Skeptic - what will happen if I modify my pressures?

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meissen
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Skeptic - what will happen if I modify my pressures?

Post by meissen » Tue Nov 27, 2012 2:03 pm

So I am skeptical about "just how well" my CPAP therapy is working. My eyes still burn throughout the day from being tired, I notice a little more energy, but I don't feel "night and day" different -- probably because I struggle through the night with mask leaks.

What would happen if I changed my machine settings for BiPap such that the pressure was 1 and 1? My thought was that if I set it so low then I would be able to sleep with the mask on and allow the S9 machine to register apnea events and I could then see what a difference my machine is really making.

Thoughts? I would probably have some explaining to do when I send my SD card to the DME or insurance or whoever but at least then I would be able to see all the apnea events (if they're any more than usual) with the machine basically on standby and not doing anything.

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Re: Skeptic - what will happen if I modify my pressures?

Post by chunkyfrog » Tue Nov 27, 2012 2:10 pm

Are you looking at your data now?
The number and kind of events is important, as well as your leak data.
Others will be on shortly to discuss software, unless you have it already.
I would not want to go down to the machine's minimum,
as it is likely helping some, even if it is not set ideally.

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Re: Skeptic - what will happen if I modify my pressures?

Post by Pugsy » Tue Nov 27, 2012 2:13 pm

meissen wrote:What would happen if I changed my machine settings for BiPap such that the pressure was 1 and 1? My thought was that if I set it so low then I would be able to sleep with the mask on and allow the S9 machine to register apnea events and I could then see what a difference my machine is really making.
The machine won't go below 4 cm pressure. So you can't set it any lower than that.
There is still some therapy value at 4 cm so you wouldn't get a "true" picture.
You would probably need to change the machine to cpap mode and set it at 4 cm.
Sometimes that 4 cm setting feels rather suffocating...like there isn't enough air movement. Lowest I can comfortably use is 6 cm myself.
It might give you sort of an answer though...if you had a truckload of events at a much lower pressure than you normally use and with your current pressure your events are well controlled then you would have an idea as to how much it is really doing.

If you are struggling with mask leaks then you aren't getting good quality sleep. Probably lots of wake ups and maybe short hours on the machine. Using the machine doesn't fix bad sleep if there are other factors giving you bad sleep.
The machine is designed to fix one aspect of bad sleep and that is the sleep apnea events. Until you eliminate any other possible culprits for "bad" sleep you can't really expect to judge the overall effectiveness of the machine.

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Re: Skeptic - what will happen if I modify my pressures?

Post by MaxDarkside » Tue Nov 27, 2012 2:13 pm

I have pondered doing the same, but haven't. 1 to 1 might be a bit low if you do. Maybe 4 to 4 or 5 to 5, so you feel you are getting air, but not a lot of therapy. If you do this, post your experience.

Regarding leaks, I use a Quattro FX as well. I made "mask seal liners" out of soft cotton. I put it over the seal then on my face. I get less disturbance when I sleep, less "face farting" going on as the Quattro FX's seal can squeal and squeek a bit with the leaks. The soft cotton diffuses any leaks and seems to keep them off my skin and out of my eyes, the worst offending location on the Quattro Fx I think. Liners work. Trust me on that one. I was a skeptic until I tried it. You can also find nice people here that sell those liners if you are scissor challenged.

Each of us are different and it takes some time to come to a new normal. You are fairly new to this. I've been on the hose for a year and 2 weeks. My therapy is notably helpful, but not fully a cure for what ails me. My numbers are good, AHI between 0.5 and 2.0, but still suffer from grog. There's probably more to my affliction than just sleep apnea events.

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Re: Skeptic - what will happen if I modify my pressures?

Post by Janknitz » Tue Nov 27, 2012 2:15 pm

As Chunky says, you'd be better off looking at the detailed data you can download to see what might be going on, before you start blindly adjusting pressures. The data can often tell you a lot.

BTW, 4 cm/H20 is the lowest pressure you can set.
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Re: Skeptic - what will happen if I modify my pressures?

Post by meissen » Tue Nov 27, 2012 5:12 pm

I use SleepyHead and download my data every morning to review the data from the night before. It's the first thing I do when I get to work every morning. I've had one night with 0.0 AHI, a handful of nights with less than 1.0 AHI, majority of the nights are between 1 and 2. I haven't had a night higher than 2.0 if my memory serves correctly. My AHI from my sleep test was 20.

The reason I'm skeptical is that when I review the data, I notice most of my apnea events occur around the time I'm tossing and turning or fighting mask leaks. I have the time projected on my ceiling so I'm basically always aware of what time it is when I'm awake.

Because my apnea events during therapy seem to be related to times when I'm struggling to sleep, I wonder if my sleep test had 20 AHI because I was tossing and turning with all the sensors and wires hooked up to me or really because of OSA.

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Re: Skeptic - what will happen if I modify my pressures?

Post by Pugsy » Tue Nov 27, 2012 5:30 pm

meissen wrote:Because my apnea events during therapy seem to be related to times when I'm struggling to sleep, I wonder if my sleep test had 20 AHI because I was tossing and turning with all the sensors and wires hooked up to me or really because of OSA.
You had an in lab sleep study with a tech there in attendance? If so then he would have been able to see if your events were related to tossing and turning or fiddling with something and if you were awake or not. They wouldn't have counted those events in your overall diagnosis.
The cpap machine doesn't have the luxury of having the EEG brain wave data to determine if you were asleep or not like the sleep tech has. So the cpap machine just records what it senses and it can and will record "events" while you are awake or semi awake that would have been probably set aside by a sleep tech.

If you had AHI of 20 with a sleep tech there to check all the EEG data and stuff..you can bet those were the real deal.
You were asleep when they occurred.

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Re: Skeptic - what will happen if I modify my pressures?

Post by NateS » Tue Nov 27, 2012 6:45 pm

meissen wrote:So I am skeptical about "just how well" my CPAP therapy is working. My eyes still burn throughout the day from being tired, I notice a little more energy, but I don't feel "night and day" different -- probably because I struggle through the night with mask leaks.

What would happen if I changed my machine settings for BiPap such that the pressure was 1 and 1? My thought was that if I set it so low then I would be able to sleep with the mask on and allow the S9 machine to register apnea events and I could then see what a difference my machine is really making.
If you feel rotten during the daytime now, wait until the day following a night running your machine at minimum pressure! You will be so oxygen-deprived that I predict that your head will be throbbing and pounding and your eyes will feel like they are bulging!

That's what happened to me when my VPAP was erroneously set to a low pressure for several nights early this year. From my notes: "Bad night; annoying dreams; felt like I had to work hard to get enough air; headache. I don't like the new lower pressure setting even though I requested it." Felt absolutely terrible all day. This can't be right!

What I think you are trying to do is get a reading out of the machine similar to a diagnostic only/no titration test at a sleep lab. But that is not what you will get if you hook yourself up to the machine. Instead you will likely be signicantly oxygen-deprived because you will be dependent on the machine, not on-demand breathing as you would have in a diagnostic only/no titration test at a sleep lab.

Nate

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Re: Skeptic - what will happen if I modify my pressures?

Post by meissen » Tue Nov 27, 2012 7:11 pm

Pugsy wrote:
meissen wrote:Because my apnea events during therapy seem to be related to times when I'm struggling to sleep, I wonder if my sleep test had 20 AHI because I was tossing and turning with all the sensors and wires hooked up to me or really because of OSA.
You had an in lab sleep study with a tech there in attendance? If so then he would have been able to see if your events were related to tossing and turning or fiddling with something and if you were awake or not. They wouldn't have counted those events in your overall diagnosis.
The cpap machine doesn't have the luxury of having the EEG brain wave data to determine if you were asleep or not like the sleep tech has. So the cpap machine just records what it senses and it can and will record "events" while you are awake or semi awake that would have been probably set aside by a sleep tech.

If you had AHI of 20 with a sleep tech there to check all the EEG data and stuff..you can bet those were the real deal.
You were asleep when they occurred.
There was a tech there, so I guess you're right. I have a cardiologist appointment for mild tachycardia that was discovered during my two sleep tests so maybe getting that fixed will also help.

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Re: Skeptic - what will happen if I modify my pressures?

Post by purple » Tue Nov 27, 2012 7:20 pm

I can understand the lower pressure of 13 being bothersome. That might be the minimum pressure you need to stint the airway open, which I translate to mean, that it would be the one pressure I would not want to dial down further.

If one has much in the way of leaks, or should I say when leaks are happening, the data is not accurate. A doctor once told me, and my diagnosis is surely different than yours, but I suspect the advice is accurate. To forget about the pressure at that time and only worry about dealing with leaks. If I stop the leaks, then we, the doc and I, would have accurate information to make decisions on.

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Re: Skeptic - what will happen if I modify my pressures?

Post by meissen » Tue Nov 27, 2012 7:52 pm

The pressure I needed was 17 - the 13 is just the exhale pressure and they said they usually set the exhale pressure 4 or so less than the inhale pressure which is how they got 13.

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Re: Skeptic - what will happen if I modify my pressures?

Post by Pugsy » Tue Nov 27, 2012 8:54 pm

I am a little bit lost as to what your problems are. Could be restate them again so I can see what they are and what is happening to cause the problem.

Also a few questions... How many hours of sleep do you average? Is that sleep broken up during the night for any reason?
Are you having masks issues....leaks...comfort ....fit?
Are you have pressure issues...comfort....rushing..whatever?
What are your concerns that have you questioning the therapy as to its effectiveness.
What specifically is the hardest part of the therapy that you are having to deal with.

Is is the fact that your AHI is pretty good but you don't feel as good as the numbers seem to say you should?
There is a lot of detective work involved when trying to sort out other issues that affect how we feel. Often it is harder work than sleepping with the mask.

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Re: Skeptic - what will happen if I modify my pressures?

Post by meissen » Wed Nov 28, 2012 7:05 am

Pugsy wrote:I am a little bit lost as to what your problems are. Could be restate them again so I can see what they are and what is happening to cause the problem.

Also a few questions... How many hours of sleep do you average? Is that sleep broken up during the night for any reason?
Are you having masks issues....leaks...comfort ....fit?
Are you have pressure issues...comfort....rushing..whatever?
What are your concerns that have you questioning the therapy as to its effectiveness.
What specifically is the hardest part of the therapy that you are having to deal with.

Is is the fact that your AHI is pretty good but you don't feel as good as the numbers seem to say you should?
There is a lot of detective work involved when trying to sort out other issues that affect how we feel. Often it is harder work than sleepping with the mask.
My biggest problem is just the leaks on the mask waking me up through the night to readjust the mask. I average at least 6 hours of "sleep" per night. I feel a little bit better since therapy started, but I still feel tired and I think most of it has to do with waking up on and off having to readjust the mask. My AHI has been good, though, if my memory serves correctly it's always less than 2, and sometimes less than 1 (but not often). I guess I'm just in denial on whether or not I need to be a hose head for the foreseeable future.

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Re: Skeptic - what will happen if I modify my pressures?

Post by chunkyfrog » Wed Nov 28, 2012 7:17 am

Do you have a mask liner?
With some of my leakiest masks, adding a fabric 'gasket' between mask and face
reduced the waking up with the annoying noises that occur between sweaty face and silicone.
I cut a ring of old, clean t-shirt fabric about a half inch inside and outside of the cushion.
Rem-zzz's or Pad-a-cheek are purchased options for the craft-challenged.
Fabric really quiets the face farts, so I can sleep.

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Re: Skeptic - what will happen if I modify my pressures?

Post by meissen » Wed Nov 28, 2012 7:41 am

My problem isn't so much the face farts (noise) as it is the gust of air on my eyes or cheeks. I tried the RemZzz's liners but they get in my eyes and seemed to make the leaks worse (although quiet, of course).

I do have a Pad-a-cheek anti-leak strap on its way - so hopefully that will fix my problems.

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