Baffled

[track]

After 4 months I am baffled....so much for home titrating with an auto. Armed with the resmed software I figured the devil was in the details, but after reviewing over the data for the last 4 months I can't find any significant trends. I started with pressures of 4-12 and have migrated to as high as 14-18 with no real pattern.....with straight cpap nights from 10, 12,13,14 and 15.
Here is what I know. My median pressure typically is about 11 and my 95% pressure is typically 12.5-14.2 but has varied from 11 to 16. My AHI has been as high as 10 and as low as 3 with AI from .3 to 2.0. It typically averages about 5.5 with 1.2 AI and the rest HI. I can't see any pattern where higher pressure lowers the numbers or raises the numbers. I might have a good night at one setting and then a bad night at the same setting. I suspect sleeping position plays a roll. Sometimes my HI and A1 come in clusters. I might have 4 AI and 4 HI in a 10 minute span or they might just come out of the blue one at a time. The AI typically are from 10-20 seconds duration, but I had one of 40 sec and a few in the 30s. Sometimes there is a snore spike that coincides with an event and sometimes not. Most snoring is below audible level according to the machine. Sometimes an event appears to occur after a spike in the leak reading and sometimes there is no correlation at all.
I suppose the smart thing to do is go get a sleep test and figure on forking over a couple of grand...but that probably won't happen any time in the near future so until then I will continue to wander around in hopes of making some sense out of all this....maybe with your help. The good thing is I feel better during the day and I am sleeping better and I am sleeping in the master as my snoring no longer bothers the wife...and maybe that's all the sense I need to make out of it all. Thanks for listening and for any incite you might have.

[TXKajun]

From reading your post, I got to wondering if you were changing your settings every night or giving yourself a week or so on each setting? I found that my Silverlining software shows that there can be some pretty dramatic variations from night to night, but over the period of a week, they can be averaged out rather accurately.

Just wondering.

Kajun

[track]

Thanks for the input...I write down on paper each nights results and I have had at least a week of each setting I can compare to other settings. For example I might have a week at 9-13, a week at 8-12, a week at 10-14 a week at 11-15 and a week at 12-16. Of course I have some mixed in between such as 9.5 to 13.5 and such as well as multiple nights at a fixed cpap number like 13.

[Wulfman]

Do you have a copy of your sleep study?
Did you have any Centrals?
What was your titrated pressure?
What were your results on each of the fixed pressure settings you tried?
Did you leave your fixed pressure settings for at least a week, too?

Den

[oldvaham]

I am experiencing the same confusion. I have been on CPAP for four months now and starting the fifth. I am recording everything. After my titration study I was given a pressure of 10. With that level, I noticed nothing special or different over one month. I must admit that my wife was pleased with no snoring and no noticable signs of apneas. I saw them all on the readouts. After three months of CPAP, I switched over to APAP. (I use the ResMed S8 Vantage.) With CPAP I adjusted moved it up from 10 to 15 gradually, finding some "improvement" at 15. In the APAP mode, I established a range of 8 to 17.6, hoping that my needs should be somewhere in between. I have only been in this mode for about two weeks. I plan to continue for about a month or two then review the reports. From comments of others, I see that maybe a week might be more appropriate. However, to be sure, I will continue for a bit longer. What I am looking for is the "optimum" setting, knowing that day-to-day variations will cause varying responses. My goal is to reduce my AHI to as low as possible and keep it there.

Good luck with your efforts,
Ken

[track]

Ken....what sort of numbers are you getting in regard to AI and HI typically?

[track]

"Do you have a copy of your sleep study?
Did you have any Centrals?
What was your titrated pressure?
What were your results on each of the fixed pressure settings you tried?
Did you leave your fixed pressure settings for at least a week, too?"

Den....
no sleep study
Centrals unknown
no titration other than my home version
results have varied.....I might get 4, 5, 6 and 7 AHIs at each setting...with the typical being 5.5. The AI varies from .3 to 2.2...typically 1.2

[blarg]

Did you try any straight CPAP pressures, particularly around that 11-16 range you seem to end up at on the auto? That might help you narrow things down.

[track]

I have tried straight cpap at 12,13,14 and 15

[TXKajun]

track, one of the things a sleep study does is check for other reasons for arousals, such as periodic limb movement, restless leg syndrome, and stuff like that which you won't be able to do at home. I'm not 100% certain, but I think that these maladies can have an effect on AHIs. So maybe you're fighting more than 1 problem and that's why your results are variable?

Also, during a sleep study, an oxygen sensor is attached to your finger to measure varying oxygen levels in your blood due to AIs and HIs. This is info you aren't getting, either.

Finally, does your machine record centrals? Maybe your pressure is too high and you've moved into the central apnea range??

Good luck and maybe, like you said earlier, it is time for a sleep test.

Kajun

[blarg]

Ok, next most important thing to address. LEAKS.

Usually when it seems like you're not getting anywhere it's either due to what Kajun mentioned above, or that you're leaking. Leaking reduces the pressure experienced in the actual airway, or what counts. Any trends there?

[track]

Leaks are always an issue...especially as you up the pressure....but I have not noticed any trends. I do the best I can with my UMFF....washing the mask every day with baby shampoo and washing my face with soap every night before bed. I usually get a pretty good seal.
Oddly enough the worst single night I have had in two months was one night when I decided to tape my mouth and use my nasal mask...no leaks either... but the AI was over 2...go figure.
I have two UMFF mask and I noticed that one of the holes in the medium mask was noticeably smaller than the rest of the holes...which is not the case with the large. I might try covering one of the holes in the large with some tape as it seems like that mask blows out the vent holes like a freight train.

[track]

Kajun.....good points. I had some issues on occasion of a restless leg but it has totally disappeared since I have been on cpap. I also previously on occasion woke up like I couldn't swallow or breath..not sure which....but that has not happened either since I have been on cpap. These are just a couple of the side benefits I have experienced. My best night on cpap was last sunday night.... I only had one AI the entire night. That day I drove into KC and toured the new parade of homes. ....so instead of sitting at a desk all day I was out and moving, climbing stairs and the like so maybe there is something there too. It was a low stress day and a day with plenty of walking. My pressure that night was 13-17 and it went to an all time 95% high of 16.2.

[TLD]

I'm a few months in myself, and recently have finally found some degree of success. Initially my AHI's ranged from 7-12. I use straight CPAP and varied my pressure from 4 to 16. There was a high degree of scatter but generally, my HI went down with increasing pressure and my OI went up. I couldn't win no matter what I tried.

Then I tried a different mask. This resulted in totally different characteristics right of the bat. My AHI's now are in the 2-5 range. I'm still fine tuning, but the point is that it wasn't until I tried a different type of mask that my AHI's consistantly and significantly dropped.

[track]

TLD....that's good info to know. I suspect the UMFF is not the best mask for eliminating HI. Unfortunately my other two masks are crap at pressures above 12....the soyala ff is ok for about 3 hours before it carves a canal into my nose

Maybe I need to try the hybrid or a new mask.