Advice on data analysis

[akramabed]

Hi all,
Thanks for this nice forum that has been so helpful in assisting me in starting my therapy. I was diagnosed with OSA and I started using APAP around 5 weeks ago. My doctor recommended pressure of 11 and cflex of 3. My sleep test showed AHI at 26 but mostly H and few A. I downloaded my first data 2 weeks ago and started looking at the numbers to understand how I should proceed. AHI values oscillates and does not tend to reduce with increased pressure( AHI is 3.8@11 mm, 5.2@10 mm, 3.3@9 mm, 6.3@8 mm 7.1@7mm) . I am assuming it has to do with time spent at that pressure to accumulate meaningful data.

Here below is some more data, I have set my min APAP to 6.5 for couple of weeks then raised it to 8 after seeing my 90% pressure @9(I cannot say I got better results), Max is set at 11, ramp at 5 for 10 minutes . I found that since I started I did not get better but on the contrary I am feeling worse. My blood pressure got also higher and I am now taking medicine for that. I am looking for the sweet spot and I would like to seek advice of some of our experienced friends.




17/09/08 - 20/10/08 (34 days)
33 days
Total Blower Hours (During Reported Period): 160 hrs. 54 mins.
Auto-CPAP Mean Pressure 7.8 mm
Auto-CPAP Peak Average Pressure 9.2 mm
Average Device Pressure <= 90% of Time 9.0 mm

Average Time in Large Leak Per Day 0 mins.
Average Time in Apnea Per Day 2.6 mins.
Average AHI 4.9


My AHI is 3.8@11 mm, 5.2@10 mm, 3.3@9 mm, 6.3@8 mm

Thanks
Akram

[Goofproof]

Average Time in Apnea Per Day 2.6 mins: This looks pretty bad. Could you post some of the dailies from Encore Pro, and link them to photobucket or some where, it would be more useful. Are you tapeing to prevent mouthleaking? No larg leaks doesn't mean you don't mouthleak. Jim

[akramabed]

Thanks jim, Here are few more data





I am not taping my mouth as I did not think it is required. You think I should?

[bdp522]

What we need to see are the charts that show pressure, AHI, AI, Hi, leak,etc. The charts tell us alot about what's going on. The daily charts(not the summary or long term) are what you need to post.

Brenda

[akramabed]

Hi Brenda/Jim,
I added data as suggested. I think the data @11mm is irrelevant due to short time spent. My question is what would be the right pressure range I should be setting my APAP at? Or should I use it in CPAP mode? I am not sure if from the data you can conclude that I need to tape my mouth as well (during sleep that is )
Thanks
Akram

[bdp522]

Your leaks don't look terrible, but I like a straighter line. I do think you might want to improve the leak some. Try taping the mouth for a night and see if it helps. At a pressure of 8 your leak should be 29, at 10 it should be about 31. Your AHI looks ok too(under 5).
I, for one, do better with one set pressure. Apap is not for everyone. You can try cpap at 8 or 9 for a few nights to a week and see if it makes a difference to you. It made a huge difference for me.

Brenda

[akramabed]

Can someone tell if he is mouth breather from looking at the leak graph? I am showing below another example(for half of the night). For some reason Encore Pro splits the night into 2 if there was an interruption of sleep. Taping the mouth is not an appealing thought but if I need to do it I will to improve my therapy.

[Snoredog]

set the Minimum pressure to 9.0 cm and the Maximum up higher like 15 cm. Don't let your working pressure bump into the Maximum pressure ceiling, it can give you a false 90% pressure result.

If you look at one of your reports it shows pressure at 10 cm with zero events. The Remstar likes to probe above that pressure to determine if current pressure is optimal, when you impose a ceiling like that it defeats that part of the algorithm.

your pressure needs will change with sleep position and other factors from night to night, might as well let the machine adjust for that.

P.S. Can you lower the price of Oil? Thanks.

[akramabed]

Hi Snordog,
I have been using the Apap for around 2 months. It was set at 6-11 and my 90% was 9. I started narrowing the range as per the information found in this forum. Reducing the maximum should help me (I hope) reducing the balluting(aerophagia) effect. With this info do you still recommend I go back to 6-15? Any comment on my original question of mouth breathing?
As for the price of oil, sorry but your wish will not be granted , rather just ask your new president to reduce taxes a(as most of the money you pay for gas is tax). Check this also. (may be we need to shift this discussion to another forum )

Crude Oil (Brent) 67.
Coca Cola 126.45
Milk 163.38
Snapple 237.72
Perrier Natural Mineral Water 300.61
Tropicana Orange Juice 307.44
Budweiser Beer 447.25
Scope Mouthwash 682.34
Starbucks Venti Latte 954.24
Ben & Jerry's Chunky Ice Cream 1,609.44
Pinot Grigio Wine 2,117.75
Bertoli Olive Oil 2,370.71
Jack Daniels Old No. 7 Whiskey 4,237.63
Tabasco Pepper Sauce 6,155.52
Visine A.C. Eye Drops 39,728.64
FLONASE Nasal Spray 902,304.00
Chanel No.5 Parfume 1,666,560.00

So is oil really expensive?

[bdp522]

do you still recommend I go back to 6-15?

SD suggested you go to 9 - 15. You want to keep this change in place, making no other changes for at least a few days(a week is better). If the aerophasia returns and is really uncomfortable you may have to lower the upper pressure, but just by 1cm at a time. Some times the aerophasia will resolve on it's own.

Foe mouth breathing, or mouth leaking; the chart won't tell you where the leak is coming from. If you don't think the mask is leaking it may well be the mouth. I would try taping for a night or 2 and see if that helps the leak. One of the tell tale signs of mouth breathing is dry mouth in the morning. But if your mouth leaking you probably won't have a very dry mouth. You could try a chin strap but they don't work for everyone(didn't for me). If you want to try tape, here are Roosters instructions on how to do it. I use this method every night(for over 2 years now).
viewtopic.php?t=9653

Brenda

[akramabed]

Thanks for your comments above,
I got 2 suggestions here, one to try to go for cpap setting(one pressure) another is to allow APAP to work for bigger range. I started my therapy with the 2d suggestion 2 months ago (pressures 6-11). I noticed that at higher pressure(11) I got a high number of events. I read also in this forum that higher than needed pressure may increase events(right?) So I established my 90% as being around 9 after 6 weeks. I set my APAP at 9-10 since 2 weeks.
I am still feeling tired avery morning(My eyes are red and itching as well)
My questions are: Am I right in assuming that 11 is bad for me and should be avoided as it increases the events? Is it better to restrict the Apap to work as cpap once you get to the right pressure?
I am now almost sure that I leak through the mouth and through the pillows. I know that I have to resolve this by either using another complete mask or taping the mouth. I started taping but I lost it after few hours of sleep, so I will double it today.
Last question: AHI does not include any weight for duration of each Apnea event. As I understand it, AHI is only measure of number of events per hour. However isn't the duration of Apnea as important(if not more). In my case I have an average duration of 25 seconds! This means that some events may have lasted more than 30 S!! Even with few events like this it will have lot of impact on health. Shouldn't the APAP act after 10 seconds to remove the event, and why does it take that long? Is this normal duration?
Thanks

[bdp522]

Am I right in assuming that 11 is bad for me and should be avoided as it increases the events?

I would try Snoredogs recommendation of 9-15 for a week and see what that shows. But first ya gotta fix the leaks.

Is it better to restrict the Apap to work as cpap once you get to the right pressure?

Some do better on one set pressure but not everyone. You won't know until you try.

You have to get your pressure high enough to stop most of those OA. Then you work on any Hypopneas. But first you gotta fix any leaks. Duration of apneas is a concern, that's why you try to stop them. If it was me, I'd get the leaks fixed then set the machine on 9-15 for a week and post the results. Then we'll have a better idea of what you need.

Brenda