Started CPAP - now I am more tired...

[glyphix]

Oh - and so I understand better... sounds like both of you think 7 is not quite cutting it for me... what is it on my graphs that shows you that? Like what's off that makes you think 7 might not be enough... (certain events/frequencies, etc) and what would a better target be. (none of said event, or less, etc)

Thanks!

[Wulfman...]

Oh - and so I understand better... sounds like both of you think 7 is not quite cutting it for me... what is it on my graphs that shows you that? Like what's off that makes you think 7 might not be enough... (certain events/frequencies, etc) and what would a better target be. (none of said event, or less, etc)

Thanks!

Well, I was sort of thinking somewhere in the neighborhood of 9 cm. (straight pressure) for the next step for a few nights.
It might help eliminate some snores, hypopneas and apneas.
I think you're "pretty close", but need just a little bit more pressure.


Den

.

[Pugsy]

Sometimes I see sort of a pattern...not really in your case though.

Mainly for me it's the snores and hyponeas shown...there's just a little more of them than I personally would be comfortable with if it were my report and I have sort of been down your road...way back when I was using 8 cm pressure. So I am drawing on my own personal experience and I my first machine was an older version of what you are using. I know how they respond and work.

Snores and flow limitations are flow reductions that haven't grown up to be hyponeas or OAs.
Hyponeas are flow reductions that aren't quite grown up enough to earn an OA flag.
So while any one thing isn't all that alarming...the combination of what we see makes me question things.
With the snores I would bet my last dollar if FL flagging was turned on there would be some.

The reason I suggested a small increase...I got that from my past experience too...plus smaller increases are a little easier to adjust to so I like to go up in stages. Going from 7 to 9 in one big jump...not impossible to do but going up in small stages is easier and less likely to cause problems going to sleep.
Besides...might get lucky and find out that all that is needed is 0.5 or 1.0 cm more. Where you are at..it might only take just a little more to do a better job.

[glyphix]

Thanks to both of you!

Quick question... So I got into clinitian set up screen and changed from CPAP to Auto and then set min and max. Then went BACK and EXIT... that's all I need to do right? I noticed when I changed from CPAP to Auto, the lines below changed... like which options where there... but all the other non-related settings should have stayed the same right?

[Wulfman...]

Thanks to both of you!

Quick question... So I got into clinitian set up screen and changed from CPAP to Auto and then set min and max. Then went BACK and EXIT... that's all I need to do right? I noticed when I changed from CPAP to Auto, the lines below changed... like which options where there... but all the other non-related settings should have stayed the same right?

Should have.


Den

.

[glyphix]

I know I need to give it a few days at a setting to get a larger pictures... but FYI here are my stats for last night with the new APAP setting.

[Pugsy]

It's showing minimum 7 cm and max of 9 cm...
Is that correct? Sometimes SH gets the settings wrong...if it is indeed 7 minimum...try 7.5 tonight.

The minimum pressure is the most critical pressure setting. It's job is to hold the airway open and give the machine a head start on the pressure when it needs to increase because the response to snores, FLs and apnea events isn't a blink of an eye response like people tend to think...it goes up slow and comes down slow.. It's a lot slower than one would think by looking at the overall pressure graph.
The sawtooth spikey things on the pressure graph...those are normal test probes and is not the machine responding to anything in particular.

[glyphix]

Thanks! I will try 7.5 tonight!

Scary that part where my O2 goes down to 78!! It appears to be associated with an H event and not an OA event... what do you make of that?

Here is a close up of the O2 in the O2 software

[Pugsy]

I am not the greatest at evaluation of O2 reports...

Just how long was the hyponea that happened around the time of this desat to 78%?
We don't know exactly how long the events lasted because the PR S1 doesn't give us duration but we can estimate it using the markers that get counted...
Go to the Events tab and then the Hyponea category and find the hyponea that is flagged around the time of the desat. The number in parentheses is a very close approximation of duration in seconds...it's going to be close like within 2 or 3 seconds.
Unless the hyponea is massively long I don't see it causing a desat like that. Hyponeas are partial flow reductions and unless we have a truckload of them back to back they aren't going to impact O2 levels all that much unless really, really long duration.

My first thought would be minor loss of signal or maybe the finger got bent causing a low flow or something.
The decrease is much more rapid than normal O2 desats would....I think anyway. Usually desats go down gradually and come up gradually.

[glyphix]

Looks like it was a 12 second H. And upon zooming it looks like the H was a couple minutes before desat started happening... and strangely the desat event seems to have teetered up and down until an OA even at 5:04 (There was a CA event at 5:03... sat was higher there but went back down)

Looks like I was under 88 for about 1-2 minutes... only at 78% momentarily and teetering up and down to low 90's for about 10 mins.

Maybe it was a bent finger thing... it was pretty quick. At least the extreme desat...

BTW--- whats up with a CA? I would think CA is the "default" state (one would hope anyway)... curious why this is an "event"?

On the bright side I have not been tired/fatigued as much past 2 days... maybe it was just the melatonin and unisom I was taking to help get to sleep while adjusting to having a mask strapped to my face... though don't recall that they had made me that tired in past... anyway... will continue to see how things go.

[Pugsy]

CA is Clear Airway but is referring to no air flow is happening but the airway is clear.
Hold your breath for 10 seconds...that's a CA. No airflow but the airway is open.
CA is Respironics term for a Central apnea.
A few centrals are normal even if they are the real deal but some CAs/centrals could simply be from the machine flagging awake/semi awake breathing irregularities by mistake.
The CAs/centrals you are seeing flagged...even if they were all the real deal there's not enough of them to worry about.

In terms of desats...10 seconds or even 20 seconds isn't really going to be able to cause significant desats unless you have a large cluster.
Put you pulse ox on and hold your breath for 20 seconds and watch the pulse ox for a few minutes afterwards.
See if anything exciting happens.

[glyphix]

Thanks!... Yea I notice when I am awake I think I stop breathing when I do things.... like when i put the mask on and I am getting alarms set on my phone or plugging it in and putting it on the nightstand or adjusting my blanket/pillows... I realize I think I stopped breathing.... is that normal? Does that mean I might stop breathing more while sleeping?

[Pugsy]

You can't compare awake breathing (or lack of) to asleep breathing.
We often hold our breath while awake for any number of reasons and not realize we are doing it. It is normal..we all do it.
That's voluntary though even though we may not realize we are doing it...asleep is involuntary. Two different things.
Since these machines can and will flag awake/semi awake breathing irregularities as some sort of apnea event we tend to discount or disregard clusters of events that happen at known awake times or even close to known awake times if someone doesn't go right to sleep.

I once was helping a guy with an AHI of around 20 with the mask and cpap...ugly reports for sure but I spotted multiple breaks in therapy where it was obvious he had turned the machine off for a short period of time so known awake times. 95% of his flagged events were occurring either right before he turned the machine off or right after he turned it back on. Come to find out he was having some real insomnia issues and laying there trying to go to or get back to sleep in the middle of the night. So he quit laying there for 30 minutes trying to go to sleep or waking up and not being able to sleep and fighting it and his AHI dropped to less than 5.0 immediately.
Once it was determined the bulk of his AHI was related to awake "events" the stress lessened and he was then actually able to stay asleep better and fall asleep easier (quicker) so not only did the AHI improve...his sleep quality also improved.

[glyphix]

Thanks!

So has it 7.5-9 last night...

I thought I woke up like 20 times... but not sure how many i really woke up... Upon final waking I realized I was having some layered dreams... because I know 2 of the times I remember "waking up"... were really definitely dreams because there where unrealistic aspects... (like my CPAP machine having a clear left side (the pump side) that also had water in it)... I never use my ramp at start of night, so I decided to just set my ramp .5 below my min... then when I wake up I can press my ramp button, which shouldn't make a lot of difference in therapy if I go down to 7 for 5 min ramp up whenever I wake up right? I figure that might at least give me a way to know if I am really waking up or just dreaming it. Because I can check the graphs to see when I really hit the ramp button.

Anyway - don't feel tired today so thats good...

[Pugsy]

You can use the "hit the ramp button" thing to document when you were really awake if you wish.
The shorter the time in ramp the better but you are in luck in that your machine will still do it's job during ramp if it senses some sort of apnea event happening that would normally cause it to increase its pressure it will still do that so you won't have apnea events happen without therapy available. Now we are still limited with the machine's response time in general so it may not totally prevent something but it will try.
The Respironics machines when in apap mode will do this.

It looks like there is maybe a pattern (small) to the clustering and it might be REM stage sleep or it might be that you are on your back.
You are also maxing out the pressure a considerable amount of the night. There does seem to be a bit of correlation with the maxing of the pressure and the OAs.

I would continue with these settings a couple more nights and if this continues I would try another small increase in the minimum and a similar amount of increase in the available maximum.

I don't know how much (if any) these small pressure changes are impacting sleep quality. Since you chose to go this way I wouldn't be so quick to go to minimum to equal maximum until you have your AHI down a little more and the reports cleaned up a bit. It's always possible that what we are seeing on the reports themselves are a factor in sleep quality and would happen even with fixed pressure.

Your choice though. I tend so real slow with changes myself but others take larger and faster leaps.
Whatever you do...don't jump around because you won't know if the changes you are normal variations or as a result of the change you implemented. Pick a plan and stick to it unless the results are horrible and at this point I don't see "horrible" at least on paper and you report perhaps feeling just a little better.