Growing success after tweaks

[Scarlet834]

If I ever had any doubts that CPAP would make a difference, they are gone. Thanks to encouragement from this forum I had the first pretty good night's sleep in ages. I went off on a weekend retreat and after feeling no better the first night I decreased CFlex from 3 to 2 and increased my pressure from 9.0 to 9.5. 20-20 hindsight I almost wish I'd changed one setting at a time to understand which had the greater impact, but the result is that my AHI dove from an average of 18 to 7.3, 4.3, and 8.9 the next three nights. That last night CFlex was at 1. My best "morning after" was after the 7.3 night. Really, I could absolutely tell when I woke up that something had shifted. Wow, night and day.

After some thought about the data printouts and how I've felt and slept, I've returned CFlex to 2 and increased the pressure one more little bit to 10 for tonight. Unless something changes for the worse I'll leave it there for a while and continue to work on leaks. System leaks could be better, but I have kept the large leaks under control. The tendency to sometimes seep air at the nostrils almost vanished after the first tweak, and I wonder if the ebb and flow in pressure at CFlex 3 made that worse. I've been using an eye mask as a chin strap, which I need, and will be picking up a real chin strap from my DME today. I don't in general breathe through my mouth, but I've caught myself exhaling or with a dry mouth unless I strap myself down. I've played with tape off and on with varying comfort and success and am ambivalent whether I need it on a consistent basis or occasionally on a bad night.

Possibly I could use a full face mask or a hybrid, but that would be on my own dime for the next few months and for the moment I'm reluctant to switch out of my completely comfortable nasal pillows or let anything touch the bridge of my nose unless there is no other choice. And I would rather stay at the alertness level I have now than ever have air blowing in my eyes again.

It's not perfected yet, but I do feel like I can actually function in the real world. As always I'm very grateful for the input I've received in this forum. There certainly are a lot of us! (I never even heard of CPAP before my sleep study, and I'm bumping into people right and left who know someone or are users themselves.)

[KengEsq]

Isn't it nice when you feel better and can attribute that feeling to OSA therapy and lower numbers. I've been on theraphy for about 1 year and thanks to a lot of attention, my numbers are typically as follows:

9/18/09 Leak in L/s = 0.20
AHI = 2.1
AI = 0.0
HI = 2.1
Use in hrs = 7.45
95th percentile pressure in cm H2O = 12.0

9/19/09 Leak in L/s = 0.38
AHI = 2.7
AI = 0.1
HI = 2.6
Use in hrs = 7.36
95th percentile pressure in cm H2O = 13.2

9/20/09 Leak in L/s = 0.10
AHI = 2.8
AI = 0.2
HI = 2.6
Use in hrs = 7.49
95th percentile pressure in cm H2O = 12.8

Keep involved and have faith it will only get better.

[BleepingBeauty]

Congrats, Scarlet! You're obviously making some serious progress in a relatively short time.

This forum is awesome, and I wish you continued success as you carefully tweak things and monitor your therapy. Keep on keepin' on.

[Scarlet834]

Thank you both! KengEsq, I noticed you advised someone else to make changes and assess a week at a time or so and not go crazy adjusting, and I will definitely take that under advisement as I go forward. Much easier to be patient after reaching a level I can call "functional".

[KengEsq]

Thank you both! KengEsq, I noticed you advised someone else to make changes and assess a week at a time or so and not go crazy adjusting, and I will definitely take that under advisement as I go forward. Much easier to be patient after reaching a level I can call "functional".

Yes. It takes time to see the results of any changes - don't expect them to be immediate. Also, try making only one change at a time so when your results improve (or get worse) you can identify what caused the change. Hey, it's taken me a year to get where I am and doing it step by step taking my time has paid off for me.

[williamco]

I want to understand your point. was it C Flex that made the difference or 0.5 pressure change?
what is the effect of C flex on AHI?

[KengEsq]

I want to understand your point. was it C Flex that made the difference or 0.5 pressure change?
what is the effect of C flex on AHI?

I think her "point" is she cahnged both so she does not know what made the difference - I can't help you on your question about the effect of C flex on AHI - sorry. If C-Flex is like ResMed's EPR, my quess is that regardless of the setting it has no effect on AHI but only adjusts comfort level for some people who may have difficulty exhaling against a constant pressure.

[Scarlet834]

KengEsq is correct. I think it was probably the pressure increase that made the difference, although I do think the decreased CFlex helped nasal leaks. There are some other posts on this forum that suggest CFlex or EPR might make things worse if your apneas are occurring during exhalation. I have no idea if this is true.

I finally got copies of both sleep studies today after camping out in the Doctor's office and I am more than a little perplexed. This is because my untreated AHI was 1.2 per hour and my AHI with CPAP at 9 cm was 0.0. However, in both studies I have an arousal index of 34-36/hour, with RERA 14 per hour untreated and 13.3 per hour treated. Based on how much better I feel the past few days I can only assume that the REMstar Pro detects at least some RERA and puts them in with the Obstructive Apnea Index on my REMstar printout. I have to believe that it was the RERAs that were "killing me" and that CPAP started decreasing the number of RERA events after my tweak. I can't make sense of this otherwise.

I once erroneously said that my oxygen saturation stayed at 100%. It didn't, but it averaged 98% without CPAP and 97% with. Lowest recorded was 93%.

On another forum I just read, "We qualify a RERA (respiratory effort related arousal) as a 30% or more change in breathing (up or down), that is directly responsible for an arousal. There doesn't need to be any O2 desaturation (hypopnea) or Apnea related to it." If anyone has experience on how such events show up on our home CPAP equipment, I'd love to hear it. (This same forum from 2006 included a person's sleep study profile that was suspiciously similar to mine--lots of RERA, comparatively few OA or H.) Anyway, my follow-up doctor's appointment in November should be interesting.