Sleepyhead data, help?

[DaisySmith]

Guys I have really tried to figure out how to read this data but I really cant. I got the Tap Pap mask and it appears to be making things worse but I cant really tell. My AHI definitely went up.
https://imgur.com/a/vUG42

Is Apria supposed to be helping with this stuff? (My DME) Im almost afraid to show my data to them because I bought the mask on my own (they dont carry it) and I change my settings sometimes. Im pretty sure nobody gives a #@! about how well Im sleeping, they just probably have alerts if I'm not being compliant.

[Ron AKA]

Guys I have really tried to figure out how to read this data but I really cant. I got the Tap Pap mask and it appears to be making things worse but I cant really tell. My AHI definitely went up.

Here are my initial suggestions based on that one chart. It would be better to look at several nights that have used the same settings. But assuming this is typical:

1. Increase minimum pressure to 8 cm - This should keep your pressure a bit higher and reduce the number of obstructive events. With a little experience there, then you might want to increase that again to say 8.5. What you are trying to do is keep the pressure up above where at least some of the obstructive events are occurring.
2. Reduce maximum pressure to 14 cm - This is not going to do much, but limiting the maximum pressure can make wear more comfortable, as long as it does not cause events when the pressure is limited.
3. For comfort you may want to consider using the ramp function. Set ramp time to say 15 minutes, and initial ramp pressure to 6 cm. This will start your treatment at 6 cm which should be comfortable and ramp it up to 8 cm by about the time you go to sleep.
4. It looks like your EPR is set kind of low at 1 or 2? I would leave it there if you find use comfortable.

To make your SleepyHead graphs more useful I would recommend you read the link below in my signature and use the tips to maximize the use of of your screen. i.e. kill the Calender and pie graph so more of your settings are displayed. If you read the link on posting data as an attachment to the post, it is probably an easier way than using Imgur.

Oops. I haven't added those links to my signature yet... Here is the one on how to organize the layout. Just use the attachment feature here to attach your image you capture with the F12 screen capture feature in Windows.

Optimizing Layout

[Julie]

Given that you just joined today, I won't say too much here, but I would certainly not lower her max. pressure to 14 now, not going to help anything and could create new problems. I also would raise her pressure less quickly, possibly to 7 over a few nights at least.

Apria will not help at all with any of this - their job is to sell, sell, sell and be very difficult to deal with as well. Don't expect help from them in any respect.

What did your AHI go up from?
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I would also not re-introduce the ramp unless for some reason you're having real difficulty adjusting to the initial air coming in when you first start out at night. Most of us don't use it at all.

[Ron AKA]

Given that you just joined today, I won't say too much here, but I would certainly not lower her max. pressure to 14 now, not going to help anything and could create new problems. I also would raise her pressure less quickly, possibly to 7 over a few nights at least.
I would also not re-introduce the ramp unless for some reason you're having real difficulty adjusting to the initial air coming in when you first start out at night. Most of us don't use it at all.

Increasing the minimum to 7 will do essentially nothing based on the chart posted. It would only clip a tiny little bit off the bottom of the pressure at 5:15 when there were no events in any case. It would take 8 cm to see an improvement from the minimum pressure increase.

The reason you lower maximum pressure is to see if it causes any events. Limiting the maximum pressure a bit is often helpful. See attachment of where max pressure is limited and no events are caused by it. There is one CA event, but those are not prevented with higher pressure and may even be caused by higher pressure.

Yes, I suggested the ramp only be considered if there were comfort issues when falling asleep. I use it, and find it quite comfortable and without any issues. I think the biggest mistake that is made in using the ramp feature is not setting the ramp starting pressure. Then it defaults to start at 4 cm which can be quite uncomfortable. If you set is at 6 or 6.5 it usually is quite comfortable.

[DaisySmith]

screenshot-20180403-214446.png (104.72 KiB) Viewed 1130 times

[DaisySmith]

This is another night with my Dreamwear mask for contrast

screenshot-20180403-214936.png (103.62 KiB) Viewed 1127 times

[USMCVet]

Personally I would put max at 20. I think ideally your min needs to be 12 with this new mask. That said I would slowly increase up to that keeping an eye on you central apneas.

[TASmart]

Personally, your events are low, no major leaks, I would leave well enough alone. Your therapy is working as designed.

[Pugsy]

I think I agree with TASmart. I wouldn't go messing with anything at this time.
Certainly wouldn't be upping the minimum from 5 to 12. Talk about using the A bomb to kill a fly when a good old fashioned fly swatter would get the job done just as well.

And I wouldn't be changing anything based on one night with a new mask. I would give it at least week to settle in first.
Going to the TapPap is a big change and some of that increased events could simply be SWJ not real stuff.
And going from AHI of 1 or less to a little over 2....far from being horribly worse even if they were all real events and none were SWJ.
I see bigger changes and never change a thing quite often.

And I never ever advise a change unless I also asked about sleep quality in general and how the person feels in general.
You guys that like to chase numbers only...that might be fine for you guys but I won't do it. Numbers alone don't mean much. IMHO.
No one here that is suggesting more of anything or changing anything bothered to ask about sleep quality, wake ups, or how Daisy was feeling in general.

So to Daisy....some questions.
Was this the first and so far the only night with the new TapPap mask?
How was your sleep quality in general? Did you wake often during the night? How would you rate your overall daytime feeling?
Yes...this one report is a bit uglier than the other 2 reports you shared in terms of AHI numbers but it's a new mask and a totally difference concept with the mouth guard thing and it can take a bit of getting used to. It's still not a horrible report by any means.

The Snore graph isn't all that helpful here but the Flow Limitation graph might be more helpful. Could you omit the snore graph and include the flow limitation graph instead? I prefer the FL graph over the snore graph myself. I figure I can always ask for any other graphs later if I should need them. 5 graphs (Events, Flow rate, pressure, leak and flow limitations) are about all we can get in one screen shot that lets the graphs be of a size for easy evaluation.
Maybe just redo the image for the reported April 2 with the new mask.
Or see what last night showed with the TapPap if you used it last night.

As to your questions about the DME helping? Good luck on that one. You are doing good with Apria if you get what you ordered.
They don't really do therapy evaluation....that's the doctor's job. Given Apria's history I don't know that I would trust anything they said even if they did do software evaluation. I can pretty much guarantee that at the most all they would look at is the overall AHI (and if it is less than 5.0) and maybe leak...and hours of use...and if all that meets minimum requirements they won't look further.
Don't be afraid to tell anyone you bought a new mask on your own but don't expect much help from them about a mask they aren't familiar with in terms of fitting. Again they barely can help with the masks they do supply.

[Ron AKA]

First off, you have done a great job in optimizing your SleepyHead layout. With the two additional days of data I would not change my original recommendation. Increase the minimum to 8 cm, reduce the maximum to 14 cm, and set a ramp start pressure of 6 and a length of 15 minutes. In the end you may find you can reduce the minimum a bit from 8 cm, especially on the Dreamwear mask. However, I would not do it until you gather at least 3 nights of data.

And if you are concerned about reducing your maximum pressure, I was too when I initially did it. While I am new to apnea, I have been adjusting my wife's ResMed S9 for over 3 years now. At first I thought, OMG what if she runs out of air in the middle of the night? Is her insurance paid up? Well, then if you think about it longer, consider that when you sleep and do not use your CPAP at all, your maximum pressure is effectively set at 0 cm. So, there is no great danger, other than it may cause a few extra events. And unfortunately there are a few events possibly related to sleep position, that are not preventable with pressure anyway. And if you are susceptible to central apneas, CA in SleepyHead, more pressure can increase them in some cases.