Sleepyhead...

[DavidC5065]

After browsing through the site for a few days, I downloaded sleepyhead and imported my data. It looks like I don't need therapy to me (lol) but I don't know how to upload the screenshots of the report like I've seen in quite a few posts. Is there a link I can go to, to find out how, so I can post it here and get feedback on any tweaking suggestions?

Thanks,

Dave

[Diamondminek]

His talks you through how to post screen shots from sleepy head: https://sleep.tnet.com/resources/sleepyhead/shorganize

I would guess it looks like you don't need therapy because the therapy is working, as in the machine is stopping the apnoea - so there isn't a whole lot to see, which is good news.

[DavidC5065]

Thanks.

[DavidC5065]

Well, I don't think I got it exactly right, but I got the screenshot up anyway. Would appreciate anyone with "tweaking" genius to take a peak and tell me if they see any suggested areas of my therapy to tweak...would like to reduce my IPAP cause 17 is quite high, but don't want to compromise any benefit. Just don't seem to be all that rested when I get up in the morning.

Thanks in advance,

Dave

[palerider]

After browsing through the site for a few days, I downloaded sleepyhead and imported my data. It looks like I don't need therapy to me (lol)

well, it's pretty clear you DO need therapy, because you're still having events even with the rather high pressures you're at.

that's a LOT of pressure support, and may be encouraging centrals...

all that said, your ahi is well within then acceptable range (under 2) and it looks like your therapy is working well.

[DavidC5065]

Ok. I have many nights with 0.0 ahi which I guess is a good thing, but I don't know what the other data means so I've got some studying to do I guess. I can get ahi right off my resmed screen so I was wondering if I needed to know other data points. I saw where some posts recommended lowering pressure when ahi was low and pressures were high but I guess there is a lot more to it. I had no idea that most of my events were centrals so I'm learning already.

Thanks again for your reply.

[kteague]

that's a LOT of pressure support, and may be encouraging centrals...

Question for you Palerider. When you say Pressure Support, are you speaking of how high their pressure is or a setting on their machine?

[Okie bipap]

Pressure support is the difference between IPAP and EPAP. The pressure support on my machine is set to 5 which my EPAP starts at 13 and my IPAP starts at 18. If the IPAP pressure goes up to support my breathing, the EPAP changes the same amount, so there is always 5 cm H2O difference between EPAP and IPAP.

[DavidC5065]

How do you know the "best" epap, and pressure support to use? For example, I used my straight cpap on 17 for 2 nights last week, and had zero events. When I use vpap some nights I have zero but some nights I have a few events, more ca than oa according to sleepy head.

[robysue]

After browsing through the site for a few days, I downloaded sleepyhead and imported my data. It looks like I don't need therapy to me (lol)

well, it's pretty clear you DO need therapy, because you're still having events even with the rather high pressures you're at.

that's a LOT of pressure support, and may be encouraging centrals...

There's a total of three CAs scored all night long. That's not enough to worry about.


Yes, a PS = 9cm is a pretty big PS. But we have no background information about how or why these settings were recommended to DavidC5065.

Without having more background, I would recommend sticking with these settings for the time being: If this data is typical, then the VPAP is doing its job. And the question then becomes: How well are you sleeping and how good do you feel in the daytime.

[robysue]

How do you know the "best" epap, and pressure support to use? For example, I used my straight cpap on 17 for 2 nights last week, and had zero events. When I use vpap some nights I have zero but some nights I have a few events, more ca than oa according to sleepy head.

In order to answer that question we need a lot more background:

1) Did you have a titration study? What were the recommended settings coming from the study? And did the study show any centrals? (Your machine scored centrals are NOT numerous enough to worry about.) Do you have any idea why you were started out on a bilevel (VPAP) machine rather than a CPAP?

My guess is that you were put on bilevel during the sleep study because you were titrated up past 15cm. And you may have been exhibiting some kind of "discomfort" in your sleep----i.e. you may not have been sleeping as soundly as they wanted you to with straight CPAP at or above 15cm. So they switched you to bilevel. Now the bilevel titration scheme increases EPAP only for snoring and obstructive apneas (as I recall). Hypopneas (and RERAs and FLs if the lab pays any attention to them) result in increasing the IPAP.

There's no point in chasing a 0.0 AHI just for the sake of getting a 0.0 AHI night after night. The real purpose of CPAP/VPAP is to get high quality sleep all night long. For many people that means there's a compromise that's necessary: You need the pressure to be high enough to prevent the obstructive events from happening and low enough to actually be able to sleep comfortably with the machine all night long. A few events here and there are nothing to worry about. Which brings me to #2:

2) When you switched to CPAP at 17cm, did you have more trouble or less trouble getting to sleep and staying asleep all night long? Did you have more problems or fewer problems with leaks waking you up? Did you have more problems or few problems with any of the comfort issues listed below?

• ability to exhale comfortably against the pressure
• air blowing in your eyes
• dry nose in the morning
• dry lips in the morning
• aerophagia (air in the stomach) during the night or during the morning

Personally, I'm not a big fan of using more pressure than is strictly necessary. I'm also much more conservative in terms of dial wingin' than most people around here. In other words, I tend to believe that if something ain't broke, don't fix it. And the first data you posted indicated that there was nothing "broke" in terms of the efficacy of your data. And you haven't made any specific comments about what (if anything) is really bothering you when you are trying to get to sleep with the machine, trying to stay asleep with the machine, or after you get up in the morning.

[DavidC5065]

Thanks very much for the responses.

Yes, I've had sleep study years ago. My first study years ago resulted in straight clap at 12 I Leif memory serves. I had a follow on tritation in 2014 where they prescribed bilevel at 8/17. I believe because imy pressure was so high that I was leaking a lot. I had the tritation done twice within a couple of months, aye the U of M medical center, because of my heart condition (HOCM). I use a FF mask, and sleep pretty well....I have rarely felt "refreshed" from sleep, but I don't usually fall asleep after a nights sleep unless reading or bored, LOL. My main question is whether I should experiment with a lower pressure since I'm not having a large number of events (apparently) because 17 IS a lot of pressure, and while I sleep ok with both cpap and vpap at this level, if lower would work just as well, I'd prefer lower. I guess I was wondering if it would be worthwhile to experiment with lowered pressure to see if the results changed much.

[robysue]

Thanks very much for the responses.

Yes, I've had sleep study years ago. My first study years ago resulted in straight clap at 12 I Leif memory serves. I had a follow on tritation in 2014 where they prescribed bilevel at 8/17. I believe because imy pressure was so high that I was leaking a lot. I had the tritation done twice within a couple of months, aye the U of M medical center, because of my heart condition (HOCM).

Because of the hypertrophic cardiomyopathy (HOCM), I'd be reluctant to plunge into a lot of dial wingin' without some guidance from both the sleep doc and the heart doc. You don't want to do something that accidentally upsets whatever is being done to manage the HOCM.

My main question is whether I should experiment with a lower pressure since I'm not having a large number of events (apparently) because 17 IS a lot of pressure, and while I sleep ok with both cpap and vpap at this level, if lower would work just as well, I'd prefer lower. I guess I was wondering if it would be worthwhile to experiment with lowered pressure to see if the results changed much.

If you are interested in finding out if lower pressures might work, then why did you change from VPAP at 8/17 to straight CPAP at 17 on the last two nights?

If you are really wanting to see if a lower pressure might work, what I'd suggest is to go very, very slowly and hopefully work with your docs.

I'd leave the EPAP = 8 since that's what your titrated EPAP was in the 2014 sleep test. And that means you probably do need 8cm to control most of the OAs and snoring. You could try reducing the IPAP to 16 so that you are using settings of 8/16 and leave the machine set there for a week or two---if the data looks as good as the data at 8/17 looks. If the AHI goes way up when you switch to 8/16, then you'll know that you really do need the settings to be 8/17.

If the data looks as good at 8/16 as it does at 8/17 for a good two week trial period, then you could try 8/15 and see what happens.

In other words, you could try to titrate that IPAP down by going very, very slowly (in terms of decreasing the IPAP) and watching the data. After each decrease in IPAP, you will need to watch the data carefully and if there's any sign that the AHI is going up a lot at the new, lower setting, you'll have to increase the IPAP back up to the previous setting.

Even so, I still think you need to make sure that your docs are aware of what you want to do. And in particular you need to know exactly how under-treated OSA might affect the heart condition.

[DavidC5065]

Thanks for the suggestions. I used the straight CPAP at 17 just to see if I could tolerate the straight pressure, and if so what the results would do. I will talk to doc.

[palerider]

that's a LOT of pressure support, and may be encouraging centrals...

Question for you Palerider. When you say Pressure Support, are you speaking of how high their pressure is or a setting on their machine?

what Okie said