5 nights of daily data - for Barbe

[Hawthorne]

I am posting these for Barbe. I got them via email attachment and they will soon be able to post from photobucket but see the sleep doctor soon and would like some feedback from forum members to prepare for that appointment.

He is using an M-Series Auto with A-Flex - set at 11cm -20cm. He has adjusted the pressure up himslef from (you guessed it!) 4 since August when he started. Humidity is set at 1 and A-Flex is set at 2. He uses a Swift 11Nasal Pillows interface.

Any comments or suggestions are welcome! Thanks!

I see these are in reverse chronological order.

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[Snoredog]

Difficult to say without knowing what type of mask is being used. Based upon the snoring seen, I'd say
the person is using a Full Face mask, sleeping with their mouth open which results in the snoring seen.

First 4 nights don't look so bad, the 5th night shows "NR" if you observe the pressure pattern you'll see where it
climbed the hill and went back down where the NR tic at the top shows up. You will also notice this shows
up above 10 cm pressure with no real improvement seen with AHI.

I can see where they were adjusting Minimum pressure up to lower the AHI but that didn't seem to have much impact. So the question becomes, is that "NR" a stuck tongue into the back of the throat? Snoring would seem to indicate that, if a FF mask is used that is my guess.

However, if those "NR's continue and/or AHI increases I would LOWER the Minimum pressure back down to a more comfortable pressure like 8.0 cm and use it there. IF AHI reduces then those "NR"'s are central apnea. Those CA's may
go away but understand they would be included in any AHI seen, they can show up under Hypopnea or Apnea counts seen.

I would try and increase the Minimum as you have been doing to reduce the snoring seen but if too many NR's show up you will have to reverse that action and allow the snoring to continue. Use of a nasal mask and a chin strap like the Pap-Cap should greatly reduce the snoring seen. If you are already using a nasal mask sleeping on your side might reduce the frequency of events seen.

If you increase the Minimum pressure up go ahead and set up a lower Ramp pressure like 7 or 8 and 30 minutes, make it easy to fall asleep.

[Hawthorne]

Thanks Snoredog!

I did say what mask he was using right at the beginning but it is not too clear. Sorry!

It's a Swift 11Nasal Pillows system.

Does that change some things you said?

[Snoredog]

Thanks Snoredog!

I did say what mask he was using right at the beginning but it is not too clear. Sorry!

It's a Swift 11Nasal Pillows system.

Does that change some things you said?

IT was most likely me overlooking the type of mask used, but it tells me when leak is under control (and it is) that the person could take a higher Minimum pressure as the NR didn't show up until 16 cm pressure.

So I would try moving Minimum up to 12 cm or higher (use the Auto:Ramp) and look for improvement. If the snore can be eliminated with a higher Minimum that is what I'd try.

I would leave the Maximum pressure up high so if it is a stubborn tongue getting lodged the machine has the pressure it needs to dislodge it. I'd also keep an eye on a the avg. apnea duration found on the last page of the trend report.

[rested gal]

Looks good to me. Nice low leak rate. I'd probably just leave it like it is, but if I were going to change anything, I'd do what Snoredog mentioned... raise the minimum pressure another cm.

[BarBe]

hi firstly many thanks to Hawthorne for helping us out and secondly to snoredog and rested gal for sharing their wisdom.
Going back on all the reports since our CPAP started NR's have popped up every now and then. On the 1st night there was 1
but I will need to send the report through to Hawthorne so you can see what happened on night 1.
That was at a pressure of 4-20. But also he didn't use a chin strap, had his mouth open lots, the hose was over the bed head but not secured and the machine was level with the bed.
There has been an NR at most pressures 11,10,9,8,6,4.
What do you call too many Snoredog? 0.3 is the worst and that was twice on the 10/29-08 -10/30/08 report and the 9/26/08 - 9/27/08 report. That night we had NR 0.3, FL 0.7, OA 5.1, H 1.0, VS 0.7 .
Pressure was set 10-20, HH 1, A-flex 2.
As to the snoring it seems to depend on the number of beers and what strengths those beers were. But then some nights the snoring has been at 0.
No, he can't keep his mouth closed even when he's asleep but he's getting a lot better. I'm always checking and it seems to be closed but ?
He does sleep on his back still, tries not to but seems to roll back there. I'm forever telling him to roll over but .......
Sometimes when he was at 10-20 pressure his OA wa 0.6,NR 0.0,FL 0.1,H 1.2, VS 1.6
average 90% CPAP 11.0 / Average CPAP pressure 10.3. 9/20/08.
Tonight I will increase his min pressure to 12 and send the report through to Hawthorne. Does he need to use the ramp?
Hasn't been using it since 9/25/08.
thanks again for all your help.
Bev

[Hawthorne]

I am adding Barbe's Sleep Study as well as the 1st night on cpap set at Provider's settings (4-20) and last night's data, when the minimum was raised to 12 cm.

Any comments welcome!

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[Hawthorne]

Sorry!! I was cleaning up my albums on Photobucket and ended up deleting the 5 nights I had previously reported for Barbe.

The data was better at 11cm-20cm as per those 5 deleted charts. I'll get them back on the forum if anyone wants them. The comments posted about them may be enough.

Last night's data ( first night at minimum 12cm) is not as good but is just one night at that pressure range so far.

[Hawthorne]

Bumping

[Snoredog]

I would put his Minimum pressure at 12 cm, Maximum pressure at 20 cm and use it.

yeah there was some Centrals seen on his PSG but not that many and since they were clustered around apnea it was probably those that contributed to them being there.

His 90% pressure is all over the place, the man should have been put on a Bipap and titrated with it.

Note on PSG: He shows some heart-related stress at 4:30AM on the PSG, above it shows a dramatic drop in O2 levels, yet there is nothing corresponding with that event on the PSG. Did they make note of that on the worded findings section? May be nothing but the heart went to 120BPM then down to 40 for some reason and O2 levels plummeted at the same time but there are no SDB events I see corresponding with that event. It would be something I'd ask the sleep doc about next time. If he is seeing a Cardiologist I'd show him the PSG report.

IF he does have a Cardiac condition, I would suggest he go back for another PSG on a bipap and use a pressure that doesn't fluctuate all over the place, the last thing you want is the machine responding falsely to events seen, jacking up pressure to cause central dysregulation to appear as that will put a lot more stress on the heart. In fact, I am inclined to suggest that you put the machine at 12 cm pressure in the CPAP mode. If he is sleeping with his mouth "open" he is doing a pretty good job at controlling mouth leaks.

Hasn't been using it since 9/25/08

He hasn't been on the machine since 9/25? what are you trying to do kill him off?
(just kidding)
He needs to go back on the machine, set it to 12 cm CPAP mode, Cflex at 2, and let it go for a while.

[BarBe]

Snoredog wrote: He hasn't been on the machine since 9/25? what are you trying to do kill him off?
(just kidding)
BarBe wrote: Tonight I will increase his min pressure to 12 and send the report through to Hawthorne. [b]Does he need to use the ramp?
Hasn't been using it since 9/25/08.[/b]
Sorry if I've confused you Snoredog. I meant he hasn't been using the ramp not the machine.
there are a lot easier ways to kill someone off ! I'm sure.
As to the heart related stress nothing was said by the sleep doc in his follow up visit or the GP when she got the report.
The Cardiologist didn't mention it either on his follow up visit presuming that he had even read the report.
B had been diagnosed with an enlarged heart 2005 and a blockage to one of the minor arteries but the cardio didn't seem to think it was a big deal and the blockage not 'bad' enough to have anything done.
I will take a copy of your suggestion down to the sleep doc, plus any information that I can find on a Bipap.
Thank you for your observations Snoredog.Yesterday he felt really tired again and slept for a lot of the day - similar to how he felt back in October 2007 when he was first sent for a stress test, Echo cardiogram, endoscopy, to see a Cardiologist and then finally for a sleep study and to see a Sleep Physican.
Today is not shaping up too good either.
Before yesterday he was seeming alot better and we were hoping he was well on the way to recover but............
Bev

[Hawthorne]

Here's is last night's report for Barbe. The 2 nights on a setting of 12 cm - 20 cm , he has slept a shorter time and numbers are worse.

His 90% is increasing and he is spending just a relatively short time at all the pressures in the range.

Comments please. Thanks.
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[Hawthorne]

I was looking again at the data from last night an the night before with pressure 12-20. He slept somewhat longer and had better data at 11cm - 20cm and she reported he was quite rested during the day. I asked her that specifically when she sent me data to post. I did delete those charts (cleaning up photobucket!! Sorry!) but still have them on my computer.

Bev said, the first night he was at this range (12-20) that he was more fatigued during the day than he had been at the other setting. This may have been the case last night as well, although I don't think she said that in the email that was on my computer this morning. She'll be here later to ask questions I'm sure (it being nighttime in AUstralia they are probably sleeping!)

He is spending time at every pressure but not a lot. Is he being aroused (not wakened) by every pressure change and that is causing him to feel more fatigued during the day? Would a narrower range help? It worked well for me when I went from a wider to a very narrow range. I know it may not work the same way for him but it might. Straight cpap may also help but I wouldn't know what pressure to suggest at this point.

Any further thoughts?

[Hawthorne]

I reposted 2 of the reports from the precious pressure setting so that people can see the difference. They posted back in the first post of the thread but do show the difference when he was at 11cm-20cm.

Thanks for comments!

[BarBe]

thanks for photobucketing for me Hawthorne.
Today B wasn't as tired. He did have a big afternoon sleep yesterday and then last night seemed to have a much better sleep.
He had a 1 hour lay down this afternoon but we had spent the day running around in town.
I've just check his report for last night and to me it seems much better. What's going on ?
Is he just trying to confuse us? must say it's working....well me anyway.
He had no beers last night , the pressure was min 12- max 20 and everything else was the same.
Bev


ps tried to photobucket last nights report but couldn't get a picture. Will try again.