words of encouragement Jerry...and I'm sorry, I wasn't trying to hijack your thread!

Just seemed logical to post my little results there since it was you that inspired me to try something. Yes, I do have an APAP and I'll probably be lowering the higher number next, since 9-15 probably too broad of a range. Seems that normally a spread of 4-5 is recommended, not 6.

I don't have the time nor patience (nor understanding, if we really want to get right down to it, lol) to do an in-depth study like you are doing.

Good luck with your continuing research! You are doing great! A true inspiration to us lazy ones!

Jan in Colo.