1 Month Newbie Check-in

[mcguirejohnr]

Been using a Dreamstation APAP for just over 30 days now. Sleep test pegged my AHI at 57 and I seem to pretty regularly stay around an AHI of 1 while on therapy and I not having any big issues other than mask leaks in the early AM hours waking me up. Working my way through Dreamwear, F20, F30 and Simplus so I am sure I will find a winner soon. My doctor started me at 5/20 pressures but moved them down when I reported dull headaches all day and that is starting to get better. He moved me to 5/10 and my AHI went uo to around 5 levels so I self adjusted to 5/13.5 and seem to have found a pretty good spot. I do always have tons of Snores reported in Sleepyhead. I am wondering if I should adjust the bottom pressure higher? Followup doctor appointment on Monday to get it all squared away with an updated RX so my DME stops overwriting my pressure changes back to the current 5/10 RX.

I "think" I have attached the Sleepyhead screenshots correctly.

screenshot-20181103-142631.png (91.35 KiB) Viewed 3969 times

[mcguirejohnr]

Flow rate did not show up so trying again.

screenshot-20181103-143642.png (94.91 KiB) Viewed 3967 times

[Snoregone Conclusion]

Snores and flow limitations are what the machine reacts to for determining the required pressure to prevent future events, and you’ve got some impressive snores and the machine trying to adjust accordingly.

I would definitely raise the bottom pressure, 5 seems rather low from what is visible. Consider it gets to 14 around RERAs, and it may even possibly go higher if you let it. If you start out closer to the max pressure you see it reaching now, you should likely see fewer events that cause it to raise the pressure at all, and lower magnitude of pressure raises when it does it. By way of comparison for snores, my scale shows 0-1.0, and my most significant snore is .38. Since I’ve found myself pre-treatment waking up just from the snores alone, that’s a major goal to eliminate that. Also, vibratory snores cause damage over time that causes things to get worse. You seem to have a lot of range you can jump up for your minimum pressure, the question will be purely that of what you’re comfortable doing for a starting pressure.

You need to scream at your DME to cut it out, perhaps put your machine in airplane mode.

[palerider]

My doctor started me at 5/20 pressures but moved them down when I reported dull headaches all day and that is starting to get better. He moved me to 5/10 and my AHI went uo to around 5 levels so I self adjusted to 5/13.5 and seem to have found a pretty good spot. I do always have tons of Snores reported in Sleepyhead. I am wondering if I should adjust the bottom pressure higher?

Your doctor, *shaking head*... Your doctor is why this forum exists. The max pressure is irrelevant for most people, and does nothing to help, especially reducing it.

What you need is more MIN pressure, as you wonder... I'd try min 9, max 20. (just get the max out of the way and don't restrict the machine from doing what needs to be done to prevent apneas and other breathing disturbances.

[palerider]

. By way of comparison for snores, my scale shows 0-1.0, and my most significant snore is .38.

You cannot compare the reporting of your Resmed with the patient's Respironics when it comes to snores, there is no relation.

[Snoregone Conclusion]

. By way of comparison for snores, my scale shows 0-1.0, and my most significant snore is .38.

You cannot compare the reporting of your Resmed with the patient's Respironics when it comes to snores, there is no relation.

Good to know...

[mcguirejohnr]

Thanks for the feedback. It seems like my "hunch" could be correct...a higher min pressure. No issues with comfort so I think I will give it a try. I would consider moving the max pressure up but the current lower setting does seem to have helped the headaches a little. I was hoping there would be some period of time to acclimate and they would go away but so far they linger even at just 13.5 max pressure. For the next few nights I think I will try 9/15 pressures and see how that goes. Lots of learning to do on this topic. I have already learned that running this through my insurance yielded next to nothing. I will end up paying around $900 for the Dreamstation with humidifier that I could have purchased direct for much less. I made direct purchases of a ResMed Autoset 10 and a ResMed AirMini for my lake home and travel...and the sum of those two costs less than the one machine via the insurance DME.

[Jas_williams]

As you have a Resmed Autoset as well then when your outside of the compliancy period it might be worth posting graphs from that as the Resmed tends to respond faster and provide lower AHI withou adjustment. The Philips can match the Resmed treatment but only when it’s settings are optimised to your pressure needs which is a higher minimum pressure

[palerider]

I would consider moving the max pressure up but the current lower setting does seem to have helped the headaches a little. I was hoping there would be some period of time to acclimate and they would go away but so far they linger even at just 13.5 max pressure.

The lower max is unlikely to have anything to do with your headaches, (at least, based on the chart you posted). You didn't hit it for long, most of the time the pressure was well below it.

Headaches are, iirc, usually due to not getting *enough* air, (ie, low oxygen, or excessive CO2) and raising the minimum pressure will help with that.

I have already learned that running this through my insurance yielded next to nothing. I will end up paying around $900 for the Dreamstation with humidifier that I could have purchased direct for much less.

Well, is it too late to take the DS back (the autoset is a better machine, anyway), and tell them to shove their overpriced stuff?

[mcguirejohnr]

Ran pressures at 9/14 last night and had an AHI of 0.2 which is my lowest since starting therapy. It "seems" like I have less headache today but likely too early to tell for sure since it is only one night. Ill probably move to 9/15 tonight. I will post last night's SleepyHead charts soon and we will see if the higher low end pressure reduced the snores. Thanks for the feedback so far.

[mcguirejohnr]

Latest screen shots.

screenshot-20181104-102817.png (96.76 KiB) Viewed 3900 times

screenshot-20181104-102933.png (89.95 KiB) Viewed 3900 times

[Pugsy]

No need for 2 images...I assume the second one to include the snore graph which really isn't needed on the Respironics reports because the snores are easily seen on the Event graph because snores are flagged like any other event.
The first image is usually all we need and you can save yourself some work by just doing the first one.
If anyone needs anything else they can just ask.

For an explanation about the VS and VS2 snores see this
viewtopic.php?f=1&t=155478&p=1182872#p1182872 you may need to scroll up to the top of the thread to see what forum member RobySue wrote.

Usually frequent snores are a sign that the airway is still trying to collapse. In your case the airway trying to collapse doesn't seem to proceed further to the point of the other event flags. Usually just a little more minimum is needed when the number of snores is a problem.
The snores themselves can disturb sleep...cause you to wake up and you may or may not remember it.
You also did hit the max for a short period of time. Unless a higher maximum is a problem I would suggest just letting the machine sort it out but since there wasn't apparently many flagged events during that max limit time...probably not the end of the world to limit the max if going higher causes problems like aerophagia or something.

[palerider]

Ill probably move to 9/15 tonight.

10-20

Remember what I said about the max pressure.

Your improvement is because of your higher MIN pressure.

[mcguirejohnr]

I think you are right. 10/20 is going into the machine now.

[mcguirejohnr]

A good number of days now and I am having very good success with the higher minimum pressure setting...thanks for the help and suggestions.