Apap with new range

This was my data three nights ago at 7-10cm:


Based on that I asked my sleep nurse if she would consider changing the settings. She changed them to 7-15cm. Here are the last two nights which are at that setting:
Monday night:


Last night:


What it looks like to me on both nights is that as the pressure floats down towards 9, the flow limitations take off and the pressure has to jump. One thing that has confused me as I read this board is that sometimes it seems like adjustments to the lower pressure are made that are still lower than the machine seems to go. Like if I raised the lower pressure to 8, it doesn't seem to me like that would make any difference. It would still float down to 9 then shoot up. Would it make sense to change the lower pressure to something like 9.4 or 9.6 or 10? Thanks!

As I look at last night's data it looks like the pressure changes follow the leak graph after the 5:30 point. Hmm, getting more confused.

AMK wrote:Would it make sense to change the lower pressure to something like 9.4 or 9.6 or 10?

Could be....depending on what you were wanting to fix or thinking you needed to fix.

I guess I thought that with a higher lower pressure I might prevent the cycle of flow limitations increasing? Or is this just how it should look?
Seeing as I am still waking up in the morning feeling worse than I did before starting cpap, I'm always looking for what could be different. This morning I was so exhausted I fell back asleep for an hour after taking the mask off, and it was heaven.

Yes, with a higher minimum pressure the flow limitations should reduce and there be less tendency for the pressure to go so high but that is also dependent on where the flow limitation is....like is it in the nose or is it a result of the airway trying to collapse a little.

With the higher maximum that one prior ugly FL area reduced considerably...and I think that the overall FL graphs for the last 2 nights look a little improved.

Are the FLs part of your continued problem? Don't know. It's possible that they are and it's also possible that they aren't.
Is it possible that the changing pressure in response to the flow limitations is affection your sleep quality and thus responsible for the continued problem...yes it's possible since some people can be sensitive to the least little pressure changes. This is where we get into the fixed pressure vs variable pressure discussion and how changing pressures during the night might impact simply sleep quality and the other discussion of just how important is it to reduce the flow limitations that are likely driving the pressures up.

If you were reporting feeling great and sleeping great I don't know that I would worry too much about a little bit of ugliness (I have seen much uglier) on the flow limitation graph but since you can't report that....well it does present a bit of a problem as to what to do next.
Do we move on and try to reduce the FLs further with more minimum pressure (since maximum is doing the best it can and it isn't quite getting the job done) or do we say the usual "give it time" and give you the standard speech about evaluating meds and sleep hygiene while giving it time?
Do we now suggest that you use cpap fixed pressure mode or if apap a very tight range on the chance that it's the pressure changes contribution to maybe poor sleep quality?

I know what I would want to do if it were me....since the machine thinks the FLs are important enough to try to deal with and since it is possible that the FLs are a contributing factor to poor sleep quality and if I had no problems with more pressure...I would increase the minimum and see what happens. I myself would just have to answer that "what if" question to my satisfaction for my own peace of mind. It's just my nature. Since the machine wants my pressure up there "what if a little more pressure helped"...that would be the question in my mind.
I would also keep the "what if the changing pressures themselves are a disruptive influence on my sleep" question on the back burner and consider a very tight apap range or cpap fixed pressure as an option to try.

Since you are more comfortable running potential changes to therapy by your medical care team then perhaps you should sit down and pick their brain about the possible causes and options available as to what would be viable options to try and in what order to try them and how much time you should give each trial....because there is still a lot of truth to the "give it time" thing.

Thanks, Pugsy. I know I should give it more time. I'll give it a week and then ask the nurse what she thinks about upping the minimum. It seems to me like if the range were tightened then I wouldn't have to go through all those swings.

Right now I don't feel as much of the brain-fog sort of fatigue where I keep making mental errors. I have more of a deep body fatigue right now where it's hard to get out of bed, it's hard to get out of this chair; tasks like cooking food seem almost insurmountable. I feel like a heavy, dense lump. Just so tired. Even breathing takes energy. I don't want to go back to bed or go to sleep, I just don't want to have to move. This is all worse than before treatment.

AMK wrote:It seems to me like if the range were tightened then I wouldn't have to go through all those swings.

And you would be correct...with a tighter range there wouldn't be as much swing.
I didn't mean to infer that it wouldn't happen because it would if for no other reason than there wouldn't be as much to swing.
I have also seen pressures stabilize better and not swing so much when the minimum is more optimally set...to prevent things instead of trying to fix things after the fact. Meaning I have seen it happen that with a little more minimum the upper range the pressure previously went to for whatever reason gets shortened. Doesn't always work out that way but I have seen it happen often enough to know it isn't some random fluke.

I'm trying to figure this out...why does it seem like hypopneas are associated with flow limitations but obstructive events are not? Another odd thing is that when I look at the clock to see what time I have woken up, and then I try to match that up with Sleepyhead, it seems like oftentimes there was a hypopnea that possibly woke me up (not an AO).

This may sound OT, but have you tried a soft cervical collar to keep your head from falling onto your chest, to help keep your airway more open and to lessen any leaks?

Julie wrote:This may sound OT, but have you tried a soft cervical collar to keep your head from falling onto your chest, to help keep your airway more open and to lessen any leaks?

I got a cervical collar and was intimidated by its bulk. I haven't yet tried to sleep in it. It's definitely something I'd like to try, though.

You may not have gotten the right type - they can be small (relative to a 'medical' one), but don't forget there's a reason to wear it, just don't make it tight.

Julie wrote:You may not have gotten the right type - they can be small (relative to a 'medical' one), but don't forget there's a reason to wear it, just don't make it tight.

I ordered one that was recommended on this board, so hopefully it's the right type. It's this: http://www.amazon.com/gp/product/B000FZ ... UTF8&psc=1

You say you ordered it - does that mean it's not the one you used last night, or is it?

I'm sorry for the confusion. That collar I linked to is the one I ordered, received, and have not yet used. I have not yet attempted to sleep in a cervical collar.

Well, at least give it a decent try - even if it means a little adjustment at the beginning - so many people have found that they work.