Interpreting My Report--Snoredog or Slinky--or anyone else..

[skjansen]

This is to snoredog or slinky or anyone else that may be able to provide some input. Here are my numbers from last night:

Therapy Mode: CPAP
Set Pressure: 13.2
EPR Mode: Full Time
EPR Level: 1.0 cm H2O

AHI & AI (events/ hour)
Apnea Index: 0.6
% of time in Apnea: 0.2
Hypopnea Index: 3.8
AHI: 4.8

Leak (L/min)
Median: 3.6
95th percentile: 8.4
Maximum: 12.0

Pressure:
Median: 12.4
Maximum: 13.2

Now, in reviewing these numbers I think they look okay. You all can correct me if I am wrong. But in reviewing my new software I noticed that an inordinate amount of my apneas/hypopneas tend to be in the last two hours I am sleeping. I believe this may be the reason I wake up feeling not so good at times. I strongly believe I have positional OSA so I rarely sleep on my back (I tie a tennis ball to my sleep shirt). I believe at the beginning of the night I tend to sleep primarily on my right side and toward the end of the night I am either on my left side or stomach. I am wondering the following:

(1) Should I increase my pressure slightly to get my AHI closer to zero?
(2) Should I turn the EPR off? I have been on straight CPAP for years prior to getting this new machine, so the exhalation does not bother me.
(3) Should I try to just sleep on my right side?

Just interested in any feedback I can get. Obviously we would all like to feel great when we get up so that is why I am questioning this now. I want to make any changes I can to get the best therapy possible.

Thanks a bunch guys. By the way, despite my best efforts, and many hours, I have not been able to post my report.

[Snoredog]

I think your numbers look fine all around. I would NOT make any changes based upon AHI information, if you are sleeping on your side that would be reflected in the above numbers.

If you are not feeling better you could try an increase of pressure by 1 cm but keep an eye on the AI value. If AI climbs after increasing the pressure it could mean you are over titrating and into disturbed sleep.

While the software is all nice and everything, your best bet is to plot the pressure and AHI information in a spread sheet, if you then graph that data in a line chart it should resemble a bell curve so when you get 2-3 plots where AI is increasing you have gone the wrong way. Along the way you are also trying to observe how you feel. You can add another row to a spreadsheet and gage how you feel from 1 to 10 or something and compare that to the other graph.

Sometimes we feel good after sleep and yet that is never enough. Rarely do we get back to the totally refreshed state once observed when starting this therapy from a stand point of being sleep deprived.

[Slinky]

If nothing else, PM someone who would understand the reports and ask if you could e-mail them via attachments. Then you can just use PrintScreen to send them as an attachment. Even "I" have FINALLY learned how to do that so I know you can easily do it.

Yer right, yer data does look good. I'd try shutting off EPR first and see what transpires. I sure would LOVE to have your Leak Rate!!!!

I'll be darned if I'd try the positional sleep training when it isn't totally necessary. I HAD to train myself not to sleep on my tummy and was successful. BUT, I'll be darned if I want to sleep in just ONE position all night every night if I don't have to!!! Wha' do you do then when that right shoulder starts to object and says to heck w/this and starts complaining? Maybe even goes on strike?

Yer doing all right. Give it time. Patience, Perseverence and a good Sense of Humor!

[Snoredog]

If nothing else, PM someone who would understand the reports and ask if you could e-mail them via attachments. Then you can just use PrintScreen to send them as an attachment. Even "I" have FINALLY learned how to do that so I know you can easily do it.

Yer right, yer data does look good. I'd try shutting off EPR first and see what transpires. I sure would LOVE to have your Leak Rate!!!!

I'll be darned if I'd try the positional sleep training when it isn't totally necessary. I HAD to train myself not to sleep on my tummy and was successful. BUT, I'll be darned if I want to sleep in just ONE position all night every night if I don't have to!!! Wha' do you do then when that right shoulder starts to object and says to heck w/this and starts complaining? Maybe even goes on strike?

Yer doing all right. Give it time. Patience, Perseverence and a good Sense of Humor!

EPR shuts down or off when SDB events are present. Let's say your pressure is 10 cm and you are using EPR=3, when NO events are present pressure would effectively be IPAP=10 and EPAP=7 when machine detects or encounters an Flow Limitation or apnea it will change EPR from 3 to 2 then to 1 if SDB persists.

You can argue that using EPR is equal to lowering pressure on a "preemptive" note, meaning had EPR been turned off the event that may have caused it to lower/disable EPR would not be present to begin with. But you have to weigh the added benefit of comfort in that assumption.

Like an autopap may allow a few events to get by untreated with no response, EPR may have the same problem. But the added comfort to therapy may out weigh any benefit of turning it off. Many turn it off because it doesn't seem comfortable in matching their breathing pattern.

[skjansen]

Snoredog. . .thanks for your feedback. At this point, I think I will chart my pressure and AHI as you suggested. I have gone back to August 3 and have already charted this. I took my pressure up to 13.2 on August 5 and my AI doubled. I am going to keep an eye on it. I also turned the EPR on around that time so I am not sure if that made a difference in my AI. Might turn the EPR off tonight and see if that makes a difference.

Slinky...thank you also for your feedback. Yes, my leakage rates are pretty good. Do you think the duct tape I wrap around my head to hold my Quattro on is helping??? Just kidding. It is on pretty tight though.

Trust me when I say that it is the perfectionist in me that makes me want to tweak everything until it is just perfect. I think perhaps I better get used to the fact that I am not going to be perfect at sleeping. It really shouldn't be this hard should it????

Thanks again.

[skjansen]

Snoredog:

It is interesting what you said about the EPR. If it does in fact work similar to an APAP in perhaps not addressing every apnea I think I would be better off with the EPR off. I honestly cannot tell the difference anyway. In fact when I initially started out with the EPR at 3 I felt like I was suffocating. That is why I turned it down to 1 anyway. I think I will turn it off and see what happens. My first machine was a straight CPAP as my doc felt like an auto machine would not address my apneas fast enough. Could be she was actually right!

[Slinky]

Yeah, well, there is always the option of putting that autoPAP in CPAP mode!

[jnk]

I noticed that an inordinate amount of my apneas/hypopneas tend to be in the last two hours I am sleeping.

I don't think that is out of the ordinary, if I am recalling correctly what I have read about OSA. I believe it is often in the later hours of sleep that you are in REM sleep the longest. So I would not necessarily consider the fact that the events that occur are occurring then to be a sign of a need to change anything.

Snoredog or Slinky, please correct me if I'm wrong on that. I just didn't see that sentence being addressed, although I may have missed it if it was.

[jnk]

Ah! Found it!

"Patients with SDB are usually worse in the later hours of sleep."--Handbook of Sleep Medicine, Avidan, Zee.

http://books.google.com/books?id=89YbKw ... &ct=result

[skjansen]

Well, that is some good information to know. Also this looks like a fantastic book. Do you have it?

[jnk]

. . . this looks like a fantastic book. Do you have it?

No. I can't afford those overpriced medical books. I just steal what I can from google! And it's only occasionally I find better stuff than I find right here in this forum. I have several weeks of reading ahead of me, now that the search feature works so well here.

Now if I could just remember half of what I read!

And does anyone know what language SWS was speaking back in the old days?

[-SWS]

And does anyone know what language SWS was speaking back in the old days?

Я думаю, он использовал для говорят на английском языке!

[Billmanweh]

While the software is all nice and everything, your best bet is to plot the pressure and AHI information in a spread sheet, if you then graph that data in a line chart it should resemble a bell curve so when you get 2-3 plots where AI is increasing you have gone the wrong way.

Does anyone have an example of this they could post? For the life of me I can't picture/understand this.

[jnk]

Я думаю, он использовал для говорят на английском языке!

OK. Guess I'll have to brush up on my English then. Wish they had taught it in Kentucky where I grew up!

jnk

[Slinky]

Looks like Greek to me!