Increase in events.

[JustWondering]

Hello all! New to the site but not new to cpap.
I was prescribed a machine about 15 years ago and hated it so much that it ended up in my closet after a few months of not sleeping. Side/stomach sleeper, huge mask which never worked well [leaking due to sleeping on stomach] fighting with a hose wrapped around my head [human heads should not have hoses wrapped around them] and feeling suffocated all the time. I gave up.

Last year due to a minor health question I was sent for another sleep study and found I had moved up from the "mild" category of 15 years ago to "moderate" at 19.6 AHI. It was suggested to me by my sleep doctor that based on previous lack of success, I should try an APAP machine vs. CPAP. Great, I'm in.

This time around I found that I did get use to using the machine, and over the past 7 weeks of using my new ResMed AirSence 10 Autoset For Her I feel that I am sleeping well enough. Newer technology I guess. There are still moments at night when I wake up because of the need to roll over and that damn hose is there again, but the mask is working well.
My machines range for pressure was initially set to "5-12". 5 still leaves me with a sense of suffocating and I could not fall asleep. Of course I found my way into the deeper levels of the machine's settings and I have since bumped the "5" up to 7. MUCH BETTER. I can fall asleep much easier now. Now if I were to be on CPAP my prescribed pressure would be 8.2, so why on APAP would the lower limit be at 5. At 5 I still feel like I can't inhale enough air and this was one of the reasons why things did not work 15 years ago and WHY the doctor suggested APAP. I understand the idea of the autoset feature going higher if needed, but if CPAP settings would have been 8.2, why start so low?

So my question, you ask?

The first few weeks my AHI was usually below 2, even below 1 at times. I was very happy with that. But the last 3 nights I went to 2.5, 2.5, and 3.2. I am wondering what caused the increase? There are two things different now.
One: I have changed settings on the machine.
Two: The last three days I have been back to work after the Christmas holidays.

Also, when waking up in the morning I noticed the actual autoset numbers on the display up around 8-11 lately. The first few weeks it as hovering around 5-6?

Are the settings to blame, and should I go back to 5-12? I don't know how that might effect my ability to fall asleep initially.

Sorry for the long-ish post.

[Dog Slobber]

1. Download Sleepyhead - https://sleepyhead.jedimark.net/
2. Read the pinned topics, especially the one about presenting Sleepyhead graphs
3. Post SleepyHead graphs
4. Profit!

[JustWondering]

Ya, well...not sure if I want to go the Sleepyheads route. I had a look, and to download the software there was a prerequisite to have a bunch of other drivers downloaded. I'm always cautious of that.

Secondly, I often think that too much information is distracting and results in a lot of unwanted and misleading information. Kind of like googling stuff about ANY health issues. I've done that and before you know it you have seventy five different diseases and are close to death. Not sure how far I want to deep dive ALL the results that Sleepyheads will provide.


So I was hoping for some actual suggestions here. I might look at the software again sometime though.

[Julie]

How do YOU think being back to work might affect your sleep? We can't really guess at that.

I wouldn't be concerned about why your settings (and results now vs 15 yrs ago) are a bit different - your body changes over time, OSA changes, etc. etc. and you should just concentrate ion how you're doing now... Apap works differently from Cpap so you can't really compare the numbers. Your doctor did the '5' setting because doctors do that - not understanding that with Apap pressure will rise to address events, but you need to help it a bit more than using such low (machine default low is 4) ones if events occur much higher (e.g. 10) to catch up on time to do the job... it does take time to reach higher numbers. Doctors understand the science of OSA, but not necessarily how machines work best. You might want to try 8 instead of 7 and see how things go, but leave the max setting at 20.

Btw, TMI is NOT a bad thing when it comes to your health... and SH is 'the' go-to place for info - almost everyone uses it here and it can only help (plus save time once you get set up correctly).

[JustWondering]

OK, I did install the software from your link, Dog. Thanks for that. That's a WHOLE LOT OF INFORMATION!!!!! I might even try to digest it sometime

Thanks, Julie. But sorry, TMI ?
Its not that I am comparing numbers from 15 years ago. Its the difference from a few weeks ago of under 2 events each night for several days, and now three days of 2.5-3.5's. I realise these numbers are well within the normal range but I am just the sort of nut bar to always ask "why" things are what they are. i.e:

Any instruction manual for ANY device IN THE WORLD..."Do not do this" .turn page...No explanation!! Why? Tell me why??

[Dog Slobber]

Good.

Now you can either post some graphs and some wonderful, knowledgeable people have help you optimize your settings, or spend some time reading their suggestions on other peoples graphs, take what you've learned and apply it to your own graphs.

Some rules of thumb I've learned:

• Narrow your APAP range. The machine takes time increasing pressure when it sees blockage indicators. Often getting there too late to address apneas.
• Setting the upper limit to 20 (the maximum) is often not a problem, the machine will typically take it only when it needs it. Exceptions sometime being: problems with Aerophagia, or getting used to pressure.
• When your machine starts to bump up against the upper limit, the intuitive solution of increasing the upper limit is often not the correct solution. The correct solution is often to increase the lower limit. This prevents the need to get there.

[Okie bipap]

Its not that I am comparing numbers from 15 years ago. Its the difference from a few weeks ago of under 2 events each night for several days, and now three days of 2.5-3.5's. I realise these numbers are well within the normal range but I am just the sort of nut bar to always ask "why" things are what they are. i.e:

Variation from night to night is very common. We don't sleep the same every night. The more you toss and turn during the night, the more likely you are to have sleep/awake junk (SWJ) events show up. These happen when you transition from sleep to wake, or from wake to sleep. Also, awake breathing is not as regular as sleep breathing. The machine does not know if you are asleep or awake. It only measures breaths. Irregular breathing confuses it, and the machine will report events that are not real events, but only changes in breathing rates.

[Julie]

TMI - too much information (you should hear it all over these days with ref. to e.g. sexy talk on TV etc.

[palerider]

Good.

Now you can either post some graphs and some wonderful, knowledgeable people have help you optimize your settings, or spend some time reading their suggestions on other peoples graphs, take what you've learned and apply it to your own graphs.

Some rules of thumb I've learned:

• Narrow your APAP range. The machine takes time increasing pressure when it sees blockage indicators. Often getting there too late to address apneas.
• Setting the upper limit to 20 (the maximum) is often not a problem, the machine will typically take it only when it needs it. Exceptions sometime being: problems with Aerophagia, or getting used to pressure.
• When your machine starts to bump up against the upper limit, the intuitive solution of increasing the upper limit is often not the correct solution. The correct solution is often to increase the lower limit. This prevents the need to get there.

"
I like to say "raise the minimum" not "narrow the range", since people take "narrow" as "lower the max", and, as you pointed out, that's rarely a good thing.

[palerider]

Ya, well...not sure if I want to go the Sleepyheads route. I had a look, and to download the software there was a prerequisite to have a bunch of other drivers downloaded. I'm always cautious of that.

Secondly, I often think that too much information is distracting and results in a lot of unwanted and misleading information. Kind of like googling stuff about ANY health issues. I've done that and before you know it you have seventy five different diseases and are close to death. Not sure how far I want to deep dive ALL the results that Sleepyheads will provide.


So I was hoping for some actual suggestions here. I might look at the software again sometime though.

Sleepyhead, and the graphs, are how we can see what's actually going on, and offer relevant and helpful suggestions.

Without it, it's mostly guessing.

"too much information" is one thing, but without actual data, there's too little information to make a meaningful suggestion.

Post some charts, most everybody else does when they're looking for help.

[Jack Burton]

[*]When your machine starts to bump up against the upper limit, the intuitive solution of increasing the upper limit is often not the correct solution. The correct solution is often to increase the lower limit. This prevents the need to get there.

That is a new one on me.
Would you please expand on that to help me understand?

[Julie]

It's not correct so don't kill yourself trying to figure it out .

[palerider]

It's not correct so don't kill yourself trying to figure it out .

I don't know what you're talking about, since you've never learned the *simple courtesy* of using the 'reply quote' button over there to the right, but if you're referring to dog slobber's comment, then you're quite wrong.

What he said is correct.

[palerider]

[*]When your machine starts to bump up against the upper limit, the intuitive solution of increasing the upper limit is often not the correct solution. The correct solution is often to increase the lower limit. This prevents the need to get there.

That is a new one on me.
Would you please expand on that to help me understand?

Sometimes, (certainly not always), people seem to get into a bad pattern during the night, for want of a better term. Pressure too low, it starts events, and once a cluster of them starts, and sleep is disturbed and poor, sometimes it ends up taking more pressure to 'break the cycle' so to speak, than it would to prevent the cluster starting in the first place.

I don't have an explanation of the mechanics of it, but it's something I've observed multiple times with multiple people.

Pressure's going up to 20, repeated obstructive apneas... but a couple nights later, when they've got the min pressure higher, and are better ventilated, pressure doesn't go as high, but they don't have the events, and the same thing keeps going on... the better result wasn't just the 'some nights are better than others' fluke.

This goes along with what I keep saying over and over and over.. "the minimum pressure is critical... the max pressure usually doesn't matter, just leave it set at the default of 20(25)".

[Jack Burton]

Pressure too low, it starts events, and once a cluster of them starts, and sleep is disturbed and poor, sometimes it ends up taking more pressure to 'break the cycle' so to speak, than it would to prevent the cluster starting in the first place.

I just learned something.
Thanks palerider and Dog Slobber.