help! still tired!

will the clear airway events eventually go away too as i become more accustom to the apap? thanks for the advice and input from everyone.

Julie wrote:I never suggested NOT trying anything, only alerted the newbie to Den's particular 'prejudice' re therapy mode. THe fact remains that the majority use Apap and find it helpful and I suggest you continue with it until such time as it's not and you've proven that is the problem rather than something else. A min. setting of 6 is low by any standards and the usual advice apart from other possible issues is to try it at a bit higher for a short time. Certainly anyone's free to do what they want at any time.

My "prejudice" is helping the users find what works best for them......including what produces the optimal reduction of events AND the best quality of sleep. It may be a range of pressures or straight pressure.

It's been obvious that many have a "prejudice" towards APAPs with ranges of pressures.
APAPs primarily respond to precursor events such as Flow Limitations and Snores. If the users don't have them or if they have them and those events DON'T precede Apneas, then the machines won't increase pressures or they may raise pressures unnecessarily. Some people also have Flow Limitations that will not be squashed by increased pressure (sometimes they even get worse). Nasal congestion can contribute to both of those precursors, so it's important for the user to try to make sure their nasal passages are as clear as possible before going to bed.
And, again, setting the minimum pressure to where it eliminates as many events as possible is very important.


Den

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Dgriffin333 wrote:will the clear airway events eventually go away too as i become more accustom to the apap? thanks for the advice and input from everyone.

That is an "unknown". No generalities that I'm aware of. They could be caused by any number of circumstances.

Edit to add: Taking another look at your report, the CAs could even be caused by a reflex reaction to pressure increases. Most of them seem to occur during those times. Cause and effect? Who knows. But, there are some ways to either prove or disprove if that's the case.


Den

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Hi Dgriffin333,
I agree with those that suggest an increase in the min pressure, but do it slowly. Max 1 at a time, this is to reduce the OAs.
You are also seeing more CAs at a higher pressure. I would keep lowering the max pressure in an effort to reduce the CAs.
When I started I had a lot of CA. With time on the machine, and lowering the upper pressure my CAI is under 1. It took me about 6 weeks.

I see some breaks in the therapy line where the machine was turned off and back on again...so you were awake some.
Were you awake at other times and didn't turn the machine off and back on again?

If you did spend some awake time with mask on then that might account for some of the centrals. Awake breathing pauses getting flagged and would be ignored if you were awake.

Fragmented sleep will trash sleep quality and your chances of feeling much improvement are slim and none if you have a lot of awakenings even if the AHI is nice and low.

I agree with the others...try 1 cm more minimum and see what happens.
Also consider trying fixed pressure at some time or other to see if you happen to be someone who sleeps better with a nice steady pressure all night.
Give yourself at least 3 nights if you make a change so you can watch for trends and patterns. We don't sleep the same each night and changing things daily based on one report from last night will only end up with your chasing your tail all the time.
So 3 to 5 nights at a change unless the change results in horrible disastrous results of some sort.

thanks pugsy for the advice and i was only awake when the machine was turned on but was only awake for a couple min and only had that awakening i was asleep most of the time.

Hi i tried raising my min pressure from 6 to 10 to 7 to 10 my obstructive events went down from 2 to 1 but my clear airway events increased from 2 to 4. wondering if maybe turing off EPR would help with the 4 clear airway events a hour?

You need to have more than one night at the new setting before you stat making more changes. When my wife first started out, she would have a sharp increase in the number of CA's every time they raised her pressure, but they would gradually come back down. She is now at an optimum pressure and her CA's are averaging less than 1 per hour.

its been 3 nights with the same results lower obstructive and increased centrals but sounds like from your post that the centrals could go down with time.

Dgriffin333 wrote:its been 3 nights with the same results lower obstructive and increased centrals but sounds like from your post that the centrals could go down with time.

Might depend on whether they're "pressure-induced Centrals".
Most of yours (in the report you posted earlier in this thread) were in the area where your pressure was spiking and choppy.
But, it's still an "unknown" whether they're diminish over time.


Den

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Wulfman... wrote:

Dgriffin333 wrote:its been 3 nights with the same results lower obstructive and increased centrals but sounds like from your post that the centrals could go down with time.

Might depend on whether they're "pressure-induced Centrals".
Most of yours (in the report you posted earlier in this thread) were in the area where your pressure was spiking and choppy.
But, it's still an "unknown" whether they're diminish over time.


Den

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Lucky us, our "Tanks", don't record Centrals, so we don't have to worry about them.... Jim

"Ignorance is Bliss"

Goofproof wrote:

Wulfman... wrote:

Dgriffin333 wrote:its been 3 nights with the same results lower obstructive and increased centrals but sounds like from your post that the centrals could go down with time.

Might depend on whether they're "pressure-induced Centrals".
Most of yours (in the report you posted earlier in this thread) were in the area where your pressure was spiking and choppy.
But, it's still an "unknown" whether they're diminish over time.


Den

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Lucky us, our "Tanks", don't record Centrals, so we don't have to worry about them.... Jim

"Ignorance is Bliss"

Well, actually, they did......sort of. Noting them as "Non Responsive Apneas and Hypopneas".

There's even a section in the Encore Pro reports when using APAP mode:
"Non-Responsive Apnea/Hypopnea Index"
"Average Non-Responsive Apnea/Hypopnea Index"

Here's the text describing the machine detection and responses.

Den

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Apneas and Hypopneas are determined by establishing a reference that is based on a moving flow signal window that is a few minutes in duration.

Apneas and Hypopneas are detected as a reduction in flow lasting for at least 10 seconds.
Apnea - 80% reduction in flow
Hypopnea - 40% reduction in flow

Response to Apneas and Hypopneas: Ptherapy
While in Ptherapy mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

Response to Apneas and Hypopneas: Poptimum
In Popt search mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

Detection of Non-Responsive Apneas and Hypopneas
Above 8 cmH2O pressure, the pressure increase for sustained apneas/hypopneas is limited to 3 cmH2O above the pressure setting at the onset of the apnea/hypopnea sequence.
The pressure setting at the onset of the sequence is called the "Onset Pressure."
The pressure 3 cmH2O above the "Onset Pressure" is called the "NRAH Threshold."
"NRAH" is an acronym for "Non-Responsive Apnea/Hypopnea."


Detection of Non-Responsive Apneas and Hypopneas
An apnea/hypopnea x2 event detected after reaching the NRAH Threshold is considered to be non-responsive.

Detection of Non-Responsive Apneas and Hypopneas
A special case of Non-Responsive A/H is when the events are hypopneas only, with no apneas.

Detection of Non-Responsive Apneas and Hypopneas
After seeing two Hypopneas, the algorithm increases the pressure by 1 cmH2O, and the Onset Pressure resets to this new pressure level.

Detection of Non-Responsive Apneas and Hypopneas
However, the Onset Pressure can not be raised above 12 cmH2O by a sustained string of Hypopnea-only events.
This does not imply that the Onset Pressure value can not be set above 12 cmH2O. It only states that the Onset Pressure can not be RESET above 12 cmH2O due to a string of Hypopnea-only events.
The maximum NRAH Threshold due to a sustained string of Hypopnea-only events will be 3 cmH2O above 12 cmH2O.

Response to Non-Responsive Apneas and Hypopneas
When the device encounters a non-responsive apnea or hypopnea, it will decrease pressure by 2 cmH2O and hold the pressure for 15 minutes.
During this 15-minute "NRAH-hold" period, the pressure will be changed only in response to detection of a sequence of vibratory snore events.
The reason for this increase in pressure followed by a decrease in pressure when an apnea/hypopnea is not responsive is to allow the device to respond appropriately to an event that is not treatable by increases in pressure, such as a central apnea.

Elevated Leak Levels represent an exception condition
The persistence of large leaks, particularly when the patient's breaths have small tidal volumes, could potentially induce false apnea and hypopnea detection. Therefore, the REMstar Auto monitors the patient's flow over several minutes.
The patient's flow is compared to "expected leak." "Expected leak" is a value that has been determined through testing of various mask and tubing combinations.

Elevated Leak Levels
As the pressure is increased, the "expected leak" also increases.
The algorithm operates normally while the patient's flow is less than two times the "expected leak."

Elevated Leak Levels
This increased flow is considered to be in "large leak" if the threshold is exceeded for more than 1.5 minutes.

Elevated Leak Levels
The REMstar Auto system responds to the "large leak" by dropping the pressure 1 cmH20 every two minutes until the "large leak" condition is cleared.
As the pressure is dropped, the "expected leak" also drops.

Elevated Leak Levels
The "large leak" is cleared when the patient's flow falls below the threshold for more than 1.5 minutes.


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Julie wrote:I never suggested NOT trying anything, only alerted the newbie to Den's particular 'prejudice' re therapy mode. THe fact remains that the majority use Apap and find it helpful and I suggest you continue with it until such time as it's not and you've proven that is the problem rather than something else. A min. setting of 6 is low by any standards and the usual advice apart from other possible issues is to try it at a bit higher for a short time. Certainly anyone's free to do what they want at any time.

I love my auto with a range of 11-17. The first thing I noticed when I looked at this person's data is the wild up and down of the pressure. For some people, that is a huge problem. We are all different, this is a suggestion that is easy enough to try. I will happily suggest to this people will lots of pressure changes even though they don't bother me. I am also aware that many people sleep through leaks, small and large, even though I can't handle a tiny little hiss.

Just because you know somebody prefers a certain way, doesn't mean they are wrong to suggest that somebody else try it too.

I'll just have to hope my CPAP TANK, keeps working, The APAP TANK is resting at about 350 hours in the somewhere in the house, along with another TANK. Jim

12 years of not worrying about anything but AHI and leaks. Jim

My treatment could be better with APAP, as I am now sleeping on my back half the night, some snoring, but AHI under 2 is close enough for hand grenades. Too lazy to bump me pressure for little good. The old TANK makes a little noise when starting up in a cold room 64 degrees, so does my hard drive in my T.V. Box, but it doesn't quiet down when warm, they set side by side. My bed table is growing to small, CPAP, T.V. server box, De-Fib, Two Clocks, 3 remotes, and a Lightning supressor w/8 outlets. And My emergency stash of Hershey Kisses and Reese Cups and 24 oz of ice and water. Just the necessities of life.