Need help evaluating/optimizing treatment

Hi
I need some help evaluating and optimizing my Cpap treatment.
I have been using Cpap since late November and it has helped but not relieved me from days like today when I am in a fog.
My sleep study 7/14/14 shows:
RDI: 34.5
AHI: 23.9
RDI: 2.7
REM AHI: 0.0
Supine RDI: 48.5
Snoring: Mild to moderate
Periodic limb movements index 88.4 per sleep hour
Limb movement arousal index (without respiratory events) 15.8 per sleep hour.

2/13/15 lab work includes:
Total iron: 108
Ferritin: 49 [Normal 20-200]
Vit B12: 484
Serum folates: 4.3
Vitamin D3: 53
Vitamin D2: Less than 4.











I stopped taking Neurontin after about one month due to drowsiness.

Any suggestions regarding Cpap or PLMD appreciated. Thank you. Kathy

Hi
I tried to attach thumbnails so they could be enlarged.
I am not understanding the process.
Kathy

Try a straight pressure of 10 cm. for a week and see what your reports look like.
You have very few "events", but your flow limitations are driving your pressure increases......for no visible benefit.
You can either try CPAP mode or set your minimum and maximum pressures to the same setting in APAP mode.


Den

.

Great!
Thank you.
I've been thinking the flow limitations were a problem

Re: Try a straight pressure of 10 cm. for a week and see what your reports look like.

Will setting the maximum pressure at "10" be high enough?
Seems like at times I reach 12.

If so,
I will set both pressures at 10 and see what happens.
Kathy

Sonnyboy wrote:Great!
Thank you.
I've been thinking the flow limitations were a problem

Re: Try a straight pressure of 10 cm. for a week and see what your reports look like.

Will setting the maximum pressure at "10" be high enough?
Seems like at times I reach 12.

If so,
I will set both pressures at 10 and see what happens.
Kathy

That's what you're (presumably) going to find out.
It's a "starting point" and you can adjust from there if necessary. (up or down)


Den

.

I process slowly these days...
I see what you are saying---
The flow limitations are driving the pressure up and this is why I can decrease to 10.


Re: You can either try CPAP mode or set your minimum and maximum pressures to the same setting in APAP mode.

I checked the manual but I'm not clear on cpap versus apap mode.

Thank you,

Kathy

Sonnyboy wrote:Hi
I tried to attach thumbnails so they could be enlarged.
I am not understanding the process.
Kathy

Just wanted to let you know that your last 3 screen shots work fine. When you click on the shot it opens in imgur and then you click on that pic to enlarge.

Sonnyboy wrote:I process slowly these days...
I see what you are saying---
The flow limitations are driving the pressure up and this is why I can decrease to 10.


Re: You can either try CPAP mode or set your minimum and maximum pressures to the same setting in APAP mode.

I checked the manual but I'm not clear on cpap versus apap mode.

Thank you,

Kathy

Try pages 7 and 15. (in the downloaded .pdf manual I have)

By setting the minimum and maximum pressure to the same setting, it emulates the CPAP (straight pressure) mode.
However, the newer ResMed machines may actually give most of the same information in either setting mode.


Den

.

Hi,
Re: Mode
I see. I have 3 settings--cpap, autoset, and autoset for her.
I'll do the "autoset for her" mode at 10.
I can't thank you guys enough for all of your help.
Kathy

Wulfman... wrote:However, the newer ResMed machines may actually give most of the same information in either setting mode.

Hey Den...you are correct about the ResMed machines and that's why I never really make a big point to tell ResMed users to do the minimum equal to maximum in apap mode thing for ResMed users because the ResMed machines record flow limitation graphs no matter which mode is used....they don't lose anything data wise by going to cpap mode over apap mode.

The only possible wrinkle in this now would be the new "for Her special algorithm apap mode" as apparently it is the only mode that will flag RERAs (how important they may or may not be is another discussion).

So if a person is using the new AirSense 10 AutoSet for Her...if they don't want to lose RERA flagging capabilities then staying in that new special apap mode and setting minimum to equal maximum would be the way to go if someone wants to mimic cpap mode.
ChunkyFrog pointed this out to me this morning as she is using the new special for Her apap mode on her new A 10 AutoSet for Her.
Now just how critical is it to know if a person is seeing or having RERAs...that's up for discussion but you know me...if I can keep a potential data point and not trash things then I like to keep it just in case it might be important somewhere down the line.
As of now that's the only real potential data loss thing that I have seen and it only applies to the people who have the new AirSense 10 AutoSet for Her models and are using that special new apap mode.

Thanks, Pugsy.
I was thinking that MOST of the information was the same, but I didn't know if it was entirely true or about the "For Her" variables.


Den

.

Hi,

I have changed my pressure settings to a straight "10" as suggested by Wulfman below.
I have 4 hours of sleep so far with a "0" AHI.
I have not pulled the SD card yet to check flow limitations, I'm going to try to get some more sleep.
Also, am going to leave pressures at "10" for a week as suggested.

I think I need help with the severe PLMD.
I have been in and out of sleep tonight, tossing and turning, up to the bathroom twice, even wrapped the hose clear around me two separate times.

I have taken small doses of Neurontin in the past for PLMD and Inderal for a hand tremor. I stopped both a couple of months ago. I don't want to take medication if I can avoid it because of daytime drowsiness.

Any suggestions???

2/13/15 lab work includes:
Total iron: 108
Ferritin: 49 [Normal 20-200]
Vit B12: 484
Serum folates: 4.3
Vitamin D3: 53
Vitamin D2: Less than 4.

My sleep doctor is a neurologist and I have a follow-up appointment mid April.
She's nice but has not helped.
No suggestions regarding pressures, I am lucky I found this forum.
She did order the lab work but has not suggested anything for the PLMD except the Neurontin.

Thank you,
Kathy

Hi,

I changed my settings on 3/10/15 to a straight "10" in autoset for her mode as suggested by Wulfman.

My AHI has ranged from .09 - 1.43 which is pretty good but if possible I would like to see my AHI stay under one.
My flow limitations still look off????

Though I feel a whole lot better today than when I started treatment in November, I still wake up a lot during the night and feel foggy during the day.
There are lots of reasons contributing like PLMD and stress but I am wondering if the pressures could use some adjusting????

Sonnyboy wrote:Hi,

I changed my settings on 3/10/15 to a straight "10" in autoset for her mode as suggested by Wulfman.

My AHI has ranged from .09 - 1.43 which is pretty good but if possible I would like to see my AHI stay under one.
My flow limitations still look off????

Though I feel a whole lot better today than when I started treatment in November, I still wake up a lot during the night and feel foggy during the day.
There are lots of reasons contributing like PLMD and stress but I am wondering if the pressures could use some adjusting????

Personally, I don't see anything "wrong" at this stage of your therapy with the range you stated.
And, the one you just posted is 0.40.
We don't sleep the same night after night.
With that range of AHI, what has your "average" been over that time period?
Because that's what this is about......averages. Too many users focus on a night or two here and there. In reality, there are lots of people who would love to see their averages below 3.0 or even 5.0.
Heck, even after almost 10 years and with an annual average of 0.4 or below, I still get a night here and there over 1.0. Not often, but occasionally. I also get many in the 0.0 - 0.5 range, too.......which helps bring the average down.

But, you could try increasing your pressure to 11 cm. for a week or so and see what happens. Like we've said many times on the forum........"If you change your pressures and things get better, you know you're going in the right direction."

Keep in mind that we didn't get this condition overnight and it can take months to feel the benefits of the therapy......especially after all the tweaking is optimized.

Regarding your Flow Limitations, some people just have them or even lots of them and for some, no amount of pressure is going to "fix" them. Nasal cleansing and other things can help, but sometimes it's just our physical attributes that cause them and nothing short of surgery may help. But, that's a last resort and for the most severe cases.


Den

.

Hi Den,

Thank you.

My 15 day average on a straight "10" is .67.
I was looking at day to day values and had not considered looking at the average.

If I decide to increase my pressure to "11", do you mean a straight "11"???

Thanks again,

Kathy