Been having some bad nights

[W_HAMILTON]

I've been diligently following my CPAP treatment for about two weeks, but the past couple of nights have been worrying.

A lot of the symptoms I had before starting CPAP have re-emerged. My mouth has been excessively dry when waking up, although I have found that I seem to drool a bit in my mask. I seem to be waking up quite often again, usually at least once or twice an hour. I've had a few morning headaches. Last night I had a few of my GERD-like acidic burps upon waking up and I went back to my old habit of getting up and setting the alarm clock to a later time so that I could get more sleep.

Since I started CPAP treatment, my machine says that my AHI has remained a steady 2.5 - 2.8. Is this number reliable? Also, I do not really have problems wearing the mask, and in fact have taken to it quite nicely. I worry that I'm not getting ENOUGH air, since it seems as though the air flow isn't as strong as when I first started, but the machine still reads the same pressure setting.

I don't have a follow-up appointment scheduled for another four weeks or so. Do you think these signs are worrying or is it that I'm still in an adjusting period and it's too early to tell?

Thank you!

[Pugsy]

Did you ever decide on anything regarding the software or something to show more details than the very limited data that is on the machine LED screen?

Perhaps it would be a good idea to make sure that the therapy is optimal and leaks are well controlled.


The software is Windows based software so if you use Mac or other OS you will need a Windows environment to run the software.
EncoreViewer 2.0 is the patient version of the software, costs $99 less bulky than Encore Pro but doesn't offer waveform data which might interest you. 32 bit version but a few users have reported getting it to work with 64 bit computers.

Encore Pro 2.4xx is the DME or office version of the software. Big, bulky and sometimes PITA to install but most people manage it quite well. Available by request. 32 bit and 64 bit versions available.

For a brief tutorial and look at the reports from EV check out member Janknitz excellent blog with pictures. Scroll almost to bottom of page to see it. It is a long page.
http://maskarrayed.wordpress.com/

Onkor online analyzer was developed recently by another forum member and does a decent job but is visually different in report aspects. Instructions at the website.
http://www.onkor.net/

Finally another member has developed an open source software but it is very, very new and by his own admission, not even ready for beta testing but if you are geeky and want to try it it does a good job.
viewtopic/t64458/SleepyHead-for-Windows ... rsion.html

Should you wish software, send me a PM and I have some hints for using it. You can check out your options and see which suits you the best.

[Janknitz]

Leak rates should definitely be checked, but you CANNOT rely on the "large leak" data on the screen of your machine. So follow one of Pugsy's recommendations for software and then you can check and see if leaking is an issue.

I have a cold and am doing a lot of mouth breathing. Even though I'm using a FF mask right now (Mirage Quattro) and not leaking appreciably, my mouth is wicked dry. I have the humidifier turned all the way up. Last night was a bit better because the machine helped clear my nose so I could keep my mouth closed more. So even if you are not leaking, mouth breathing can still cause problems. Some people find they still need to use tape or a chin strap, even in a FF mask.

[W_HAMILTON]

I have stayed away from the software because (1) it is expensive and (2) I wasn't sure how much it would help me, since I would be wary of changing any settings at least until my first follow-up with my sleep doctor. I was hoping to rely on the basic information (such as AHI) shown by my machine, because I figured even if I was having other issues, if my AHI was low and that number was reliable, that meant the CPAP was working.

As for leaking, obviously I can't tell while asleep, but I usually sleep in a way so that the mask is almost pressed into my face, making me believe that I shouldn't have many leaks. Even so, if I did have leaks, meaning treatment was not successful, wouldn't my machine show a higher AHI reflective of this?

Also, I forgot to mention in my original post, another reason last night was such a bad one was because it was the first time since wearing CPAP that I actually had to get up and go to the bathroom in the middle of the night. This, combined with the other issues listed, made it seem like I went through all this trouble and yet I'm still having the same problems pre-CPAP

[Pugsy]

I have stayed away from the software because (1) it is expensive and (2) I wasn't sure how much it would help me, since I would be wary of changing any settings at least until my first follow-up with my sleep doctor. I was hoping to rely on the basic information (such as AHI) shown by my machine, because I figured even if I was having other issues, if my AHI was low and that number was reliable, that meant the CPAP was working.

3 of the 4 choices above for software data are free.

Just because you look at software reports doesn't mean you HAVE to change anything. Sometimes it just helps to reaffirm things or spot a problem. Leak would be the most obvious and the onscreen Large leak report is pretty much useless.
What you see on screen is simply an hourly average based on 7 (or 30) days worth of numbers and it sure won't offer any idea what happened during one night.

Actually while we would automatically think that large leaks would allow large number of events to be scored (and it does happen) large leaks can also simply mess with the scoring of events and they tell us that scoring AND therapy can be impaired. It may simply miss scoring events.

Many people complain that they "are having same problems as before cpap" and often it is just a matter of "giving it time" before we can expect to see those mornings when the miracle happens that some people do report. Most of us didn't have those and it just takes time for the body to recover from all the stress that has been going on.
So what do we do? We look at the full reports to make sure that at least on paper things are optimal (low AHI, low leak, enough hours of sleep, etc) and if those are all okay then we look at other factors which can impact how we feel. There are many. Problem is how do you know if therapy is optimal just by looking at one number on the machine? You don't/can't.

Here is one example... Suppose that onscreen AHI 7 day average is 4.5....Technically within acceptable limits but what if you happen to be one of those people who has times with no events and times with clusters of events which can happen in REM stage sleep or simply sleeping on our backs. Those clusters of events can put stress on the body and still make us feel bad the next day despite the overall average being okay.

Again, just because you have the software reports doesn't mean you have to change anything at all. It is just for information and only after you are quite comfortable with things do you need to worry about any changes.

[TalonNYC]

As a Mac User, I can tell you that creating a Boot Camp Partition (which is free as long as you have a copy of Windows to use) will allow you to run the software. Short story, it will allow you to shut down as MacOS and boot up as Windows when you need to, but go back to MacOS the rest of the time.

Good luck!

[archangle]

What's your humidifier setting? You might try turning it up.

Your REMstar Pro does not adjust your pressure up automatically, so it should still be at the same setting.

When you first do CPAP, you tend to think your breathing into a gale. Your body rapidly adjusts and you won't feel the pressure as much after a while. After a while, you may wonder if you're getting any air at all. To convince yourself you're still getting air, hold your hand in the airstream coming out the exhalation vent on the mask. Remember how it feels. Breathe in and out and notice that the airstream is still there. Look at the air vents and realize that the pressure in your mask is blowing all that air out through those tiny holes. Lift up the edge of your mask with a finger and see how much air gushes out.

If you have the ramp function turned on, it reduces the pressure when you start, but it will slowly ramp up to the same pressure every time. If you "check your pressure" during the ramp period, yes, you will be getting less air. I recommend not using ramp at all if you're worried about not getting enough air. I think your machine can do autoramp. Turn that off if you can.

[W_HAMILTON]

That's one thing that worried me -- I DON'T use the ramp feature. I don't feel the need to. I've heard others talk about this feature, and my DME provider made a point of telling me to use it, but I don't feel it necessary. In fact, it feels like I'm not getting enough oxygen when I use it. Even at my normal pressure of 15cm, it doesn't bother me.

As for the humidifier, I had it set at 3, but the air I was breathing in seemed to be too warm, so I bumped it down to 2.

Also, I just pulled out my memory card to try to come up with a report, and I see that the filters have been blown out again! Grrr. My DME provider said that I should bring my machine in sometime this week if it was still doing that; do you think it truly has a problem, or may I just not be fitting them in there correctly?

[TalonNYC]

On the S9, I set the ramp to 15 min, but raised the minimum pressure to 6, so that I don't feel that "where's the air" feeling when it starts out. Not sure if you can do that with the machine you have.

[archangle]

Also, I just pulled out my memory card to try to come up with a report, and I see that the filters have been blown out again! Grrr. My DME provider said that I should bring my machine in sometime this week if it was still doing that; do you think it truly has a problem, or may I just not be fitting them in there correctly?

Are you using the white pollen filter? Do they have the little tab on them? I understand that Respironics has stopped putting the tab on the filters because it causes them to pop out. You might try cutting the tab off the white filter or finding untabbed filters.

This probably means you may need some sort of tool to get the filter out. Someone was complaining that the filter would slip down under the cover, too.

[W_HAMILTON]

Yes, it does have the little tag! I actually just did a google search and I think I saw a post where you and others were talking about how they are no longer making the tabbed filters. I had just been using a small sliver of tape along the top of the filter to keep it in place. My DME provider shipped me my allotment of replacement filters last week; I didn't pay atttention to them, but I will check them later on to see if they have the tabs removed.

[LoQ]

Even though I'm using a FF mask right now (Mirage Quattro) and not leaking appreciably, my mouth is wicked dry. I have the humidifier turned all the way up. Last night was a bit better because the machine helped clear my nose so I could keep my mouth closed more. So even if you are not leaking, mouth breathing can still cause problems. Some people find they still need to use tape or a chin strap, even in a FF mask.

Good advice. I also use the Mirage Quattro FFM and would add that if I didn't do something keep my mouth closed. I'm sure I would have LARGE LEAKS via my mouth when I fall asleep. Heck, the way my face is shaped, I could eat a hamburger through the bottom of my FFM, even if it is strapped on tightly.

[mayondair]

There has been some discussion of the filter problem, I just use a rubber band around the machine to hold the filters in place, ugly and low tech, but it works. kathy

[robysue]

I've been diligently following my CPAP treatment for about two weeks, but the past couple of nights have been worrying.

...

Since I started CPAP treatment, my machine says that my AHI has remained a steady 2.5 - 2.8. Is this number reliable?

The numbers are accurate enough for trending since they are 7 and 30 day averages. But they tell you very little about what's going on from night to night. Here's the math lesson you don't want, but need in order to understand why seven day averages tell you little or nothing about any individual night's events.

First: That seven day average is computed by dividing the total number of events recorded in the last seven days by the total number of therapy hours the machine has provided during that same period of time. So let's work with your 7-day AHI = 2.5 for the time being. Now you've not told me anything about how much you've used the machine during the last seven days, so I'll assume that you've used the machine for approximately 56 hours during the last seven days (that's about 8 hours per night). That means that you've had about 2.5*56 = 140 apneas + hypopneas recorded during the last seven days. Because the PR S1 rounds the AHI to one decimal place, you actually could have had anywhere between 137 and 143 apneas + hypopneas during the last seven days. But notice that knowing the approximate number of apneas for the week doesn't really tell us anything about how many of those 137--143 apneas occurred last night.

Second: To make both the meaning and the computation of those 7-day and 30-day average AHI's much, much clearer, let me make up some fake data and run you through how the machine's LCD 7-day average AHI would look each morning after it updates the data at noon GMT, which currently is 8 AM EDT for those on the US East Coast.

Here's the "fake" data for the initial two week period along with the overnight AHI which is NOT shown on the PR S1's LCD each morning. The AHI in the table below is shown as it would be in EncoreViewer and EncorePro, which means the AHI is rounded to one decimal place.

Code: Select all

night   #events   #hours   AHI          night   #events   #hours  AHI
 1         20        8      2.5            8       10        7     1.4
 2         15        7      2.1            9       21        8.3   2.5
 3         22        7.5    2.9           10       17        7     2.4
 4         25        8      3.1           11       24        8     3.0
 5         15        6.5    2.3           12       18        7     2.6
 6         21        8      2.6           13       19        7.5   2.5
 7         18        8      2.3           14       25        8     3.1

And here are how those 7-day averages are computed each morning. Note that until there are seven nights of numbers, all the data goes into the 7-day average AHI. After that, the oldest night's data is dropped from the computation and the newest night's data is added to it:

Code: Select all

morning  7-day AHI
 1       (20 events)/(8 hours) = 20/8 = 2.5
 2       (20+15 events)/(8+7 hours) = 35/15 = 2.3
 3       (20+15+22 events)/(8+7+7.5 hours) = 57/22.5 = 2.5
 4       (20+15+22+25 events)/(8+7+7.5+8 hours) = 82/30.5 = 2.7
 5       (20+15+22+25+15 events)/(8+7+7.5+8+6.5 hours) = 97/37 = 2.6
 6       (20+15+22+25+15+21 events)/(8+7+7.5+8+6.5+8 hours) = 118/45 = 2.6
 7       (20+15+22+25+15+21+18 events)/(8+7+7.5+8+6.5+8+8 hours) = 136/53 = 2.6
 8       (15+22+25+15+21+18+10 events)/(7+7.5+8+6.5+8+8+7 hours) = 126/52 = 2.4
 9       (22+25+15+21+18+10+21 events)/(7.5+8+6.5+8+8+7+8.3 hours) = 132/53.3 = 2.5
10      (25+15+21+18+10+21+17 events)/(8+6.5+8+8+7+8.3+7 hours) = 127/52.8 = 2.4
11      (15+21+18+10+21+17+24 events)/(6.5+8+8+7+8.3+7+8 hours) = 126/52.8 = 2.4
12      (21+18+10+21+17+24+18 events)/(8+8+7+8.3+7+8+7 hours) = 129/53.3 = 2.4
13      (18+10+21+17+24+18+19 events)/(8+7+8.3+7+8+7+7.5 hours) = 127/52.8 = 2.4
14      (10+21+17+24+18+19+25 events)/(7+8.3+7+8+7+7.5+8 hours) = 134/52.8 = 2.5

When we compare the overnight AHI to the 7-day average AHI, it becomes really obvious that once there are seven or more days worth of data, it takes either a pretty big jump in the overnight AHI or several days worth of more minor changes in the daily AHIs to affect that 7-day AHI by even a modest 0.1

Code: Select all

night    overnight AHI   7-day AHI       night   overnight AHI   7-day AHI
 1            2.5            2.5            8          1.4           2.4
 2            2.1            2.3            9          2.5           2.5
 3            2.9            2.5           10          2.4           2.4
 4            3.1            2.7           11          3.0           2.4
 5            2.3            2.6           12          2.6           2.4
 6            2.6            2.6           13          2.5           2.4
 7            2.3            2.6           14          3.1           2.5

The 30-day average AHI work the same way, except that its even harder to move the 30-day average by 0.1 unless there's a real trend upwards or downwards in the daily AHI data. That's because you're averaging 30 numbers together and between one day and the next, 29 of those numbers are the same.

All brought to you by robysue, the friendly math prof

[turnerk]

As for leaking, obviously I can't tell while asleep, but I usually sleep in a way so that the mask is almost pressed into my face, making me believe that I shouldn't have many leaks.

This doesn't account for all your symptoms, but if the mask exhaust vents get blocked you can have rebreathing problems. I've woken up a couple times feeling bad due to stale mask air.