Got the Software, numbers look awful, what to do?

[gljo1215]

Ok, my software came today so downloaded my card to see how I was doing. If I’m seeing right, I am torturing myself a lot for not much therapy! I can see why people give up! I don't want to be one of them, but this sucks.

Total AHI’s for the last few nights were 19.6, 10.3. 13.8, 7.2, 11.7, 17.2. Not exactly what I was hoping for….

Looks like I have lots of Vibratory snores – don’t know what that means…

Mask leaks between 37 and 46. I know it’s supposed to leak some (for vent) but don’t know how much is normal…

If I remember right, my machine is set for Auto between 7 and 15. The 90% average was always around 15-17.

Soooo, is my pressure too low? Mask too tight/not tight enough? (leak problem?)
Should I go to straight CPAP? - At what pressure? I'm a bit worried that higher pressures will blow my mask off!

What should I try first? HELP!

I’m not sure I understand any of this!

gljo

[jules]

you might get some better feedback if you post the reports - this is my most recent post to paul22 on how -

viewtopic/t37508/viewtopic.php?p=318303#p318303

this is a round about way to give you the information - I have a link in that message and then in link in that message --- hope it is all clear as mud --

however I have been having problems myself with photobucket lately on getting the right url copied with the IMG option ---- have to click on the left side then do a control C I think to copy it

[GumbyCT]

you might get some better feedback if you post the reports - this is my most recent post to paul22 on how -

viewtopic/t37508/viewtopic.php?p=318303#p318303

this is a round about way to give you the information - I have a link in that message and then in link in that message --- hope it is all clear as mud --

however I have been having problems myself with photobucket lately on getting the right url copied with the IMG option ---- have to click on the left side then do a control C I think to copy it

Just comparing the viewtopic link results. To see if the quoted link shows up better than (diff even) in the orig post.

The reason people get the software is so they can fix what is not working correctly. It is rare that things would work correctly the 1st time. So you shouldn't be disappointed.

[Wulfman]

Ok, my software came today so downloaded my card to see how I was doing. If I’m seeing right, I am torturing myself a lot for not much therapy! I can see why people give up! I don't want to be one of them, but this sucks.

Total AHI’s for the last few nights were 19.6, 10.3. 13.8, 7.2, 11.7, 17.2. Not exactly what I was hoping for….

Looks like I have lots of Vibratory snores – don’t know what that means…

Mask leaks between 37 and 46. I know it’s supposed to leak some (for vent) but don’t know how much is normal…

If I remember right, my machine is set for Auto between 7 and 15. The 90% average was always around 15-17.

Soooo, is my pressure too low? Mask too tight/not tight enough? (leak problem?)
Should I go to straight CPAP? - At what pressure? I'm a bit worried that higher pressures will blow my mask off!

What should I try first? HELP!

I’m not sure I understand any of this!

gljo

Yeah, seeing the reports would help, but from your posted information, it's pretty apparent that your pressure is too low. High snoring numbers and high AHI are big clues. Snoring and leaking will drive an APAP/Auto crazy trying to keep up and can distort your 90% numbers. What was your titrated/prescribed pressure? Also, how did you arrive at a pressure range of 7 - 15?
On the bottom of your reports, there are some pressure "grids" that show AHI numbers at the various pressures your machine traveled through during the night. Look at those numbers and see which pressure is showing the lowest AHI. I would venture to guess that it may be around 12 cm. Anyway, I would strongly suggest setting your machine in CPAP mode, either at your titrated pressure or at the lowest AHI number in your reports. Try that for a week and see what things look like.
It's also much easier to get leaks under control when the pressures aren't fluctuating all night. One of the problems with a range of pressures is that too frequently the masks are adjusted to the LOWEST pressure and need to be adjusted to the HIGHEST pressure that a person may reach during the night. If it's not adjusted properly, the leaks will lead to more leaks and since we tend to snore when we're leaking, there will probably be some of those happening to keep the pressure fluctuating/increasing.

Your mask should have had an instruction (users) manual included with it which should show a graph of the "Vent Flow Rate" at various pressures. The Vent Flow Rate is the "normal" exhaust rate for that mask under ideal (factory-tested) conditions.

Den

[gljo1215]

Thanks for your replies. I am working at getting my reports changed to jpgs… will have a techie son help me post somewhere, even if it’s just in a post here. Jules, you are right, your photobucket directions are as clear as mud to me… I am not very web-literate.

Wulfman, you are probably right about my pressure being too low. That’s what I’ve suspected all along but was hoping the Auto would deal with that. (I know now that the Auto would take waaay too long to get there!) My sleep report wasn’t very clear, since I slept very little after they put a mask on me. I think it was 15. I hated that much air blowing in my face and up my nose, but after using it a bit more now, maybe I would be more tolerant…???

The second DME I dealt with, changed my setting to AUTO 4-20. As far as I can tell, it did NOTHING. It almost NEVER budged off of 4. In fact, now that I can SEE my therapy, I can see that it only moved off of 4 after 4 hours! I wonder if she had it set to ramp for 4 hours or ?? When changing the settings myself, the directions I have say the ramp MUST be set to 0. I'm sure it was set on 4.0. Is that possible? Anyway, in my previous post, I mentioned that I set it to 6-20 and someone told me to tighten up those numbers, so I split the difference and set it to 7-15. Figured I would change gradually…

As you suggested, I think I will go back to straight CPAP and see if that helps. I looked at the grid numbers at the bottom of my reports and it seems that the lowest AHI numbers are at 13 and 16. Perhaps I will change it to 13 and see what happens for a week.

I can see that the leak situation would be easier to control on a steady pressure. I will have to find the manual for my Liberty mask and check the leak rate. Hope a higher number will not blow it off my face!

gljo

[jules]

You need to have the screen shots residing in another place to post them here.

Once you get the photos uploaded, you can post the link here and people can find them.

[rested gal]

The second DME I dealt with, changed my setting to AUTO 4-20. As far as I can tell, it did NOTHING. It almost NEVER budged off of 4. In fact, now that I can SEE my therapy, I can see that it only moved off of 4 after 4 hours! I wonder if she had it set to ramp for 4 hours or ??

Sounds like the DME had (accidentally, stupidly, however'dly LOL!) turned on "Split Night Therapy." That means the machine will use only the lowest pressure in the range it's set for for however many hours (2, 3, or 4 hours) that the person sets Split time for. Will simply record data but will not change pressure at all no matter how many apneas/hypopneas the person is having during those first hours.

When changing the settings myself, the directions I have say the ramp MUST be set to 0.

The directions may not have been clear (I apologize if I wrote 'em! lol ) On the older pre-M Respironics machines, the Split Night Therapy mode setting is a bit confusing on the menu. There is no real "ramp" feature in APAP or AFLE (auto with C-flex turned on) mode. Ramp can be used only when the older pre-M autopap is being used in CPAP or CFLE (cpap with C-flex turned on) mode. So, when using APAP or AFLE mode (autotitrating modes...range of pressures) when you come to a setting that looks like where you'd set a "ramp" time or a ramp "start" pressure, that's really the Split Night Therapy mode setting. That's what needs to be set for "0" (off) and not for one of the other choices it would give like 2:00, 3:00, 4:00 (those are the number of hours it would blow just the lowest pressure in Split Night Therapy mode.)

Respironics cleared up the confusion about the Split Night Therapy setting somewhat (not completely, but somewhat) in their M series autopaps. They at least labeled it "Split Time" in the M series menu. But it's not called that in the older pre-M tank model machines. I can see why some DMEs got confused about that setting in the older machines. If an older machine is set for APAP or AFLE mode, that split night setting is going to come up in the menu right about where they were used to seeing "ramp" come up if they had been setting a CPAP machine. However, people who work for DMEs and set up machines should know their stuff.

in my previous post, I mentioned that I set it to 6-20 and someone told me to tighten up those numbers, so I split the difference and set it to 7-15.

About "tightening the numbers" or "narrowing the range" when using an autopap -- here are some links to my thoughts about that...just my opinion -- for most people the important thing is raising the minimum pressure...not bringing down the max pressure:

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

Den's suggestion of gathering some data using a single straight pressure a la CPAP is always a good thing to try. Suits some people better than autotitrating. If I were going to try a straight single pressure with an autopap, I'd keep the machine in auto mode and simply set the maximum and minimum pressures to the same number. Then it will operate like a cpap, but will gather flow limitation data along with the usual apnea/hypopnea/snores/leaks info. If you set it for CPAP mode, it will record all those things except "flow limitation". It won't record flow limitation data in CPAP mode.

[gljo1215]

Jules,I posted one day to Photobucket - will have to have techie sons help with the rest tomorrow. Hope it works!

http://s463.photobucket.com/albums/qq35 ... 1-6-09.jpg

Rested Gal, thanks for your explanations. I don’t know if you wrote the directions or not… I found them in a search of this site. The gal at the DME had to call Respironics to find out why my machine no longer said CFlex on the screen, so I’m guessing she didn’t know what she was doing. That should have been my first clue to run like hell. Good thing I found you guys!

Just to try it, I went up and changed my machine to CFLE 13 and tried my mask on. Whoa! I don’t think that is going to work…. My mouth puffed up like a chipmunk and even with CFLEX set to 3, I could barely exhale! This is not good! I immediately had a mental picture of those balloons they have in the Macy’s Thanksgiving Day Parade!

I had a hard time keeping the nose prongs in, so tried the next bigger size. That was worse. Back to the smalls and fiddled with it a bit more and finally was able to wear it for a few minutes. Still felt like I had to WORK to even breathe. Then, when I swallowed, my ears popped and felt funny for about an hour afterwards. Also, my teeth are very sensitive to cold air and they STILL hurt. I can’t imagine SLEEPING with all that going on!

Makes sense to raise the lower pressure and leave the upper at 20 as you suggested in one of your previous posts. Perhaps I should go back to Auto 10 -20 for a few days and see if I can handle that? After all, I spent 2 weeks at only 4!

Ack! This is soooo confusing!

Thanks!
gljo

[Bluebonnet_Gal]

gljo,

Raise your lower number SLOWLY so you have time to get used to the increased pressure.

[Wulfman]

Looking at that report, it would appear that the time period from the 1.5 hr. to the 2 hr. point, where things kind of "level out", there aren't many events there.....and the pressure level appears to be about 13. So, that's an indication of where you need to be. How you're gonna get there.......well, I guess there's some things you're going to have to figure out with your mask (or get a different one that doesn't have direct pressure into your nostrils). As long as you're going to leave the upper pressure setting with no upper limitation your leaks are going to keep looking the same on your reports.

Good luck.

Den

[jules]

in the cpap or cfle mode you can use ramp

does your apap have cflex? there were some out there that don't have the blue cflex sticker that are older

in APAP or AFLE mode don't use ramp

[gljo1215]

Jules, funny you should ask about the blue sticker... It originally didn't come with one, but when I visited the second DME, she PUT ONE ON. Never did find out why or what the difference was...

I am anxious to go to bed tonight... I've changed settings about 3 times today! Will be interesting to see how well I sleep and what the report says tomorrow!

gljo

[gljo1215]

Sorry, Jules! Didn't answer your question.. Yes, I have cflex and would not be able to breathe without it!!! This is probably part of the reason why I gave up 2 years ago. No one told me about cflex until I found this site!

g

[Wulfman]

Jules, funny you should ask about the blue sticker... It originally didn't come with one, but when I visited the second DME, she PUT ONE ON. Never did find out why or what the difference was...

I am anxious to go to bed tonight... I've changed settings about 3 times today! Will be interesting to see how well I sleep and what the report says tomorrow!

gljo

Hmmmm.......interesting. However, if your machine has the optional setting selections for AFLE and CFLE, it's the one WITH C-Flex.

Den

EDIT: I didn't see your post to Jules as I was typing this post at the same time you were.