new member CPAP stats

[Tdew]

Hi guys,

Around two weeks ago I started my first topic here about the CPAP devices I got from my health care and asked for opinions.I'm happy to say that after two weeks of trying different machines (mainly - Resmed Airsense 10 and Weinmann Prisma SMART) I chose to go with the Prisma smart one. I know it's not popular here(as it's German and more popular in European countries), but it was the better fit for me. Also, I want to make a note that my mask is still a bit uncomfortable(the area where Weinmann lacks) and therefore I'll probably order the N20 or another companie's mask sometime soon as they were more comfortable when trying them.

Regarding the stats(and the reason for this topic) -

Unfortunately, SH doesn't support the machine(I'm willing to provide data and help to get it in the software if it helps) but currently the machine comes with software of its own. Hopefully, the experienced people in this forum can help me figure out the best configuration for me as it seemed pretty detailed and for some reason, I'm still waking up tired each morning. here are the pics:
https://imgur.com/a/ySKok
I added the general data for all of the time I've been using it(8 days) and the specific data for the past two days, 16/1, 17/1 as it seemed I slept overall better on those days than the previous ones(just a general feeling). I woke up less at night, and I'm not sure if its because I'm getting used to the machine or a coincidence. But it's still puzzling as I'm waking up tired, but might have more energy during the day.

If there's anything else I can provide, please let me know.
Thanks!

[Pugsy]

I will do the best I can with those reports.

What are your pressure settings? Looks like auto mode with minimum of 4 and max of 8...is that correct?

Do you often sleep on your back?

While the AHI is acceptable....your snores (not part of the AHI) at times are a bit ugly. Which makes me wonder why okay some parts of the night and not others and sleep position comes to mind.

How many hours of sleep are you averaging? Do you take any medications of any kind and if so what? How is your sleep quality...waking up much that you remember or sleeping soundly with minimal wake ups?

[Tdew]

I will do the best I can with those reports.

What are your pressure settings? Looks like auto mode with minimum of 4 and max of 8...is that correct?

Do you often sleep on your back?

While the AHI is acceptable....your snores (not part of the AHI) at times are a bit ugly. Which makes me wonder why okay some parts of the night and not others and sleep position comes to mind.

How many hours of sleep are you averaging? Do you take any medications of any kind and if so what? How is your sleep quality...waking up much that you remember or sleeping soundly with minimal wake ups?

Thanks you for the quick reply!
1) I do often sleep on my back..I feel comfortable sleeping on the sides normally, but I can definitely say that because of the mask I've been falling asleep on the back. Can imagine I automatically turn on my back if the mask bothers me when I turn to the side.

2) Yes, the min pressure is 4..and I'm almost positive its a max of 8(can call and check what the agent put)
3) I take ADHD medication, Ritalin, and I do it early in the morning so I'll be able to fall asleep early. I usually take it around 8am~ as if I wait until 9am+ it makes me stay awake untill 11-12pm.
4) I've been sleeping pretty bad in the past two weeks, mainly for waking up a lot by the mask being uncomfortable. There were even a few times where I just took it off mid-night, intentionally and unintentionally . I'd say the avg sleep time was around 5-6h more or less. But on the past two days I slept exactly 7h each while waking up considerably less and overall ''good''. but just as the other days I woke up feeling tired, so I'm not sure anything changed. I think I woke up less because I changed the position of the tube connecting to the mask and now it bothers me less when I turn around when I sleep.

Edit: also, it might worth saying that when I did my sleep test, the lab results showed that I have severe sleep apnea while sleeping on my back, and perfectly normal sleep on my side. So I guess I am indeed sensitive to sleeping positions..but I thought the CPAP should correct that no matter what position

[Pugsy]

Well cpap auto adjusting should take care of the variations in pressure needs from supine to on your side but you have to untie its little hands first or give it a better head start with more minimum.

Looks like the machine wants to kill the snores because we see it hit the max of 8 cm during the times when there are a lot of snores.
It would go higher if it could but its little hands are tied so it can't.

Snores are thought of as one of the first warning signs that the apnea is trying to collapse and that's why these auto adjusting machines will usually try to increase the pressure to prevent the snores from ever happening.
So you need to untie the machine's hands and let it go higher if needed. Now sometimes we can attack the snores from the other end...with more minimum and that is an option to try. If it were me I would increase the max to maybe 10 or more and see where the machine wanted to go and how effective was it at preventing those snores. Usually for snores without a lot of the other obstructive stuff like OAs and hyponeas it doesn't take a lot more pressure to deal with the snores. Heck...maybe allowing the machine to go to 9 might be enough.

Snores...early warning signs of the airway trying to collapse but in your case the machine is preventing further collapse into the realm where an OA or hyponea would get flagged.....and sometimes snores disturb sleep.
Anything that could potentially disturb our sleep is unwanted. Good solid sleep is one of our main goals because without it the AHI numbers really don't mean much.

Now as to how you are feeling during the day.
A lot of things have to come together to stand much chance of feeling and even then sometimes it isn't something quickly seen....or as quickly as we hoped.
Obviously we aren't going to feel so great with less hours than might be optimal.
Even with 7 to 8 hours of sleep if that sleep is fragmented with multiple wake ups during the night we won't have much chance of feeling the good numbers. Been there and done that myself because of issues unrelated to sleep apnea and remember...the machine can only fix the sleep apnea caused issues.

Wake ups from the mask for whatever reason...comes with the territory until we get fit, leaks, comfort and the brain to be okay with having an alien stuck on its face. Heck I think it was 3 months before my brain quit poking me and saying "hey dude, do you know there is an alien stuck on your nose and blowing air up your nose?" and I had no mask comfort or leak issues at all. It was just the brain alerting me that something wasn't normal.
Eventually the brain got okay with its new best friend but it took some time.
If you add in leak or comfort issues...going to take even longer.

Medications...some meds will mess with sleep quality or cause sleep maintenance insomnia because we just don't sleep as soundly. Least little thing can cause a wake up whereas without the meds me might sleep through that least little thing. Ritalin will do that....any of those meds can mess with sleep architecture and sleep quality. How much of your wake ups and poor sleep quality might be related to the Ritalin is unknown. Each person is different in terms of how they react to medications.

Could the snores be a factor in sleep quality even if maybe not horribly closing off the airway.....they sure can and for that reason (along with the fact that they mean the airway is trying to collapse) I would want to try to reduce their numbers if it were me.
Ever snore and wake yourself up? I have...it's very possible that the snores are a factor in poor sleep quality.

Finally....even if all the planets and moons and stars line up and we can get 7 to 8 hours of really sound sleep and the sleep apnea is very well controlled and medication side effects aren't messing with us and all that....sometimes we just don't become that new person first thing in the morning despite everything looking like we should. That happened to me. Finally got everything all lined up and while my other symptoms of sleep apnea went away...headaches, nocturia, need to nap during the day, etc....I just didn't wake up with that burst of energy that I read about people having.
I was wondering what was wrong and then I realized that I was expecting the machine to make me into something I never was in the first place....a morning person. I was wanting it to fix something that couldn't be fixed by the machine because I just was never a morning person anyway.
I was wanting it to make me into something that I never was in the first place even before the sleep apnea stuff came on (mine was menopause).

Doesn't mean we quit trying though...just means that we try to have realistic goals.
In your case there is still room for things to improve upon and who knows...maybe with improvement you will feel better first thing in the morning.
Gotta reduce the snores....reduce the wake ups from whatever the cause and routinely get 7 to 8 hours of good solid sleep. A handful of wake ups is normal...like after a REM cycle but any more than that and the sleep is so fragmented that you don't get the nice progression into each stage and the need % of each sleep stage and we need that for the restorative powers of sleep to work its magic.

[Tdew]

Wow, what a great response!
This is exactly why I joined this forum.. thank you I will keep an open mind and let my body and mind adjust to the device.

As per your suggestions, I tried to untie the machine hands a bit by raising the min to 5 and max to 10.5 (feel free to correct me if those are too low/high).
Also, as you emphasized on the snoring part I took the time to research and got to the machine algorithm guide(more or less). It's different than the user manual I got, but it has explanations about the different settings it uses. One that caught my eye was APAP Standard vs APAP Dynamic. The machine comes with Standard option by default. Do you think I should change it to dynamic? Here is the url for it:
https://www.docdroid.net/LPC2YQl/prisma ... tx#page=19
https://www.docdroid.net/LPC2YQl/prisma ... tx#page=16

Seems like Dynamic is targeting snoring..what do you think?

Thanks Again!

[Pugsy]

It does seem like Dynamic is more aggressive when it comes to snores but as to how much more aggressive we don't really know.
I don't think it is going to do much different in terms of response to OAs, hyponeas, etc. That's probably unchanged.

We have a similar type of difference in algorithms for auto adjusting between the ResMed brand and the Respironics brand.
ResMed responds faster and Respironics a bit slower/gentler in its response. It's necessarily just for snores though. It's all the obstructive stuff.
And some people do seem to do better with one brand over another but I think that most people would do okay with either once it the machine is optimally adjusted for how it wants to go about doing its job.
I know that I can use a lower minimum with the ResMed auto algorithm than I would need with the Respironics auto algorithm to achieve pretty much the same results in the "numbers". In terms of how I sleep or feel though...it's about the same with either brand but since I just like to use as little pressure as possible to get the job done I lean towards ResMed's way of doing things as being best for me.
But that's just me and doesn't mean that the next person would be like me.

Here in the US people don't often get to try different brands to see which might work the best for the individual. We get dispensed whatever the chosen DME wants to dispense and that usually means whichever brand they got the best wholesale price on equipment.
I have tried both brands because I have bypassed the traditional DME/supplier and just bought my machines privately. For me with my insurance and co pays it has been either a wash in terms of out of pocket costs or I have actually saved money by buying privately. Since by nature I like to experiment with stuff it has worked out well for me because I can do what I want when I want and I don't have the hassle of talking the DME or doctor into giving me something different just to try it.

So....with your machine you have 2 options in how it wants to do its job in auto adjusting mode and I know what I would do if it were me...I would eventually try both. You won't ever know how you will do with something until you actually try it yourself....and trying it won't hurt a thing so might as well give it a go.

I do think that a change in the minimum to 5 and max to 10.5 is a good choice. So that's a good place to start your experiments.

Do try to remember Science 101...keep your variables to a minimum so you can best evaluate any changes in results and repeat the experiment several times before going and changing something else.
We don't sleep the same each night so you need to get 4 to 7 nights before changing something else again. We can all have fluke off/bad nights and we can't go changing stuff daily based on one night that might have been a fluke night.
So unless the results of a change are just so horrible you don't want to risk repeating you need to give each experiment several nights before changing something else.

While there's no urgent need to increase that minimum...I would still increase it if it were me.
I know that changing both minimum and max is 2 changes but in this situation I don't think it matters all that much and the important thing is give it a good few nights trial.
What I would do if it were me would be try 5 min and 10 (or whatever) max and see where the machine actually wants to go in this standard mode for a week....and then switch over to the other mode with the same settings and see what happens.

I would just have to try the other mode just because it was there and it might do something different that might help my sleep quality.
Now it being a bit more aggressive could be a negative in terms of sleep quality but you won't know until you try.
I try everything I can get my hands on if I think it will stand the slightest chance of improving sleep or how I feel.