Another New Guy Needs Help

[gbvol54]

I've been lurking for the past week or so picking up lots of useful information but I'm to the point where I need to come out of the shadows and ask for help.

About a year ago I had a sleep study that showed a AHI of 19.9 composed of "mostly obstructive" events. I spent most of the following year in denial, but finally started CPAP therapy about a week ago. I've had a tough time dealing with the resistance on exhale (I've got the Aflex set to 3) but gradually have been able to increase my "mask time" to 6 to 8 hours per night of pretty lousy sleep. Unfortunately the results are not good. The last three nights had AHIs of 6.66, 8.61, 13.19 (links to daily graphs below). I've omitted data from the 19th (AHI of 14.85) due to that number perhaps being influenced by my taking benadryl. I'm thinking I need a pressure increase, but I've raised the min from the original 4 to 6 without much result. I would be very grateful If anyone could spare the time to look over the charts and offer an opinion. In addition to the pressure question it seems to me that my Tidal Volume is low while I'm in an otherwise 'quiet' period.

Thanks in advance

http://imgur.com/a/QP8JU

Phillips Respironics Dreamstation APAP Auto with humidifier and heated hose
ResMed Swift FX Nasal Pillows

[Wulfman...]

For one thing, your minimum pressure is WAAAAAY too low.
Start moving it up and see if things get better.


Den

.

[Pugsy]

Continue increasing that minimum pressure. I suspect you won't see much in the way of results until you start around 8 cm.
If that's too much of a jump comfort wise...go up slowly in 0.5 cm increments so that you can get adjusted more easily to the pressure change.

As to the Flex setting...play with all of the settings without thinking about the amount of reduction but instead focus on how "natural" or more in rhythm with your own breathing each setting might be.
A setting of 3 may offer the "most" reduction but sometimes people complain that they feel like the machine is rushing their breathing and they have trouble keeping up.

[Imatryin]

I am new too - 3 months. I had the same problem. I moved my aflex to 3 but I also jumped my low pressure to 8 which was a big help. I use nasal pillows as well. Check these two things...1) Make sure the pillows are not being pulled to tight. They may be collapsing, and 2) maybe try the next size pillow up (if you're not already using the biggest size). For me, even though the medium was a good fit for my nostrils, I have a wide septum. So the large pillows gave me that little bit of extra room which allowed the air to go directly up into my nose vs. blowing towards the septum then going up. That also helped with the exhale as well. I didn't feel like I had to work as hard to exhale.

As far as your charts...I'll leave that to the experts here

Good luck and keep trying. I'm finally starting to see some small, but to me, very significant improvements after 3 months. Some people adjust more quickly than others.

[gbvol54]

Wulfman/Pugsey, Thanks guys. I'll bump the min pressure up to 8 and maybe wear the setup while I watch some TV tonight to play with the aflex settings to see which feels best. I'm assuming I should stick there a few days to let the results settle out?

Imatrying, I've also tried all three sizes and all are reasonably comfortable and all with what I interpret as reasonable leak numbers. I'll try the large again to see if it helps my exhale issues while I'm experimenting this evening. I also occasionally get a "flutter' in the pillows. Any experience with that?

[russmac]

As Imatryin said, the size of the pillows can make a difference. I started out with small because that's what the sleep center put in the Swift FX mask. At that time I went along with anything they told me, so I had no reason to think I should switch them. After a while I felt there was too much resistance trying to push air back through those tiny holes. I remembered seeing the medium pillow in the mask box and installed it. So much better. I also bumped up the pressure when I found out it was something I could do myself. When I switched to the AirFit P10 there was a large pillow in the box, so I tried it. Even better. Your problem my have a different source, but it's worth checking the pillow size if you haven't already.

[Malinalli73]

Ditto on the pillow size. Also make sure you're not having them too tight, I did that a few nights and the pillows would collapse. The giveaway is the "piggy nose" when the mask is too tight.

[Imatryin]

I also occasionally get a "flutter' in the pillows. Any experience with that?

I'm not sure I know what you mean by flutter. Sometimes I feel like the air is pulsing, but that's usually when I'm falling asleep and probably having that first apnea/hypopnea of the evening but I'm just awake enough to feel the machine increasing pressure. Hold your breath for about 10 to 15 seconds and see if that's the "flutter" your feeling and then look at your machine and see if the air pressure went up.

Sometimes I feel flutter when I've got the mask just a hair to tight. The pillows start to collapse but the air pressure puffs them back up again. Try a very small adjustment to the straps and make them looser, but not so loose that you start to have leaks.

Hope that helps.

[russmac]

I think the flutter is from the edge of the inner nozzle-like ring vibrating against the exhale. I remember this happening when I used the Swift FX. I would sometimes need to push from the back to pop the nozzle thing back into proper shape. I would also change the position of the mask or the position of the hose to get it to stop. I hadn't thought about it until now, but my AirFit P10 doesn't do it.

[gbvol54]

Morning folks,

I bumped up the min pressure from 6.5 to 8 and went with the large pillows. AHI dropped significantly from 13.9 to 7.86. Still crappy, but a move in the right direction. I'm debating whether to try another bump to 9 or sticking with 8 for a few days to let the numbers settle out a bit. Still had a bit of pillow flutter, but was able to adjust the fit and get rid of it.

I'm attaching a link to last night Sleepyhead graphs. If someone who is familiar with Tidal Volume could take a look I'd appreciate their input. It looks really spiky. Perhaps that's normal, but it seems other folks are much more smooth. If it is 'extra spiky' any idea what that means?

Thanks

http://imgur.com/a/pIFOm

[palerider]

Morning folks,

I bumped up the min pressure from 6.5 to 8 and went with the large pillows. AHI dropped significantly from 13.9 to 7.86. Still crappy, but a move in the right direction. I'm debating whether to try another bump to 9 or sticking with 8 for a few days to let the numbers settle out a bit.

I'd say 'yes', you're still nowhere near acceptable as far as AHI.
also, turn off the calendar next time, it is useless and just hides good info in the stats below it.

use F10 or menu/view/take screenshot to take the screenshot, it'll turn off the calendar automatically.

[gbvol54]

Good Morning,

Back again folks with another night's results linked below (this time without the calendar). I bumped the min pressure up again to 9 resulting in a small drop in overall AHI from 7.68 to 7.25, but a closer look shows a nice drop in Hypopneas (from 5.34 to 2.71) but rises in both CAs (2.08 to 3.19) and Obstructives (.26 to 1.3). I suspect I can get another drop in the Hypopneas, perhaps down to a reasonable level, from a another minimum pressure bump to 10, but the increases in CAs and O's concern me. Any thoughts on why they went up, or is a one night sample too limited a data set?

As always, thanks for the input.

http://imgur.com/a/SFMdX

[Imatryin]

I'd give it a good couple of days and more data before I'd get too concerned. Different things affect our sleep each night. For me eating too close to bedtime messes my sleep up. Alcohol is another factor.

I do love my Cabernet, but too much or too close to bedtime...

Unfortunately, I'm too new to look at your data and give you advice on that - sorry. If you don't get a response from someone else about your data, start a new post with the new data.

Good luck!