SleepyHead Data: Is it time to raise my pressure?

[Starlette]

When I went to check my reading this morning, the first thing I saw was this pink line across my data (I know what that means: Worst data Rx Setting). I also confirmed with this with the Records portion of SleepyHead which I also included in photo.
QUESTION: Is it time to raise the pressure?

Starlette

[carbonman]

How are you feeling?
Is your sleep hygiene stable?
Are you comfortable w/your mask/hose management?
Are you comfortable?
Are you comfortable w/your routine?

Be patient. Be consistent.
AHI may vary from other factors in your life right now.
I would suggest that you stay the course for another week.
It looks like you are on the right course.

[Pugsy]

I forget your usual breakdown in your AHI numbers.....how much of those AHI numbers are clear airway indexes? If minimal to none CA index...might consider a small increase in that minimum. If 50% of your AHI is typically CA index...remember increased pressure won't do a thing for the Clear Airway events.

[Starlette]

@ Pugsy - I made a copy of my sleep journal.
*Thinking out loud* I might be jumping the gun. This past week, I've had a bad cold so it may have come out in the data.

Starlette

[Pugsy]

from this journal..almost every night with a 3 to 4 AHI also has almost 50% (or greater) of that AHI being Clear Airway index. The only real exception are the 1/27 & 28th nights. Mentally back out the CA index from your AHI to get an idea what the obstructive components are. I will use your 1/22 data as an example.
AHI.....3.74 with Clear Airway Index of 2.18....

Subtract the 2.18 from 3.74 to get your obstructive component index (OAs and Hyponeas index)

for 1.56 index for your obstructive events. Quite acceptable number and no need for a pressure change for this index.

Remember that Clear Airway events are never treated with increase pressure....it just doesn't help them at all so any modifications to any pressures need to be based solely on the obstructive components of your AHI. You could use straight 15 cm pressure and still have clear airway events flagged occasionally.
We can't stop them with these machines that you and I use.

FWIW...I also have nights where I may have zero to 1 Clear airway index and other nights maybe CA index of 3. One night I had CA index of 4 and had one sole lonely Hyponea the entire night. I totally throw out any Clear Airway index or event when I mentally evaluate my reports. I feel sure that the bulk of any of my clear airway events are related to turning over in bed holding my breathe and or pain. Since I have nights with minimal to no CAs....I know I am not having the magnitude of centrals (even if they are the real deal) to have it be a problem. We don't treat centrals with cpap/apap pressure. For people who do have enough centrals for it to really be a problem....they need a different machine. For people like you and me...we don't have enough "centrals" for it to be a problem and we don't try to prevent them because we can't. We just shrug our shoulders and concentrate on the obstructive stuff.

[Starlette]

Thank you Pugsy. You make total sense! I've now included your calculation in my spreadsheet.
Hot digoty Pugsy, there is so much to learn! I'm not going to put the effort into the past, now I'll bet you anything my numbers may not have looked so bad after all prior to getting the apap. Now looking at EncoreViewer, it does include CAs in the total AHI calculation which really makes it look worse than it really is. Like I said, I added your calculation into my spreadsheet which NOW paints a whole different picture. To be honest with you, I want to sit down and have a good cry. Sorry Pugsy for being such P.I.T.A. (call it what it is). I have to believe there will be a whole lota folks learning from my post. Thank you Pugsy *humbly stated* In conclusion, there really isn't a need to change my apap settings.

You ever find yourself in Denver, let me know. I'll buy you a drink

[CROWPAT]

I don't post often anymore, but I think those who are trying to help you missed a very important data point on what you posted: hours used per day. You are only using your machine for a very small portion of the night. Why aren't you sleeping all night with it? IMHO I think it unreasonable to consider anything at all about data based on so few hours of use per night just as I don't give much credence to data that includes high leak rates no matter what machine or mask is in use. Both data set elements are extremely important to allow any credible evaluation of the effectiveness of your treatment. I've been a hosehead for well over ten years now and have benefited often from those who have tried to help me here. There is no better place on the net to learn and help others.
Pat

[Pugsy]

I think those who are trying to help you missed a very important data point on what you posted: hours used per day. You are only using your machine for a very small portion of the night. Why aren't you sleeping all night with it?

I know that Starlette knows, that her hours asleep using the machine are not optimal. She has another thread about what to do to keep her from taking the mask off during the night and not realize what has happened until the next morning. It is something she knows that needs working on so there was no need to bring it up again here (for me anyway). She and I have had that discussion quite some time ago.

In conclusion, there really isn't a need to change my apap settings.

Correct. At least no change based on what we see here. Before these new machines that scored "centrals" in the AHI it was real easy to say to a person that had an AHI of 5 or 6 that they for sure needed more pressure because centrals weren't in the equation. Now we have to step back and evaluate the AHI a little more closely. Remove any central component from the equation because we don't treat centrals with cpap pressure anyway. Now there might be a different reason to change the pressure....like if pressure changes disrupted your sleep and we need a much tighter range. If you had an AHI 0.5 with pressure range of 8 to 12 but the changes in pressure woke you up all the time...we don't want that either so then we find perhaps a little higher minimum and lower maximum to reduce sleep disruptions.

Some people are just super sensitive to pressure changes and some people never know the pressure changes during the night.

Since your problem with short hours on the machine (taking the mask off and not knowing it) predates the start of APAP over CPAP (if I remember right)....it likely is not the pressure changes disrupting your sleep to the point of waking and removing the mask and not realizing it. You already know something in your subconscious is at work here. Now is something going on with your sleep apnea causing you to wake up? We don't know.

But back to the AHI and CA component...now with the new machines I find I have to stop and step back and not automatically say "increase the pressure" until we have determined how much of that AHI is even something pressure will take care of. If you rarely had any clear airway events...different story entirely but since a good chunk of your AHI is predominantly clear airway and it happens for most of your nights, then a pressure increase is not critical. Now if you think you might sleep better and want to try a little more pressure just to see if you sleep better and are not chasing the AHI...then by all means go ahead and try a little more minimum pressure. You will have nights with more and less AHI anyway. But the goal is to see if you sleep better, maybe not take the mask of..or generally feel better. Different goals than just a set of numbers.

[SleepyToo2]

Starlette, I am not a sleep doc, but based on my experience I would stop fiddling with PR factors. You have gone from A-flex+ to A-flex to C-flex+ to C-flex in short order. This does not give your body time to get used to the new setting before you change it again. Something to think about - and consult with your DME to find the best setting for you. However, you will probably not find a magic setting in one night.

[Starlette]

Hi Sleepy.

I definitely agree. When I initially got my auto 1/9/2012, I was checking to see what the best flex setting was for me. Unbeknownst to even me, I somehow switched it to C-Flex+. Still had to document in my journal as a change. I still don't know how I did that. I was trying to decide between A-Flex and C-Flex only. i already knew from cpap that I didn't care for C-Flex+. I quickly realized that I really didn't care for A-Flex and have kept it at C-Flex since.

Starlette

[DoriC]

Starlette, thanks for this thread! I know how important this is for me to read and "digest"! I've probably driven Pugsy crazy with all my pressure scenarios that I present which she tries to explain many times,but having her interpret your data is finally clicking with me. I'm glad you get it too. Me happy!

[Starlette]

*chuckles* It's FINALLY clicking with me too Dori I wish understanding our data and the mechanics of cpap, apap, etc. came as fast as switching on a light, not so. I think I've learned more about my machine and how it works in the last couple of weeks than in the last four years. I figure if anything, I've saved someone the embarrassment of coping their lack of knowledge in a particular area while I've come to for front and stuck
my neck out. Like I stated before, through Pugsy's help, I've come to understand that my numbers aren't that bad after all. They aint what I consider sexy, but they aint as ugly as I had initially thought either. I'm cool with that. Lastly, in appreciation for all that I've recently learned from Pugsy (she's had to rephrase a couple of times), I told her that if she ever visited Denver to hook up with me and I'd buy her a round of drinks

Now, if I could just keep my blimpity blimpin' mask on at night, I'd have the ability to do snoopy dances every morning.

[Pugsy]

Now, if I could just keep my blimpity blimpin' mask on at night,

You've tried several different masks. Is there any one of them that you can keep on longer before taking it off and not knowing?
I don't have any clear cut answers for those that prematurely remove the mask and go back to sleep without realizing what has happened, like I can come up with from simple numbers on the reports.

[DoriC]

*chuckles* It's FINALLY clicking with me too Dori . Lastly, in appreciation for all that I've recently learned from Pugsy (she's had to rephrase a couple of times), I told her that if she ever visited Denver to hook up with me and I'd buy her a round of drinks

Now, if I could just keep my blimpity blimpin' mask on at night, I'd have the ability to do snoopy dances every morning.

Hey, you may have to include me too! My daughter now lives in Longmont and she's relocated to a new law office in Denver.(Long story)! I haven't been able to visit her yet but God willing, if Mike's OK in the Spring we may take a trip?? I only drink white wine these days! I'm sure you've gone all over this with Pugsy but have you tried turning Cflex Off? Tried straight pressure? And what about the HH settings? Is there something about the mask that bothers you? Mike has tried several different FF and the UM seems to be the best for him although sometimes he has leak problems after 2-3months. Luckily we can get a new mask every 3months if necessary, and I have some spare cushions that I use if leaks start before 3 months. We also use an anti-leak strap from PAC during that leaky period which helps. Hope you'll be dancing soon!

[Starlette]

Really? Coolness! Longmont isn't too far a distance from me. Some distance, not excessively far, about a 40 minute drive. In fact, you know what would be the ultimate??? Come join us for our monthly CPAP meeting this spring, we'd love to have you and Mike join us Some of us bring our spouses too. Afterwards, I'll buy you and Mike a round of drinks. See if we can syncronize the time. Man Dori, I'm totally stoked about that! I'm down for it! Wow, that would be totally cool! When the time comes to making plans we'll exchange phone numbers (I'll give you my cell#) via PM. As for commenting on this thread to you and Pugsy (I do have an answer), I need to wait till tomorrow to respond. I've spent the last four hours communicating to Pugsy since 10am this morning via a letter to her. I need to show some production to DH before he comes home. Now Dori, you got me plannin' and schemin' man, too cool!

Starlette