Am I running into limitation of having a cpap

[greenall]

Folks.

I have been on straight cpap for about 2 years now and have been pretty much on top of my numbers for that time. I monitor with sleepyhead, and do all that good stuff. Number is always less than 5. Usually varies between 2-4. Untreated my ahi was close to 70.
Pressure is a straight 15 (I may manually go up a bit when I'm especially stuffed up because of allergies), using the dreamwear full mask, with basically a 0 leak rate.

The last little while I feel the daytime sleepiness creeping back into the picture again. This morning I felt like crap. Looking at my graphs when this happens, I see lots of RE's, but the graph is basically shotgun. A bit of everything. My feeling is that since this is a bit of everything, a straight cpap is not going to resolve it.

Am I running into events that a straight cpap can't resolve? I've included few nights.. 1 good night, and 2 not so great nights for comparison.

Looking for opinions please

[Julie]

My first question when that mystery happens is usually - have you gained even a little bit of weight recently, because it can make a surprising difference... even 10 lbs.

Second Q - are you on any new meds? New stressed? New anything in your life, large or small?

And why aren't you in 'auto' mode with your (and my) machine?

[greenall]

weight gain.. Maybe 10 pounds over the last year.. (yeah, maybe a bit lazy.. (-: )
no meds, no other health issues besides hay fever.
This machine has no auto mode. Its a straight cpap machine.

[Julie]

Yes, but why? Autos do plain Cpap if you like, but not the other way around and many more people find the autos more helpful, more options for treatment, etc. plus the cost is the same to the insce. co. (and don't let the DME tell you different!).

[LSAT]

Yes, but why? Autos do plain Cpap if you like, but not the other way around and many more people find the autos more helpful, more options for treatment, etc. plus the cost is the same to the insce. co. (and don't let the DME tell you different!).

His machine is only 2 years old...you should have told him that 2 years ago.

[greenall]

should I have been given an auto.. yep most likely. Unfortunately back then this is what the doctor prescribed, and I didn't know any different.

Also, insurance wouldn't pay for an auto (said it wasn't required), and I didn't know any better.

Hence my question. Am I just completely screwed here given I have a straight pressure machine? If I was to just go out and straight by a machine and given these graphs what would you recommend, if any change at all?

[Pugsy]

Your machine will go up to 20 cm so you do have the option of increasing the fixed pressure.

As far as why the change....dunno but when I see reports where part of the night the pressure is obviously doing a good job and during some other times it isn't I wonder what changed to make that pressure no longer be doing a good job.
The 2 most likely culprits....REM stage sleep or sleeping on one's back more for some reason. The timing of your clustering of events when you likely need more pressure doesn't look like REM to me so I would think maybe you are on your back more.

[palerider]

I'd try bumping the pressure up 1 cm... see if that helps, then if needed, try another cm.

As to the '5' number, that may be what doctors bandy about, but it's really pretty crap... like getting poked with a sharp stick every 12 minutes, all night long.

[greenall]

Well, I bumped my pressure from 15 to 16 last night, and got some interesting results, though I'm having a hard time quite believing what sleepyhead is telling me. I think I might have run into some kind of bug.

A little explanation. First off, the display on the airsense says I ran with 3.5 events per hour which is higher than my normal. Sleepyhead says I ran a 0.60. I did take a nap yesterday afternoon at approx. 5:00 for an hour, and that shows up on my graph, but that was at 15 before I bumped the pressure, and notice that all of my events are showing up during that hour. If I take that hour and exclude it, sleepyhead is telling me I ran a 0.0 at 16 for the entire of last night. I just think that sleepyhead is somehow failing to mark events on the graph.

At this point, just call me confused, but hopeful.

[palerider]

Well, I bumped my pressure from 15 to 16 last night, and got some interesting results, though I'm having a hard time quite believing what sleepyhead is telling me. I think I might have run into some kind of bug.

A little explanation. First off, the display on the airsense says I ran with 3.5 events per hour which is higher than my normal. Sleepyhead says I ran a 0.60. I did take a nap yesterday afternoon at approx. 5:00 for an hour, and that shows up on my graph, but that was at 15 before I bumped the pressure, and notice that all of my events are showing up during that hour. If I take that hour and exclude it, sleepyhead is telling me I ran a 0.0 at 16 for the entire of last night. I just think that sleepyhead is somehow failing to mark events on the graph.

It wouldn't be the first time that SH was caught not showing flags.

Easiest way to find out is to zoom in and scan the breathing for longer than 10 second pauses.

Or you can turn on user flagging, and set it to the same levels that apneas and hypopneas are.. (I think it's > 50% reduction for hypos and > 90% reduction for apneas)... then rebuild your data.

[greenall]

I had a more thorough look through the graph, and yep, there are definitely some events in there that sleepyhead just isn't flagging. At this point, I think I'll just leave at 16 see what surprises tomorrow's data brings.

[greenall]

Better night last night. Sleepyhead is acting correctly and marking events as normal. Was tired so went to bed early, ran a 2.72 all night. If you toss out the bit of waking up crap at the end, its closer to 2.00. Had a few leaks at the beginning until I woke up and re-adjusted the mask. After that, basically no leak. Feeling not to bad, Lets see how long the gas tank lasts today.

[palerider]

You don't need pressure, mask pressure, or resp rate charts... the two pressure ones are completely irrelevant, since you're on fixed pressure

[greenall]

Yeah I realize that.. That's what I get for posting in a rush just before heading out for the day.