WOW, What a Great Night!!

[red1]

Hello everyone!

I had a great sleep last night! THis is thanks to many of you!!

I have temporarily been able to rent, S9 Autoset. ITs not a bipap, but it's better then the S8 Elite ii straight CPAP I was using. Until such time as I get one.

ANyways, I have been using it for about a week now. WHile I was using the straight cpap, a good night for me was an AHI of 13.5. That was even rare. After I was able to rent the S9Autoset, which I have used now for about a week, I was able to get my AHI down to about 7. That was much better then the 13.5. Also considering my AHI is about 106 or so without XPAP.

Last night I was looking up a terms. I think one of them was Tidal Volume. It took me to a post that spoke about various definitions, like tidal volume, minute ventilation, flow, etc. I think it was Pugsy that also posted a wiki definition to some of these & spoke of how important Minute Ventilation was an important parameter in respiratory medicine, due to its relationship with cabon dioxide levels. I think it was Pugsy that also that posted a link to another CPAP Talk Post that talked about the importance of raising the lowest setting of the 2 settings to the point of your least amount of apneas. Something about the machine not being able to raise up fast enough to stop the events, from a bottom line low setting on your first setting. Sorry for not remembering those who were part of that conversation.

Before I made any changes, I realized that the machine was always hitting the top number every night. My doctor suggested I set it to 4 & 10. I found the four to be an uncomfortable setting. Kinda felt like I was not getting enough air.

I decided to try out what was talked about by Pugsy & others. I raised the lower number to a more comfortable 6 & the top number to 12.

This small change made such a difference in last nights numbers. I slept 8 hours. MY obstructive events were 1.3, Centrals was 0.2, giving me an Apnea index of 1.5. My hypopneas were at 0.3, giving me an AHI of 1.8.

I have never had it the numbers even close to that, in all my time with XPAP. The results show a pressure median of 7.1, 95 Percentile of 8.7 and a Max pressure of 9.5. I really want to thank you all again!

Rick

[Pugsy]

Well congratulations are in order. I hope you feel as good as you sound.
Funny how just a little minor change can make such a huge difference.

[RandyJ]

Good for you! It's great when therapy works! It's sad that so many of us have to get there on our own, that our sleep study titration Rx is not what we really need for successful therapy. This forum is great for that reason; it fulfills a need that shouldn't exist, but does.

[2 B Sleeping Soundly]

Congratulations Rick!
I have been following your different posts and am so glad to hear of your positive results with the new machine and newly tweaked settings. May this be the start of a new well rested you!!
John

[2 B Sleeping Soundly]

It's sad that so many of us have to get there on our own, that our sleep study titration Rx is not what we really need for successful therapy. This forum is great for that reason; it fulfills a need that shouldn't exist, but does.

I couldn't agree with you more RandyJ, well said!

John

[red1]

Good for you! It's great when therapy works! It's sad that so many of us have to get there on our own, that our sleep study titration Rx is not what we really need for successful therapy. This forum is great for that reason; it fulfills a need that shouldn't exist, but does.

Thank you Thank you Pugsy, Randy & John for your wonderful comments!

You are so right Randy! THis forum and the wonderful people on it, are so needed. I would be no where near where I am today, if not for this forum. I made a post a few weeks back on another forum & it got deleted. They said I was not to post anything that had to do with self treating. I needed help. My doctor was not helping me.

Rick

[Muse-Inc]

I'm glad you found an ideal range...so important with an APAP, not too low and not too high...the sweet spot that makes for great sleep!

[DoriC]

Great news! Glad you remembered what you read! Keep us posted!

[red1]

All good things come to an abrupt end.

Even though my AHI only got up to 4.1, that is more then double the night before.

Last night I slept 10 Hours.

My numbers from last night were : Obstructive 3.2, Centrals 0.6, Giving me a AI index of 3.8, Hypopnias index was 0.3. Giving me an AHI of 4.1

Pressure- Median 0, 95% 10.3, Max 11.9

Leaks - Median 0, 95% 7.2, Max 12 Acceptable range below 24. Presssure 6 & 12

Once again, numbers 2 nights ago were: Obstructive 1.3, Centrals 0.2, Giving me an AI of 1.5, Hypopnea index .03. Giving me an AHI of 1.8

Pressure median 0, 95% 8.7, Max 9.5

I happened to go 1.5 hours into tonights numbers, as it was 1:30pm when I got up & the day changes at 12:00pm.

That 1.5 hours had real bad numbers.

Obstructive 10.4, Central 0.9, AI index 11.4, Hypopneas 0 AHI 11.4

Pressure - Median 10.1, 95% 11.8, Max 11.9, which is very close to the 12 Max pressure set.

Leaks - Median 0, 95% 8.4, Max 15.6

Should I up the bottom pressure? Should I up both, since the 95 percentile pressure in the 1.5 hours was only .1 from the set upper pressure?

I was so disappointed when I looked at the numbers today. What could cause such a change? My meds have not changed. THe only difference was I was completely exausted the first night when I got the good numbers. Last night I was tired, but not completely exausted. The night of the good numbers, I took 1 miligram of ativan during the day, but none at night. Usually I take 1 in the am & 1miligram, about 7 hours before going to bed.

Thanks

RIck

[Pugsy]

That 1.5 hours had real bad numbers.

Obstructive 10.4, Central 0.9, AI index 11.4, Hypopneas 0 AHI 11.4

Pressure - Median 10.1, 95% 11.8, Max 11.9, which is very close to the 12 Max pressure set.

Is it possible that you were awake or semi awake during this 90 minutes?
Is it possible that sleep position impacts event occurrence and pressure needs?
Is it possible that REM sleep impacts even occurrence and pressure needs?

Normally I suggest giving things time to settle in before making changes but I know you are only using this machine for a short while. So you pretty much have to make changes sooner than is ideal.
So yeah..you might increase your min and max by a small amount and see what happens. It would be what I would probably do in your situation. All depends on how comfortable you are with changes and understanding of them. Your events are still predominantly obstructive and not central in nature so a little increase probably won't make the centrals occur more often but one needs to keep an eye on them.

Bear in mind that it is normal to have wide variations from night to night in AHI numbers even with no changes in anything. Last night could just have been a fluke....but I do understand your questioning mind. Been down that road myself many times. I have been known to have AHI of 4 one night and next night AHI of 0.8 and next night AHI 3.2..with zero changes to anything that I can think of. It just happens.

Curious....are you still thinking BiLevel machine now or just changing to the S9 Autoset?
I have been experimenting with the S9 VPap Auto last 2 nights. I know you had a bad experience with the PR S1 BiPap auto titration. I have been thinking about you when I am trying to see if I can perceive any differences between the 2 machines so I could maybe offer some insight that might help you.

[red1]

That 1.5 hours had real bad numbers.

Obstructive 10.4, Central 0.9, AI index 11.4, Hypopneas 0 AHI 11.4

Pressure - Median 10.1, 95% 11.8, Max 11.9, which is very close to the 12 Max pressure set.

Is it possible that you were awake or semi awake during this 90 minutes?
Is it possible that sleep position impacts event occurrence and pressure needs?
Is it possible that REM sleep impacts even occurrence and pressure needs?

Normally I suggest giving things time to settle in before making changes but I know you are only using this machine for a short while. So you pretty much have to make changes sooner than is ideal.
So yeah..you might increase your min and max by a small amount and see what happens. It would be what I would probably do in your situation. All depends on how comfortable you are with changes and understanding of them. Your events are still predominantly obstructive and not central in nature so a little increase probably won't make the centrals occur more often but one needs to keep an eye on them.

Bear in mind that it is normal to have wide variations from night to night in AHI numbers even with no changes in anything. Last night could just have been a fluke....but I do understand your questioning mind. Been down that road myself many times. I have been known to have AHI of 4 one night and next night AHI of 0.8 and next night AHI 3.2..with zero changes to anything that I can think of. It just happens.

Curious....are you still thinking BiLevel machine now or just changing to the S9 Autoset?
I have been experimenting with the S9 VPap Auto last 2 nights. I know you had a bad experience with the PR S1 BiPap auto titration. I have been thinking about you when I am trying to see if I can perceive any differences between the 2 machines so I could maybe offer some insight that might help you.

You have been so patient & sweet with all the help you have given me. I so thank you for that Pugsy.

I slept all night both times on my right side. However, if I were to go to my left side or my back, events would be higher. I do know however, that on this occasion I did not switch sides. I know, because my right shoulder begins to hurt, part way through the night, from sleeping on my right side. I wake occasionally from the shoulder pain. When ever I woke up, I made sure to stay on that side, even though there was pain in my shoulder.

Yes, I do not have much time with the S9 Auto set, so I am kinda panicking at finding the right combination. Being I was titrated on the bipap, I will still go for that, once I see my Sleep Doc on the 20th of December. I know the numbers they come up with will not be right. I slept for about 5 hours during the titration, but according to the tech, I never got into rem sleep at all.

I so wish I could find a way to try out a VPAP before I get it, since it is all out of pocket, becuase my insurance only pays for XPAP once every 5 years & its only been 3. The VPAP goes for about $3000.00 in Canada. I thought about getting it from the States, but then it would be difficult getting support for it, if I should need it repaired.

I don't think straight bipap would work for me, just like straight Cpap did not. I somehow have to find out, if the Auto Vpap will cut my breath short. I so hope that was simply a tech not programing the machine right.

I know leaks are not causing the change in my numbers with the autoset. I know position sleeping is not, because both times, I slept on my right side only. The only 2 things that were different was, that I had 1 milligram of ativan (Lorazapam), during the day, when normally, I have 1 milligram twice a day. Second, I was almost fall down exausted & fell asleep in just a couple of minutes, the night of the good numbers. THe second night I was tired as per norm, but not as exausted as I was the night before. Maybe I will try raising both pressures. A pressure of one for the low setting. From 6 to 7 & a .5 incresase for the higher number. From 12 to 12.5, since I did hit the max at times throughout the night.

Thanks again Pugsy.

[RandyJ]

Could the Ativan be a factor? I couldn't tell by your posts (I read them twice) if you had only 1 Ativan on the day of the good numbers and 2 on the day of the not-so-good numbers? I say not-so-good because 4.5 is not terrible, though you are right it is not as good as under 2.

Having more or less of a drug in your system can be a factor. My AHI is usually less than 1, but on a night when I took a muscle relaxant (Flexeril) it was crazy high (for me), over 8 I think.

All I am saying here is that sometimes you need to consider more than just the machine settings. Medications can definitely have an effect on overall AHI, and general sleep quality.