What am I doing wrong?

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 2:46 pm

Hey guys am on my third night of CPAP and had my longest night using the machine at 5.33 hours but my AHI is 7.38. I am not sure what I am doing wrong or what I have to change to bring that down but I have attached a screen shot of the data to see if anyone can interprit for me.

DrPepper00 · Post by **DrPepper00** » Thu Apr 19, 2012 3:54 pm

Your screen shots are focused in on a very small period of time. You need to let us see how the pressure varies during the whole night. I see your pressure is set at 4-20. The lower number is probably not giving enough support to prevent the events. When it drops down after an event, it can't get up quickly enough to prevent the next one.

Welcome to the quest for better sleep.

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 4:17 pm

Thanks heaps for the reply . What a mission trying to get it all right. I have an autoset machine so not sure how to fix this problem? I am waking up feeling better than before but still my stats seem too high.

chunkyfrog · Post by **chunkyfrog** » Thu Apr 19, 2012 4:28 pm

Using the machine, like using the forum, gets easier and more effective with practice.
Welcome to the new, improved, land of Nod.

jweeks · Post by **jweeks** » Thu Apr 19, 2012 4:37 pm

Joshaldo wrote:Hey guys am on my third night of CPAP and had my longest night using the machine at 5.33 hours but my AHI is 7.38.

Hi,

That image says that your pressure varied between 16 and 20? Is that right? If so, I think you may have the wrong machine. Anything above 15 is pretty high for pressure. That is where BiPAP becomes the preferred treatment. You can get successful treatment without a BiPAP, but it means setting up your machine to have a really tight pressure range. Since you are having events even at 16, you need the machine set for something like 18 to 20. I think your machine max'es out at 20. It might be that 20 isn't high enough for you. A BiPAP will go to 25. I think you might want to go back to your sleep doctor and ask about these changes.

Did you get a formal titration study done? If so, what is your prescription?

There is a tricky thing that goes on at higher pressures where it can cause something called "central" events. In some people, the pressure needed for treatment is higher than the pressure that causes centrals. In this case, BiPAP can help because it reduces the pressure on exhale, reducing or eliminating the centrals, but has a higher pressure in inhale, which helps blast open your airway. There are some folks who are so sensitive to this that they need ASV machines.

The final question to consider is your sleep position. Are you on your back or on your side? Some people have far less for symptoms when they sleep on their side. In fact, in my case, I was considered to be untreatable on my back since a pressure of 30 didn't help. In order to make CPAP work, I have to be on my side, and I still need a BiPAP set to 20 on the high end.

Good luck with this...there is a solution, but it might take some effort to find it.

-john-

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 5:06 pm

Thanks heaps for the reply. I did do an overnight study and was.diagnosed with severe OSA. Do you think I have central apnea? I didn't go back for the titration study thinking the auto set would do the job. So now I am confused, if I need a higher pressure does that mean it is likely central apnea or does higher pressure cause central events? Thanks again for any info

Pugsy · Post by **Pugsy** » Thu Apr 19, 2012 7:29 pm

Clear airway events (centrals)...you don't appear to have any problems with central sleep apnea.
It is normal to have a few and you didn't have any on this report you posted.
Some people (around 10 to 15%) using cpap may develop centrals as a response to pressure and it doesn't even have to be a high pressure. There is nothing in this report that even hints at your being part of that 15%.

Actually except for the 2 "clusters" you did really well through the night. The clusters might be REM stage sleep...might be supine sleeping...might be a combination of REM and supine sleeping....all which are common. Are you waking often during the night? Where you perhaps awake during that first large cluster? The machine will do that...scored events while you are awake...it doesn't know when you are awake or not..it just calls them like it sees them. Sometimes our awake breathing is more fractured than we realize and the machine scores stuff that is happening while awake.

I can't see the overall pressure line.. I see only the zoomed in pressure line. Same thing about the leak line.
What is your overall average pressure? You overall average leak?

Off hand, without seeing the rest of the overall stuff...My first thought is that the minimum of 4 might be too low if you are spending a lot of time near 16 cm and the leak is under control.
Leak has to be well managed first....then we can more accurately evaluate the other data.

So without looking at the AHI....tell us how you feel? Waking up often? We already know short hours of sleep but that will get better as you get used to things. Having mask issues?

When doing your screen shots..remove the AHI hourly graph from the graphs..it is unneeded at this point.
Adjust your graphs so you can see the events graph at the top...the flow graph...the pressure graph and the leak graph...the other stuff don't bother with right now. Don't zoom in on anything....we need to see each of those items from start to finish.

Like this one of mine.

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 8:24 pm

Wow, Pugsy thanks so much for that info. Your post cleared a lot up for me . Yes, I wake a couple of times a night remove mask then turn machine off, fall back asleep then put my mask back on when I rewake. I am feeling better during the day than what I was. I wake up now at 5 and feel like I could get up and get ready for the day when before that was not possible. The mask has been good, I am getting used to it more and more each night. Here are a couple more stats: Once again thanks for your replies

http://img201.imageshack.us/img201/706/ ... 0at122.png

Uploaded with ImageShack.us

Pugsy · Post by **Pugsy** » Thu Apr 19, 2012 8:36 pm

Pressure set 4 to 20 and averaging around 14 with EPR of 2.
Leaks are fine..not an issue..well below 24 L/min (large leak we want to avoid)

Still don't have a pressure line to look at but....if that first cluster was related to supine events or REM stage sleep events or both..then likely the machine couldn't get to the pressure needed to treat those events from its current minimum setting. Sometimes supine or REM events need more pressure than usual.
Solution would be to increase the minimum some and see where those clusters don't happen any more.
Sometimes we just have to give the machine a bit more headstart so it can get to the higher pressure needed..at little quicker.

That said..you have only been at this for a short time...give it a few more nights to make sure those clusters are real and not your being awake and breathing funky messing with the machines sensors.
If you aren't comfortable adjusting the pressure...talk to your doctor about what you are seeing here if they continue. If it wasn't for the cluster...I wouldn't be thinking of doing anything except "give it time" because there is a lot of truth to that statement.

One question the AHI??? what was the category index breakdown?....clear airway index? obstructive apnea index and hyponea index? It is important to know the breakdown when evaluating pressure needs/

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 8:48 pm

Ok, will give it a few more days and see how it is going. Thanks again for your replies. Hope I don't have to get a new machine just bought this from US . I have attached the AHI breakdown is this what you are after?

Uploaded with ImageShack.us

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 9:56 pm

Sorry attached the wrong one. Is this what you are looking for? Do you think the autoset might not be powerful enough for me?

Uploaded with ImageShack.us

Pugsy · Post by **Pugsy** » Thu Apr 19, 2012 10:06 pm

That's one of the. The next would be the graph. Did you know you can hove the mouse over the bottom line of the graph and actually slide the bottom up just a bit creating more room..do this for first 3 and you have room for a forth graph on one page...so one screenshot of the whole thing..the colored bars ad stuff as well as the graphs.

I just want to see if you were having many centrals (clear airway) events before we start talking about pressures modification. You don't so that is a non issues.

You had a good night with that AHI less than 3 that one is great.....how come it is different comparing with this AHI of 7?

You need a full week to get an idea what is going to settle down and what isn't .

Joshaldo · Post by **Joshaldo** » Thu Apr 19, 2012 10:14 pm

Cool, I just had a play around with it then thanks for the tip. So I am not having any centrals is a good thing? I will post some more data at the end of the week. Thanks again for the replies, you are very helpful . Also what do centrals look like on a graph?

Pugsy · Post by **Pugsy** » Thu Apr 19, 2012 10:18 pm

Centrals/clear airway events are purple. and if you have some..they will show on the top line of the graph and as a big purples slice of the pie.

Here's one of min,.don't laugh at the leak it is bad..I was experimenting with something and it work out as planed.

jweeks · Post by **jweeks** » Thu Apr 19, 2012 10:35 pm

Joshaldo wrote:Here are a couple more stats:

Hi,

This one shows both the events and your pressures. The random OA events are not too much to worry about. The clusters are the issues. Since your breathing gets a bit excited (based on the black area of the flow graph), I suspect that these are REM sleep cycles. REM can aggravate OSA because your body is at its most relaxed state.

I notice that your pressures are either maxed out, or very nearly maxed out. This says that one of two things is happening:

1) Your machine isn't reacting fast enough. To fix this, try a pressure range of 18 to 20. That way, when you have an event, it is already at 18 and only has to ramp up 2 cm of pressure. When the starting number is 4, your machine has to ramp up 16 cm of pressure to get to 20, and that simply takes too much time, and your OA event happens before the machine is in position to help.

2) You need more than 20 cm of pressure. In that case, your current machine is not up to the task. You would need, at a minimum, a BiPAP machine, which can go to 25. If you need more than 25, the ASV machines typically go to 30.

Since the more advanced machines get expensive, with BiPAPs running $1750 US and ASV machines at around $5500, you probably do want to do that titration study. I'd hate to see you spend nearly $2K on a BiPAP only to find out that you need an ASV.

In my earlier reply, I wasn't suggesting that you were currently having central events. Rather, when you get to these high pressures, you run the risk of that happening. That is why I wouldn't suggest that you simply change your pressures, but rather, you should do that titration study and get a formal prescription. It is possible to introduce more problems than you solve. If you simply don't have the option of doing this study, then your best shot might be trying the range of 18 to 20 and see if the clusters improve.

-john-

What am I doing wrong?

What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?

Re: What am I doing wrong?