After losing 150 pounds?

[projecttoday]

Attached are some screen shots for 12/25/2018. I can do more. Of course, I don't know what any of this means, but in scrolling through the days, there seems to be quite a bit of variation for most of these measurements from day to day. So I don't think you could call this typical, as there doesn't seem (to my untrained eyes) to be any typical.

Any help is appreciated.

[Arlene1963]

150 pounds is an incredible amount to lose, congratulations on this.

You are having hypopneas and RERAs and this indicates that you still need to use your CPAP.

Your CPAP pressure is quite low at 6CM and you have a 30 minute ramp time set at 4CM. These are very low numbers and many folks feel suffocated at such a low ramp pressure (4CM). This would also make me feel "tethered" to the machine.

You mention variations in your nightly numbers, as high as over 8 and as low as 0.38. This means that some nights are worse than others, and that you're still experiencing breathing "events" which without the machine would be much worse. Such a wide range of reported AHI is not optimal, and you need to tweak your CPAP treatment.

My 2 cents is that you raise your fairly low pressure just a little at first, over a few weeks. See how that goes and post charts here.

Also the leak rate looks bad. Weight loss results in facial changes and this can cause leaks with your mask (which previously fitted just fine, now not so good?).

Please wait for others to comment. I am not an expert.

[Jack Burton]

I'm going to try to help here with the understanding that if I say something wrong the more experienced folks her will set the record straight.

TL;DR you still need CPAP therapy and the therapy your getting appears sub-optimal IMHO.

*very little sleep to actually analyze
Is it typical for you to only sleep ~4 hours a night?

*your leak score is crazy big
For a third of the time you actually slept your machine couldn't really get a clear handle handle on how to treat you.
First thing to do is address the leaks.

*humidifier is off
Unless you live in a place that is fairly humid you might consider using the humidifier.

*you have a 30 minute ramp time from 4cm H2O to a cpap 6cm H20
That does not seem like a sensible prescription for someone who lost 150 pounds.
My setup is apap 10-20cm H20 with no ramp.
When I was >300 pound I needed all that pressure and possibly a bit more.
At ~235 pounds I still get up to the high 13's nightly.

My wife's setup is apap 8-20cm H20 with no ramp.
her max pressure is typically low 11's

Her initial prescription was non cpap 6cm H20 and she felt like she couldn't get enough air so I bumped it up to 8(her sleep doctor was cool with the changes)

As you have a few years therapy under your belt you most likely don't need the ramp anymore.
For most people apap(allowing the machine to automatically adjust the pressure up and down) is the way to go.

cpap = continuous static pressure
apap = automatically adjusted dynamic pressure

[projecttoday]

Thank you, Arlene1963 and Jack Burton.

I don't know where to start. I thought that the doctor had to adjust the pressure. Can I adjust the pressure myself?

Where are you getting sleeping for 4 hours? Doesn't it say 7h 31m?

How do I address the leaks? tighten the mask?

What about the humidifier? What is that? Is it possible the reservoir was just out of water? Or do I need to turn the humidifer on explicityly? How?

Ramp up: what is this?

[Jack Burton]

I don't know where to start. I thought that the doctor had to adjust the pressure. Can I adjust the pressure myself?

Your sleep doctor may not like it but yes you could change your own settings.

Where are you getting sleeping for 4 hours? Doesn't it say 7h 31m?

The graph you posted shows no therapy between shortly after 1:00am through almost 9:00am.

How do I address the leaks? tighten the mask?

That is a bit of a dark art.
The mask should be not to loose and not too tight.
You may also be leaking through your mouth in which case a chin strap might help.
Beyond that I recommend checking your stats for leaks on a daily basis and just figuring it out.

What about the humidifier? What is that? Is it possible the reservoir was just out of water? Or do I need to turn the humidifer on explicityly? How?

If your bedroom is humid all year round then don't worry about it. If not then read further.
Have a look at this link https://www.directhomemedical.com/pr-sy ... onics.html
Does your machine look like this?
The right side is the humidifier and you need to fill it with water.

Also the humidifier probably needs to be enabled in the cpap settings as the report indicates it is disabled.

Ramp up: what is this?

Ramp is a xpap setting that gradually increases pressure at the start of the therapy session.
Most users don't need it after they get used to therapy.
You can search online for information on how to change your cpap machines settings.
I don't have your brand of machine so I can't give specific advice on this.

[projecttoday]

Hello again, and thanks for your continued support. First of all, I found this more-comprehensive view on SleepyHead (attached below).
Otherwise< I tightened the mask some. I also turned on the room humidifier. (I have always put water in the cpap). So, for the last week, the large leaks have ranged from 7.6% to 17.7%. But note that on December 29, 2018, which was before I tightened the mask, it was 0. Anyway, the tightening of the mask may have helped a little, I'm not sure. Do you still recommend increasing the pressure?

[ChicagoGranny]

Do you still recommend increasing the pressure?

The chart is not very helpful. Please read the first two posts that are in this thread at the top of the index page. Here you can learn how to make a helpful chart - Pugsy's Pointers...SleepyHead Tutorial and TX Hints.

[Pugsy]

Yes...more pressure.
And why not change to auto mode and just see what the machine wants to do.
Fixed cpap mode that you are using now...doesn't tell us much.
And the statistics summary page you just shared...doesn't tell us much either despite all the numbers it shows.
It's just an overall summary data page with averages over a period of time. Not really enough actual nightly details available.
In the detailed data there is stuff that isn't included in the AHI numbers that is just as important as the AHI numbers.

The Flow Limitation index...it shows 0.00 BUT that's not because none happened...it's because FL flagging is turned off when in cpap mode...you might have had a truck load of FLs happen but the machine just didn't flag them.

If you just have to use a fixed pressure for whatever reason...do it in auto/apap mode so that you can get FL flagging turned back on.
They are real important to know if they are happening or not because when in auto/apap mode Flow Limitations are part of what will drive the pressure up in an effort to hold the airway open. They are critical...and in cpap mode we don't even know if they are happening...stupid way of doing things.

If you don't want apap range...just set to auto mode and set the minimum to equal the maximum and it will function like cpap mode but FL flagging will be turned on.

[projecttoday]

Thanks, Pugsy and Chicago. Okay, how do I go to apap mode? And how do I increase the pressure? So I take it I need to focus on major leaks and FL. Another SleepyHead capture from last night is below.



The Pugsy's Pointers post is huge. But the only problem I seem to have encounted with images is they seem to want to go to the bottom of the post. I'm using Snagit. So is my thinking off?

[Pugsy]

You need to to get the clinical/provider manual for your machine.
In it you will find the secret handshake needed (combination of button pushing) to get into the clinical setup menu area where you can make changes to everything.
You can request it here via email. Instructions about a third of the way down the page.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Your are using the Respironics PR System One 60 Series Auto CPAP and this is what you would request...it's probably going to be a combo manual. Remstar means nothing but it's needed in terms of which choice to make.

Respironics PR System One 60 Series REMstar Auto with A-flex

As far as your image attachments going to the bottom of the post...you are missing seeing an option to place it "in line"...that option shows up late and people often miss it.

So you can place it inline and not have it be at the bottom of the post....like this one.

jan3perfectleakline.JPG (335.12 KiB) Viewed 911 times

But once you attach it wait a few seconds to see the "Place inline" button show up right next to the Delete button.
If you don't click on "place inline" the image goes to the bottom of the post.

[projecttoday]

I was able to go into provider mode and change the mode from "CPAP" to "Auto".

Problem: there is no "CPAP pres" on the setup menu like it shows in the manual.

These are the items on the menu:

Back
Mode
Auto max
Auto min
Opti-Start
Flex type
A-Flex
SYSTEM ONE humidification
Humidifier
Tubing type lock
Tubing type
SYSTEM ONE resistance
Lock SYSTEM ONE
Auto on
Auto off
Mask alert
Mask fit check
Humidifier LED Backlight
Show AHI/leak/PB
Split night
Silent mode
Language
Back

What to do?

[RogerSC]

"Auto max" and "auto min" sound a lot like the maximum and minimum pressure for "auto" mode (apap mode). Don't know Respironics, but my intuition tells me that's where I'd look *smile*.

[palerider]

I was able to go into provider mode and change the mode from "CPAP" to "Auto".

Problem: there is no "CPAP pres" on the setup menu like it shows in the manual.

These are the items on the menu:

Auto max
Auto min

That's because in auto mode, you don't have a single cpap pressure. You've got a min (set it to 1 less than your previous cpap pressure) and you've got a max (leave it at 20)

[projecttoday]

OK, Roger and palerider, I think I get that. Thanks.

[projecttoday]

Am I still ramping now that I'm on auto?