Screwy home Sleep Study............HELP!!!

[Kalypso]

I just finished a home APAP study (due to not having insurance for the $3000.00 in-office study). While I have my Remstar, Auto with C-Flex results, I have nothing to compare them too, so I don't really know how bad my Apena was prior to using the APAP. (My GP is clue less but is willing to give me a scrip for an APAP). If it helps, here are my results.....does anybody have an idea about if these results give any inclination about my actual Apnea?

32 days at 100% compliance (although, those are mostly 3-4 hour blocks of time with waking time between until I'm so tired I need more sleep).

Maximum Usage = 12hrs, 25mins
Average Usage = 9hr's. 1min
% of Days with usage >= 4hrs = 96.9%
% of Days with usage <= 4hrs = 3.1%
Mean Pressure = 6.9cm
Peak Avg Pressure = 11.5cm
Average Device Pressure ,= 4hrs = 8.7cm
Avg. Time Apnea per day = 41.8secs
My 90% Average pressure was 9cm
AHI avg. was 1.2

Based on this, am I correct in assuming that I should set up my APAP (my GP told me I probably have more knowlege than him) to run between 7cm-12cm? Also, any other advice or insite would be appreciated (like how do I get out of this 3-4hr sleep cycle rut? I only recall one REM cycle, which is reflected in my daily patterns)!

As an aside, after this month, I gott'a say that I've never been more tired in my life. 3-4 dangerously-close-to-falling-asleep on my feet episodes a day...

After some more thinking (& reading), my Remstar APAP is still set for the 4-20 range. My 3-4hr wake-ups are caused by high pressure leaks that totally wake me up & continue unless I unplug the machine & wait about 10mins before restarting (it's actually located on a platform under the headboard of my anitque post bed (plenty of space there but I can't reach the ramp button). My inclination it to think it's increasing the pressure over my 12 max necessary and constantly waking me.

I guess my question is, since I still have another 10 days or so with this machine while I wait on my new Remstar Auto to come in, shoud I go ahead and set it up to run within the 7-12cm range?
Thanks!

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, AHI, Ramp, auto, APAP

[NightHawkeye]

.....does anybody have an idea about if these results give any inclination about my actual Apnea?

If you want to know what your actual apnea is, you'd have to do what physicians do for the sleep study, which is record your sleep without Positive-Air-Pressure. You can't do that with the machine, obviously, but what you can do is run your machine at its lowest pressure. I've done it and it's an effective recording technique. If you really want to know your baseline AHI, it's probably your best bet short of a laboratory sleep study.

As an aside, after this month, I gott'a say that I've never been more tired in my life. 3-4 dangerously-close-to-falling-asleep on my feet episodes a day...

I can relate. My machine is set for a low pressure of 5 cm and it wakes me up most of the time when it gets over 10 cm pressure. If you can narrow the range, I'd expect that you would do better. (I'd follow my own advice, but I have other problems raising my minimum pressure . . .) Most folks here seem to prefer a narrow range though. The other recommendation which I see repeated often is to set your minimum pressure at or near your 90% pressure (9 cm in your case). That way, the machine keeps your airway open and only rarely neeps to raise pressure. If you think 12 cm is your top end then try it with a 9 cm - 12 cm range and see how you do for a few days. The thing you will probably notice first is that with your low pressure set so much higher than it is now, you will have to deal with your mask leaks. Maybe by eliminating the leaks, since you say they wake you up, you will find yourself sleeping a whole lot more soundly.

Sounds like you're on the right track to getting things sorted out.

Regards,
Bill

[yardbird]

definitely narrow the range. I wouldn't set the low end lower than 5, but I think I'd set it at 6. This will allow it to drop off as needed. With a 90% average of 9cm I'd say drop the high end pressure to 11, but since you're new I'm going to suggest 12 as the high end. That should keep the machine from running away to max output, but still keep you in a useable range. When you've been successfully using it for a while you take a look at your pressures again and narrow more from there if necessary, but I don't think I'd try narrowing it ddown to what you think is "final" pressures right off the bat.

You do want to stop those runaway high pressures though. Takes some getting used to. How is your mask?

[capt]

I totally agree with Yardbird and would use those settings. Actually doing the study the way you did was how mine was done. I certainly have not suffered due to it. Quite frankly, what difference could it make for me to know what things were like without using a machine. I already knew it was the pits! The use of the apap machine has changed everything for me. Using an apap really lets you control and take charge of your treatment, and it allows you to make almost any change necessary to have the best treatment. The home study you had would also have determined if you had needed treatment using a bipap machine, which you do not. Take care and all the best!

[Snoredog]

it would be difficult to measure the severity of your disorder using only the autopap, although not impossible. The machine does have a special Split-Night mode for that particular purpose. However, the problem you run into even when using the special mode is even the lowest pressure delivered can treat some events and throw off the count for determining said severity, even the starting pressure set on the machine will treat some events and skew your data results, so not a real accurate a measure by any means. But the data does prove you can benefit from its use. If you were not having any OSA events the machine would/should have stayed on the lowest pressure setting, yours didn't.

If the Remstar says your 90% avg. pressure is 9cm, then that is what they most likely would have come up with from any titration study if one was completed. Pressure does NOT determine severity. You can be severe and only require 5cm pressure. The 11.x pressure found from your reports is what I call the "dabble space" the Remstars like to play with this space to see if the number of events seen reduce with increased pressure(s), if they don't drop with this higher pressure, it drops back down to the 90% found pressure. The 90% pressure is the pressure that treats 90% of the events seen. Resmed uses a 95% figure here. Yes, your 7 to 12cm range is okay.

I would not leave the machine at default 4-20cm pressure range. Setting your "range" 2-3cm above any 90% found pressure allows the Remstar to continue to have its dabble space. You want this space as part of your range should your condition change or worsen where the machine needs to adjust up 1-2cm. If you see flatening on pressure reports, then you want to increase that ceiling higher.

Missing from your home study is sleep architecture or a measure of how well you sleep in the various stages including REM. This can show if microarousals exist which can impact REM sleep. Also missing is how low your oxygen levels drop during sleep. However both should improve with any use of cpap. Restoring your normal blood oxygen levels is the main reason to use cpap and most important part of this therapy.

As for your short periods of sleep? Longer or increased sleep comes after weeks of getting used to using the machine so you can sleep normally again. You also have to reach normal REM sleep and repay any sleep debit, it can take weeks or months of sleep to repay that debit.

Note: you'll need to keep a close eye on your machine's air filters when keeping it on the floor, that is the most dusty place you can put a machine in any home, but also the quietest place.

You should have NO ramp in any of the auto modes on the Remstar. If you are attempting to use the Ramp button (and its working) your machine is set up incorrectly. I suggest waiting until your new machine arrives for the clinical manual and setting the machine up correctly. If set up correctly, that machine will run at the minimum pressure when your awake. Your doctor may have the machine in a Split-night diagnostic mode. During this mode the machine won't respond to events and will run at a set pressure from 2 to 4 hours. After this timer has expired it switches to a therapy mode and runs that mode the rest of the night. If this mode is enabled your ramp button would function. For normal autopap modes, the machine should be set as follows:

mode=afle (autopap w/cflex, options are: cpap, cfle, auto, afle)
cflex=2 (options are 1, 2 or 3, suggest starting at 2, no this is NOT an altitude adjustment).
low ramp=7cm (your low or starting pressure)
high ramp=12 (your pressure is 9cm, u want +2cm, but 3cm okay also)
timer=00:00 (5-45min =ramp timer for cpap modes, >02:00hr=special split-night diagnostic mode**)
patient alert=0 (0=off, 1=on, beeps on large leak or mask off)
LED=1 (turns On/Off LED lights)

**this parameter should be set to zero 00:00 for ANY of the autopap modes (auto or afle modes).

[Kalypso]

I appreciate everyones input! I think I'll start at look into setting up the range to those suggested (if I can find out how;-)

I have the Aura Headrest Mask (with the rubber band trick) & it works like a charm (until the machine ramps up so high it blows the pillows off of my nose)! I use a chinstrap at night & have trained myself to sleep on my sides only. I have seemed to have trained myself to not need the chinstrap too, although I've only tried this during a daytime nap (since I'm only getting 3-4hrs of sleep. I ususally have to shut down some time during the afternoon). My first 2 nights I woke up with a dry mouth & it has since stopped.

Edit: I believe I have it set up now, low end at 6cm (conservativly), high at 12cm. CFlex at 2, etc. Also, it isn't really sitting on the floor....the bed is about 3ft from the floor to the bottom of the box springs & I have the unit setting on an wooden antique step unit that keeps it about 3" under the springs & 3" from the front of the headboard (I mainly chose this placement because the bedside table isn't that stable & is about 4ft high, & I didn't want to hear the rental machine hitting the floor one night)!

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CPAPopedia Keywords Contained In This Post (Click For Definition): Aura

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CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, Aura

[capt]

It sounds like you have things pretty much in hand. I would not make any changes based on one day, but rather would keep checking and after a week or even two weeks of data, you could start making the minor adjustments to enhance things. With the max pressure at 12, your Aura should not give you any problems. Good luck!

[Linda3032]

Kalypso - I would definitely try to get an Auto since you will pretty much be taking care of yourself (since your doctor admittedly has limited sleep apnea knowledge).

Who is reading your smartcard for you?

Snoredog - what I would refer to as a "ramp" on an auto is simply the minimum pressure. My machine is set on 6/10. If my pressure is blowing at 9 and I'm awake, if I hit the ramp button, the pressure drops immediately to 6.

[Kalypso]

I would really like to thank everyone for their help (I posed my plight on 3 other forums without one peep). I took a test run at my new settings (& after getting used to the new 6cm starting pressure & the CFlex set at 2, instead of 1), I slept hard for 3.5 hrs...first time I can remember sleeping so deeply in 8yrs! Not one time do I remember rolling over, having a leak or waking for a thing...if the phone hadn't woken me, I'd still be asleep!!

My local Lincare rented me the Remstar w/CFlex & are doing my card readings for me. My GP didn't even look at the printouts, but relied on what I read to him & told me to call him to tell him where to fax my scrip. I called Lincare again today & they agreed to meet CPAP.coms pricing plus, let me set up a pay schedule for the new machine. When I told them I had set the rental up at the new settings, they even agreed to give me another reading after 10 days (about the time for my new machine to get here) & are letting me keep my one month rental machine 12-18 days past my original agreement for free...hard to beat that! Thanks again!!!

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CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, CPAP

[Linda3032]

wow, that is really great news. It sounds like you have everything under contro. And super that Lincare will work with you on the cost.

Hope you continue to sleep great.