One Week Later...

[Sleep Pilgrim]

Howdy All!

Well it's been a full week since I began my therapy and so far so good. Energy level is up. My personality has begun to sparkle just a wee bit--rarely my old doom and gloom self anymore. All around feeling much better. I've had some trouble with masks, though. Nothing major and probably par for the course around here. I started on the Breeze with pillows and generally liked it. Quiet. Didn't aggravate my nares. Rarely leaked. I just didn't feel comfortable sleeping on my back. After about 5 nights with the Breeze I went to my DME and got a Nasal Aire II. That lasted one night. Liked the idea better than the application. Couldn't get a proper fitting. Hurt my nares like nobody's business. Went back to my DME and got a Swift. Okay, now we're talking. In some ways it offered me what I liked about the Breeze, allowed me to sleep on my back with no need for adjustments. Was a bit noisy compared to the Breeze but nothing intolerable. Nares felt fine this morning. Oh and no "Nike swooshes" like I expected (from reading all those Swift posts here). In all a very pleasant surprise. I think this might be my mask of chose for the time being.

I won't be seeing my Sleep Doc for another two weeks and I don't have access to the data on my SmartCard. So I'm running blind when it comes to the nitty gritty about my therapy--other than how I feel. I do have a question about pressure ranges on my apap.

I was titrated at 6cm during the sleep study. According to my results, at 6cm all apneas and hyponeas were reduced to 0. Snoring to 0. O2 went up to 97% (up from around 87%). The apap I'm using is set on a 6cm-15cm range. Every morning, just before I shut off the apap, I check to see what pressure it's operating at. I've noticed over the past week that it has varied by quite a range. It's at 6cm one day, 7.5 another. One day it was as high as 11cm. This morning it was 9cm.

What are the variables that might influence these different settings? Logically, if according to my study 6cm gives me an AHI of 0, why would I need higher pressures throughout the night. I think I know the answer, but I just wanted to hear other opinions.

Thanks!

Will

[Guest]

I don't have access to the data on my SmartCard. So I'm running blind when it comes to the nitty gritty about my therapy--other than how I feel.

How you feel is a fantastic gauge of your treatment thus far! And it sounds like your treatment is going swimmingly!!

If you're interested in knowing exactly what's happening by obtaining the information from the software (SmartCard), rather than wait until you go back to the doctor (and to save you the time and expense of the appointment), you could buy a card reader (I got mine at cpap.com) so you can begin examining your nightly data every day. Should you choose to do so, you'll be able to conduct self-titration experiments by using different pressure ranges, different C-Flex settings, even different modes: APAP (auto without C-Flex), AFLE (auto with C-Flex), CPAP (straight single pressure cpap), or CFLE (CPAP with C-Flex). You'll be able to zero in on the very best settings needed to give you the very best treatment with the least resultant apnea/hypopnea events.

It is so good to hear when someone clearly reaps the benefits of this therapy. It's very encouraging and uplifting!!! Thanks for your update!

[neversleeps]

OOPS!!
'Guested' again. Sorry! That was me!

You may want to check out this current thread regarding pressures:

Confused...still???

[rested gal]

What are the variables that might influence these different settings? Logically, if according to my study 6cm gives me an AHI of 0, why would I need higher pressures throughout the night. I think I know the answer, but I just wanted to hear other opinions.

You've put so much good thought into your treatment... I bet the answers you're mulling over in your mind are the right ones.

A few that come to mind:

1. One night snapshot. The sleep study was a one night snapshot, albeit a very thorough "snapshot". If the sleep study had been done on a different night (or even been performed by a different sleep tech) a different "titrated pressure" might have been arrived at.

2. Sleep position. The pressure needed can vary greatly depending not only on whether you're sleeping on your back but also on the position of your head. Generally we have more obstruction causing "events" (apneas/hypopneas) when lying on our back (supine) so that's the way the sleep lab wants to have you be as much as possible - to look at worst case scenario. Perhaps you weren't on your back much during the titration.

Even if you were supine during the titration, perhaps your head was tilted back somewhat -- lessening the throat closure a bit, a la CPR head position. At home perhaps you sleep with chin tucked down more toward your chest. Difference in height of head pillow used during the study vs at home could make a difference in how tucked your chin is when you sleep on your back.

3. Air leaks. Massive air leaks from mouth or mask...unlikely it's the mask or you'd probably notice that...can cause pressure to go up some. That's one of the many benefits of having software to look at the data yourself the very next morning. You could at least see if the graph showed leak spikes correlating to increased pressure. Might be a bit of chicken vs egg to figure out which came first, but can be helpful to keep an eye on when leaks happened.

4. Varying conditions. The usual variables that can affect the laxity of our throat muscles/tissues from one night to another - congestion, more stressful day than usual, more exercise than usual, amount and timing of food and drink consumption. Illness, new meds, weight changes, allergies...on and on.

Another good thing about having software to look at autopap data yourself the next day is that you might find the "11" that you saw in the machine's display window was used for just a very few minutes. It might be that your "titrated" pressure of 6 really was used the vast majority of the night.

Sounds like your treatment is going very, very well!

[OldSeaRock]

Good stuff, Will! Thanks for sharing.

Masks are evil .

[rock and roll]

I don't know, the Swift and Activas are my friends really.