Interpret Data Help Request

[frogman]

Can someone help me interpret my data? I have been on APAP since 10/21/09 and although I probably have my mask adjusted too tight, the leak rate has improved since I began and I can sleep better with the tightness as opposed to small air leaks that immediately wake me up. Much of the other data elements have shown very little change. Here is the detail from last night.



Why doesn't the pressure go up as the AHI is increasing? If the pressure was at or above 10 cm I would suspect it would not increase due to the ResMed algorithm and no precursor to the apnea event; I believe the pressure is below that threshold.

Here are the Stats for the last week.



I am concerned with the number of apneas since the only ones I had during the sleep study were centrals induced by APAP and the AI has actually increased slightly. The hypopneas have varied downward at points but the HI has remained pretty much the same. I have seen improvement in that my nightly bathroom trips immediately reduced from 2-4 to 0-1 and instead of being exhausted all the time I would say I am tired all the time.

Overall, I think I have adjusted to APAP treatment fairly well and have seen some improvement during the first few days. At this point I am not sure what I should do to see further improvement. I am trying not to make too many adjustments prior to going to my DR for follow up in a couple of weeks, but would like to have some idea what to discuss or suggest for continued improvement. I do not have a feel for how she will respond to my taking an active part in my treatment. All I can say is during the initial visits she was very open and took time to go over the sleep study and suggested an APAP with data capabilities instead of going for another sleep study (2nd half of sleep study night w/APAP did not gather much data due to lack of sleep time). Most of the dialogue was from her since I did not have a clue what we were dealing with. Thanks to this forum, that is slowly changing as I make time to read and learn.

Many thanks, frogman

[Slinky]

I'd be inclined to drop that high pressure setting of 18, at least, to 14 to give the Auto more time to respond to an event. I'd give that a week and then try raising the lower pressure setting to maybe 10. And try that for a week.

[JohnBFisher]

Can someone help me interpret my data? I have been on APAP since 10/21/09 and although I probably have my mask adjusted too tight, the leak rate has improved since I began and I can sleep better with the tightness as opposed to small air leaks that immediately wake me up. Much of the other data elements have shown very little change. Here is the detail from last night. ...

I don't pretend to be any type of expert, so take my thoughts with a grain (maybe a lick) of salt. But with that in mind, let's see what the data shows...

I agree with you about the leak rate. I'm struggling with slowly adjusting my mask to drop the leak rate to an acceptable value. I've about decided to do what you did, over tighten it and then back it out a little bit at a time.

So, I think you took a good approach to adjusting your mask.

... Why doesn't the pressure go up as the AHI is increasing? If the pressure was at or above 10 cm I would suspect it would not increase due to the ResMed algorithm and no precursor to the apnea event; I believe the pressure is below that threshold. ...

A few notes here...

First, you will note that your AHI index increases in a periodic pattern. I suspect (and would put money on this one) that it increases as you go into deeper stages of sleep and peaks as you go into REM sleep. Then it drops suddenly. Probably the increased pressure (as your machine combats the increased events.

Second, it does in fact increase as your events increase. It is a small shift upward then it goes down as you arouse and cyle back through the stages of sleep.

Third, I think slinky has it right. A high top pressure might be artificially restricting the movement upward.

Finally, remember the algorithm attemps to increase the pressure only enough to stop the apnea events and keep the hypopnea events to a minimum. (They don't want to arouse you by SUDDENLY increasing the pressure). So, it appears to be doing what you need.

... I am concerned with the number of apneas since the only ones I had during the sleep study were centrals induced by APAP and the AI has actually increased slightly. ...

The Apnea Index is very good. Though it's increased slightly, you are probably improving your overall sleep enough to well ofset the occassional added apnea event.

... The hypopneas have varied downward at points but the HI has remained pretty much the same. I have seen improvement in that my nightly bathroom trips immediately reduced from 2-4 to 0-1 and instead of being exhausted all the time I would say I am tired all the time. ...

It takes a while for your body to become fully adjusted to the new situation. As you increase your physical activity, you will find that your energy level should also increase.

... Overall, I think I have adjusted to APAP treatment fairly well and have seen some improvement during the first few days. ... but would like to have some idea what to discuss or suggest for continued improvement. I do not have a feel for how she will respond to my taking an active part in my treatment. All I can say is during the initial visits she was very open and took time to go over the sleep study and suggested an APAP with data capabilities instead of going for another sleep study (2nd half of sleep study night w/APAP did not gather much data due to lack of sleep time). Most of the dialogue was from her since I did not have a clue what we were dealing with. Thanks to this forum, that is slowly changing as I make time to read and learn. ...

Sounds as if you have a "keeper" there. Most doctors should WANT their patients to take an active role in their therapy. Why? They have the most on the line. As long as they work with the doctor and can back it up with data, it is the best way to approach it.

Think of it as the same thing as treating diabetes. How does someone with diabetes know if their diet or medication is helping. They know by testing their blood sugar and the periodic A1c blood tests. As my endocrinologist noted, the testing I do at home is more important than the A1c tests, since it helps me modify my behavior to improve my health.

So, the daily blood tests and periodic A1c tests are direct analogies to the data capable machines and sleep studies. The feedback from the machine allows you to find the things that work best for you. The periodic sleep study (as needed) allows you to find much more detail about issues. But hopefully with the data capable machine you will be able to dial in what works well for you and avoid further sleep studies (unless you lose weight or have some other health change).

Con congratulations on taking such an active role in your therapy. It already appears to be helping. Best wishes.

[brain_cloud]

I am concerned with the number of apneas since the only ones I had during the sleep study were centrals induced by APAP and the AI has actually increased slightly. The hypopneas have varied downward at points but the HI has remained pretty much the same.

Remember that the machine scores both apneas and hypopneas differently than was done during your sleep study. It is easy to get this number of apneas or even more just through normal sighs (long slow deep breath generally followed slow shallow breath). If no arousal, then these would be passed over during your sleep study. But the machine tags the shallow breath as an A or an H. Dude, your AI is fabulous.

I have seen improvement in that my nightly bathroom trips immediately reduced from 2-4 to 0-1 .

A huge sign that things are going much better for you.

[frogman]

...to give the Auto more time to respond to an event...

Slinky thanks for your input. I'll see what the DR has to say when I go back and depending on how that goes I'll start making changes with or without her agreement. Is it that the machine responds more aggressively within a smaller window (pressure range)?

First, you will note that your AHI index increases in a periodic pattern. I suspect (and would put money on this one) that it increases as you go into deeper stages of sleep and peaks as you go into REM sleep. Then it drops suddenly. Probably the increased pressure (as your machine combats the increased events.

Second, it does in fact increase as your events increase. It is a small shift upward then it goes down as you arouse and cyle back through the stages of sleep.

John, once again, thanks for responding. I also noticed the AHI periodic pattern, however I was thinking more on the lines that when it went abruptly to 0 I was aroused because the machine had not responded enough. I can see the slight changes in pressure, it just doesn't seem to be enough to me - but then what do I know.

...But the machine tags the shallow breath as an A or an H...

brain_cloud, this makes sense, but I am still having a problem seeing how the machine effectively handles the shallow breathing, which is my main problem. I just do not see any improvement in the HI. Does the shallow breathing become less shallow after a period of time with treatment?
Thanks for your input.


Glad all of you have patience with all the questions.

frogman

[Muse-Inc]

...still having a problem seeing how the machine effectively handles the shallow breathing, which is my main problem. I just do not see any improvement in the HI. Does the shallow breathing become less shallow after a period of time with treatment?

CPAP therapy does not improve the condition that causes your apneas and hypopneas; what CPAP therapy does is prevent your airways from narrowing to the point where your oxygen level drops or from narrowing to actual collapse (apnea). I have no doubt that if I were to not sleep with my machine <shudders in horror> that all my many, many hypopneas would occur, my oxygen levels would drop, my blood pressure skyrocket, and brain panic thinking I was suffocating...again. So, CPAP therapy has not eliminated the condition that causes my OSA. If you had centrals (apneas or hypopneas) in your sleep study, there is likely a good pressure range that will eliminate most if not all obstructive events and not trigger centrals. I wish you success in finding that sweet range.

[Wulfman]

Why doesn't the pressure go up as the AHI is increasing? If the pressure was at or above 10 cm I would suspect it would not increase due to the ResMed algorithm and no precursor to the apnea event; I believe the pressure is below that threshold.

I think you answered your own question in that paragraph.
Your pressure rarely exceeds 10 cm., so that's where I'd recommend setting the minimum (until you see some more data).......and it probably doesn't make any difference where you set your maximum because it appears the A10 algorithm won't go after your events anyway.


Den

[Muse-Inc]

...I have seen improvement in that my nightly bathroom trips immediately reduced from 2-4 to 0-1 and instead of being exhausted all the time I would say I am tired all the time...

This is how my recovery from the bad effects of OSA began: nightime peeing stopped for me on night 1, then over the next 3-4 wks, my exhaustion turned into plain ole tired as I started sleeping thru the night and began remembering dreaming. You are making progress, took me months with small steady improvements to really feel good & 9 months to have the energy to exercise again. I was frustrated but as my sleep doc and cardio doc told me, I was doing fine because some poor folks take up to a yr or longer to see CPAP benefits...I was glad I wasn't one of them.

[brain_cloud]

... I am still having a problem seeing how the machine effectively handles the shallow breathing, which is my main problem.

If the shallow breathing is occasioned by airway obstruction or airway thinning, then I could see the machine helping at the right pressure. If, on the other hand, the shallow breathing has some cause more exotic than airway collapse/blockage, then I have no idea how cpap would help that. Doesn't mean it wouldn't. Just means I have no idea.

[frogman]

From the sounds of it, I am being impatient and should be thankful for the immediate overall improvement I have seen. Not knowing exactly what is causing the shallow breathing and therefore uncertain how that will respond to treatment is a little frustrating. Given that I did snore significantly without APAP, perhaps the shallow breathing is obstructive in nature and I can find a good setting to bring the HI down some - I don't really care about the number as long as I become less tired all the time. And this may improve in time even if the HI doesn't.

Muse-Inc, I see a lot of similarity in how we each responded to initial treatment; did you have have mainly hypopneas too?

Thanks to all for your comments and suggestions. I'll see how the follow up goes and will most likely be back with more questions after that. In the mean time I'll keep reading and try to learn as much as I can from the ongoing posts here.

frogman