New member, 3 months in, please review my data

[jani7]

Hi there,

This is my first post, so please advise if I'm doing something wrong.

During this past Spring I was diagnosed with severe sleep apnea with a score of 39 per hour.
My wife said I snored like a freight train with occasional quiet periods (not breathing perhaps?). I always felt dead tired in the morning, relying on multiple cups of coffee to get me going, then I was fine for the rest of the day. After dinner, it was hard not to nod off while we watched TV in the evening.

With the motivation of the Dr. reporting me to the MOT and me then losing my license, and hoping I'd feel less tired and more energetic during the day, I went and got my prescription filled for a CPAP device. While waiting for my sleep test results (4 weeks +!), I read this forum daily trying to learn as much as possible. Through this forums general consensus, I chose the Resmed 10 Airsense for her and the Resmed Airfit N20 mask.
Surprising to me, I had no problem adjusting to sleeping hooked up to a machine and it's hose. I must be very lucky considering the many people who have posted their difficulties in adapting to a CPAP. During my 1 month grace period with the DME I tried a different mask each week, and even managed to keep a couple. BTW - The woman I dealt with at the DME I chose because of convenient location and the recommendation of the clinic, demonstrated a complete lack of interest in helping me with recommendations. She would not suggest anything, I always had to do my research in this forum for a different mask to try. She could care less it appeared. I could name the DME in a subsequent post if anyone cares.
Anyways, the N20 is my go to mask, has been from day 1. The N10 was the only disastrous mask I tried, it felt suffocating, and I changed out of it after a couple of hours. The F20 I like, I can see it being preferable when I have a cold, but my #2 fav is the p30i; I like it and wouldn't have a problem using it regularly, just for a change.

The end result now is that I feel much less tired in the morning, and have a lot of energy throughout the day. It has made a huge difference in my life after 3 months. I'm going back for a follow up sleep test in 10 days with my favourite mask, so I'm curious what their observations will be.

I've attached a few screenshots below, I'd love some feedback about how I'm doing. My AHCI has gone from 39 in the study, to now averaging between 0 to 0.4.

screenshot-20190908-124408.png (106.38 KiB) Viewed 1590 times

screenshot-20190908-124335.png (103.65 KiB) Viewed 1590 times

screenshot-20190908-124145.png (107.95 KiB) Viewed 1590 times

[palerider]

Hi there,

This is my first post, so please advise if I'm doing something wrong.

Please review the "read this before posting" post at the top of the announcements on the front page, which includes instructions on how to format your screenshots for posting.

Alternatively, there's this: wiki/index.php/Sleepyhead:Organize

[Okie bipap]

The only thing I see wrong is you have your max pressure set to 9 and your machine is maxing out most of the time. It appears it wants to go over nine. I recommend you raise your top pressure to 20 and see where the machine wants to go. I doubt if it will go much higher than 9 since your AHI is nice and low. If you don't want to go to 20, set it to 12 and see what it does.

[Dog Slobber]

Is there any particular reason you're in APAP for Her mode?

There's nothing wrong and for Her mode and no rules than men can't use that mode either.

[jani7]

Is there any particular reason you're in APAP for Her mode?

There's nothing wrong and for Her mode and no rules than men can't use that mode either.

I never noticed that, I can't find anywhere in the settings to change it. Perhaps the DME set it like that?
Can anyone guide me in the right direction to change it?

Thank you!

[jani7]

The only thing I see wrong is you have your max pressure set to 9 and your machine is maxing out most of the time. It appears it wants to go over nine. I recommend you raise your top pressure to 20 and see where the machine wants to go. I doubt if it will go much higher than 9 since your AHI is nice and low. If you don't want to go to 20, set it to 12 and see what it does.

My prescription said for the pressure range to be 6 - 9.
What would the effect be in increasing the pressure limit to 12, or 20? What would I notice?
I don't see how to change this setting as well.

Thank you for your help.

[Dog Slobber]

Yes, it sounds like the machine was set up that way by the provider and you've never been in clinician settings mode.

Most of us here, take charge of our therapy and that means adjusting pressure and other settings only available in the Clinician Menus.

Here are instructions, you can also have the send the Clinician Manual which I suggest you become familiar with.

https://www.apneaboard.com/resmed-airse ... setup-info

You can also google ResMed AutoSet Setup and find youtube videos.

To change modes:

• Enter Clinician Settings, (press Select and Home for three seconds until menu changes)
• Move down to Mode,
• Change from AutoSet for Her to AutoSet

After changing modes, you may want to consider change the response from Standard to Soft. This defines how aggressively pressure is increased and decreased. For Her mode uses a Soft Response, this way your machine will still "feel" the same d your numbers are pretty good. BTW, I use a Soft response as well.

Perhaps later you can try the Standard response, to see how you like it.

[Dog Slobber]

The only thing I see wrong is you have your max pressure set to 9 and your machine is maxing out most of the time. It appears it wants to go over nine. I recommend you raise your top pressure to 20 and see where the machine wants to go. I doubt if it will go much higher than 9 since your AHI is nice and low. If you don't want to go to 20, set it to 12 and see what it does.

My prescription said for the pressure range to be 6 - 9.
What would the effect be in increasing the pressure limit to 12, or 20? What would I notice?
I don't see how to change this setting as well.

Thank you for your help.

The pressure settings are also in the clinician Area.

If you look at your graphs you will see the pressure hits 9 and flattens out. The machine wants to go higher, but can't because it has an upper bound pressure of 9.

I and many others, keep our machines at 20. My machine minimum is 11.2 and usually doesn't go to 12. Your machine will only go to what it needs.

Think of it like your car accelerator, your car is capable of going (100 MPH), you don't, but if you NEEDED to, you could. You typically go 55.

Right now, your machine is handcuffed to only go 55MPH and it needs to do 60 and you won't let it.

[jani7]

The only thing I see wrong is you have your max pressure set to 9 and your machine is maxing out most of the time. It appears it wants to go over nine. I recommend you raise your top pressure to 20 and see where the machine wants to go. I doubt if it will go much higher than 9 since your AHI is nice and low. If you don't want to go to 20, set it to 12 and see what it does.

My prescription said for the pressure range to be 6 - 9.
What would the effect be in increasing the pressure limit to 12, or 20? What would I notice?
I don't see how to change this setting as well.

Thank you for your help.

The pressure settings are also in the clinician Area.

If you look at your graphs you will see the pressure hits 9 and flattens out. The machine wants to go higher, but can't because it has an upper bound pressure of 9.

I and many others, keep our machines at 20. My machine minimum is 11.2 and usually doesn't go to 12. Your machine will only go to what it needs.

Think of it like your car accelerator, your car is capable of going (100 MPH), you don't, but if you NEEDED to, you could. You typically go 55.

Right now, your machine is handcuffed to only go 55MPH and it needs to do 60 and you won't let it.

Oh I see, thank you for the tips. I'll check it out at home.

[jani7]

I only adjusted the max pressure from 9 to 12 last night.
I didn't really notice any difference, but my AHCI was 0.5, the highest it's ever been while on CPAP.

Is this just a coincidence, or am I perhaps better suited to return the max pressure back to 9?

Or, should I try a few more nights to see how it goes?
Cheers!

[Dog Slobber]

You can't draw reliable conclusions because of one night
We see volatility in the three posted graphs 0.0, 0.15, 0.38. 0.5 is not out of line. The difference between 0.5 and 0.38 is 0.12, or one event over an eight hour period.
Allowing the machine to move from a max of 9 to a max of 12 is unlikely to cause a measurable increase of obstructive events, and we don't even know if your machine moved from 9 because no graph was posted.

We are our sleep our sleep quality are extremely volatile, make changes and then watch for a bit.

When I started optimizing my setting last October, the smallest time period listed in my Statistics is six days.

[jani7]

So after 6 nights of increasing the max pressure, it appears that my cpap doesn't have to go quite that high. Here are 3 nights from this past week.

screenshot-20190915-170245.png (108.58 KiB) Viewed 1372 times

screenshot-20190915-170222.png (107.58 KiB) Viewed 1372 times

screenshot-20190915-170203.png (106.37 KiB) Viewed 1372 times

[Miss Emerita]

Your AHI is terrific, and you report that you are sleeping decently and feeling better during the day. This is all excellent!

There are just two points I'd be curious about. One is leaks: do they wake you up at night? Or do you find you have a dry mouth in the morning?

The other is flow limitations. If you wanted to post another chart, I'd suggest you replace the mask-pressure graph with the flow-limitations graph. If the graph is fairly active, you could try increasing your EPR setting to 2 or 3, which might help to reduce the flow limitations and the amount of effort you have to put into inhalation. In theory that might make you feel a bit more rested.

Oh, and one other thing. I see your starting pressure is 4. For a lot of people, that leaves them feeling somewhat air-starved. You might try a minimum pressure of around 5, 6, or 7 and see whether you like the feel of that any better.

[jani7]

Your AHI is terrific, and you report that you are sleeping decently and feeling better during the day. This is all excellent!

There are just two points I'd be curious about. One is leaks: do they wake you up at night? Or do you find you have a dry mouth in the morning?

The other is flow limitations. If you wanted to post another chart, I'd suggest you replace the mask-pressure graph with the flow-limitations graph. If the graph is fairly active, you could try increasing your EPR setting to 2 or 3, which might help to reduce the flow limitations and the amount of effort you have to put into inhalation. In theory that might make you feel a bit more rested.

Oh, and one other thing. I see your starting pressure is 4. For a lot of people, that leaves them feeling somewhat air-starved. You might try a minimum pressure of around 5, 6, or 7 and see whether you like the feel of that any better.

Thank you for the valuable suggestions!
I sometimes wake up because I hear hissing, so I groggily re-position my face on the pillow until the hissing stops. But I guess some other times I don't wake up. I've woken up with dry mouth only a couple of times during my 3 months, so it's not a regular occurrence.

I'm not sure how to adjust the order of graphs so Flow Limitations appears in the snapshot. Increasing the EPR sounds like a great idea, it sort of ties in with my next comment.

I quite often do feel air starved at the beginning because of the act of settling into bed. I wonder why they set the machine at 4 as the default. I'll adjust it upwards tonight.

[Pugsy]

I'm not sure how to adjust the order of graphs so Flow Limitations appears in the snapshot

You can click and drag the different graphs around.
Also you can turn off unneeded graphs and let the flow limitation graph move up into the viewing area.
See the arrow at bottom of the lower right of the graphs where it says Event flags....click on the little arrow to expand the menu and look for mask pressure...click on it to turn it to red/black and it will be hidden from view and the FL graph might just move up into viewing area. You don't need 2 pressure graphs (the mask pressure graph line and the regular pressure graph line). In your situation the regular pressure line is the most useful so show it and hide the mask pressure graph.
You could also omit/hide the snore graph at this stage of the evaluation. It's not very exciting. You aren't doing a lot of snoring.

You can always unhide the graphs by going back to this same area and just clicking on the graph to change it back to green/black.

But based on what I see with the numbers on your FL statistics section. I don't think the FL graph is going to be wildly ugly.
Usually ugly FL graphs have much higher numbers than you are having.