Get to play Doctor

[Sircadian]

I'd say it'd be better to NOT fiddle, and gather as much auto data as you could, you've got tons of time to fiddle with set pressures in the future

Yep, y'all made me anal ..... it's not my fault.

Clinic had a full week of data before the clinician gave me a green light. She knew ... my wife told her the internet messed me up.
Going to take one more run at it ... now I have to pick a number for tonight ...hmmm

Have to fiddle, no use proctrastinating ...

[palerider]

I'd say it'd be better to NOT fiddle, and gather as much auto data as you could, you've got tons of time to fiddle with set pressures in the future

Yep, y'all made me anal ..... it's not my fault.
Have to fiddle, no use proctrastinating ...

well, at least the river of deNile that you're paddling up is different that the usual one we get treated to here

[Pugsy]

Tonight ... no use running it with a pressure range starting at 6cm because in a few days she won't have that option.
Thanks for the advice.

Here is an earlier image with original open settings ... what steady pressure might you try next?

Well if you had done the minimum of 6 cm like I suggested then we could maybe give you a reasonable steady pressure to try. Quite often when the minimum pressure is more optimally set then the range we see in apap mode actually reduces and the pressures become more stable and then we get a clearer picture of what would be a decent fixed pressure to try.
Believe it or not but there was a method behind my madness with the suggestion to use a higher minimum pressure and then evaluate things from there.

[Sircadian]

Fair enough, point taken, I'll run an apap range of 6-10 cm tonight unless you have reservations with that. Made the wife aware of what I was doing last night, explained a few things to her about the graphs and let her pick a number for last night. She chose to retry 8 cm cpap because that is the number her clinician had suggested. Again, similar poor results like the other 8 cm graph that was posted. I'll post the 6-10 results tomorrow night after my golf game.

Turns out she can keep the loaner (A10 for Her model) until May 26 which is a few days longer than their normal 2 week titration.
Buys me a little extra time to play with settings and maybe learn something.

[bwexler]

Agreeing with Pugsy, I would try 6-10 for AT LEAST 3 NIGHTS in a row to try to establish a pattern.
Any one night has too many variables to pin down a solution. It is a shame the Canadian Governments provide such strict control over what medical equipment you get. Can't wait for US to "catch up".

[Jay Aitchsee]

So, the worst AHI I've seen in what you've posted (I may of overlooked some) is 3.89. Not exactly horrible. The AHI's that have been posted include a significant number of CA's, which could be caused by not being used to and being disturbed by the therapy. These events could easily be reduced as your wife becomes accustomed to the machine. I don't think you are doing her any favors by your constant "fiddling". As I think was stated earlier, one night does not constitute a trend.

[palerider]

Buys me a little extra time to play with settings and maybe learn something.

it's foolish to do *anything* but auto settings while you have the machine.

you're playing with fixed settings now, you'll have forever to play with fixed settings once you get the fixed setting machine, you only have now until the 26th to gather data in auto mode.

[Sircadian]

Agreeing with Pugsy, I would try 6-10 for AT LEAST 3 NIGHTS in a row to try to establish a pattern.
.

Pugsy picked the lower number (6). Hoping the top number (10) that I picked is okay with her ... my reason for that is because at no time has the open settings or pressure gone above 10. Just tightening up the range, no more 4-20 wide open.

[Sircadian]

So, the worst AHI I've seen in what you've posted (I may of overlooked some) is 3.89. Not exactly horrible. The AHI's that have been posted include a significant number of CA's, which could be caused by not being used to and being disturbed by the therapy. These events could easily be reduced as your wife becomes accustomed to the machine. I don't think you are doing her any favors by your constant "fiddling". As I think was stated earlier, one night does not constitute a trend.

No, not horrible but after ~6-7 days of an AHI that averaged ~1.75 the 3.89 is more than double the wide open 4-20 cm setting.

To address you and Palerider's comments on the 'fiddling'. Keep in mind the clinician that called, after remotely reviewing her first week of open therapy, seemed surprised I hadn't fiddled and suggested an 8 cm setting to my wife as a starting point. Admittedly, I was itching to see what a straight pressure would do. I'm doing this on a green light from the sleep clinic. I am starting to question my belief that CPAP works just as well or better than APAP. My CPAP brought my numbers down, not so in this case. Make any assumptions you wish but the experimenting interests me.

[Tatooed Lady]

I hope your wife really likes you, because if it were me on the receiving end of the fiddling, by now you'd have been on the receiving end of my elbow. But then, I'm occasionally aggressive that way. By the way, are Canadian divorces as expensive as American?

[Sircadian]

I hope your wife really likes you, because if it were me on the receiving end of the fiddling, by now you'd have been on the receiving end of my elbow. But then, I'm occasionally aggressive that way. By the way, are Canadian divorces as expensive as American?

You wouldn't turn things physical with me, trust me, nothing physical under this roof other than friendly contact

Actually, the wife really appreciates that I was the one pushing her to be tested. Since my treatment started ~ 6 months ago, I've persuaded her brother and her sister-in-law to deal with their snoring. From what I've read here, feel I'm improving the quality of their lives, and yes, that gives me a good feeling.

My wife is in good hands, she is wary of the sleep center, has a great mask (p10), software loaded on her laptop and sleeps with someone who has been taught by the best .... all of you

Our divorces are just as expensive but worth every cent.

[StephenR]

Free government option for a new machine?

I'm in Canada, Sask. .. there is a program, SAIL (Sask Aid for Independant Living) that looks after anyone needing a machine.

Ah! That explains a lot

just to be clear, each province in Canada has a different policy re CPAP, in BC where I am the province does not pay for CPAP equipment,
it will pay for sleep studies if you can qualify, and DME loaners...

Stephen

[Pugsy]

The 10 cm maximum limit is fine. If the machine never goes there it sort of becomes a moot point anyway. Just because the machine can go somewhere doesn't automatically mean that it will go there and if it doesn't go there it doesn't matter what the machine is set at.
If these machines could go to 100 cm and it only goes to 9 cm...you could set it at 100 cm and it still wouldn't matter.
Having any upper limit becomes a non factor if the machine never goes near it. Now sometimes having an upper limit and the machine's reason for going higher could be detrimental to sleep quality or cause aerophagia to be worse creates more problems than it solves but that doesn't appear to be the case here because the machine simply hasn't had the need to go higher. If it had then we would have a different discussion about the maximum setting.

I don't know why the 8 cm caused "worse" results unless perhaps jumping to 8 cm from the initial 4 cm caused some sort of general discomfort or something and maybe there's some SWJ flagging going on. Given what you show on these reports here...8 cm would be a logical choice. Unfortunately sometimes this cpap stuff isn't always "logical".
Thurs night my AHI was nearly 7.0 but I slept great and felt awesome Friday and got a ton of outside work done ..on paper and logically my butt should have been dragging...but I felt great. Sometimes the numbers aren't a good marker to go by in terms of success or failure.

Increasing the minimum to 6 cm is just what you are thinking....limiting the range in an effort to find a suitable fixed pressure. Sometimes when the minimum pressure is more optimally set then the pressure itself doesn't always have the need to go up as much....so that minimum does a better job of holding the airway open in the first place and thus the machine doesn't have to supply as much pressure in an effort to try to fix the collapsing airway.
Always better to prevent something than to try to fix it after the fact.
So we already know the machine doesn't feel the need to go to 10 cm...so somewhere between 4 and 10 there's a suitable pressure....then with using 6 minimum that number is somewhere between 6 and 10.

Ideally we would have more time to fine tune the pressure by giving each setting multiple nights at a setting because sometimes we just have "off" nights and we don't know why. That AHI that I had Thurs night of 7.0...Fri and Sat night the AHI was 2.5 and 2.6 and I changed nothing.
We don't know if the "bad" numbers were related to anything other than maybe an "off" night....unfortunately in your situation you don't have a lot of time to devote to a single setting to see how it wants to trend.

Let's see what the pressure wants to do with 6 cm minimum and then re-evaluate things and if it still looks like the "ideal" pressure is going to be up around 8 ish...maybe go up slowly if we can. I know there's not much time but going up in smaller increments might simply be an easier adjustment. Maybe it was just the big jump itself that sort of monkeyed with things.

[palerider]

Agreeing with Pugsy, I would try 6-10 for AT LEAST 3 NIGHTS in a row to try to establish a pattern.
.

Pugsy picked the lower number (6). Hoping the top number (10) that I picked is okay with her ... my reason for that is because at no time has the open settings or pressure gone above 10. Just tightening up the range, no more 4-20 wide open.

the top number generally doesn't matter, it's the bottom number that matters. (now, I see, pugsy said that, more eloquently as usual)

6-10 and 6-20 are exactly the same if you only need a max of 9.5 for instance.

there are rare cases where limiting the top number makes sense... but, again, rare.

[palerider]

To address you and Palerider's comments on the 'fiddling'.

fiddling is fine, but fiddle with the apap mode, raising the lower pressure until you start getting something that's good and happy..

it's a limited term opportunity to gather data.