New user needs advice

I have guessed for a while that I had some sleep issues and after months of trying to get tests and results and more tests, I finally am the proud owner of a Dreamstation APAP and Dreamwear mask.

My dr had me on supplemental oxygen for over a month (although due to my extensive travel, I didn't use it much) due to an overnight oximetry test where my saturation got down to 71%. After some work and effort, I was able to do a home sleep study and was given the results of: Apnea Index: .4 (I have no idea what this means, all my research has brought up AHI, which is obviously different. If anyone can help with defining this or pointing me in the right direction, it would be appreciated!), AHI 17.2 and RDI 20.8.

I received my machine on Thursday and read a bunch of stuff on here, made some adjustments (min pushed up to 5 vs 4) and went to bed. I have done well with the supplemental oxygen and the sleep test, so I thought I would do ok. Boy, was I wrong. It took me more than an hour to fall asleep and then woke up in the middle of the night and was up for over an hour again. When I got up in the morning I was a total zombie. I downloaded my info onto SleepyHead and read the user guide and wiki and posts on here to understand my results. I have a decent understanding of what each chart/graph shows but would really like some help/input into suggestions to improve things. I made some slight adjustments after all my research.

Last night I fell asleep faster, woke once but fell back asleep much more quickly and woke today feeling more like what I normally do (which still isn't fabulous, but functional).I had upped the minimum to 6 before bed, as I had a more difficult time the night before when it was lower. I uploaded my data and my numbers seem nearly the same.

I have no problem making adjustments as I am very proactive in researching and being in charge of my health.

The first night I slept on one side half the night, before turning over. Last night I was only on one side, the same that I started on the night before. I have a shoulder injury that is mostly healed but still gives me some issues, so I try to stay off of it. I am typically a side sleeper, occasionally roll to my back, but not often. I do sleep with pillows all around me, which keeps me on my side.

I do take 10mg of Melatonin at night, have for at least 2 years. Since I was very young I have always had a hard time falling asleep, but once asleep I am typically good. Even if I wake up to use the restroom, I fall back asleep pretty easily most nights. My best sleep is usually after 5-6am until I get up. I tend to sleep 9-10 hours and dream a lot, every night, which all has been pretty consistent throughout my life.

I do travel a ton, and am luckily home this week, leaving next Thursday, so I have some time to make adjustments more easily. Once I am on the road (flying every few days, hotel stays of 1-2 nights at a hotel before moving, typically, trips of 1-3 weeks at a time), I have less time to research and me getting at least enough sleep to function is highly important as I have meetings all day. So I would really like to do whatever I can to get things dialed in a bit and understanding what to watch for/adjustments I might need to make in the future.

I hope I didn't go on too much, just wanted to give all the relevant info to make it as easy as possible for anyone who has ideas/suggestions. I am one who likes to learn and understand why someone suggests what they do, so if someone has ideas, if you can tell me why, or even just point me to another thread or place that will explain why you are suggesting what you are, it would be greatly appreciated. This way I can understand and learn how to make appropriate adjustments in the future.

For now I am going to add the two nights data. I understand that more detailed views might be needed, and can supply those if requested. I tried to research what was needed, I do hope I did this correctly! If I did anything wrong, please let me know and I will fix it.




Ok, so I got the first night loaded and resized ok, I am not sure about the second. I tried to do it the same way (and other ways) many times, and it just wouldn't seem to work. I followed the instructions on another thread and so if it isn't viewable, I can try again.

One more question. In both graphs you will see when I woke up to use the restroom and just undid the vent from the facemask. Should I actually be turning it off and back on rather then just letting it run unattached?

Thanks for any help anyone can offer!

go ahead and turn off the machine when you get up.

as with most people, you need more pressure to tame the hypopneas and obstructives, 8 might do it, may need more like 9, possibly more for a minimum pressure.

I always turn the machine off when I wake up in the night, if I'm also unplugging the hose. Leaving the machine on is OK, but Sleepyhead will register a large leak until the machine turns itself off. Your numbers and other reports in SH will look better and be more accurate without the unintended large leak.

Thank you both for the replies!

So, as I move the minimum up, if I am having less events, that will mean I am moving in the right direction. What would be an indication that I went too far and the minimum is too high?

I will turn the machine off when I get up, I did notice the spikes on the graph and don't want to mess up my numbers by doing so. I guess my concern was it starting lower again, which seemed to bother me and make it difficult to fall back asleep. Turning the minimum up, and maybe the ramp off (or at least up) seems like it will fix the reason I didn't shut it off.

Thanks again... I am looking forward to seeing how tonight goes!

GEG wrote: What would be an indication that I went too far and the minimum is too high?

there's little, if any indication in the data from the machine of pressure being 'too high'. you could look for pressure never ever going above the baseline (except for those sawteeth which means the machine thinks you're sleeping great). some people can have central apneas start to become more prevalent if their pressure is raised...

some people will experience enough air getting into their stomach that it's painful. other than that, there's really no downside to more more pressure than you really need.

GEG wrote:I will turn the machine off when I get up, I did notice the spikes on the graph and don't want to mess up my numbers by doing so. I guess my concern was it starting lower again, which seemed to bother me and make it difficult to fall back asleep.

you can always turn off the ramp if the lower starting pressure bothers you, the only purpose for ramp is to help people get to sleep while they get used to the pressure, though some people continue to prefer using it even after they've been on cpap for a while.

Thanks Palerider.

Now that you mention it, I do recall reading about the CA becoming more of an issue if it is too high. I was just reading a recent post about air in the stomach. I just wanted an idea of what to watch out for.

I think I will turn the ramp up tonight, and if all goes well tonight maybe even off tomorrow. I did mess with the humidity settings a little last night and learned that I went too warm and didn't like that.

It sounds like my biggest step will be to up the minimum and hopefully get the AHI number down.

Thanks for the quick and helpful responses!

GEG wrote:I do recall reading about the CA becoming more of an issue if it is too high

While there is a small number of patients who start cpap therapy will have Centrals/CAs pop up with higher pressures it really isn't all that common. Lots of us use a lot higher pressures than you are using and we never have more than a random central. Besides..it really doesn't have to be higher pressures causing the centrals..they can pop up with as little as 5 cm pressure in some people.

Cross that bridge if/when you come to it. Chances are you won't come to it.
Fix what you know needs fixing now with a little more pressure and if you end up with more than a few centrals here and there then we can have a different discussion.
Remember a few centrals here or there doesn't mean anything bad is going on. To have a few is normal. Centrals are only a problem if they come in large numbers, cause desats or keep bouncing you out of sleep. So don't panic if you see a few here or there on your software reports.

Thanks Pugsy. I really wasn't worried about it, just wanted to understand what to watch for. I appreciate you taking the time to share the info.

I was going to bump it up to 8 last night, and at the last minute did 8.5. I guess I am hesitant to go too far too fast, but there didn't seem to be any negatives, all went well as far as wearing the mask, leaks, falling asleep (much improved still from the first night).

My numbers are better, but still can improve I would think. So what do you guys suggest I move to tonight? 9.5? 10?




Thanks!

Try 10 and see how things go... 10 seems to be a very popular place actually, many people starting lower end up there and don't necessarily ever go higher (YT included). You're not going to suddenly get 'centrals' from doing that, though as has been said, you might get a few prior to waking or on going to sleep... those are normal and not a problem at all.

I prefer to go up slowly when at this stage of tweaking the pressures.
Like 0.5 cm increases slowly...give yourself 3 to 5 nights at a setting to sort of settle in.
Others like to be more aggressive and take bigger and faster jumps. The bulk of your AHI appears to be hyponea and usually it takes very little to rein those in a little better. I see no sense in using more pressure than is necessary but it hurts nothing to use a little more than what might be technically necessary as long as it doesn't create a problem with the usual problem being maybe some aerophagia and believe me...if that happens you will know it.
I have only had it really bad a couple of times but I sure don't want to have to deal with it on a regular basis.

So up to you what you want to use tonight. My job isn't to tell you what to do but instead I prefer to educate you as to what you are looking for and expectations and let you make your changes based on your own educated choices.

Whatever you choose to do tonight plan to stick with it a few nights now that you are so close to optimal settings before considering another change.
I have personally seen an AHI of 3.0 go to around 1.0 or less over a 6 week period with absolutely no changes. There is some truth to the "give it time" strategy and letting your body get adjusted to the new settings so that you can spot patterns and trends. We don't sleep the same each night and it's normal to have some variations in AHI, etc even with no changes being made. If you keep making changes each day based on last night's report you can end up chasing your tail.

Thanks Julie. I was leaning toward that, I just don't want to go too far, too fast, for some reason. I think it is more a mental block. Just getting confirmation that it makes sense to do that gives me the confidence to just do it.

I have another question, but about the humidifier. I want to understand what the functions do. The humidifier numbers adjust the amount of moisture, but does it also affect the temperature? Obviously the heated tube adjusts the temperature of the tube. How about the adaptive, does that work with a heated tube, or only with standard tube?

I am feeling the air is a bit too warm and stuffy when I first put it on at night. I tried lowering humidity (down to 1, from 2 or 3, can't recall) and the inside of my nose started to hurt a bit. I just got over a bout of serious nosebleeds (lasting 4-5 hours, requiring ER visits) so really want to avoid getting too dry. I bumped it back up and seemed just fine after that, as far as moisture level. I have been preheating the water, and am thinking maybe I will not do that tonight and see how it goes.

As long as I understand what the functions do, I am comfortable messing around with it. I just don't understand if there is a way to get more moisture without more heat?

Thanks for any help, I tried looking around at other threads and didn't see anything that clearly answered the questions.

GEG wrote:Thanks Julie. I was leaning toward that, I just don't want to go too far, too fast, for some reason. I think it is more a mental block. Just getting confirmation that it makes sense to do that gives me the confidence to just do it.

it only takes a couple minutes to lower the pressure back down, ya know

Thanks for the input Pugsy.

What you are saying makes a lot of sense. I am trying to get as close to optimal as possible this week, as I have only 4 more nights till I take off on a 2-3 week trip, where I will be changing hotels every 1-3 nights. I will be in different cities, with different beds, humidity levels, temperatures, etc, so want to get things dialed in as much as possible while I am home. 3-4 of the nights will be with my boyfriend, so the added change of having another person in the bed with me, and the worry about his thoughts on all of it and how it will affect him/his sleep. He has been very positive about it and my concerns on that end are probably uncalled for, but I still think about it.

I will think on it today and figure it out. I am hoping that the change tonight will be enough to get it into the range that seems good and I can keep it there and give it some time.

I really appreciate your stance of trying to educate and let people make their decisions. That works very well for me and what I was hoping for here. I also do like others sharing their feelings that if it was them they would go to x or make y adjustment. Thanks for sharing your knowledge and explaining the situation in detail, and quickly as well.

Thanks to everyone who has responded for helping to make this transition a little easier, it is very much appreciated.

palerider wrote:

GEG wrote:Thanks Julie. I was leaning toward that, I just don't want to go too far, too fast, for some reason. I think it is more a mental block. Just getting confirmation that it makes sense to do that gives me the confidence to just do it.

it only takes a couple minutes to lower the pressure back down, ya know

Are you sure?? I thought once a pressure was set, you had to stick with it for at least 30 days, or the DME police would come after you?!!

Good point, I have no idea why the block, just didn't want to go too aggressive. I obviously have no problem making adjustments. I don't even know when the DME or anyone sees my data. Since the only way I could get a sleep study done before December was to have my PCP be the one who manages my case, and she didn't seem to know the difference between a CPAP and an APAP, I am pretty much on my own with this. I am good with that, not one who would do well with someone micromanaging what I do, how I do it and not allowing my input due to how I feel, reports, etc.

Is your hose a heated hose or a regular non heated hose?

There is a way to have the heated hose not warm the air all that much but still crank out the higher amount of humidity if that is what your nose likes (mine likes a lot of moisture).
With the heated hose you can set the hose temp separately from the humidity to be delivered.
It all starts with the ambient room temp when it comes to the heated hose doing its job. If the ambient room temperature is already pretty warm you want want to add more warmth if it makes things too warm but you don't have to sacrifice humidity. I do this with my heated hose...in the summer I don't want the air that much warmer but in the winter when the bedroom temperature is in the low 60s or high 50s I want it a lot warmer.
So I adjust the air temp to cooler in the summer and warmer in the winter and I never change the humidity that is to be delivered.

So if you have a heated hose you should be able to adjust the hose air temp to a lower setting and the humidity setting separately and not sacrifice humidity.
If you don't have a choice...either the hose is a non heated hose or the machine is set to some sort of auto function (I am not all that familiar with the DreamStation heated hose/humidity options). There should be a way to take it out of "auto" if that is what is going on.

Do you have the clinical manual that explains all the options?

Now I understand your desire to move quickly to optimal settings. You are close...pick something soon and plan to stick with it for a few days though. You can always go up or down or change something later if you end up finding it doesn't quite suit your needs.