Please help...

[Davedbd6]

I'm brand new to the forum and cpap. Please help me understand these charts. I read through the tutorials and some videos. So, I have a basic understanding. My assumption is my therapy is not going well... Am I correct?? I still feel terrible and nothing has changed. HAve an apt Monday with doctor. I just want to be able to understand and follow my treatment.
I use a Philips Respironics
System One 560P
RemStar Auto with A-Flex
Mode: CPAP 5.5cmH2O.....prescribed at 5 but i manually raised it.

Nuance nasal pillow

THANK YOU

[BobHale]

Davedbd6,

This early into CPAP you are doing well. Maybe the numbers could be better but they are not in the range I would worry about.
I felt a little better in the first weeks but I took several months to really notice a difference.
I had a lot of issues with centrals in the beginning and pestered my doctor who ignored the issue. They did fall off with time.

Having access to the detailed information from your machine is a double edged sword. While you can see what is going on and try to make changes to improve, you can become obsessed with the numbers. You need to allow your body to adapt to settings changes and look for trends.

I'm 3 1/2 years into CPAP and my AHI numbers range from 1 to 7. My last 30 day's average is 2.82.

[Pugsy]

Welcome to the forum.
Your machine choice in your equipment profile points to the wrong one...the correct choice would be
PR System One 60 Series Auto CPAP
Forget the Remstar part of the name..they use that on everything.
If you would use text instead of icony we can see at a glance what equipment you are using...see my equipment profile.

Your reports aren't horribly horrible but the snores are more numerous than we would like to see
You are in cpap mode so the machine isn't able to tell us anything about Flow limitations (available only in auto / APAP mode)
but I wouldn't be surprised if you had a bunch of FLs to go along with those snores.

The snores are indicative of not quite optimal pressure. If you were using apap mode the machine most likely would try to increase the pressure to better prevent the snores which are warning signs of a partial collapse of the airway trying to happen.

Would fixing the snores (just need a little more pressure) result in your feeling like a new person?..don't know because there's so much more to feeling better and sleeping better than nice clean low AHI reports.
Doesn't hurt to try to improve what might stand some improvement though.

Are you sleeping without the mask at any time during the night?
The 6 to 7 hours of sleep you are showing on the report....do you find yourself waking up very often?
Do you take any meds of any kind even OTC? If so, what, dosage and when?
Any other health issues? Pains?

When you say you "feel terrible, nothing has changed"...exactly what symptoms are you talking about?

[Davedbd6]

These numbers concern me. In the events tab.....to the left

Ive been on CPAP for about 1 month. I feel exactly the same. Tired, Headache, need naps. I'm a firefighter who works 24 hr shifts and I wear this at work. Im very worried because waking up in the middle of the night I feel awful. I'm expected to perform 100%, not zero.
I do not take any OTC meds.
I'll change my equipment now.

Thanks for the support.

[Davedbd6]

I will discuss with my doctor increasing the pressure and using auto mode. I had thought this was the way to go from input from friends but decided to let a month go by to see how i did. I'm hoping he will let me switch it for a bit to see how that helps. If not, would changing the settings on my own interfere with insurance and compliance?

[Pugsy]

The OAs and snores...your pressure is not quite optimal. Your therapy can stand some room for improvement. Doesn't need huge improvement....just a little improvement. Snores shouldn't be so numerous...and if the snores get better prevented...most likely the OAs will come down along with them.
We can't guarantee improving (reducing) the snores or OAs will make you feel better but it would give you a better chance of feeling better.

Again...the 6 or 7 hours of sleep you do get ...and 7 is barely enough...do you wake up often during those hours for any reason (not counting the alarms at the fire station that you can't do anything about)...at home during off time...do you wake often?
This is important to know.
If you are waking often for any reason then your sleep architecture is messed up and chances of feeling better even with optimal therapy is severely diminished.

So...how is your sleep quality..wake often ...during the 6 or 7 hours of sleep you do get?

[Davedbd6]

I do wake up often. That I can tell, it's many small episodes. Usually to adjust nasal pillow or no reason at all but fall back asleep. I've been limiting my evening coffee or any liquids to stop the mid night bathroom break. But I often do wake up for short periods for no reason. I'm basing much of this on my girlfriends input. While she says my snoring and Aeneas are significantly down, she does say she feels me moving around, messing with mask and some snoring.

[Pugsy]

Insurance companies don't care about the settings...they just care that you use it the minimum number of hours each night.
If you aren't comfortable changing things yourself then wait and talk to the doctor about it.
DMEs don't really care either and if you don't tell them often they don't even notice...they are looking mostly at hours of use so they can tell the insurance company you are using it and so they can get paid.

I would want to use apap mode to get Flow limitation flagging...you can still used a fixed pressure to mimic cpap mode if you wish...just set the minimum to equal the maximum...works like cpap but give FL flags which might be worth seeing.
5.5. cm....not enough pressure to prevent the collapse of the airway...I suspect 6.5 or 7.0 would make a substantial difference in the looks of the reports.
Whether it will help you feel better...unknown but at least it would improve the chances.

[Pugsy]

Waking frequently equals fractured sleep architecture and when we don't get the normal progression of the sleep stages in the normal (and needed) percent of time in each stage...it really messes with how we feel during the day.
When I first started therapy it took a couple of weeks of tweaking to get the reports looking good but I still had a lot of awakenings due to my arthritis so I didn't feel nearly as good as those reports said I should feel. The pain issues were separate issues unrelated to OSA and the machine couldn't fix those.

The number of snores shown...could be disrupting your sleep..could be waking you up....could be a factor in the wake ups...and so they need to be reduced.
It's a place to start...something that definitely needs improvement.
If that doesn't help your sleep quality...then we look at other things.
When you have a lot of awakenings it is going to complicate things in terms of how you feel during the day...some awakenings are normal but when we have more than 4 or 5 that we can remember (which usually means a lot more that we can't remember) then we have a potential significant factor in sleep quality that needs to be worked on and sometimes it's a lot of work.

[Davedbd6]

Thanks Pugsy, I will speak with dr. Monday. Then I'll change the mode to apap with a range maybe from 5-8??

[djhall]

Thanks Pugsy, I will speak with dr. Monday. Then I'll change the mode to apap with a range maybe from 5-8??

Even if you switch to auto mode, I wouldn't recommend setting the bottom of the range below 6. Auto works best when the minimum is an adequate pressure for the majority of the night and the machine increases for periods of increased need. The strings of VS2 and the H events indicate that 5.5 is a little below optimal.

[Pugsy]

Then I'll change the mode to apap with a range maybe from 5-8??

I think 6 to 8 maybe if doing APAP mode....given the snores at 5.5 now...I still think a little more pressure so the machine does a better job preventing the collapse and doesn't have to work so hard trying to "fix" things.
Also less chance of the actual pressure changes being a disruption to your sleep quality which is already fragile anyway.
Some people sleep through big changes in pressure (that would be me ) but others find that the least little change disturbs sleep. A change from 5 to 8 might disturb your sleep...using minimum of 6 there is less chance for the need to go to 8 and if it did go there...less of a change in range.

The machine doesn't respond nearly as quickly as people think it does and with minimum at 5 the amount of response time is maybe going to impact things. When I was using APAP machine...my minimum had to be 10 cm...at 8 minimum my reports looked like yours.

[Davedbd6]

Ok. Great. Since I know how to get into the system setup, I will try 6-8 tonight apap.

[Julie]

Ask your girlfriend if you generally have your mouth open to any extent once asleep... if so, you're losing therapy air that way and a trial of a full face mask might be in order.

[OboeVet]

Davebd6: I hope you also are keeping track on other occupational hazards, like higher carbon monoxide levels, early pulmonary & cardiac disease, and PTS (I leave off the "D"). Shift work messes with sleep & interrupted sleep multiplies the complications. THANK YOU FOR YOUR SERVICE! Don (former EMT)