1 month in...what to work on now...

Hi All,

I am about a month in and things seem to be going well. It appears that all my stats are getting better but was just wondering if anyone sees anything I need to work on.

My diagnosis was severe OSA with an AHI of 68 during my sleep study. I am using it in CPAP mode with a constant pressure of 12 which at night is almost unnoticeable to me.



I am also including my daily charts for the last 4 days. My AHI over the last month has typically been between 3 and 5 with a day here or there in the 7 to 8 range. The last 4 days have been under .5 and for the most part almost 0. The only change I made was to get a CPAP pillow. Could the pillow be helping? Are my VS and RERA too high? Should I do something about them? I saw in another post that the flow limitation data could be helpful. I do not see that chart in sleepyhead and the stats show 0. Any ideas how to make it show?









Thanks for all your help and advice. This forum has made this adjustment so much easier. I can't even begin to think how much more difficult it would be if I was just relying on the DME and doctor.

other than the snoring, looks great.

In the Respironics machines Flow limitation flags are turned off in cpap mode. That 0.0 reported doesn't mean anything in cpap mode.

To get Flow limitation flags you need to turn APAP mode on and then Flow Limitation flags will show up if they happen.
You can still use a single fixed pressure though...just set the minimum pressure to 12 and the maximum to 12 and it will function like cpap mode pressure only the FL will be flagged if they happen.

Given your snores...I would be surprised if you didn't have any FL flags...now how many...I don't know but I bet there's some there if those snores are real.

I'll go ahead and change it to APAP with 12 set as the min and max and see what it comes back with. Thanks.

I would suggest doing nasal cleansing before bedtime to try to get the snoring numbers down. If you're using a "high" humidity setting, you might experiment with turning it down or even off. Too much warm humid are can contribute to nasal congestion and that may mean more snoring.


Den

.

Thanks for the responses.

I changed my machine to APAP with 12 for both min and max. It automatically selected A-Flex. My doctor prescribed and I have been using C-Flex 3. I went ahead and changed it back to C-Flex 3. Is this ok or should I be using A-Flex since it is in Auto?

I have been using nasal saline for the last 2 weeks and don't feel any significant nasal congestion.

I did not get a chance to look at my data before I left for work, but will upload a screenshot tonight.

Thanks again for all the help.

Doesn't really matter which Flex you use. AFlex is only offered in apap mode. I personally liked AFlex better than CFlex but whichever Flex you choose is really up to you and what you feel is most comfortable.
http://aflex.respironics.com/
you can see the CFlex description link in the upper right.

It's just exhale relief and your doc won't care about which you choose to use.

Here is my data for last night. I see that the flow limitation events are being tracked as well as VS and VS2.



Thanks for the help.

Man those are some ugly snores....
How are you sleeping? Feeling?
Do you sleep on your back most of the time?
Is your throat ever sore?

Usually my side. Seem to be sleeping well and yes my throat is sore.
My wife says she doesn't hear the snores. She says they are very soft if that makes a difference.

Just to add to the last post. Feeling good as well. Not tired during the day. There has been a day here or there where I have been tired, but can't seem to tie it in to the data. Don't see anything exceptionally different when I look. It's not like the AHI or snores or RERA on those nights has been out of line compared to the norm.

Your reports look alot like mine when I first started......but less snoring on yours. I've got Snore Index reports that are in the HUNDREDS (one is over 600....it's a solid red line for most of that night).
And, I had low AHI numbers, like yours.

Mine gradually went down over time, but I also did nasal cleansing before bedtime and bumped my pressure up a couple of centimeters.


Den

.

They could be low level snores that the machine might not want to respond to (if in apap mode with a range it might increase the pressure to try to stop the snores if they were the real deal).

In most situations if the snores are real (as in the airway is trying to collapse and the airway tissue is vibrating) the machine will increase the pressure in response because snores are an early warning sign of an obstructive apnea trying to happen.
In your case they aren't growing up to be full apneas though.

In some cases bad nasal congestion can sometimes fool the machine into thinking snores are happening but you say you aren't having in noticeable nasal congestion so that's probably not it.

If you have a Pug dog like I do..and it snores and lays on you..the machine might pick up his snores ( I mention this because I have a Pug and he snores something awful and my machine would pick up his snores but wouldn't increase the pressure because it seemed to know they weren't my snores).

Sometimes the snores aren't real but are hose movement noise on the bed or mattress...machine wouldn't respond to that either. But it would really be unusual to have that much hose noise just from the bed or linens.

Then there's the sore throat thing...that points to probably the snores are real. Unless your wife is awake all night she may have missed some that are louder than others....or maybe it is just low level snores going on.

If it were me I would open up the apap range a little just to see what the machine wanted to do...like maybe set the maximum 2 cm above the minimum. If it increases the pressure...you will see it and then you can decide if you want to do anything about it and how you might want to address it.
Generally...with snores we just need a little more pressure to better hold the airway open and prevent that vibration that is happening when we snore.

Now if you are sleeping great and feeling great ...there's no apparent urgent need to do anything but say "those are ugly snores" since your other data is super good looking.

Sore throat and the ugly snore graphs points to at least partial airway collapse and confirmed by wife reporting low level snoring which might be more than low level unless she is awake all night. It's still probably a lot better than pre cpap snoring though.

I have a little nasal congestion but nothing too crazy. I'll continue to do the saline rinse and see if it helps.

No pets and I have my hose in a hose wrap and on a hose buddy hanger so I doubt it's the noise.

Due to the sore throat the snores being real but mild seems likely. I will adjust my pressure to be a low of 12 and high of 14 and see what happens.

If snores were a 9 before CPAP she says they are a 2 or 3 now. She never complained before and is definitely not complaining now.

Thanks again for the great insight and quick responses.

Precpap...I would wake up with raging sore throats from the snoring.
Now...never.
Hubby would say I would shake the glass out of the windows with my snores...now he has to put his hand in front of the mask to feel the vented air to know I am even breathing. He used to poke me in the side and wake me (not a nice thing to do) to tell me to "put your mask on" ...when it was on...everything was so quiet.
I told him about the hand over the mask thing to verify the machine and mask was on...or else if he continued to poke me in the ribs I would poke back and it wouldn't be the way he would liked to be poked.