Question about my 8 day report

[t00fan]

Hi,

I've been on apap therapy for about 3 weeks. My DME swapped out my older HC254 cpap with a new one of the same kind. I acquired the software for it through some very helpful folks on this forum, and have made a 8 day report (last 8 days). My question is this:

In the daily charts it is showing that I am having Apneas and Hypopnea during the night. Is it telling me that it's actually preventing those with the pressure, or are they actually still happening despite of the cpap machine. It's a little confusing. My AHI number seems to be low, but the amount of events that I have are in double digits.

Would I benifit from increasing the pressure (both low and high), since i seem to have an event almost always AS SOON as I fall asleep, and my max is reached most of the nights?

Thanks for all your help, and feel free to comment on anything else in the report.

Here is the link to d/l the pdf of my report:

http://dl.dropbox.com/u/351318/110-117.pdf

Thanks,
Dharmesh

[timbalionguy]

From what I can see here (Disclaimer: I am not a doctor!), your therapy looks quite good. Your AHI is consistently below 5, something many folks here long for.

I am not sure how this machine is measuring mask leak. If it is showing intentional leak (what comes out of the mask vents) plus unintentional leak, you are probably doing good. If intentional leak is not part of your leak number, you might have something there to work on. However, your leak is pretty constant, which tells me that this graph includes intentional leak.

Hypopnas like you are seeing are usually indicative of pressure that may be a bit low for you. A lot of people experience hypopnas like this. But looking at your graphs, you are staying well within the therapy range of the settings of your machine. Your low pressure setting, however, is awfully low, and most people would have trouble breathing against 5 cm. If you are comfortable with this low setting, more power to you!

If I were to recommend anything to try, it would be this: First, address any possible mask leaks, or possibly mouth breathing (although I don't think you are doing this, either). Then, try increasing your min and max pressure by 1 cm. Wait a week and see if things change. If you aren't seeing a change, try raising your min pressure (only, your max seems fine with just 1 cm boost) one more cm. If you do not see any change, stop there and talk to your doctor. My suspicion is that you will be a little more comfortable with the initial 1 cm min and max increase.

As far as apneas when you are falling asleep, there are quite possibly 'sleep staging induced central apneas'. These are pretty normal in many people,and are usually harmless. (I experience a lot of them) Ask your doctor about them, but I wouldn't worry too much about them.

Good luck on your therapy. It looks like you are off to a great start!

[Pugsy]

F & P machines report total leak which is the intentional mask vent rate plus any excess leak. They say they can handle total leaks up to 95 L/min I think it is. Your leak rate is half that.. so leaks aren't excessive and I doubt that leaks are an issue at all.

Your AHI is acceptable..generally we like to see AHI less than 5 and yours meets that guideline easily.

Most of the nights you barely reached 10 cm maximum. You could open the range a bit if you wish.
I do think that the minimum is probably more critical though. While technically your AHI is acceptable..it might improve and give you peace of mind if you increased the minimum just a bit. It also might not improve. Your report based on numbers shown do not really warrant an increase in pressure as it is but if you are feeling like something is missing or you aren't doing quite as well as you would like to then a little nudge of that minimum pressure up to say 5 or so (in small increments) might help.

On a whole your reports shown are quite good though. Nothing glaringly needing any huge changes by any means.

[archangle]

In the daily charts it is showing that I am having Apneas and Hypopnea during the night. Is it telling me that it's actually preventing those with the pressure, or are they actually still happening despite of the cpap machine.

The machine reports events that occurred despite CPAP. You usually try to keep the AHI number below 5 events per hour.

[t00fan]

Thanks for the detailed reply all of you!

I am pretty sure my therapy is working. I have already noticed the following benefits:

1) More energy. I don't need naps. (and for it I get to spend more time with my kids)
2) Don't pass out while watching TV at night (and for it I get to watch movies at night with the wife)
3) I don't have cravings anymore for fried foods. I get full faster, and STAY full longer. (maybe this is just in my head, but I swear before this I would pass Bojangles every day and 3 out of 5 days I would cave in to getting a chicken biscuit. For 3 weeks now, I have passed it everyday and had no desire to eat it)
4) I don't wake up looking like a parrot (my hair used to be a mess when I got up in the morning. Now I get up EXACTLY like I slept).
5) I feel mentally awake while driving. Sort of like a buzz.
6) Caffeine actually gives me a buzz. Before I could drink coffee and go right to sleep. Now I have to be careful when I consume it or I will not be able to sleep at night. I have stopped drinking caffeinated soda at dinner time because of this.

So as you can tell, Its definitely working. I was just trying to top it off, and squeeze as much benefit out of it as possible. If below 5 is the average, then I guess I'll leave things as it. Just wanted to strive for getting the AHI in the 1-2 range.

Thanks once again,
Dharmesh

[Pugsy]

If below 5 is the average, then I guess I'll leave things as it. Just wanted to strive for getting the AHI in the 1-2 range.

You may find that in time the AHI drops down all on its own. I found that happened when I first started therapy after I got my pressures dialed in and left them alone that things trended downward all on their own after about 5 months. In October I changed to a BiPap. Found a good setting (giving 4 to 5 AHI for the most part but I felt great) so I left it alone and now I see AHI of 1 or less fairly often. Sometimes see AHI of 4 again but for the most part...trending downward. Even had one night with a single lone Hyponea over 8 hours which is superb for me.

If you had reported no improvement in how you feel..yeah maybe a drop in AHI might help how you feel and so maybe a little increase in that minimum pressure.

Important thing is how you feel. Some people have an AHI of 0.5 and don't feel the good numbers. A low AHI doesn't guarantee feeling like a million bucks. While it is nice to see sometimes just for a pat on the back thing, perfect numbers are just perfect numbers. Since you are reporting feeling great there is no huge need to change anything.