MY Analysis -- Comments Please

I am now 9 weeks on CPAP and have achieved the Medicare compliance rate of 22/30 nites of 5 or more hours on the machine (for payment).Without SH I wouldn't have had a clue as to how to do this as I was falling way behind at 3.4 hours nite average, until.

After investing God-only knows how many hours reviewing SleepyHead charts, I think I'm getting a handle on (1) at least some of what it means, and (2) what I can do with it. Mainly the issue of mask leaks as I really don't see any other areas in which I can alter any negative events ( have already changed the machine pressure settings and that helped considerably).

(I would post my charts but haven't yet mastered how-to)

Leaks were my big problem and the pressure graph was showing me when and possibly why they were occurring. I observed that the major leaks always (1) either correlated with big increases in pressure (imagine that !!!) or (2) if not, could possibly be related to every time I move my head and disturb the mask. The later would explain big leaks not related to pressure increases. But the only thing I can do in this respect is to tighten the mask, which causes other problems.

At this point, my leaks problem is reduced an estimated 50%. I have nights where leaks are 95% below threshold (1/3 rd) and nights well above threshold (2/3rds), but not terribly bad, just concerning.

In 3 months Medicare will pay for a new mask, so I will try a different type, but so far I like the Amara View. I have serious sinus problems and I don't know if this is the best type of mask for that, however, I will say that my nose breathing has definitely improved since going on CPAP with this mask.

I always sleep on my back (by necessity) and do not move much, that I know of.

Since starting with SH I've made significant progress but there's still room for improvement yet I don't know what else I can do.

Weekly average AHI has dropped from 4.8 to 2.4
% of time above leaks threshold, 26.7 to 14.4%
RERA index .67 to .46
Avg. hours sleep from 3.43 to 5.1
Rarely tear my mask off anymore in my sleep.

How important is a blood oximeter and should I get one. About what do they cost? Other than information, are the results useful in making changes?

Re: (I would post my charts but haven't yet mastered how-to.)
What questions need to be answered before you can post your charts?

Sonnyboy wrote:Re: (I would post my charts but haven't yet mastered how-to.)
What questions need to be answered before you can post your charts?

I just need to find time to study how to do it. That's all

blownaway wrote: How important is a blood oximeter and should I get one. About what do they cost? Other than information, are the results useful in making changes?

Might be useful for validating therapy effectiveness if you are worried about O2 levels.
A lot depends on how low your Oxygen went without cpap therapy though.
If you didn't have desats that went below 90% without cpap then it may not be that educational to see what the oxygen level is with cpap but if you spent a lot of time in low 80s or lower then it might be worthwhile to invest in an overnight pulse oximeter or ask your DME for an overnight pulse ox (they do those).

Costs depend on what model and where you get it....slow boat from China will get you one for around $40...for a CMS 50 D Plus...as the least expensive that will record overnight.
so 40 to 100 depending on model and where it comes from...from a US seller it will cost a little more for the same machine.

CMS 50 D Plus or higher model is what you want....lower doesn't record over night.
http://www.coopermedical.com/overnight-pulse-ox

Unless you had scary low desats without cpap...I wouldn't be in a rush to buy a pulse ox unless you just need the reassurance.

How to post images explained here
https://sleep.tnet.com/reference/tips/imgur

and examples of what we like to see (don't need all those SH graphs)
viewtopic/t103468/Need-help-with-screen-shots.html

The Imgur site is very user friendly. Use the screen shot function on the SleepyHead program. It will save to a folder on your computer. On my Apple I searched Screenshot, and there they were. LOL. Then you upload them to Imgur. Once that is done, there are options for sharing the file on the right. We have to master this skill or the experts on here are driving blind trying to help us. It's not that hard, so give it a shot.

Screenshots get saved somewhere I can't find them. Tried to see if I could assign the address, but no luck.

Anyway, found this Pugsy post elsewhere that points me in another direction:

[quote]
The 2 most common causes of the pressure being fine for some time and not other times are either supine sleeping or REM stage sleep or both because it's common for us to need more pressure during REM sleep or when we are on our backs.
The timing of the clustering points to maybe REM stage sleep because we tend to have more REM sleep as the night progresses with the greatest amount of REM occurring in those wee hours of the morning.
No way to know for sure but what I usually suggest is just deal with it because we can't always control sleeping position and we sure can't control REM sleep.

My thoughts about minimum of 14.5 and maximum of 20 using apap mode still stands.
Your 14.5 works well for a good bit of the night but when you see the snores and clustering of events that pressure isn't working so great.

Flow limitation flagging...only available in apap mode and for that reason even if someone ends up with a fixed pressure (minimum to equal maximum in apap mode) or a tight apap range...stay in apap mode so that the FLs can be monitored.[/quote]

What is apap mode?

APAP mode is the mode where the pressure auto adjusts as needed based on what it senses is going on.
Not sure what it is called on your machine but it may say simply "auto" or "autoset".
Those comments I made above about FL flagging pertain to only the Respironics machine that person is using.
Your ResMed machine reports FLs differently and in reports it in either cpap or apap mode.

In case you haven't seen the manual for your machine
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Edit: Looks like apap mode is called "autoset" on the AirSense 10 AutoSet machine that is what you have showing in your profile.

Use the search function if you are using Windows, or the spotlight if you are on a Mac. Type in screenshot, and see if it doesn't find it for you. The spotlight on a Mac should be in upper right corner of taskbar. Looks like magnifying glass.

Blown Away,
The thing about mask leaks is... if headgear is too tight or too loose, leaks will occur. Practice with loosening/tightening the mask and see if that makes a difference for you. When I started this journey, I had the same difficulty, and when I couldn't tame the leaks I learned on this forum that there's something called a mask liner. I ordered several kinds to see what might work for me, and once I found one I liked, that changed the game for me. I use a liner every night, washing them after use. The two main ones that people around here use are Pad-A-Cheek, available from http://www.padacheek.com, and RemZzzs, available from many DMEs and online, from the sponsors of this forum, https://www.cpap.com.

I was more interested in what Pugsy said about flags and REM stage than in how the machine reports them.

My problem here is that my post was too long and posed too many questions. If I want simple, concise answers, I should ask simple, concise questions. My fault.