S9 Data - After One Week

I have been working this week to get my leak numbers under control. Last night I had my first night without any leaks above red-line.

http://i40.photobucket.com/albums/e215/ ... g~original

Why was the session broken up into five parts? The machine was on from the start time to the finish. The gaps seem to correspond with my awakenings. AHI is under control apparently, but my "sleep architecture" is still broken.

So, is this level of leaks OK, or should I still be working to bring it down? Can I assume that my original pressure setting of 13 was too high? Did I accidentally arrive at an ideal pressure or do I need to make more adjustments?

Here's your report so we don't have to click on the link
I just copied and pasted the IMG address from the box of choices instead of using the url address.
Will answer your questions in a separate reply in a few minutes.

JQLewis wrote:Why was the session broken up into five parts? The machine was on from the start time to the finish. The gaps seem to correspond with my awakenings.

Looks like you turned the machine off briefly and then back on. Did you get out of bed during those awakenings?
Something turned the machine off.

Could you please use the regular pressure graph and turn off the mask pressure graph?

JQLewis wrote:So, is this level of leaks OK, or should I still be working to bring it down?

Is it possible the leaks disturbed your sleep??? If not, while the leak line isn't real pretty it is certainly within acceptable limits and thus unless the leaks are a cause of the awakenings I wouldn't worry about them at this point. We don't get extra points for "pretty" leak lines.
If you will click on the lower left corner of the leak graph where the vertical and horizontal lines intersect at 0.0 the graph will become auto adjusting and you will lose the 120 L/min which you don't need and be able to see the leak line zoomed in. See the ups and downs in closer detail so that you could maybe evaluate higher leaks with wake ups.

JQLewis wrote:Can I assume that my original pressure setting of 13 was too high? Did I accidentally arrive at an ideal pressure or do I need to make more adjustments?

It's possible that the 13 cm RX was a worse case scenario pressure. It's what has to be done when using fixed cpap mode. Maybe for a short period during the titration sleep study you needed that much pressure for some reason.
It's nice that you don't need it a lot since higher pressures create aerophagia issues for you.
I can't really comment on pressure graph since I can't see it and using the mask pressure graph I can't really see if you are maxing out the pressure a lot but from the 95% number it appears that you are.
12.4 cm really isn't a huge step down from 13.0 anyway in terms of therapy but it can be significant in terms of aerophagia threshold.

I don't see the need to increase the pressure and since we know it creates aerophagia issues then I wouldn't do it.
If you still had aerophagia issues at these pressures your AHI is quite low and with leaks not impacting the reports then you could probably reduce the pressure a little and not have it significantly impact the AHI.
AHI varies from night to night anyway and pressure needs can also vary from night to night.

Do you sleep on your back very much?

Your FLs graphs are a bit ugly and with using EPR we are reducing therapy a bit but I hesitate to advise reducing EPR in case it makes your aerophagia worse.

How is your sleep quality now and how do you feel during the day now?
I don't know how critical it might be to improve the looks of the FL graph because I don't know how much of an impact they are having on how you feel but we already know that aerophagia impacts how you feel. I tend to try not to swap devils when I know there's already a known devil with the aerophagia.

Fixing ugly FLs requires more pressure and with more pressure comes aerophagia in your situation so if the FLs aren't a huge problem then I don't know that they need to be fixed. Sometimes we have to make compromises.

Now if you sleep mainly on your back and you wish to try side sleeping to see if it helps....sure won't hurt to try.
If your sleep quality is crappy and you still feel crappy and which to try to reduce the FLs to see if it helps just bear in mind that more pressure might be needed and reducing EPR will increase your EPAP (pressure on exhale) and it might bring on the aerophagia...so if it does then you know why. So it might and it might not...just so you know what might happen and reducing EPR might not be enough to make much of a difference in the FLs anyway.

Pugsy wrote:

JQLewis wrote:Why was the session broken up into five parts? The machine was on from the start time to the finish. The gaps seem to correspond with my awakenings.

Looks like you turned the machine off briefly and then back on. Did you get out of bed during those awakenings?
Something turned the machine off.

Could you please use the regular pressure graph and turn off the mask pressure graph?

What I did at each instance was 1- Wake up. I have no idea what woke me. 2- Turn on the "mask fit" feature to make sure Mr. Smiley Face was still with me (does that turn off the machine? If so, oops. ) 3- Stand up and use the standard hospital urinal I keep by my bed. 4- Back to bed.

Here's a modified SH screenshot:



I haven't looked at any data besides leaks yet. I figured if ridiculous levels of leaks compromise the accuracy of the data, take it one step at a time.

Pugsy wrote:Is it possible the leaks disturbed your sleep???

It could be. There's a spike in leaks before each awakening. The noise or loss of pressure or both could be the culprit.

Pugsy wrote:It's possible that the 13 cm RX was a worse case scenario pressure. It's what has to be done when using fixed cpap mode. Maybe for a short period during the titration sleep study you needed that much pressure for some reason.
It's nice that you don't need it a lot since higher pressures create aerophagia issues for you.
I can't really comment on pressure graph since I can't see it and using the mask pressure graph I can't really see if you are maxing out the pressure a lot but from the 95% number it appears that you are.
12.4 cm really isn't a huge step down from 13.0 anyway in terms of therapy but it can be significant in terms of aerophagia threshold.

I don't see the need to increase the pressure and since we know it creates aerophagia issues then I wouldn't do it.
If you still had aerophagia issues at these pressures your AHI is quite low and with leaks not impacting the reports then you could probably reduce the pressure a little and not have it significantly impact the AHI.
AHI varies from night to night anyway and pressure needs can also vary from night to night.

I guess it makes sense to see what a week's worth of data reveals. AHI looks good, so there's no pressing need to make changes.

Pugsy wrote:Do you sleep on your back very much?

Exclusively.

Pugsy wrote:Your FLs graphs are a bit ugly and with using EPR we are reducing therapy a bit but I hesitate to advise reducing EPR in case it makes your aerophagia worse.

I'll have to get up to speed about flow limit.

Pugsy wrote:How is your sleep quality now and how do you feel during the day now?
I don't know how critical it might be to improve the looks of the FL graph because I don't know how much of an impact they are having on how you feel but we already know that aerophagia impacts how you feel. I tend to try not to swap devils when I know there's already a known devil with the aerophagia.

From a purely subjective POV there hasn't been a huge change in sleep quality. I fought to preserve some kind of sleep hygiene for the first 15-20 years of undiagnosed OSA, then about five years ago I threw in the towel. Since then I've lived between naps. About a year ago I had what was termed a TIA. I went to the emergency room and my blood pressure was through the roof, and after the ER doc and a neurologist both insisted, I checked into the hospital. It was after being hooked up to a heart monitor that I was told I had OSA. I was also put on a ton of BP meds, which completely destroyed my ability to function. I'm down to only two pills now, but I can't really begin to evaluate how much those meds still affect my daytime sleepiness. I still wake up 4-5 times a night with a fairly regular pattern to the awakenings. I think there's been an improvement. I remember dreams a lot more since starting CPAP, which suggests to me that I'm getting a lot more REM sleep.

Bottom line: after living for 20-25 years with a sleep disorder, I feel like my therapy finally began yesterday. Now I have to figure out where to go from here. I'm going to read up on flow limit and I have a bunch of other questions I need to ask. Hopefully the picture will start to become clearer now. As always, thanks for your help.

When you woke up and checked the mask fit feature that effectively turns the machine off briefly. No big deal but it explains the session fragments.

Do you have prostrate issues that are maybe causing the wake ups or some of them anyway?

Fragmented sleep for whatever reason is going to seriously impact how a person feels the next day. We simply don't get a chance to get the nice normal progression of sleep stages that the body needs.

If you can't sleep on your side then we deal with the supine sleeping but if you can sleep part of the night on your side you might see if the Flow limitations (they are reductions in air flow that don't meet the criteria for hyponea or apnea...either not long enough to make it 10 seconds or maybe not quite enough of a reduction) could potentially be a factor in sleep quality and wake ups. Is it a for sure thing? We don't know for sure. I don't know if making the FLs would allow you to sleep more soundly and feel better or not. It's something to consider though.

Pugsy wrote:When you woke up and checked the mask fit feature that effectively turns the machine off briefly. No big deal but it explains the session fragments.

OK. Good to know.

Pugsy wrote:Do you have prostrate issues that are maybe causing the wake ups or some of them anyway?

No prostate problems. I had an ultrasound a year ago or so and all was normal, both size and position. My having gone so often last night is unusual. That's one thing which has diminished with CPAP.

Pugsy wrote:Fragmented sleep for whatever reason is going to seriously impact how a person feels the next day. We simply don't get a chance to get the nice normal progression of sleep stages that the body needs.

Clearly that's the next thing I need to address. There's a few things I've been considering as possible causes of my awakening so often. I wrote a thread yesterday (here) about PLMs. Then there's leaks. I certainly have been having enough of those.

Pugsy wrote:If you can't sleep on your side then we deal with the supine sleeping but if you can sleep part of the night on your side you might see if the Flow limitations (they are reductions in air flow that don't meet the criteria for hyponea or apnea...either not long enough to make it 10 seconds or maybe not quite enough of a reduction) could potentially be a factor in sleep quality and wake ups. Is it a for sure thing? We don't know for sure. I don't know if making the FLs would allow you to sleep more soundly and feel better or not. It's something to consider though.

Having done a little quick reading I'd say it's definitely in the mix, but I was having a problem yesterday. It was the first night I'd slept without air conditioning since the start of the summer. That always stuffs me up. None of my other days showed anything like last night in the flow limitation data, and my RERA's in my sleep study were zero.

I am going to let the forum members with more experience help you with the PLMD discussion. I don't have it and thus no experience and other than know it messes with sleep...I don't really know all that much about it and we have so many good forum members here that do know a lot about it first hand, I really haven't had the need to read up on it. I keep busy enough with the basics.

If you were a bit congested last night then that certainly could impact that FL graph and also the overall quality of your sleep so maybe not worry too much about last night since it really isn't what you normally see.
We all have some weird nights sometimes. I still get them myself after over 5 years. Fluke bad nights I don't really even both trying to do much evaluation to because I wouldn't be doing much about it anyway. I don't make changes based on just one night's worth of data. I want to see trends and patterns first before I go making changes.
Nights that aren't what I normally see...unless they continue with something new and ugly...I just shrug my shoulders and blame it on the aliens experimenting with me again. The aliens get blamed for a lot of weird stuff around here.