Dreamstation AHI # and General Help

[griz31]

Are you having any dry mouth?

If those were my charts, I would set the machine to APAP mode with min pressure 4.0 and max pressure 8.0. Let the auto function do some work and see if it can reduce the number of events. The chart should be reviewed after one night with the changes.

I'd suggest at least 5 for min, 4 is too low, based on the single pressure, maybe even 6-10cm.

Thanks for the input all. I'm not experiencing any dry mouth.

Are there any risks involved with changing the pressure:
1. Any health risks? Sorry if that's a silly question.
2. Any compliance risks? Like will insurance not cover if you are not in compliant with doctor prescribed recommendations?

Thanks,
Jon

[ChicagoGranny]

Any health risks?

- Higher pressures can induce central apneas in some people. But, I assume you did not have central apnea as part of your diagnosis. You have obstructive apnea, right? In any case, if you raise your pressure, you can check the next day whether any central apneas occurred.

- For most people, higher pressures are only a matter of potential discomfort.

Like will insurance not cover if you are not in compliant with doctor prescribed recommendations?

You have to be using the machine for most insurances to pay. I don't know of a case where the insurance company checked actual machine setting against prescribed settings.

Periodically, your insurance company may require a certification that you are using the machine. This can be done by a DME or a doctor's office. You can take the machine SD card in, and they will prepare a report and forward it to the insurance company.

What kind of insurance do you have, and are you in the U.S.?

[yaconsult]

Wow, you've got a good auto machine that is detecting your events and is well able to treat them but someone has it up to prevent it from doing so! This is very strange - maybe they pushed the settings button once too many times and didn't notice. Suggest you change the mode from cpap to auto and see how you get on. The pressure will only go up as high as it needs to. You need to download the clinical manual if you don't already have it. Use sleepyhead again and see what the data looks like.

[griz31]

For most people, higher pressures are only a matter of potential discomfort.

Thanks, I will try to adjust the settings and post an update.

Periodically, your insurance company may require a certification that you are using the machine. This can be done by a DME or a doctor's office. You can take the machine SD card in, and they will prepare a report and forward it to the insurance company.

What kind of insurance do you have, and are you in the U.S.?

I am in the U.S. and have Anthem BlueCross Blue Shield. I do own the machine and am not renting it (my insurance didn't offer any other option). I believe they will continue to pay for replacements parts and what not which is why I was curious.

Wow, you've got a good auto machine that is detecting your events and is well able to treat them but someone has it up to prevent it from doing so! This is very strange - maybe they pushed the settings button once too many times and didn't notice. Suggest you change the mode from cpap to auto and see how you get on. The pressure will only go up as high as it needs to. You need to download the clinical manual if you don't already have it. Use sleepyhead again and see what the data looks like.

Thanks - I am planning to make some adjustments!

Thanks
Jon

[griz31]

Are you having any dry mouth?

If those were my charts, I would set the machine to APAP mode with min pressure 4.0 and max pressure 8.0. Let the auto function do some work and see if it can reduce the number of events. The chart should be reviewed after one night with the changes.

I'd suggest at least 5 for min, 4 is too low, based on the single pressure, maybe even 6-10cm.

Thanks for the input all. I'm not experiencing any dry mouth.

Here are the charts from the latest adjustments. I'm not sure I feel a bunch better, but I do actually remember dreaming last night which hasnt happened in awhile.



Any suggestions on the new info?

Thanks,
Jon

[palerider]

I suggest 7.5 min, 10 max.

[griz31]

I suggest 7.5 min, 10 max.

Palerider, can I ask how you came to this? Looking at the info - it looks like the average level was 5.6 so would that not be the minimum? Just curious how you picked those suggestions!

Thanks,
Jon

[palerider]

I suggest 7.5 min, 10 max.

Palerider, can I ask how you came to this? Looking at the info - it looks like the average level was 5.6 so would that not be the minimum? Just curious how you picked those suggestions!

you have to go beyond trying to summarize the night into a couple numbers.

look at your pressure traces, look at the events that are happening at what pressures. sure, your average pressure may be 5.6, but you're still having a lot of hypopneas at that pressure. it's not until you get well above that level that your breathing gets better.

the 10 is just an off the cuff, normally, I'd say max at 20, but some new people get scared, not realizing that normally, with rare exceptions, the pressure won't go much higher than is needed.

the minimum pressure is typically the most important, you want it high enough to curb most events before they happen, and leave the exceptions (rolling on your back, rem sleep, etc) to the auto function.

[griz31]

I suggest 7.5 min, 10 max.

Palerider, can I ask how you came to this? Looking at the info - it looks like the average level was 5.6 so would that not be the minimum? Just curious how you picked those suggestions!

you have to go beyond trying to summarize the night into a couple numbers.

look at your pressure traces, look at the events that are happening at what pressures. sure, your average pressure may be 5.6, but you're still having a lot of hypopneas at that pressure. it's not until you get well above that level that your breathing gets better.

the 10 is just an off the cuff, normally, I'd say max at 20, but some new people get scared, not realizing that normally, with rare exceptions, the pressure won't go much higher than is needed.

the minimum pressure is typically the most important, you want it high enough to curb most events before they happen, and leave the exceptions (rolling on your back, rem sleep, etc) to the auto function.

Thanks for the insight and explaining it a little more so I could understand better. Really appreciate everyone's help while trying to figure this all out.

Thanks,
Jon

[palerider]

Thanks for the insight and explaining it a little more so I could understand better. Really appreciate everyone's help while trying to figure this all out.

Thanks,
Jon

hopefully, it makes some sense... to really get a very good idea what you need, zoom in with SH, and look at what pressures you are at when you have events... it'd be great if SH would add that to the event list.... however, you can see, with a bit of work, "well, when it's this low, I have problems when it's above ... say.... here, I have less problems...

[griz31]

hopefully, it makes some sense... to really get a very good idea what you need, zoom in with SH, and look at what pressures you are at when you have events... it'd be great if SH would add that to the event list.... however, you can see, with a bit of work, "well, when it's this low, I have problems when it's above ... say.... here, I have less problems...

That is very helpful as now I am starting to understand how to read the charts.

How long should you leave the machine at a setting before making any new adjustments? Is it frowned upon to try and readjust every night at the beginning?

Thanks,
Jon

[robysue]

How long should you leave the machine at a setting before making any new adjustments? Is it frowned upon to try and readjust every night at the beginning?

Our OSA is not the same every night AND it takes a while for the brain and body to acclimate to any change in the script. Some of us are more sensitive than others to changes.

It's also important that CPAP data is best thought of as "trending" data. In other words, you don't want to over react to one bad night if the overall trend is good.

I would recommend leaving the machine at the new settings for a minimum of 3 nights. If it takes you a while to adjust to changes in your sleep environment, I'd suggest leaving the machine at the new settings for 4-7 days.

It's also important to not change more than one thing at a time. When you change multiple variables, it's hard to tease out which variable is the important one.

[griz31]

Our OSA is not the same every night AND it takes a while for the brain and body to acclimate to any change in the script. Some of us are more sensitive than others to changes.

It's also important that CPAP data is best thought of as "trending" data. In other words, you don't want to over react to one bad night if the overall trend is good.

I would recommend leaving the machine at the new settings for a minimum of 3 nights. If it takes you a while to adjust to changes in your sleep environment, I'd suggest leaving the machine at the new settings for 4-7 days.

It's also important to not change more than one thing at a time. When you change multiple variables, it's hard to tease out which variable is the important one.

Makes total sense. In the context of the previous recommendations,I made the initial changes (going to APAP 4-8). Before trying the new recommendations (APAP 7.5-10). I should wait a couple days to see if, in fact, I tend to have most of my events below the 7.5 threshold. (So far at 2 nights where most events seemed to be triggered when pressure was in the 4-6 range)

Thanks,
Jon

[palerider]

I have a slightly different view than RobySue does.

for the first few nights, right at the beginning, I think that making significant changes is fine, especially if you're starting out with a default setting machine (typically 4-20), look at your data every day, and adjust till you've got the lower pressure in the ballpark, taking account of other issues you may have (dry mouth, bloating, etc).

when you're "in the ballpark" pressure wise, then I'm in complete agreement, make small changes, let things settle, because it's very true, you'll have better and worse days without any changes at all to the machine, the biggest variable in the whole equation is you, the squidgy, imprecise, funny shaped bag of water.

[ChicagoGranny]

I suggest 7.5 min, 10 max.

+1

for the first few nights, right at the beginning, I think that making significant changes is fine, especially if you're starting out with a default setting machine (typically 4-20), look at your data every day, and adjust till you've got the lower pressure in the ballpark, taking account of other issues you may have (dry mouth, bloating, etc).

+1