Ok, I gotta change something...

yardbird · Post by **yardbird** » Sat May 10, 2008 8:49 am

I'm not one of those who downloads data religiously. I did at first, but when it always looked about the same I stopped. Haven't read data in probably a year. I did it this morning and was shocked (and bummed).

My total AHI for the last week is 5.8

Way back when I last read my data I spent most of the night at around 6 or 7 cm. I have my auto set to range between 6 and 10. Titrated at 8. I almost NEVER hit 10 before. Now my data says I' spending around 40% of my night at 10 and having apneas at that pressure. My vibratory Snore rate is very high as well, but I KNOW that this is affected by me dragging the hose across the edge of the night table or bed frame. I just don't know if that's what's causing it.

link to pdf

Opinions invited

Should I just raise the top of the range and see where this goes?

ozij · Post by **ozij** » Sat May 10, 2008 9:41 am

I'd start by making sure there were no artificial (i.e. hose dragging) vibratory snores - the make the machine raise its pressure unnecessarily.

Since your machine is raising the pressure in response to those artificial snores, you may be getting too much pressure - resulting in pressure induced apnea. Your obstructive apneas are low at all pressures but for the top. On the other hand, you're getting more hypopneas a lower pressure, and less at about 9. Respironics will only admit to a non-responsive apnea after having 6 or 8 in a row that don't respond. The fact that no NR are reported is practically meaningless.

So: first step, make sure there are no artificial snores to drive the pressure up.

Second step: see what happens if you keep your pressure at 7-8 or 8-9. By raising the bottom pressure you may get rid of some hypopnea, and by limiting the top you'll avoid "snore chasing".

If you don't feel refreshed, and you AHI is still high and at the top of the range, then try to raise the pressure.

O.

yardbird · Post by **yardbird** » Sat May 10, 2008 9:44 am

What would you think about maybe just flipping to straight CPAP for a while at 8cm? (my titrated pressure) and see what it looks like?

ozij · Post by **ozij** » Sat May 10, 2008 9:47 am

Perfect.

O.

Guest · Post by **Guest** » Sat May 10, 2008 9:49 am

yardbird wrote:What would you think about maybe just flipping to straight CPAP for a while at 8cm? (my titrated pressure) and see what it looks like?

9 cm looks better. That was what I was thinking too. It's obvious that the pressure range isn't working right now.

Den

ozij · Post by **ozij** » Sat May 10, 2008 9:54 am

You do have less hypopneas at 9 - Den's right from that point of view.

Getting a base rare of how you're doing at 8 is perfect for deciding how to continue.

O.

CentralScrutinizer · Post by **CentralScrutinizer** » Sat May 10, 2008 10:01 am

All I've got is straight CPAP... Some of my best (lowest) AHI come on worst nights for vibratory snore numbers...

If I'm understanding you guys correctly the auto machines in crease pressure when they detect snoring?

While watching my data from my REMstar pro... I don't see any relationship to apnea events and snore detects...

I'm running straight 8CM and consistantly have average AHI under 1, I've seen snore as high as 40...

ozij · Post by **ozij** » Sat May 10, 2008 10:10 am

CentralScrutinizer wrote:All I've got is straight CPAP... Some of my best (lowest) AHI come on worst nights for vibratory snore numbers...

If I'm understanding you guys correctly the auto machines in crease pressure when they detect snoring?

Yes, you are understanding us correctly. All auto's function based on the assumption that snores are precursors to obstruction, and when they identify a snore, they respond by raising the pressure.

While watching my data from my REMstar pro... I don't see any relationship to apnea events and snore detects...

That would mean to me the your pressure is usually high enough to keep you from having apneas, but still not high enough to keep you from snoring.

O.

yardbird · Post by **yardbird** » Sat May 10, 2008 10:56 am

Ok I set it at straight 9cm with c-flex on. I put it on to try it at straight 9cm and it felt a bit awkward exhaling so I turned on the c-flex and set that at 2.

I'll be curious to see the numbers in the morning and see if there's a drastic change. I've had it on the same settings since I got it almost 6,000 hours ago. So this will be a bit different.

**edit**

OH! And last saturday I switched from my Swift to an Ultra Mirage full face mask. THAT's quite a switch. But looking at the numbers from Thursday and Friday (using the Swift) and then the rest of the time with the new mask.... the only thing that looks different is that "large leak" instances. Had more of them on the swift as I was opening my mouth and just spewing Dragon Breath

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX

sagesteve · Post by **sagesteve** » Sat May 10, 2008 12:24 pm

"Ok I set it at straight 9cm with c-flex on. I put it on to try it at straight 9cm and it felt a bit awkward exhaling so I turned on the c-flex and set that at 2."

That looks pretty good. I was using Auto with little success. Straight Cpap works A LOT better. I have the C-flex set at 3 with a pressure of 10.5...Mriage Quattro Mask. I also have a 2 litre oxygen bleed-in. The auto would jump to 15 and blow my mask off (leaked like crazy) and always woke me up. Since reading on here about the success with straight Cpap,I went that route.

yardbird · Post by **yardbird** » Sun May 11, 2008 5:23 am

Well... at 9cm (auto is off) my numbers look worse than the previous night on auto. AHI = 8 (holy cow)
at 9cm:
Apneas 5.4, Hypops: 2.6, Snore: 56.1

on auto the night before:
Apneas 4.1, Hypops: 2.3, Snore: 15.1 and the AHI was 6.4

The "swarms" of snore and apnea events correlate to and stop at times when I woke up and peeked at the clock (1:30am, 3:30am and 6am) so it's tough for me to believe this is a machine anomaly or it's "chasing snores" because of the hose dragging across something. I think there's more to this.

And as much as I am not one for chasing numbers, I think I'm going to drop back to 8cm for tonight and see what I get. And leave it on straight CPAP. Actually.... my best numbers looking at the 2 nights side by side, are at 7cm. (with an AHI of 0.7 and an hour and a half of time at that pressure.... roughly the same amount of time as I spent at 9cm) so.... undecided right now but might drop back to 7 instead of 8 ad see where this leads me.

SleepIsHell · Post by **SleepIsHell** » Sun May 11, 2008 7:55 am

[quote="yardbird"]Well... at 9cm (auto is off) my numbers look worse than the previous night on auto. AHI = 8 (holy cow)
at 9cm:
Apneas 5.4, Hypops: 2.6, Snore: 56.1

on auto the night before:
Apneas 4.1, Hypops: 2.3, Snore: 15.1 and the AHI was 6.4

The "swarms" of snore and apnea events correlate to and stop at times when I woke up and peeked at the clock (1:30am, 3:30am and 6am) so it's tough for me to believe this is a machine anomaly or it's "chasing snores" because of the hose dragging across something. I think there's more to this.

And as much as I am not one for chasing numbers, I think I'm going to drop back to 8cm for tonight and see what I get. And leave it on straight CPAP. Actually.... my best numbers looking at the 2 nights side by side, are at 7cm. (with an AHI of 0.7 and an hour and a half of time at that pressure.... roughly the same amount of time as I spent at 9cm) so.... undecided right now but might drop back to 7 instead of 8 ad see where this leads me.

yardbird · Post by **yardbird** » Sun May 11, 2008 8:13 am

Nope. Nothing that I'm aware of. If I can't get a handle on this relatively quickly I may just schedule an appointment with the doc and see what we come up with.

Snoredog · Post by **Snoredog** » Sun May 11, 2008 11:06 am

allergies, a glass of wine with dinner can drive up AHI.

My opinion:

Bump up the bottom pressure to 7 and move the Max from 10 to 15.

the key to what is happening to you is snore, if the report indicates that you are bumping into the 10 cm limit then you need to remove that limit unless you have a problem with centrals, if that is not an issue don't limit the top end allow machine to eliminate the snores.

yardbird · Post by **yardbird** » Sun May 11, 2008 3:06 pm

I've never had a problem with centrals. You think I'm wrong trying this at straight 8cm without auto?

You think I should just let the auto "do its thing" and see where that goes instead?

Mask	Humidifier

Additional Comments: CPAP Pro No Mask,Full Quattro Mask, SleepWeaver cloth mask InvaCare Oxygenator 2.5L bleed, Control III, M Series