How soon should I start tweaking my settings?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
lorrpb
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How soon should I start tweaking my settings?

Post by lorrpb » Tue Nov 25, 2014 4:25 pm

Hi, Thank you for this forum and all the information shared. I've been on APAP for 4 nights. I have looked around this site and found a lot of answers and great info, but still have a few specific questions.

The good news is that I have had very little trouble adjusting to equipment, which I had been quite concerned about. The mask is reasonably comfortable, no significant leaks, no rain out, no hose problems, and so on.

During my sleep study, which was about 1 month ago, I slept only 2 hours and had AHI of 18. Never got to the titration study because of the short sleep time.

Machine is set at 5-20.

I am puzzled because although I am not aware of any equipment issues, I am not seeing the results I hoped for. It has helped some, I do feel somewhat better rested, but my AHI still seems high and I am still waking early and not going back to sleep.

My AHI was 4.85 last night and 5.1 the night before. I won't count the first night (7.95) because I was getting used to the equipment.
My median pressure was 6 & 6.5 and the 95% pressure is 8.7 & 9.40.

I wear the mask for 7-8 hours per night. I am waking up after 6 hours and unable to go back to sleep. This was happening before CPAP too. My AHI climbs up to 15-20 during this early morning time, much higher than the rest of the night. One of the things I had hoped xPAP would improve, and doc said it would, is the early wakings.

Here are the questions banging around in my head right now:
What do the leak readings in Sleepyhead mean? There are 2 lines. One is about 30 and the other is 0. The only spikes are when I take the mask off to go to bathroom or adjust, a couple times per night. Does the line at 30 represent a leak issue even though my machine doesn't flag it?
Why is my AHI still so high? Why doesn't the pressure go higher to reduce the AHI?
Why am I still waking early and what can I do about it? Why does AHI go so high when I am pretty much awake the whole time?
Should I start tweaking the settings or wait---and how long?

I don't mean to sound impatient, just want to have improvement ASAP.

Thanks for any insight you can offer.

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Julie
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Re: How soon should I start tweaking my settings?

Post by Julie » Tue Nov 25, 2014 4:48 pm

Hi - I'd definitely raise my low end pressure as your software is telling you to (as is your untreated feeling). I'd put it at about 8 and you can leave the high end open, or lower it to e.g. 15, but it's the low end one that's not working at 5(!). I imagine you're waking up early because you're now getting halfway decent sleep compared to previously, though once you tweak your pressure it should feel even better. Your AHI is high because when your machine tries to address the events taking place it runs out of time to do it, having to climb all the way from 5. At least this is my take on things. Others will tell you to incrementally raise your pressure by .5 of a cm over weeks, but to me there's no point in that, especially in light of your stats. You're not going to do yourself great harm at 8 (or 9 or 10) and within a few days should know if it's working.

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Nick Danger
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Re: How soon should I start tweaking my settings?

Post by Nick Danger » Tue Nov 25, 2014 4:50 pm

lorrpb wrote:
Machine is set at 5-20.

My AHI was 4.85 last night and 5.1 the night before. I won't count the first night (7.95) because I was getting used to the equipment.
My median pressure was 6 & 6.5 and the 95% pressure is 8.7 & 9.40.
The setting at 5-20 is not ideal. No rush to tweak this, but a range of 6 to 10 makes more sense based on your results.
lorrpb wrote: I wear the mask for 7-8 hours per night. I am waking up after 6 hours and unable to go back to sleep. This was happening before CPAP too. My AHI climbs up to 15-20 during this early morning time, much higher than the rest of the night. One of the things I had hoped xPAP would improve, and doc said it would, is the early wakings.
The good old sleep/wake junk - when you are half awake (or even fully awake) your breathing isn't as regular as when you are fast asleep. Those irregularities may be flagged as events even though they really shouldn't count. Without seeing your graphs, it is hard to know how much this is overstating your AHI - but your actual AHI is probably a good bit lower than the 4.85/5.1 readings you are getting.
lorrpb wrote: Here are the questions banging around in my head right now:
What do the leak readings in Sleepyhead mean? There are 2 lines. One is about 30 and the other is 0. The only spikes are when I take the mask off to go to bathroom or adjust, a couple times per night. Does the line at 30 represent a leak issue even though my machine doesn't flag it?
Why is my AHI still so high? Why doesn't the pressure go higher to reduce the AHI?
Why am I still waking early and what can I do about it? Why does AHI go so high when I am pretty much awake the whole time?
Should I start tweaking the settings or wait---and how long?

I don't mean to sound impatient, just want to have improvement ASAP.

Thanks for any insight you can offer.
Leak of 30 should be fine with a Respironics machine - it reports total leak and that number is not a problem (the mask probably vents around that much intentionally to keep you from rebreathing your carbon dioxide exhalation).

AHI may be overstated due to your early waking - have to see the graphs for that.

The early waking may or may not go away over time.

Many people find an initial setting of 5 cm to be too low to use comfortably - I feel I am not getting enough air unless my settings are at least 6 cm.

Post your graphs! We have some very knowledgeable people here who are absolute whizzes at reading them.

Julie, her median pressure is 6 to 6.5 cm - I'm not sure it is really necessary to go with a minimum above what the machine sets itself to for most of the night - but the graphs would help answer that question.

Great start!!!!!

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Nick Danger
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Re: How soon should I start tweaking my settings?

Post by Nick Danger » Tue Nov 25, 2014 4:57 pm

To give you an idea of how overstated the AHI may be, you said you had around 15-20 events during the hour you laid awake. If you slept for 6 hours and laid awake for 1 hour, those events would add between 2 and 3 to your AHI for the whole night. So your real AHI may be as low as 2-ish for the time you were asleep. Again, I encourage you to post the graphs.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: APAP mode, minimum pressure = 9. No ramp, EPR = 3, medium. Soft cervical collar. Sleepyhead software.

Guest1

Re: How soon should I start tweaking my settings?

Post by Guest1 » Tue Nov 25, 2014 5:16 pm

I won't worry about changing settings for at least 10 days. Your AHI is close to 5 so you are already seeing better results than untreated state. Your body is still getting used to breathing against pressure (your diaphragm muscles are working harder, your back muscles are probably working less due to not moving too much).

I would suggest you move the lower bound by +1. after 10 days on therapy. Then wait there for 10 days. Analyze the reports in SH and then go higher +1/+0.5 at a time. Also, I would get the ramp time to zero, breathe comfortably at that pressure, before I raise the pressure.

I started APAP with the same machine and a FFM 60 days ago with the range wide open (4-20). My AHI was 77 untreated, 8 on day 1 of APAP. 4 on day 5. And then slowly it came down to 1.5 - 0.5 range. I stayed on 4-20 for 44 days. Then I raised my lower bound to 5. And stayed on that range for 11 days. My AHI came down a bit more (< 0.5 everyday) and I even had 2 "0.00" days in that week. Then I raised the min to 6. And somehow my AHI has crept up to (0.5+ - 1.5). But I have had a cold and I am sleeping well so I am not worried about it.

YMMV.

lorrpb
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Re: How soon should I start tweaking my settings?

Post by lorrpb » Tue Nov 25, 2014 5:32 pm

Here are graphs of the last 2 nights. Let me know if you want to see something different.
I am not using the ramp up at all.
>>THANKS<<

11/23
[img]<iframe%20src="https://app.box.com/embed_widget/s/q6hj ... n></iframe>[/img]

https://app.box.com/s/q6hjihsfzmybkiwyno4g


11/24
[img]<iframe%20src="https://app.box.com/embed_widget/s/9mw6 ... n></iframe>[/img]

https://app.box.com/s/9mw6teydrnlivafuu42y

PS It looks like the url works, but not the IMG. Would appreciate a tip on how to make this work, as I think I followed the instructions posted elsewhere on this site.

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palerider
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Re: How soon should I start tweaking my settings?

Post by palerider » Tue Nov 25, 2014 6:39 pm

please use imgur.com, the appbox thing doesn't appear to work

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Guest1

Re: How soon should I start tweaking my settings?

Post by Guest1 » Tue Nov 25, 2014 8:39 pm

lorrpb wrote:Hi, Thank you for this forum and all the information shared. I've been on APAP for 4 nights. I have looked around this site and found a lot of answers and great info, but still have a few specific questions.

The good news is that I have had very little trouble adjusting to equipment, which I had been quite concerned about. The mask is reasonably comfortable, no significant leaks, no rain out, no hose problems, and so on.

During my sleep study, which was about 1 month ago, I slept only 2 hours and had AHI of 18. Never got to the titration study because of the short sleep time.

Machine is set at 5-20.

I am puzzled because although I am not aware of any equipment issues, I am not seeing the results I hoped for. It has helped some, I do feel somewhat better rested, but my AHI still seems high and I am still waking early and not going back to sleep.

My AHI was 4.85 last night and 5.1 the night before. I won't count the first night (7.95) because I was getting used to the equipment.
My median pressure was 6 & 6.5 and the 95% pressure is 8.7 & 9.40.

I wear the mask for 7-8 hours per night. I am waking up after 6 hours and unable to go back to sleep. This was happening before CPAP too. My AHI climbs up to 15-20 during this early morning time, much higher than the rest of the night. One of the things I had hoped xPAP would improve, and doc said it would, is the early wakings.

Here are the questions banging around in my head right now:
What do the leak readings in Sleepyhead mean? There are 2 lines. One is about 30 and the other is 0. The only spikes are when I take the mask off to go to bathroom or adjust, a couple times per night. Does the line at 30 represent a leak issue even though my machine doesn't flag it?
Why is my AHI still so high? Why doesn't the pressure go higher to reduce the AHI?

Why am I still waking early and what can I do about it? Why does AHI go so high when I am pretty much awake the whole time?
Should I start tweaking the settings or wait---and how long?

I don't mean to sound impatient, just want to have improvement ASAP.

Thanks for any insight you can offer.
The 2 leak lines are "intentional leak" and "unintentional leak". Every mask has to bleed some air to make sure you are not rebreathing exhaled CO2. The intentional leak (30 L/min or so in your chart) is just that. If the other line (close to zero in your chart) is not above 24L/min, you are okay. SH computes this by subtracting intentional leak from total leak by using an approximation of leak for the pressure running (for the mask type).

AHI is not high. An AHI of < 5 is still a more than 75% reduction from untreated in your case.

You are waking early because, its just been 4 days. Your body is thinking its got all the rest it needs in 4-5 hours instead of the usual time. (since AHI is lower than untreated and cumulative restorative effects of sleep are achieved earlier in the sleep duration). As your body adapts, it will stretch to be your normal sleeping hours. I had the same thing happen to me. I am currently sleeping my usual 7, after 60 days of PAP.

Impatience works both ways. For example, Getting on a scale every day to check your weight may be counterproductive to your weight loss goals. So can getting on the scale once a year.

Don't we all wish our body adapted to internet time and did things 3x faster

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palerider
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Re: How soon should I start tweaking my settings?

Post by palerider » Tue Nov 25, 2014 8:48 pm

Guest1 wrote:SH computes this by subtracting intentional leak from total leak by using an approximation of leak for the pressure running (for the mask type).
this is not correct, there are no mask settings in sleepyhead. SH approximates unintentional leak by baselining the variances in the total leak amount, and applies math to that.

also, the 24lpm is only applicable to resmed machines, which don't have the two leak lines.

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Nozzelnut
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Re: How soon should I start tweaking my settings?

Post by Nozzelnut » Tue Nov 25, 2014 9:04 pm

I'll be the odd man out.

If you need to go back to your Dr for your compliance check in 30 days; I'd wait to make any adjustments. Not that they're going to arrest you or anything, but your Dr might hassle you about making changes.

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palerider
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Re: How soon should I start tweaking my settings?

Post by palerider » Tue Nov 25, 2014 9:26 pm

Nozzelnut wrote:, but your Dr might hassle you about making changes.
at which point it's good to remind the doctor who works for who.

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lorrpb
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Re: How soon should I start tweaking my settings?

Post by lorrpb » Tue Nov 25, 2014 9:37 pm

Thanks for the feedback. I will appreciate the gains I've had and wait a little bit longer before tinkering, as there have been slight improvements each day. I see the doc again in mid-Jan and don't necessarily want to wait that long to make adjustments if needed.

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Wulfman...
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Re: How soon should I start tweaking my settings?

Post by Wulfman... » Wed Nov 26, 2014 5:16 pm

How soon?
My answer is "As soon as you wish to tweak your therapy to improve it."

Having a pretty much wide open pressure range is "sub-standard therapy" in my opinion.


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palerider
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Re: How soon should I start tweaking my settings?

Post by palerider » Wed Nov 26, 2014 5:22 pm

Wulfman... wrote:How soon?
My answer is "As soon as you wish to tweak your therapy to improve it."

Having a pretty much wide open pressure range is "sub-standard therapy" in my opinion.
what he said... 5-20 is a great *starting point* for a couple days, to get an idea what kind of pressures you need, then bump the lower pressure up to where you don't have much in the way of events.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.