What graphs or info to post for help

[steveb3]

In office sleep study full face at 10 CPAP was my best sleep
I am having more events with my at home new full face mask- mach is set at 10 CPAP not Auto per my in office sleep study. I am wondering if I need to slowly raise the pressure up till I have less events or go back to Auto or both ?
18 events-2- CAA, 10-H & 6 OA last night of nose pillows 7/29
AHI- 3.21 23 events 1-CAA, 17-H & 5 OA 1st night of full face mask 7/30
AHI-6.69 47 events 5-CAA, 27-H & 15 OA 2nd night FF
AHI-2.74 21 events 4-CAA, 16-H & 1 OA 3rd night
AHI-5.09 - 48 events 2-CAA, 45-H & 1 OA 4th night
My 4 weeks of nose pillows AHI's were from <1 to <4 never a 5 or 6 but I had such bad dry mouth and then the sleep study showed the full face mask had the best results so I went with the full face.
No real leaks with the full face mask
Thanks

[Pugsy]

You wouldn't be the first person to find that they might need a little more pressure with a full face mask than with a nasal pillow mask.

Are you using EPR exhale relief..if so at what setting?

Which graphs?....which software?

I like the Events graphs, flow rate graph, leak graph, and Flow limitation and snore graphs if they show much activity.
In SleepyHead..also the AHI bar graphs on the left.

[steveb3]

What is EPR exhale relief ?
I have Sleepyhead software
I have the ResMed Auto S9 unit.
My Dr said the sleep study showed full face at 10 CPAP not Auto- see you in 4 weeks- well the first week I feel the same or worse and do not want to wait 4 weeks to see him again
You think going up to 11 and maybe going back to Auto in lieu of CPAP mode ?
Or wait another week so I would have 2 full weeks at the 10 and CPAP ?
I feel waiting another 3 weeks, loose all that sleep, just to see the Dr and then he says lets go up to 11 ?
I am new to this but I am not getting the help from my Dr like a lot of other people on this site.
Thanks

[Pugsy]

Download this and read it if you haven't already. It is the clinical manual for your machine and it explains EPR..exhale relief.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
It will tell you how to get to the setup menu and find out if it is turned on and what setting.
Sometimes people are using EPR of 3 and that's a 3 cm reduction during exhale and sometimes simply reducing EPR to 2 will help lower the AHI.

Can you go ahead and post a couple of your reports so we can see what you are seeing?
Don't know how?
viewtopic.php?f=1&t=81072&p=737779#p737779

Your AHI isn't horrible by any means but may not be quite what you would like to see. If you are sleeping poorly through the night with a lot of wake ups and/or fragmented sleep the machine might be flagging some events by mistake. They can and will flag awake breathing irregularities by mistake because they don't know if you were awake or not. If you see large clusters of events near a time where you were awake..they may not be real and wouldn't respond to pressure increases anyway.
So it's a good idea to try to understand what you are seeing and wanting to fight to make sure it's worthy of a fight.

If you are feeling worse...maybe we can figure out why.
How many hours of sleep are your getting?
Are those hours of sleep fragmented with multiple wake ups for any reason?
Mask issues? Leak issues?

viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html

[steveb3]

EPR was Off, so I turned it on and set it to 2.
No leaks or mask issues
I had the mask on for a good hour trying to get use to it, so no I am not getting 9 hrs sleep-trying to get at least 7 hours of sleep
These are from last night 8/1 it looks like I had 8-H & 1-OA from 3:17 to 3:23 and woke up at 3:35, took mask off for a few minutes and got a drink of water
Should I be looking more closely at the CA & OA and not put that much weight on the H's ?

[Pugsy]

Your CAs and OAs are minimal to none. Not enough to worry about.

Your Hyponeas...the cluster at 03:12...do you remember being awake for a short while before turning the machine off?
What about at 5:36?

No I wouldn't pooh pooh off the hyponeas...there's enough of them in clusters... and if you were asleep...they could be a problem and affect how you feel.

Though there are 2 breaks in therapy that we see...so sleep quality isn't optimal either.
Are the hyponeas maybe causing some arousals? Entirely possible.

If your hyponeas increase with the addition of EPR to your settings but you like the comfort then you may need to increase the pressure a bit to compensate for the drop in pressure on exhale.

[steveb3]

yes I remember being awake for a few minutes around the 3:12 mark but not the 5:36 as usually if I wake up the mask is coming off for a few minutes
Wow Pugsy- with the EPR on and set to 2 for the first time I only had 16 events- 11-H, 4-OA & 1-unspecified Apnea.
AHI- 1.79 best night yet with the full face at home !!
I feel pretty good and that was before I looked at this morning's info
Hopefully this is not a fluke
Either way Thank you Pugsy so much for at least one night's sleep- hopefully a lot more
Steve

[Pugsy]

I sure hope that last night's report becomes the norm for you.
I see you still have some fragmented sleep...3 times last night. Any thoughts on why?

It's too soon to speculate much but perhaps the addition of EPR allows for more comfortable sleeping...thus feel better. I know that I noticed a big difference in how I felt when I tried the bilevel machine (and your using EPR at 2 makes your machine work like a bilevel machine with 2 cm difference between inhale and exhale) even when there wasn't a significant change in the "numbers" on the reports.
I just slept better.
I suspect that some of your event clusters were awake/semi awake event clusters so not technically real OSA events. The by product of sleeping better would be the reduction of fragmented sleep and thus the reduction of awake/semi awake clusters.
We can't blame it all on awake/semi awake but I suspect that some of your AHI was from having the fragmented sleep even if you didn't turn off the machine straight away.

[steveb3]

I am not use to the full face and I think that is causing some of my wake ups as soon as I wake up I feel like I have to rip that thing off my face for a few minutes.
Trying to find that sweet spot by loosening & tightening the straps. When if feels OK I get some minor leakage so I tightened the straps. I wish the nose pillows would work better for me, but I have no dry mouth issues with the full face as I did with the nose pillows which I think the dry mouth woke me up as well.
Thanks again for all your help.

[steveb3]

Well the fog is back



A lot of OA last night so I am thinking about setting up my camcorder and see if they are related to me rolling on my back and snoring.
I had a leak for about 20 seconds right at 2:00 AM mark during my snoring and events
Also I think I might raise the pressure up from 10 to 11 CPAP no Auto and see if that helps
Steve

[Pugsy]

The variability from night to night is why we suggest that people give a setting change about a week to see which way things are going to go.
Like was last night the fluke bad night or was the prior night the fluke good night?
And why I don't get super excited about a report until I see several of them that match one or the other (good or bad) at a setting choice.

Using EPR at 2 cm reduces the pressure during exhale and could possibly allow some events to sneak past the defenses during exhale if the pressure setting was bordering on the line between optimal and sub optimal.
If you like the comfort that EPR at 2 brings...then sometimes we do have to increase the pressure just a little to compensate for the EPR reduction.

Your clusters...either supine sleeping or REM sleep stage. Supine sleeping can sometimes be limited by fixing up some sort of impediment to rolling over on your back. REM sleep stage we have zero control over and no sense in trying.
If you like cpap mode...then yes, probably another 1 cm pressure would be an option and give it at least 3 or 4 days to see how it trends.
Or you can maybe try APAP mode with 10 minimum and maybe 12 or 13 maximum to see if the machine wants to try to prevent those clusters with more pressure. Small range and varying pressures within a small range are less likely to disturb a person's sleep ...if varying pressures are a disturbing factor to sleep (it is for some people and not for others).
Or APAP mode with a larger range in the max.

Either way...I think you are very close to optimal settings...just need to figure out what little tweak gets you there.