How does one get consistent results?

[ChicagoGranny]

exhalation relief ---
Would this be the "flex" setting on the device?

Look at the pressure graph. There are two lines. The top one is the pressure on inhale, and the lower one is the pressure on exhale. If you reduce the flex setting, the lower one will move up. If you turn off the flex setting, there will only be one pressure line.

[palerider]

You can start to speculate on a trend in the numbers but until you have more data you are guessing. Continue to track but start looking seriously after 50 - 100 data points.

That is BS. If his pressure is too low, or his leaks too high, it's ridiculous to wait 50 - 100 days to make appropriate corrections.

+1

[palerider]

Granny you missed my point...

When tracking a number that varies a lot, you need lots of data points to get a proper feel for it.

The point was that rather than focus on AHI perhaps a focus on restful sleep assessment would be better.

Originally we only had AHI data over a very short time to evaluate. With the addition of more data I would suggest raising the minimum from 8 to 9 and see if that helps.

I still wouldn't pay a lot of attention to AHI until there is more data available.

I would.

the time to make big changes is at the start, when there's big gains to be made, the time to take a lot of time and watch averages is when you're fine tuning.

[GuestStar]

First night with new minimum pressure setting. This time the data shows a lot of "vibratory snores" and the pressure hitting max during this time. As far as I recall this is the first time his pressure has gone up that high. What does that mean, that the pressure was working because there were no apneas, just snoring? Does the snore value count as an apnea or is it harmless?

[Pugsy]

Snoring is considered a warning sign of the airway trying to collapse and it's part of the machine's algorithm to respond to snores with more pressure because its job is to prevent the airway from collapsing.
There are other things that the machine's algorithm considers worth of increasing the pressure but you won't see them if the machine prevented them.

Since the snores are clustered I would suspect the usual culprits...supine sleeping or REM sleep or maybe a little of both.
The clusters are a bit ugly but there's really only a couple of them and they aren't hugely prolonged and if he slept well and is feeling decent then I don't know that they are of critical importance.
The key to preventing is a little more minimum pressure again but I don't know that it is something that is critical at this point to do anything about.
I think I would wait to see how many other nights end up showing this type of snoring clusters and then decide. This might be a fluke or it might be something that you see show up even worse.

I don't know if allowing the machine to go higher than 16 would make much of a difference or not...or even if it is needed. Personally...I would probably open the machine up to 20 and let the machine at least try to do a better job...that is of course assuming that the changing pressures to higher don't cause problems with sleep quality.

So you have some options but I don't know that I would do anything until I have more than this one night at the new pressures to evaluate.
The options are....allow the machine to go higher or start with a higher minimum (probably 1 cm would get it done)...or maybe both.

[HoseCrusher]

Snoring usually involves some collapse of the airway. If the max pressure is unable to keep the airway open, it may be worthwhile to bump that up a little. You are at 16 now and perhaps a guess would be to increase it to 18, or leave it wide open to the max pressure the machine can provide (usually 20).

As a side note, many doctors indicate that an AHI < 5 is a good target to strive for. From there you can micro manage to find the optimum.

[ChicagoGranny]

First night with new minimum pressure setting.

Let us know how he felt today, both early in the morning and toward the end of the day.

[palerider]

What does that mean, that the pressure was working because there were no apneas, just snoring? Does the snore value count as an apnea or is it harmless

there were apneas, and hypopneas flagged. snoring in and of itself is seen as a problem, just a minor one.

[GuestStar]

well I'm not very happy with today's results. AHI of 5.47. All kinds of different apneas, worst being obstructive (index 2.47). He did have some (non hard) alcohol with dinner. There are just so many different variables to this. I wish the program had a way to flag external factors such as alcohol consumption to see over time the significance.

Code: Select all

Periodic Breathing	1.25%
Large Leak	0.00%
Clear Airway	1.41
Obstructive	2.47
Hypopnea	1.59
RERA	0.53
Flow Limitation	0.35
Vibratory Snore	0.00
Vibratory Snore (VS2)	0.71
Pressure Pulse	3.89

I'm hoping this weekend he will get lots of (good) sleep.

[ChicagoGranny]

(non hard) alcohol with dinner

How much time elapsed between finishing dinner/drinks and bedding down? Food and drink can interfere with sleep and with breathing during sleep. Recommendations range between three and five hours without consumption before bedtime.

Here are the basics:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

[Jay Aitchsee]

(non hard) alcohol with dinner

How much time elapsed between finishing dinner/drinks and bedding down? Food and drink can interfere with sleep and with breathing during sleep. Recommendations range between three and five hours without consumption before bedtime.

Here are the basics:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

I wish the program had a way to flag external factors such as alcohol consumption to see over time the significance.

Paper and pencil still work. An old fashioned log or diary can be useful. Here's an example, but track what you think important and variable.

[Julie]

But in the end an AHI of <3 obstructives certainly isn't terrible... even a glass of wine could make a difference depending on the person, their weight, etc., but one has to enjoy life a little!

[palerider]

I wish the program had a way to flag external factors such as alcohol consumption to see over time the significance.

investigate the "notes" tab.

[GuestStar]

Okay guys. An update. His AHI has never been better (0-2). I definitely see a correlation with alcohol too close to bed, so that is being minimized. However, there was a more significant change that seems to have improved results. He no longer uses the chin strap. Without the chin strap he had one night with mask leakage but overall that does not seem to be an issue.



Now as you can see (compare to previous images above / previous page), his pressure is no longer "flat". It is constantly spiking. Are there any consequences to this, or is one better or does it not matter?

[Pugsy]

Those spikes you see now are normal pressure probes that the machine does just to test things out a bit.
Entirely normal and nothing to be concerned about.
We saw some of them on the first images but now that is pretty much all you see ..that's a good thing.
Respironics auto adjusting algorithm will do these little 1.5 cm increases as it sees fit. Might see a lot of them and might see just a few.
They aren't occurring nearly as rapidly as it appears on the graphs. If you were to actually zoom in really close you would see it's a very gradual increase and a very gradual decrease.

So entirely normal function of the machine and its auto adjusting algorithm and nothing at all to worry about.