So is 12cm

my sweet spot?

MISSING from that chart is the snore data. You almost would think that those lines go down to near zero beyond 14cm pressure range, but your range used limits the display of data.

Those lines with a downward "trend" are what you want to see.

Would 14.5cm be better than 12cm? You don't know because your range is limited to 14cm.

I would open up the Max pressure to like 16cm and see what happens. 12cm is not bad but is that your ideal sweet spot? Hard to tell from that report, 14cm setting looks as good as it gets although it could also reach a AHI=0 if allowed to.

APAP was set to 11.5 to 14.

I think I was getting arousals at the higher pressures. My original Rx was for 12, but that was a long time ago.

OK, here's snores...

Is this snore index vs pressure typical?

It would seem that the higher the pressure, the less the snores would be.
Why is this not the case.
tom

tomjax wrote:Is this snore index vs pressure typical?

It would seem that the higher the pressure, the less the snores would be.
Why is this not the case.
tom

eggactly! what you would expect to see, but snores are climbing which could indicate several things:

1. increased pressure of cpap flowing over a flabby soft palate is generating the snores sort of like letting the air out of a balloon. As pressure climbs more snores are seen (vs. reduction in snoring).

OR

2. the person is becoming much more in a relaxed state where the tongue is allowed to collapse and fall back into the back of the throat with partial closure seen which generates the same snore vibrations right before it slams shut.

So if #1 assumption is correct and snores are palatal caused snores, a lower AHI would most likely not be seen beyond 14cm pressure. If pressure beyond 14cm reduced or changed that snore curve then you can probably guess that the snores were caused by a tongue falling into the back of the throat which may indicate an apnea may soon follow.

But you can't see that because the pressure isn't allowed to go that high. If you could determine which type of snores those were you could almost gage where the state of the airway is. If 14.5cm or 15cm pressure only causes those snores to increase in frequency you could say they were palatal snores. If that increased pressure caused the snores to dramatically drop or cease, then you could say it was snores caused by a collapsing airway from the tongue which means the tongue then is on the verge of a fully collapsed airway. In that case more pressure would be warranted to stent the airway back patent.

But you only want to limit the Maximum pressure on the machine if you are at risk of having pressure induced Central apnea. That is something every OSA patient should know in my opinion because it determines how you should run your machine. If you are not at risk, open it up let it do its job.

If you open it up and the next set of reports show things continually climbing a hill then you know that going forward at which case you look at the above chart and say looks like 12cm is the best you are going to see.

You also have to look at the quality of data, is that 1 night or 7 days avg? If it was 7 days avg. AHI I would be more inclined to go with that data result, but if it is only 1 night's worth, I'd say for that "night" 12cm would be good.

That is why Encore pro data is most useful, snores could have driven the pressure to the top, and or leaks could have made the pressure ineffective in stopping the snores. The Chicken and the Egg vs the crossing the road syndrome.

By looking at a vertical like through Encore Pro Dailies, you can see a better picture of what's going on. Jim

I haven't figured out yet how to post Encore Pro pdf's. I read all the info but I don't get it.

That info was for seven days....both charts.

I remember from my sleep study several years ago that they told me I had more than sleep apnea. I now know that they were talking about centrals.

I don't have my old sleep study report and don't know if I could even get it. It was a long time ago.

Earlier this year I had my machine set at 14 / 18 and was having a hell of a time with arousals. I think it was you, Snoredog, that told me to turn it down and see how I did. I started sleeping better.

The last week I have been trying the Breeze because I was having leak issues with the Adams, and I was hoping the breeze would cure that. Within a few days, the Breeze leak rate was no better than the Adams. I was running between 30 and 35 lpm and should have been at around 25 for that mask and pressure.

AHI's have been in the low range. 1.3 to 1.8, but I haven't been feeling rested in the mornings.

No insurance, so another sleep study is out of the question right now.

Thanks,


JeffH

Here are three month charts when I went up to 15cm

JeffH wrote:Here are three month charts when I went up to 15cm

Okay, that is what I was looking for;

See that "red" line beginning in the top chart at 14cm pressure? That red line according to the Legend at the top of the chart is NRI or Non-Responsive Apnea Hypopnea Indice. For that flag to even register in that report, you have to be having a bunch of those non-responsive events because it takes like 3 to trigger a NRAH event.

Sure your snores fall rapidly at 15cm pressure (meaning your snores are caused by the tongue falling into the back of the throat as suggested above in theory #2. They fall rapidly because 15cm pressure stents the airway open to stop the snores. Only drawback is that same pressure you start firing off with central apnea. Those will make you wake up and say gee what the heck just woke me up?

So right now, I'd say your ideal pressure is 12 to 12.5cm. Maybe you could get by with 15cm on straight cpap and avoid the centrals. But your threshold for those centrals firing off appears to be about >14cm pressure.

If you could eliminate those snores you could probably get better quality sleep, but then if that same pressure causes a central which wakes you up you are not really gaining anything.

You could use a mask interface that retains more CO2 and possibly prolong those Centrals from showing up at a higher pressure. But to be sure of that you should be monitored in a lab.

The current interfaces you are trying to use, the breeze and adams circuit are not thought to be ideal in that aspect. The swift even worse (wrong direction), the opti might be something worth trying.

The centrals are not going to cause you a problem other than waking you up. But waking up several times per night for no reason is no fun either.

I'd stick with 12-12.5cm for the time being and work on getting a better interface.

Thanks for the help, Snoredog.


JeffH

OK, OK. Jeff, are those graphs from the Encore software? If so, I can't WAIT until I get my M-Series and software. Went to see my Doc yesterday and insisted that I get a CPAP/APAP with self monitoring capabilities. She tried to talk me out of it, but I persisted (I mean, it is MY treatment, right?) The RT I spoke with was very helpful - showed me some of the reports that the Encore software puts out, and spoke highly of the M=Series.

One question - how do you like your machine? The RT mentioned some problems with the humidifiers - any problems by you?

(FYI - nose finally fully healed. I Can actually breathe now!

Erik

erik67 wrote:OK, OK. Jeff, are those graphs from the Encore software?

No, this is James Skinners Encore Pro Analyzer program...a must have with Encore Pro.

erik67 wrote: If so, I can't WAIT until I get my M-Series and software. Went to see my Doc yesterday and insisted that I get a CPAP/APAP with self monitoring capabilities. She tried to talk me out of it, but I persisted (I mean, it is MY treatment, right?) The RT I spoke with was very helpful - showed me some of the reports that the Encore software puts out, and spoke highly of the M=Series.

One question - how do you like your machine? The RT mentioned some problems with the humidifiers - any problems by you?

No humidifer problems on mine. I think that issue is all fixed. They used to have an elbow on them that they eliminated, if I understand right. I really like my M series, but only have an old Sullivan to compare it to.

erik67 wrote:(FYI - nose finally fully healed. I Can actually breathe now!

That's great! Mine is doing much better also. Still doing the saline rinse everyday and that seems to help it say open better. Good to hear from you.

Erik