New CPAP User, Sleepyhead Says AHI Not So-good

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p6gorilla
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New CPAP User, Sleepyhead Says AHI Not So-good

Post by p6gorilla » Mon Dec 22, 2014 5:11 pm

Hi all!


New CPAP User here.

Sleepyhead software tells me that my AHI isn't so good, so I'm looking for some feedback from experienced CPAPers.

Here's my equipment:

Philips Respironics System One (60 Series) RemStar Pro with C-Flex+Model 460P
Resmed Quattro FX mask

Here's the CPAP configuration:

PAP ModePAP Device Mode CPAP
PressureTherapy Pressure 7 cmH2O
Flex LevelPRS1 pressure relief setting. x2
Flex ModePRS1 pressure relief mode. C-Flex+
Headed TubingHeated Tubing Connected No
Humid. Lvl PRS1 Humidification level x3
Humidifier StatusPRS1 humidifier connected? Connected
Ramp PressureStarting Ramp Pressure 4 cmH2O
Ramp TimeRamp Delay Period 15 Minutes

And here's the results of a ~2hr nap I had a few minutes ago:

Date Sleep Wake Hours
12/22/2014 16:09:20 17:54:26 01:40:50
Cheyne Stokes Respiration 0.00%
Large Leak 0.00%
Clear Airway 1.19
Obstructive 0.60
Hypopnea 5.36
Flow Limitation 0.00
RERA 2.38
Vibratory Snore 0.00
Vibratory Snore (VS2) 1.19
Pressure Pulse 2.98

If the raw data is needed, just let me know & I'll try to figure out how to do that within Sleepyhead, then attach to this thread.

Thanks!

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palerider
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by palerider » Mon Dec 22, 2014 5:39 pm

hypopneas generally mean your pressure is too low.

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Julie
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Julie » Mon Dec 22, 2014 6:20 pm

And a nap is not indicative of much - you need 4 hrs for the machine to really consider it a 'session' worth tracking.

Rtrtrt

Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Rtrtrt » Mon Dec 22, 2014 7:49 pm

Remove c-flex to reduce hypopneas. I'd do this before I started increasing my pressure.

Sleeprider
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Sleeprider » Mon Dec 22, 2014 7:53 pm

The only category that is slightly high is hypopneas. Normally I would like to see at least two nights of data, but it appears you are a new user trying to set an initial titration. 7 cmH2O is relatively low, and it might be worth increasing the pressure to chase these events. As long as your tolerance of increased pressure allows you to comfortably sleep, there is no problem. Your obstructive and clear airway events are relatively low, but if either increase significantly, you should re-evaluate where you are going.

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archangle
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by archangle » Mon Dec 22, 2014 10:59 pm

Your numbers are not that bad. Unless you're having some great distress, It's probably worth leaving your settings alone for at least a week or so to see how you settle out. Results may vary as your body adjusts to CPAP. Definitely don't tinker without a few full nights of sleep on the CPAP.

If you had a sleep test and are working with a doctor, give him a chance to work things out without you changing things.

There's some risk of increasing your CAI (central apnea) if you increase your pressure.

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p6gorilla
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by p6gorilla » Tue Dec 23, 2014 8:22 am

Ah, understood!

I'll let it ride for a few more days so there's at least a week's worth of data to go-on.

Thanks for the feedback!

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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by p6gorilla » Thu Jan 29, 2015 1:11 pm

Hi all!


I'm back now with about 30 more days worth of data, but I'm not sure of how to attach that to this thread for analysis. If that would help give advice, just let me know where I can post it.

Recapping my previous posts, I created this thread after noticing a poor AHI via Sleepyhead software. Now here I am, with around 30 days worth of data. And I have not had a single full-night of sleep wearing my mask.

I've spent a ton of time thinking about why I'm pulling off the mask at night. And I think what is going on, is that I'm struggling with inhaling & exhaling into the device.

There are times I can recall, when I'm trying to inhale and the machine acts as if it wants me to exhale instead. And then there are times when I am trying to exhale and the device feels like it-is trying to push air back into my lungs. So it's sort of a push-pull scenario. And I am extremely reluctant to try and adjust my breathing "cycle" simply because the machine wants me to breathe a certain way.

What's more, is that I did not have those challenges whatsoever during my 2nd sleep study, which was the 1st one when I was hooked up to a PAP machine. And the PAP machine I was hooked up to during that study, was a ResMed S9 AutoSet. I'm not sure exactly why, but instead of being prescribed that device, I was given a Phillips Respironics SystemOne (straight CPAP?).

So am I in a situation where other PAP-machines should be evaluated?
Or am I just a noobie making simple-mistakes?

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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Sleeprider » Thu Jan 29, 2015 1:32 pm

Follow this tutorial on posting screenshots using Imgur by member Krelvin: https://sleep.tnet.com/reference/tips/imgur

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p6gorilla
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by p6gorilla » Thu Jan 29, 2015 1:50 pm

Ok I'll work on getting screenshots uploaded. Thanks!

In the mean-time, maybe this will help (CSV-export from SleepyHead):
http://privatepaste.com/9cc065ba13

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novatom
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by novatom » Thu Jan 29, 2015 2:08 pm

My AHI during my first 3 weeks of therapy was averaging between 5-6. My doctor said that's higher than he'd like to see but he decided to keep the pressure at 6 until my next followup visit on St. Patrick's Day. My assumption is that it's better to see some improvement at a lower pressure because once you increase the pressure, you can't go backwards. Or is that an incorrect assumption?

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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Pugsy » Thu Jan 29, 2015 2:29 pm

Are you still using the original CFlex exhale relief setting of 2?
If you are you might try playing with different settings and/or even turning it off to see if your inhale/exhale issues improve.

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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Pugsy » Thu Jan 29, 2015 2:33 pm

novatom wrote:My AHI during my first 3 weeks of therapy was averaging between 5-6. My doctor said that's higher than he'd like to see but he decided to keep the pressure at 6 until my next followup visit on St. Patrick's Day. My assumption is that it's better to see some improvement at a lower pressure because once you increase the pressure, you can't go backwards. Or is that an incorrect assumption?
Incorrect assumption. You can always go backwards if you wish. Now sometimes it can be a bit uncomfortable to go back down once we are used to higher pressures but it can be worked through by going down slowly (assuming the change higher was rather significant). I went to 13 when on APAP and experimenting but it didn't improve anything over what I was getting at 10 cm so while I went up to 13 slowly I dropped to 10 in one night and it was a bit uncomfortable initially...I was able to get past it fairly quickly.
You can always go back down until you can't go any lower if you want.

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p6gorilla
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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by p6gorilla » Thu Jan 29, 2015 3:33 pm

Pugsy wrote:Are you still using the original CFlex exhale relief setting of 2?
If you are you might try playing with different settings and/or even turning it off to see if your inhale/exhale issues improve.
Thanks for pointing that our Pugsy! I'm extremely new so I'm not aware of any configurations like that.

I just checked it & says it's at level 1... which I'm guessing is the lowest level.

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Re: New CPAP User, Sleepyhead Says AHI Not So-good

Post by Pugsy » Thu Jan 29, 2015 3:46 pm

There should be a Flex setting Demo you can use so you can try the other settings to see if you maybe might do better with a different Flex setting. Just highlight and select the Flex box on the machine display and see if you can access the various settings and the demo. If you can't then we just have to access that area in the clinical set up and turn it on for patient access. Let me know if you need help doing that.

Flex exhale reduction is more about the timing of the reduction than the amount of reduction. It's hard to explain but sometimes it's the timing of the reduction that is more of a problem than the amount of reduction and some people simply need a different timing and that's why I suggest that people try all the settings to see which feels the best....and even turn it off to see how that feels...and choose the setting that feels the best in terms of respiration comfort and don't worry about the actual setting number.
If you can't breathe easily, with comfort and seem to be fighting the machine in terms of respiration then it is really hard to get good sleep and getting good sleep is extremely important.
When someone tells me that they are fighting the machine in terms of exhale and inhale then experimenting with the Flex settings is the first thing I suggest.
Also..play with the machine while awake and not right at bedtime so that you aren't under the gun to try to get right to sleep.
Watch TV...read a book...whatever you do to relax to take your mind off the machine itself.

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