Experimental Results of increasing pressure

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sleepy1235
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Experimental Results of increasing pressure

Post by sleepy1235 » Sat Jul 19, 2014 1:35 pm

Since June 1, 2014 I have been experimenting with increasing my pressure on my machine and seeing what the results are.

Note: I am not going to be posting graphs with this data.

Disclaimer: I am not a doctor or any type of certified sleep specialist. I am not making any recommendation. Anything I am doing is at my own risk, and anything you are doing is at your risk.

The results have been very interesting. I am using a S9 Elite Resmed system. I have an Oximiter which reports SpO2 in 1 percent increments.

The S9 Elite system's software has very rudimentary statistics.

1. 5/2/2014 to 5/31/2014 I had my pressure set at 8 cm-H2O. My original prescribed pressure.

Results: The median SpO2 for these days was about equally split between 92 and 93. The time where SpO2 was below 90% would vary from less than a minute to over 30 minutes.

2. 6/1/2014 to 6/10/14. Tried 9 then 10 cm-H2O.

Results: Median was 9 out of 10 times 93, one time 92. Too small a sample to tell. The time where SpO2 was below 90% was 4 minutes or less. Small sample size, not able to draw a conclusion.

3. 6/11/14 to 6/15/12. set pressure to 12 cm-H2O with the EPR turned ON

Results: Sample size small, SpO2 medians at 92 and 93. One <90% was greater than 39 minutes. Respiratory effort data seems to be missing.

4. 6/16/14 to 7/10/15. Set pressure to 12 cm-H2O, EPR OFF. This was based on reading some papers suggesting that RERAs need to be at least 4 cm-H2O higher than what was necessary to eliminate Apneas.

Results: Medians almost all 93, however 3 nights median 92, 3 nights 94, and 1 night 95. <90% almost in all cases less than 3 minutes. Frequenty less than a minute. A few nights zero seconds. Began to focus more on management of leaks.

5. 7/11/14 to 7/18/14. Set pressure to 15 cm-H2O. EPR OFF

Results: One night forgot to put chip in. Of the seven days I do have data 3 days had a median of 95, and 4 days had a median of 94. No days were less. Regarding time < 90% worst case 20 seconds, two days with no time.

Overall Results:

A. In stages #1,2,4, and 5 I had respiratory effort data. The EPR mode seems to prevent any statistics for stage #3 of testing.
Unfortunately there isn't any statistics of respiratory effort given so I can't assess stages #1,2,4,5.

B. Visually looking at the detailed trace of SpO2 I can see that with the higher pressure I am doing much better. I would estimate it is 2 percent or more higher than before with 8 cm-H2O. The dips in SpO2 are often eliminated or much less in magnitude.

C. The dreaded central apneas that might result from increased pressure didn't.

D. Still sleep many evenings.

So my conclusions are:

1. Very significant improvement in SpO2 can be achieved with increasing pressure.

2. The pressure increase seems to need reach a critical point where it starts impacting SpO2 levels. I started to have an occasional improved night at 12 cm-H2O, but it wasn't until I reach 15 that I had consistent improvement.

3. Collect at least seven days to draw a conclusion.

Next Steps:

1. i would like to try a higher pressure, but leaks are proving to be a problem. I have a head band adapted to keep my mouth closed. Not entirely effective. Will have to come up with a solution.

2. At 15 cm-H2O your throat starts to feel like a balloon. Not sure what 18 or 20 will feel like. I fall asleep easily to it probably won't be a problem.

3. Try 20. See if there is any point at which the indicated respiratory effort spikes stop.

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bwexler
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Re: Experimental Results of increasing pressure

Post by bwexler » Sat Jul 19, 2014 1:56 pm

You seem to be totally focused on SPO2. No mention of AHI or leak rates.

Like driving a car requires attention to speedometer, tachometer, fuel gage, temp gauge, etc, so does XPAP therapy.

Metrics are different but attention must be given to all areas of therapy, including how you feel during and after you sleep therapy.

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Re: Experimental Results of increasing pressure

Post by JDS74 » Sat Jul 19, 2014 2:21 pm

sleepy1235

I like your experimental approach. End parameter of the experiment and variables clearly stated.
I would like to see a couple of additional data points as you go along.
1. AHI etc.for each series
2. How do you feel in the morning?

Those two extra correlated with SpO2 values would be helpful.

Extra pressure doesn't always trigger pressure induced central apneas and that looks to be the case here but reporting all the apnea indices would clarify things.

Are you using SleepyHead for data collection? If not, you might consider doing so as it will make the data collection easier.
Cheers

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avi123
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Re: Experimental Results of increasing pressure

Post by avi123 » Sat Jul 19, 2014 6:08 pm

See my experiment and read the results:

https://sites.google.com/site/avisleep/

It's the full face masks F & P #431 and #432 that did not work for mewhich I changed to my present nasal traditional mask and also switching to S9 Autoset in APAP mode that saved me beside setting the higher pressure of 9 to 12 cm.

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LSAT
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Re: Experimental Results of increasing pressure

Post by LSAT » Sat Jul 19, 2014 8:32 pm

In my opinion, the purpose of the CPAP is to eliminate or reduce apneas. The result of reducing apneas is the increase in O2 levels. Your goal is to find the pressure setting that gives you the lowest AHI which in turn should give you an accepable O2 level.

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Re: Experimental Results of increasing pressure

Post by SleepyToo2 » Sat Jul 19, 2014 8:33 pm

A combination of the reporting of avi123 and sleepy1235 would provide some very useful information, although I agree with avi123 on the report that it would have been better to stay on each setting for longer. On the other hand, given the AHI at the early settings, I think I would have moved faster! But that's just me.

Sleepy1235, I am intrigued by your comment that RERAs need to have at least 4 cm H2O higher pressure to eliminate them. Can you post the citations, please?

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Re: Experimental Results of increasing pressure

Post by CoffeePgh » Sun Jul 20, 2014 5:32 am

Enjoyed reading this. I have been experimenting with increasing EPAP pressure here, too, from a 4, to 6, and now to 7.6. And like you, I've been keeping notes and using the SleepyHead software to track it

Keep reporting your findings.

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Re: Experimental Results of increasing pressure

Post by sleepy1235 » Sun Jul 20, 2014 8:34 am

For some of the issues raised.


1. Dear Sleepy Too2: I looked for the reference and regret I can't find it. It is probably buried somewhere in the days reading I did one Saturday. I am somewhat disappointed I can't find it.

2. It is the low O2 which causes waking and also has the negative effects on the body. Raising it is significant. The AHI's are posited as a cause of the low O2. Raising the O2 is significant, especially the elimination of the time at low SpO2 below the red line.

3. My AHI incidents since the beginning have been very low. From a few for the entire night or less or none. Usually in the beginning of the night, when I might have coughed or done something while still awake.

The few AHI incidents that did occur didn't correlate well with the drops of SpO2 I did have when I had the lower pressures. The AHI is an inferred event from the pressure trace detected by the machine. I think the algorithm has a few false positives.

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Re: Experimental Results of increasing pressure

Post by sleepy1235 » Sun Jul 20, 2014 8:44 am

I forgot one last thing.

Last night tried 20 cm-H2O. Feel asleep. Woke up in a about 1 to 2 hours feeling choked and turned off machine pulled off all the stuff from my head in a great hurry and expelled a great deal of swallowed air. I then slept the night without the machine since i was too tired to deal with it.

Programmed the machine this morning. Went back to sleep.

One thing I do when doing these experiments is make major changes on Friday night or Saturday to leave Sunday night for recovery.

I am thinking that 15 cm-H2O is going to be the maximum for any sleep experiments I am going to do. So I am done exploring the pressure range.

I am not sure what to do next. I might try the EPR at 15 cm-H2O. It might be useful to steady my breathing with I am having flow resistance.

Try higher oxygen with a concentrator.

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Re: Experimental Results of increasing pressure

Post by sleepy1235 » Sat Jul 26, 2014 6:26 am

I am using an S9 Elite with an oximeter.

One week follow up. Still readings of 94 and 95, up from 92 to 93 with the 15 cm-H2O.

Not sure what to do next. Charts still show periods of flow limitation during periods of more minute ventilation variation.

I am not going to raise the pressure further since I don't want to swallow air and additionally at 20 cm-H2O I still had flow limitation and the elimination of flow limitation was the reason I was trying it. The SpO2 seemed not to be changed.

15 cm-H2O seems to be my upper limit. Waking up bloated with swallowed air is very uncomfortable. I can go to sleep, but I do feel like an inflated balloon.

I am interested in the use of the EPR, but I don't know if it interferes with the flow limitation tracking. Flow limitation is detected through an algorithm that interprets the pressure trace of the air being applied to you. With EPR I would think this would be interfered with since it is changing the pressure applied.

I tried both MED and FAST mode. With FAST mode I didn't have flow limitation and with MED mode I did. This leads me to think that the EPR in the FAST mode does interfere with the flow limitation algorithm, since I don't see how the difference between MED mode and FAST mode should be that different in terms of the impact on flow limitation.

However, i did the prior study at 12 cm-H2O, and at 15 cm-H2O I might have different results.

The EPR is designed to making living with higher pressure more comfortable but I am thinking it might induce more regular breathing by acting in some type of synchronicity with a persons breathing. Just a speculation.

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Re: Experimental Results of increasing pressure

Post by englandsf » Sat Jul 26, 2014 6:35 am

I'd be interested to hear about your AHI. My machine is set at 10-20 'cos my titration was flaky and I run at about 12 average and AHIs below 2. I am thinking of lowering the upper pressure but also wondering if it makes any difference.

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Re: Experimental Results of increasing pressure

Post by sleepy1235 » Sat Jul 26, 2014 7:28 am

My experimentation was to increase the pressure from 8 to 12 then to 15 cm-H2O. My AHI was low at 8 and stayed low at higher pressures.

Did your doctor do a titration using a written protocol? If not, ask for another sleep study gratis.

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Re: Experimental Results of increasing pressure

Post by HoseCrusher » Sat Jul 26, 2014 10:04 am

Some machines (older like the S8) chase leaks and can get stuck ramping up to the maximum pressure. I believe this changed with the newer machines. If you have this issue then setting a lower maximum pressure will avoid it. If it is not an issue then the maximum pressure setting doesn't matter as long as it is nigher than the pressure that provides therapeutic use for you.

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Re: Experimental Results of increasing pressure

Post by sleepy1235 » Sat Sep 13, 2014 4:31 pm

There is another development with my higher pressure of 15 cm-H2O.

It seems that possibly there is some type of adaptive learning with breathing, I don't know, but in the last month my sleep has further improved. Though the median value has not increased, two other SpO2 statistics have improved.

1. The amount of time below 90% has stopped entirely.

2. The minimum value for the whole night seems to be higher and mostly 90 to 91.

Looking at the traces it seems I have a fairly consistent level without low periods or drops.

Unfortunately the flow resistance isn't given in units but it seems that I am having less of a struggle to breath with the new pressure.

Again, I started out with a doctor recommending 6 cm-H2O, the next doctor recommending 8 cm-H2O. I didn't get improvement at 12 cm-H2O but 15 cm-H2O made a big difference in my SpO2 level.

I feel better also. For those who are looking at AHI index, there is a lot happening that you don't see until you have SpO2 monitoring.

My next step is to look at getting an O2 concentrator and an EEG monitor to see the frequency I am waking up. They require a prescription so I am going to have to figure out how to get them.

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Re: Experimental Results of increasing pressure

Post by palerider » Sat Sep 13, 2014 5:11 pm

sleepy1235 wrote: My next step is to look at getting an O2 concentrator and an EEG monitor to see the frequency I am waking up. They require a prescription so I am going to have to figure out how to get them.
ever typed "oxygen concentrator' into craigslist?

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