Optimising Treatment (inc. pics)

[Dansworth]

I've recently bought a DreamStation Auto CPAP machine, after reading about my old/bricked Resmed S9 Escape and how it was pretty obsolete compared to newer machines.

On the first night, I kept to regular CPAP - I tried the pressure settings given to me by my NHS technician, 4-11cm. Here are the results:



Then on the second night, I tried to Auto CPAP and here are the results:



The AHI numbers are pretty low, but I'm wondering if they could be better or if anything looks amiss? The AHI numbers are actually higher on my machine/DreamStation app, so not sure which is accurate?

There also seems to be a lot of leakage, although it feels snug when it goes on. Just been watching a couple of YouTube videos, and potentially the jaw relaxes which lets air in when I'm actually asleep? They suggest a gum shield to keep the jaw together.... thoughts?

Any thoughts on the data would be greatly appreciated. Let me know if you need anything else and/or a better screenshot with more information.

Thanks

[Julie]

Are you sleeping on your back?

Please post again if possible with no calendar, but let the typed results on the bottom left show up - they're important. Your treatment's not optimal - lots of snores which more pressure might help, and too much leakage, but let us see the report properly to see your pressure settings etc.

[Dansworth]

No, I sleep on my side. Potential leakage from that?

Here's the pics without the calendar, hopefully you get the info you need.

Day 1 (CPAP)


Day 2 (Auto CPAP)


Even if the AHI is low, with all the leakage, does that effect my apneas/significantly impact treatment?

Thanks

[Julie]

You need to raise your min. setting to e.g. 7 (it's at the machine default low now of 4 and not good for much at all, including being able to inhale comfortably), and see how things go for 1-2 nights. Hopefully your snores will be addressed more fully. Leave the max alone for now.

Someone more familiar with your mask fitting should be along soon, because it's pretty bad. Have you tried other masks? It's ok to have some leakage, but maybe not so much as you're having.

[Pugsy]

In your second set of images you seem to have the fixed pressure image posted twice and not the APAP image.

Turn off the pie chart...Preferences/Appearance tab and remove the check mark for show pie chart.

I don't know how you are doing your images but I could only enlarge one of them so that I could read the statistics numbers on the left and unfortunately it was the one with fixed pressures so the statistics didn't help much.

How are you fitting the mask? Are you fitting it at the beginning of the night when using the ramp and the 4 cm pressure?
If so...don't turn the ramp on during the fitting because the seal you get at 4 cm isn't going to work so great at fixed 11 or higher in apap mode.
While the leaks are a bit ugly the AHI is probably accurate. With Respironics machines the AHI is still fairly accurate until someone gets large leaks in excess of 100 L/min total leak. Are those leaks waking you up?

My suggestion..
APAP mode..
Minimum of 7 and max of 20 ( might even need more minimum but let's see how much your machine wants to move around once it has a more optimal starting point).
Fit your mask to the 7 cm pressure and then push the ramp button only if you need it to fall asleep.
See if you can eliminate the wildly varying pressures to start with by using a more optimal minimum pressure and at the same time fit the mask at the higher pressures to increase the chances of reducing the large leaks.

Is your hose moving around on anything that might be creating some hose movement noise that might explain the VS2 snores?

[Pugsy]

Review this thread

viewtopic/t158560/How-to-post-images-for-review.html

See if you can figure out why we can't enlarge your images to better see the numbers or just use imgur or the attachment feature available here.

Do a better job including all of the leak graph. You should be able to show 4 graphs and not have any of the graphs be very small.
You can resize the graphs.
No need to redo these images but mentioning this for future reports with the changes in pressure implemented.

[rick blaine]

Hello again, Dansworth,

I see you've bought your own machine. Good. You've done something positive for yourself.

Here's something your sleep technician doesn't seem to know:

In the auto-adjusting mode, and for most cases, the machine does best when its minimum is set not more than 1 cm or 2 cm below the median or average. There's an explanation why this is so, but I'll save that for another time.

You can get that median/ average after a few nights - say, seven - from Sleepyhead. In 'CPAP Statistics', it shows both the average for each night and the average over however-many nights.

Also, in the auto-adjusting mode, there are very few reasons not to have your 'top of the range' (currently at 11 cm) at the machine's maximum – which is 20 cm.

The machine's algorithms 'know what they're doing'. If they don't need to go much above 11, then they won't.

And if they do go much above 11, then that tells you and us something.

So, better to have your max at the machine's max – for the moment. If you start to swallow air into your stomach, or higher pressure wakes you up, then we/ you can adjust it downwards again.

As to jaw dropping open, a separate and additional strap is one way. You can get a chin strap from Eu-PAP/ Intus in Reading, England, or from Hope2Sleep – also in the UK – and both are on the internet.

Another, cheaper way to keep your chin up is just a length of micro-pore tape. You can get micro-pore tape from Tesco's – 5 metres for 50p.

[Pugsy]

Hey Rick,

He's using 20 cm max in auto mode. He's just got one of his reports mislabeled as apap but it's not apap mode...it's fixed at 11 cpap mode. He's shown the fixed night twice in his last set of images...
To see apap mode night need to look at his first set of images.

[rick blaine]

Hi Pugsy,

Got it. My bad.

[Dansworth]

Thanks all.

I've set the machine to Pugsy's settings and I'll give it a few days before posting the results here.

I have a Chromebook, which doesn't work with SH, so using a really old Windows laptop for SH, which makes things pretty difficult. I'll do a better job of getting some decent screenshots next time though!

Last night I had no leaks, but a higher AHI (4.6). But I'll get a few more night's data before posting it up here to see if there's a trend.

Thanks again for your help!

[Dansworth]

HI,

So a few more days have passed and I've got an admission to make - I made an adjustment to the pressure after 2 days.... I did this because my DreamStation App said my AHI was 4.7 on Sunday and 4.2 on Monday. My 90% pressure was around 14, so I upped my minimum pressure to 11.5/12 (that's what I'd read was a good suggestion on the Forum elsewhere - drop it 2cm under your 90% pressure). However, maybe the median pressure is more informative?

However, to my surprise after uploading my data to SH just now, my AHI on Monday was 2.75 rather than the 4.2 reported on the DreamStation App.

I won't make any further adjustments from now on without the say so of those in here! I guess my excitement/impatience got the better of me. Soz.

Here's the data:

Sun - 7/20


Mon - 7/20


Tues - 11.5/20


Weds - 12/20


I'm also aware that it's quite a small sample size of data, so realistically, how many days do I need at a certain setting before I make an informed decision about changes?

Thanks again.

[palerider]

You *REALLY* need to stop shrinking your images, they're fuzzy and hard to read.
I don't know if it's you doing it, or the site you're uploading them to.

You can attach pics to the post directly, or use imgur, instructions below.

The 90% number is something that people that don't know much talk about, all it is, is the max you got to, without any brief spikes. It's NOT a good way to set pressure.

Bump it up to 13.

[Pugsy]

I would also suggest bumping that minimum up to 13.
I don't see much sense in waiting in this situation.

What position do you think you sleep in? Side...back or both....which one primarily?

90% pressures aren't the holy grail that some people think they are in terms of settings. Yes, they can sometimes be helpful as a guide but they can also be worthless for some people because they are easily inflated.
All a 90% pressure is...by definition it's a number you were at OR BELOW for 90% of the night. They fail to understand the "or below" part of the definition.

Is this machine a loaner or a forever machine?

[Dansworth]

This is a forever machine. I hope so, as I bought it myself!

I tend to sleep on my side.... At least I fall asleep on my side anyway.

I'll give min pressure 13 a go then. Thanks.

As a side note, what AHI should I be aiming for?
Also, is it just a matter of finding a sweetspot? Should I be worried my AHI is 4+ on min. 7 and 11? Or is it just trial and error?

[Pugsy]

For me it's not so much the AHI as it is a combination of AHI and what else I see reported/flagged and how a person is sleeping and feeling.

The minimum of 7...kinda doesn't really matter much what that minimum is because the machine goes up because it spots something it doesn't like and it pretty much stays up there anyway. It's not like it bounces around and back down to 7 a lot anyway.
It goes up and wants to stay up...might as well give it a better head start since it is going to be up there anyway.

Let's see what the minimum of 13 does in terms of cleaning up some of those snores and see if the AHI comes down a little.

And when you report tomorrow please include how you think you slept and feel. That's just as important as the AHI if not more important.

The snores bother me more than the AHI at this point because the snores mean that the airway is still trying to collapse and often. They are the first warning signs that the airway is trying to collapse. We probably can't kill all of them but I would like to see less of them especially less in clusters.
If you could get an AHI around 2 ish...with less snores AND you report to sleeping fairly decently and feeling fairly decent...then I would be satisfied with AHI 2 ish or 3 ish. If you don't report feeling good and sleeping decently...then we try for even lower AHI.
And maybe at the same time start looking at other potential culprits for not sleeping or feeling so great.