Two months in

[Mudrock63]

Hi all. Diagnosed with severe SA early October. AHI in upper 30's. Oxygen deprivation during sleep study down to 60%. Put on CPAP late October with a fixed setting of 6.0. Pulled a report with a month's data that showed my AHI averaging 22.0. A doctor (not my ENT) suggested trying a higher pressure and felt that 6.0 setting was way too low to address my problem. So I have dial-winged it with some success. AHI now down to 9-15 depending on the night. Currently using 14.5 as the setting, but have not been on it long enough to gauge long-term results. Lowest ever was 4.32, and have only had two nights since late October 6.0 or lower. I am feeling somewhat better overall, but have still not kicked the nap habit. I do wear the mask when I nap. I do not go back to the ENT until the 28th. And I want to go back with suggestions to help my therapy.

My question for the day is......I see that many of you use the auto settings on the machine within a range of pressures that allows the machine to adjust to what you need at a particular moment. It seems rather intuitive that this would be the way to go. But I have no clue what ranges to set. Just in my limited experimentation it appears I do better with a minimum of 9.5. 14.5 is the maximum I have tried so far. Am trying to do a week at a time on various pressures to get a decent snapshot of how I do at each one. The mask doesn't bother me, and the pressure doesn't bother me. What bothers me is not getting close to the holy grail of a low AHI.

I have a week left to experiment. Should I jack the sucker up to 18 or 20 to see if the AHI goes down? Experiment with the auto feature and range it from 9.5 to 16.0?

I don't feel like the benefits of the therapy have been maximized, and I am not overly confident that my doctor is going to come up with that magic formula that needs to get me where I need to be. Any other suggestions?

[Pugsy]

What machine are you using? Brand and model?
Are you using the software to monitor that AHI or just getting it off the LCD screen?

[Mudrock63]

Philips Respironics System One (60 Series)
RemStar Auto with A-FlexModel 560P - P14572839FEC6
PAP Mode: CPAP

I am using SleepyHead. Sorry, thought I had already added machine to profile. Will try again.

[Pugsy]

What is the AHI breakdown into event categories?....Clear Airway? Hyponea? Obstructive Apnea?
Any large leak flags?
Do you find that you are spending much time with the mask on and you are awake?

[Mudrock63]

CPAP Statistics
61 days of CPAP Data, between Wed Oct 21 2015 and Sun Dec 20 2015
Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 04:42 09:11 09:17 09:06 09:06
Compliance 100% 100% 100% 100% 100%
Therapy Efficiacy
AHI 9.57 13.20 14.51 17.92 17.92
Obstructive Index 5.95 10.90 11.80 13.44 13.44
Hypopnea Index 3.40 2.02 2.40 4.05 4.05
Clear Airway Index 0.21 0.28 0.32 0.42 0.42
Flow Limitation Index 0.00 0.00 0.00 0.00 0.00
RERA Index 3.83 2.61 2.98 3.97 3.97
% of time in Cheyne Stokes Respiration 0.90% 0.77% 1.05% 1.35% 1.35%
Leak Statistics
Average Leak Rate 0.42 0.36 0.66 2.54 2.54
90% Leak Rate 1.00 1.00 2.00 2.00 2.00
% of time above Leak Rate threshold 0.00% 0.00% 0.14% 1.76% 1.76%
Pressure Statistics
Average Pressure 14.50 13.84 10.58 8.30 8.30
Min Pressure 14.50 12.00 6.00 6.00 6.00
Max Pressure 14.50 14.50 14.50 14.50 14.50
90% Pressure 14.50 14.50 14.50 14.50 14.50

[Mudrock63]

Sorry, need to work on my screen shot skills. I don't seem to have a huge problem with leaks. OA's seem to be prominent.

[Pugsy]

I would switch over to apap mode and set the minimum to what you are using now in cpap mode and set the maximum to 20. See where the pressure wants to go.

Can you post an image of last night's detailed report?
Showing the AHI & statistics on the left side along with these graphs on the right side....
Events
Flow rate
Pressure
Leak
don't need all those other graphs (you can turn off unneeded graphs using the events flag thing down at lower right side by just clicking on green bar and turning it red). You can also resize the graphs a bit.
See this thread for examples
viewtopic/t103468/Need-help-with-screen-shots.html
You can hide the calendar and turn off the pie chart in Preferences.

Mainly curious to see if there is any clustering of events with periods of nothing going on.

I am short on time as I will be leaving in a few hours for a week with the family...so I may not be able to get online tomorrow to see the results of apap mode. All depends on if I have internet access but someone else here will be able to help. Just mentioning so you won't think I abandoned you.

[Mudrock63]

There is the overview. Will post last night shortly. Thank you, Pugsy!

[Mudrock63]

And last night's data.

[blownaway]

I, too, am just two months in and I would conclude that you are doing fine. Nobody can tell you exactly what you should do. We have to experiment to find out what works for us individually and you are on the right track, so keep it up.

[Mudrock63]

I, too, am just two months in and I would conclude that you are doing fine. Nobody can tell you exactly what you should do. We have to experiment to find out what works for us individually and you are on the right track, so keep it up.

I have been learning a lot reading this board. Not the most computer-savvy individual out there, but did manage to post a couple of screen shots finally. LOL. I am going to try Pugsy's suggestion and see where that leads me. At this point, I trust her and a few others on this board more than the medical experts I have dealt with to this point. I want to maximize the benefit of this therapy. Preferably without 50 visits to the ENT for permission. I would be easier to walk in and hand her the solution, I think.

[Pugsy]

Almost like I like to see the reports..the AHI bar graphs showing AHI and each category index on the left which is under the details tab and not the events tab..the details that show each colored bar graph for each category that makes up the AHI.

Though I just mention it for further image postings...I can see what I need to see on the top events graph on the graphs on the right side.
The presence of the OAs and hyponeas along with the snores means that during those times the pressure is not sufficient to keep the airway open.
The lack of Flow limitation flags doesn't mean anything because in cpap mode the FL flags are turned off. I bet you would have seen some FLs along with those snores if you had been in apap mode.

The 2 most common causes of the pressure being fine for some time and not other times are either supine sleeping or REM stage sleep or both because it's common for us to need more pressure during REM sleep or when we are on our backs.
The timing of the clustering points to maybe REM stage sleep because we tend to have more REM sleep as the night progresses with the greatest amount of REM occurring in those wee hours of the morning.
No way to know for sure but what I usually suggest is just deal with it because we can't always control sleeping position and we sure can't control REM sleep.

My thoughts about minimum of 14.5 and maximum of 20 using apap mode still stands.
Your 14.5 works well for a good bit of the night but when you see the snores and clustering of events that pressure isn't working so great.

Flow limitation flagging...only available in apap mode and for that reason even if someone ends up with a fixed pressure (minimum to equal maximum in apap mode) or a tight apap range...stay in apap mode so that the FLs can be monitored.

Unless you end up having problems with varying pressures...I would suggest using the apap in a range and then see what happens. I don't know if you need more than 14.5 minimum or not....need a few nights with apap mode to get a feel for where the pressure wants/needs to go.
It may not need to go far above that 14.5 or it may need to go to near 20 cm.

I think that you will see a significant improvement if you try apap mode.
It's for situations like this where the pressure setting works well for the bulk of the night but not so great at other times that the apap mode shines.

Leaks are minimal to none...so not an issue.
Just need a little tweaking of the pressure settings to break up those clusters.
I had the same issues when I first started therapy...my OSA is worse in REM sleep and would sometimes see a need for pressures of 18 cm...and other parts of the night 12 cm would do a great job.

[Mudrock63]

Just changed settings to what you suggested. Can't wait to see the results! Thank you and enjoy your time with your family!

[Mudrock63]

[Mudrock63]

Best night ever vis a vis AHI. I was probably semi-awake for the last 15 minutes. Pugsy, I am leaving the settings as they are until you get back to read the tea leaves. Feel pretty refreshed on five hours sleep. Thanks for giving me some hope, and some progress.