Hypopnea and some questions

I'm not posting a Sleepyhead chart since I don't think it's relevant.

I also realize that I've got two issues going on.

First and foremost. I have been on Klonopin for over a year. Tapering off. Started at 2 mg. Decreased the dose by 0.25 mg/month. Right now, I'm down to 0.50 mg. Two months to go.

Hypopneas have been my primary issue. I'm not trying to get my AHI to under 1.0, but . . . There have been times when I've been below 1.2 for a week.

I'm now up to an average of 3.0, which I'd classify as fair to good.

Based on recommendations here,

September 1st (approximately) my machine was set at 5.0 and 10.0.

I've increased the low end pressure gradually and now am at 7.5 and 11.0.

#1 - While I've increase the low end pressure, for most of the time, my peaks during the night always seem to be 1.5 higher than my low end pressure. There are some exceptions, but not many. So when I was at 5.0, it would peak at 6.5 and now at 7.5 I peak at 9.0. Is that normal?
#2 - Can I assume (I know ASS), that since I have been able to get weeks at 1.2, that I should at least be able to get under 2.0?
#3 - Is it possible that I should continue to raise the low end pressure since the hypopnea events are still in an unacceptable range?
#4 - I'm assuming that I should also be raising the high end pressure. Any comments about that?
#5 - I just noticed that I was getting results under 2 when the A-Flex was at 3. Can't remember why, but at some point I apparently changed this to 1. My guess is that should go back to 3.

Thanks up front to everyone.

You folks have been significantly better at helping me than my doctor.

BTW. Last time there. His nurse practitioner mentioned how she wished he would allow them to put Sleepyhead on their machines to review data. I had brought some of my information in and she was excited about all of the extra information it provided.

Dogjudge wrote:I'm not posting a Sleepyhead chart since I don't think it's relevant.

I also realize that I've got two issues going on.

First and foremost. I have been on Klonopin for over a year. Tapering off. Started at 2 mg. Decreased the dose by 0.25 mg/month. Right now, I'm down to 0.50 mg. Two months to go.

Hypopneas have been my primary issue. I'm not trying to get my AHI to under 1.0, but . . . There have been times when I've been below 1.2 for a week.

I'm now up to an average of 3.0, which I'd classify as fair to good.

Based on recommendations here,

September 1st (approximately) my machine was set at 5.0 and 10.0.

I've increased the low end pressure gradually and now am at 7.5 and 11.0.

#1 - While I've increase the low end pressure, for most of the time, my peaks during the night always seem to be 1.5 higher than my low end pressure. There are some exceptions, but not many. So when I was at 5.0, it would peak at 6.5 and now at 7.5 I peak at 9.0. Is that normal?
#2 - Can I assume (I know ASS), that since I have been able to get weeks at 1.2, that I should at least be able to get under 2.0?
#3 - Is it possible that I should continue to raise the low end pressure since the hypopnea events are still in an unacceptable range?
#4 - I'm assuming that I should also be raising the high end pressure. Any comments about that?
#5 - I just noticed that I was getting results under 2 when the A-Flex was at 3. Can't remember why, but at some point I apparently changed this to 1. My guess is that should go back to 3.

Thanks up front to everyone.

You folks have been significantly better at helping me than my doctor.

BTW. Last time there. His nurse practitioner mentioned how she wished he would allow them to put Sleepyhead on their machines to review data. I had brought some of my information in and she was excited about all of the extra information it provided.

#1. I don't know if I'd use the word "normal", but it's somewhat common, depending on the user's breathing characteristics. Since an APAP increases pressures on Snores and Flow Limitations, and there may not be enough of them present, that may be all the higher the pressures will go. They typically won't increase pressures on Apneas without the FLs and Snores being present. Consequently, if the minimum pressure isn't sufficient, the events MAY occur without a response from the machine.

#2. Without looking at some of your reports, it's hard to say, but you could conceivably get your AHI down much lower than that.

#3. Yes.

#4. Not necessarily, unless the pressures are consistently staying at the maximum.

#5. The "Flex" settings are for exhale relief and don't necessarily affect therapy. Your pressures are not necessarily in a range where they are even needed at all. You might also try turning off the Flex and see how that feels. I used C-Flex at a setting of "2" for years and then a few years ago decided to try it with straight pressure and no exhale relief. I actually liked it better, my numbers got better and I wondered why I hadn't turned it off years before.


Den

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Dogjudge wrote:Dogjudge

You don't mention how you feel, and what your subjective judgment of your sleep quality and quantity is.

Thanks to both of you.

I guess my problem/issue is that when I'm lower than 1.2, I feel really rested. When I'm above 2.0 I feel as if I slept through the entire night, but just okay.

I'll try changing the Flex to nothing first. Then maybe a week and then increase the low end pressure.

Dogjudge wrote:Thanks to both of you.

I guess my problem/issue is that when I'm lower than 1.2, I feel really rested. When I'm above 2.0 I feel as if I slept through the entire night, but just okay.

I'll try changing the Flex to nothing first. Then maybe a week and then increase the low end pressure.

Is your pressure ever hitting the max? Or does it hover somewhere in between?


Den

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Going back over the last three weeks.

I had 4 days where I was over 4.5. On all of those nights I had periods during the night when I was at maximum pressure for periods of time.

2 days over 3.0. Both days I was over this 1.5 differential and my maximum pressure. That's why I asked the question about a 1.5 increase being part of the machine's setting, no matter what your low end pressure is.

Dogjudge wrote:Going back over the last three weeks.

I had 4 days where I was over 4.5. On all of those nights I had periods during the night when I was at maximum pressure for periods of time.

2 days over 3.0. Both days I was over this 1.5 differential and my maximum pressure. That's why I asked the question about a 1.5 increase being part of the machine's setting, no matter what your low end pressure is.

It's very common for the "average" or "90% / 95%" number to be a moving target when using ranges of pressures. And, in particular bumping up the minimum pressure can/will move those percentage numbers upwards, too.

It all depends on the person's breathing characteristics and how the machine reacts to them.


Den

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Remember when using a Respironics machine there's always going to be the chance of the test pressure probes affecting the overall numbers when using apap mode. Since those test probes will be on top of any minimum pressure it stands to reason that if the minimum is raised then the test probe pressures will also cause an increase in the 90% numbers even if events didn't drive the pressures up. We never know when the machine will decide to use the test probes or even if it will use them.

Dogjudge wrote:Going back over the last three weeks.

I had 4 days where I was over 4.5. On all of those nights I had periods during the night when I was at maximum pressure for periods of time.

2 days over 3.0. Both days I was over this 1.5 differential and my maximum pressure. That's why I asked the question about a 1.5 increase being part of the machine's setting, no matter what your low end pressure is.

If this is the case. your max pressure should also be raised. You are not allowing the machine to go higher than 11 to stop some events. The top pressure can be raised all the way up to 15 or 20...the machine will only take your pressure as high as necessary to stop an event.

Dogjudge wrote: Hypopneas have been my primary issue. I'm not trying to get my AHI to under 1.0, but . . . There have been times when I've been below 1.2 for a week.
...
I guess my problem/issue is that when I'm lower than 1.2, I feel really rested. When I'm above 2.0 I feel as if I slept through the entire night, but just okay.

Well, you seem to be saying that you feel better when your AHI is under 2 and you have been able to stay under two for at least a week in the past. So, why did you change, if you did? Were you chasing an even lower AHI? I think I would go back to the settings that produced the feel good under 2 AHI and stay there for a while to see if the results returned.

Jay Aitchsee wrote:Well, you seem to be saying that you feel better when your AHI was under 2 and you have been able to stay under two for at least a week in the past. So, why did you change, if you did? Were you chasing an even lower AHI? I think I would go back to the settings that produced the feel good under 2 AHI and stay there for a while to see if the results returned.

+1

LSAT wrote:The top pressure can be raised all the way up to 15 or 20...the machine will only take your pressure as high as necessary to stop an event.

+1

Pugsy wrote:Remember when using a Respironics machine there's always going to be the chance of the test pressure probes affecting the overall numbers when using apap mode. Since those test probes will be on top of any minimum pressure it stands to reason that if the minimum is raised then the test probe pressures will also cause an increase in the 90% numbers even if events didn't drive the pressures up. We never know when the machine will decide to use the test probes or even if it will use them.

Pugsy, Can those probes be seen on one of the pressure graphs of SH?

ChicagoGranny wrote:

Pugsy wrote:Remember when using a Respironics machine there's always going to be the chance of the test pressure probes affecting the overall numbers when using apap mode. Since those test probes will be on top of any minimum pressure it stands to reason that if the minimum is raised then the test probe pressures will also cause an increase in the 90% numbers even if events didn't drive the pressures up. We never know when the machine will decide to use the test probes or even if it will use them.

Pugsy, Can those probes be seen on one of the pressure graphs of SH?

Lots of them in the reports on the page in this link.

viewtopic.php?f=1&t=108720&p=1038247&hi ... s#p1038247


Den

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Wulfman... wrote:Lots of them in the reports on the page in this link.

viewtopic.php?f=1&t=108720&p=1038247&hilit=probes#p1038247

Thanks.

I counted 17 in eight hours. That's not so many. Unless they wake you - that would not be nice.

ChicagoGranny wrote:Pugsy, Can those probes be seen on one of the pressure graphs of SH?

Yep they sure can.
Whether apap or bipap when in auto adjusting mode. What's weird is that there can be times where there aren't many probes and then other times when they are fairly consistent. I have no idea why or how the machine determines the need to do the probes to "test the waters" though...I just know they can do it and will do whenever it thinks it needs to.

Here's one from an apap and doesn't have much going on except the pressure probes



These images below are linked to photobucket so you may need to right click the mouse over them and choose "view image" if they are too large to see the entire image. I don't know how to do the large thumbnail thing at photobucket.

Here's one from a bipap which shows a little more actual pressure changes in response to whatever it was responding to.



and here's another bipap graph where I was showing the relationship between total leak and pressure changes.



And this one from Encore that shows a 90% pressure of 15 which is a good example of my "when 90% numbers don't tell the whole story" discussion. Long term (like over 6 months) my 90% pressures on apap were around 12 cm which is closer to the overall average. And why I don't put all my eggs in a 90% basket.