Newbie wants opinions of SH data

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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palerider
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Re: Newbie wants opinions of SH data

Post by palerider » Fri Aug 22, 2014 2:51 pm

Pugsy wrote:
palerider wrote:I was going to suggest possibly lowering the PS for that reason. perhaps getting 'overbreathed' as it were.
When I tried PS of 6 (just for grins) I got light headed like I was hyper ventilating. PS of 5 is about the most that I feel comfortable with...PS of 4 works great for me.
I saw a report once from someone who went from PS of 4 to PS of 8 and it was packed with centrals at 8 PS and none at 4 cm. High PS definitely contributed to the high centrals.
so, I went back and looked at that titration report, and I gotta wonder, what orifice did that 'board certified' doctor pull that 12/6 pressure out of?

they never tested at that high an ipap, and never at that high a ps, the closest to that ps they got was 5, and that showed 6 centrals in 23 minutes of sleep for an ahi of 23. backing down the PS lowered the centrals.

highest tested pressure was 11/7... so

where did 12/6 come from?

looks to me like the 'doctor' said 'oh, patient is fat, must have OHS, needs lots of PS" *scribbles signature" NEXT KACHING!

I freely admit I'm guessing here, and would love to learn more.

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Re: Newbie wants opinions of SH data

Post by Pugsy » Fri Aug 22, 2014 3:43 pm

palerider wrote: so, I went back and looked at that titration report, and I gotta wonder, what orifice did that 'board certified' doctor pull that 12/6 pressure out of?
I have thought that very same thing quite often. I figure they like even numbers or "a little more is better than not quite enough" or they are using the magic eight ball trick to come up with numbers.

I think it was just a guess based on someone thinking that 6 was a good PS and for some people it might be. Maybe it worked great on the last person he RX'd it for.

There always the chance that it's the PS that might be triggering the centrals similar to what happens with some people using EPR. It's a small minority but it's there. Maybe any PS is a problem.

When in doubt my gut reaction is to back down the the basics and start from there and work up but when someone is actively under a doctor's care and so new to therapy it isn't my place to push my ideas on someone.

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Re: Newbie wants opinions of SH data

Post by Snowleopard28 » Fri Aug 22, 2014 4:16 pm

Just one thing, I "just" finished taking a good look at the events my machine marked as events using both SleepyHead and Encore and it was WAY off. More than 60% of the CA's (clear airways) were not CA's and it was even worse with the hypoapnea's. It was very obvious when you zoom into the flow rate, about 2 min. window. I couldn't believe it. You might want to do the same and take a closer look to make sure they are actual events.

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Re: Newbie wants opinions of SH data

Post by palerider » Fri Aug 22, 2014 4:27 pm

Pugsy wrote:when someone is actively under a doctor's care and so new to therapy it isn't my place to push my ideas on someone.
"here, try this wild guess of mine and come back in a month" *shudder*

that kind of care scares me

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Re: Newbie wants opinions of SH data

Post by Pugsy » Fri Aug 22, 2014 4:46 pm

palerider wrote: "here, try this wild guess of mine and come back in a month" *shudder*

that kind of care scares me
Yeah it does me too. I respect a doc for saying "I don't know...let's try so and so" a lot more. We don't know the reasoning behind the a fore mentioned settings and maybe he has a good reason and maybe I am overly cautious. I figure might as well see what he says once he gets the reports. Give him the benefit of the doubt anyway.
Remember there is some truth to the "give it time" thing too. Sometimes this whole sleep apnea stuff isn't so cut and dry and not so easy to figure out.

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Re: Newbie wants opinions of SH data

Post by Details » Sat Aug 23, 2014 1:31 pm

Lots of discussion since I last posted--sorry I didn't follow up yesterday. I got home yesterday (Friday) to a message on my answering machine from the sleep center asking me to call them to set up another titration study to see if I qualify for an ASV machine (I think the message said ASV--it definitely said new machine). So they are obviously wanting more information to see what's going on.

On one hand I'm happy to re-test and get some (hopefully) good data instead of just changing pressures and see what happens. On the other hand, I'm kinda irritated that they didn't get the data the first time. I mean they woke me up at 5:40 am to send me home! Why couldn't they have just run the test for another 60-90 minutes? Considering my normal sleep would be from about 1:00 to 8:00, asking me to fall asleep (in a foreign place) at 11:00 and then end the study SO early is ridiculous. But I'm sure my complaints wouldn't influence the process. Oh well.

Now I'm wondering if I should continue using the CPAP until after the study. Last night my AHI was 33.92. I think I may be better w/o it.

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Re: Newbie wants opinions of SH data

Post by palerider » Sat Aug 23, 2014 2:13 pm

Details wrote:Lots of discussion since I last posted--sorry I didn't follow up yesterday. I got home yesterday (Friday) to a message on my answering machine from the sleep center asking me to call them to set up another titration study to see if I qualify for an ASV machine (I think the message said ASV--it definitely said new machine). So they are obviously wanting more information to see what's going on.

On one hand I'm happy to re-test and get some (hopefully) good data instead of just changing pressures and see what happens. On the other hand, I'm kinda irritated that they didn't get the data the first time. I mean they woke me up at 5:40 am to send me home! Why couldn't they have just run the test for another 60-90 minutes? Considering my normal sleep would be from about 1:00 to 8:00, asking me to fall asleep (in a foreign place) at 11:00 and then end the study SO early is ridiculous. But I'm sure my complaints wouldn't influence the process. Oh well.

Now I'm wondering if I should continue using the CPAP until after the study. Last night my AHI was 33.92. I think I may be better w/o it.
well, if it were me (insert foot long list of standard disclaimers here) I'd make some of the changes that were suggested above, in the meantime, and see what happens, then take that data with you.

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Re: Newbie wants opinions of SH data

Post by Details » Sat Aug 23, 2014 2:34 pm

palerider wrote:well, if it were me (insert foot long list of standard disclaimers here) I'd make some of the changes that were suggested above, in the meantime, and see what happens, then take that data with you.
You mean lowering the pressure? Yeah, I think I will. I won't be able to call and set up an appointment until Monday, and I'm sure it will take at least a few days (if not two weeks) to actually get in. So I have some time to play. And it's probably better to lower the pressure on my own and see the results than to not PAP at all. If I tick someone off they'll at least know that I'm serious about improving my health. I know the DME would freak out because when I stopped by their office before choosing them, I asked if I could have access to the data and the response was a resounding "NO". I was told that I could have a printed report, but not access. Oh well, what they don't know won't hurt them. (Note this was the same nurse that didn't want to work with me on finding a better mask.)

Looking at my titration numbers, it looks like 7/3, 8/4 and 9/5 were the best numbers tested. Perhaps I'll pick one of these to try.

Thanks again for helping!

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Re: Newbie wants opinions of SH data

Post by palerider » Sat Aug 23, 2014 2:39 pm

Details wrote:
palerider wrote:well, if it were me (insert foot long list of standard disclaimers here) I'd make some of the changes that were suggested above, in the meantime, and see what happens, then take that data with you.
You mean lowering the pressure? Yeah, I think I will. I won't be able to call and set up an appointment until Monday, and I'm sure it will take at least a few days (if not two weeks) to actually get in. So I have some time to play. And it's probably better to lower the pressure on my own and see the results than to not PAP at all. If I tick someone off they'll at least know that I'm serious about improving my health. I know the DME would freak out because when I stopped by their office before choosing them, I asked if I could have access to the data and the response was a resounding "NO". I was told that I could have a printed report, but not access. Oh well, what they don't know won't hurt them. (Note this was the same nurse that didn't want to work with me on finding a better mask.)

Looking at my titration numbers, it looks like 7/3, 8/4 and 9/5 were the best numbers tested. Perhaps I'll pick one of these to try.

Thanks again for helping!
I'd lower the pressure support, and lower the pressure some, maybe 9 /6... the 7/3 is an awfully low epap. if your machine will even go that low,

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Re: Newbie wants opinions of SH data

Post by Pugsy » Sat Aug 23, 2014 7:51 pm

I would vote for 9/6 if it were me and see what happens. Maybe 9/5.

And about the need to go back for an additional titration study using the ASV machine. 60 to 90 minutes more wouldn't have been near enough time. It's a very special machine and more time is needed and the tech would have had to have already had an order for it to be done and the ASV titration isn't something that is commonly part of a script for routine sleep study or titration. Only about 10 to 15 % of the people who start out on cpap have Complex Sleep Apnea develop to the point of needing the ASV machine.
Going back for a full night ASV titration is actually the normal situation. It's the best way to find optimal pressures when centrals are a problem.
palerider wrote: Oh well, what they don't know won't hurt them. (Note this was the same nurse that didn't want to work with me on finding a better mask.)
No need to share with the nurse that you already know about the software. She/he isn't going to be supportive and helpful anyway.
Those types think we are too stupid to understand this cpap stuff....I hate those types but there are plenty of them out there.
Your situation is a bit more complicated than the majority of cpap users but with a little time and education you can easily understand what is going on. It isn't rocket science ...even dealing with Complex Sleep Apnea.

I am glad your doc isn't wasting any time stepping in and moving on to the ASV machine.

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Re: Newbie wants opinions of SH data

Post by Details » Wed Aug 27, 2014 2:45 pm

Update with four nights (Sat. through Tue.) of lower pressure and the results look good. I set the pressure to 9/6 and my AHI numbers were: 3.34, 3.08, 5.95, and 4.04! I would have updated here sooner, but the first two nights were only about four hours of data per night. I can upload screenshots if folks want to see them.
Pugsy wrote:And about the need to go back for an additional titration study using the ASV machine. 60 to 90 minutes more wouldn't have been near enough time. It's a very special machine and more time is needed and the tech would have had to have already had an order for it to be done and the ASV titration isn't something that is commonly part of a script for routine sleep study or titration. Only about 10 to 15 % of the people who start out on cpap have Complex Sleep Apnea develop to the point of needing the ASV machine. Going back for a full night ASV titration is actually the normal situation. It's the best way to find optimal pressures when centrals are a problem.
Okay, I see. But what I meant about 60 to 90 more minutes was mainly to try more pressure combinations during the titration. I know I slept horribly that night at the sleep center, so limiting the time seems counter-productive. Perhaps they would've found pressure settings that work better than what they prescribed.
Pugsy wrote:I am glad your doc isn't wasting any time stepping in and moving on to the ASV machine.
Right now I have an appointment for a followup with a NP on 9/22 and a second titration on 10/7. I plan on sharing my results of the lower pressure settings after a few more days and I'll see what they say. I'm hoping that they cancel the second titration and just go with the equipment I have (I don't really want to pay for another titration if I don't need it).

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Re: Newbie wants opinions of SH data

Post by Pugsy » Wed Aug 27, 2014 3:26 pm

Details wrote:I set the pressure to 9/6 and my AHI numbers were: 3.34, 3.08, 5.95, and 4.04! I
Details wrote:Right now I have an appointment for a followup with a NP on 9/22 and a second titration on 10/7. I plan on sharing my results of the lower pressure settings after a few more days and I'll see what they say. I'm hoping that they cancel the second titration and just go with the equipment I have
You may be one of the lucky ones who can get by with keeping the pressures low enough to keep the centrals away but still be effective against the obstructives. It sure looks like it from the above results. I will cross my fingers for you.
By the time you have your follow up visit with the doctor you should have enough data available to see if you are consistently staying down to where centrals aren't a worry.

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Re: Newbie wants opinions of SH data

Post by Details » Wed Aug 27, 2014 4:01 pm

Snowleopard28 wrote:Just one thing, I "just" finished taking a good look at the events my machine marked as events using both SleepyHead and Encore and it was WAY off. More than 60% of the CA's (clear airways) were not CA's and it was even worse with the hypoapnea's. It was very obvious when you zoom into the flow rate, about 2 min. window. I couldn't believe it. You might want to do the same and take a closer look to make sure they are actual events.
Just to follow up on this idea. Here is a zoom in of several CA events:
Image

I've examined many events in SH and they tend to look like these. So I think that they're being flagged correctly.

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Re: Newbie wants opinions of SH data

Post by Details » Wed Aug 27, 2014 4:08 pm

Pugsy wrote:I think it was just a guess based on someone thinking that 6 was a good PS and for some people it might be. Maybe it worked great on the last person he RX'd it for.

There always the chance that it's the PS that might be triggering the centrals similar to what happens with some people using EPR. It's a small minority but it's there. Maybe any PS is a problem.
Another follow up: My machine is in 'S' mode, not 'VAuto'. In 'S' mode, there isn't a PS setting, but in 'VAuto' mode there is. Is the difference between these modes worth looking into? Should I talk to the doctor/NP about it on my 9/22 follow-up?

When I changed the pressure settings I left it in 'S' mode and just changed the IPAP from 12.0 to 9.0.

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Re: Newbie wants opinions of SH data

Post by palerider » Wed Aug 27, 2014 4:09 pm

Snowleopard28 wrote:Just one thing, I "just" finished taking a good look at the events my machine marked as events using both SleepyHead and Encore and it was WAY off. More than 60% of the CA's (clear airways) were not CA's and it was even worse with the hypoapnea's. It was very obvious when you zoom into the flow rate, about 2 min. window. I couldn't believe it. You might want to do the same and take a closer look to make sure they are actual events.
just out of curiosity, what makes you think that?

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