CPAP therapy optimization - a cautionary tale

[Pneumophile]

OK so I've been on a CPAP machine for just over seven years - until a week ago the Respironics M Series Auto A-flex and since then the System One 560. The old machine still works and now serves as a back-up and possibly for travel sans humidifier. In the early days I tried a few different masks and ultimately settled on a nasal cushion that has served me well. I used a couple of different chin straps for a year or two but then stopped doing so thinking they weren't necessary as my CPAP data seemed to be OK.

BUT, the last couple of years or so I've been putting up with headaches in the morning of variable intensity, that usually go away during or after breakfast. This would go on for weeks or months and then go away for weeks or months. I also sometimes got headaches during the day when hungry, e.g. if I left it too long until lunch or dinner. I concluded that these headaches were hypoglycemia-induced and nothing to do with my OSA.

I noticed that I felt better in the morning the last few days on the new System One and that my 90% pressures are up from 9-9.5 to 10-10.5; the AHI's were a little bit lower, maybe from 4.5-5.5 down to 3.5 to 4.5. My wife woke me up two nights ago saying that there was a noisy leak so last night I tightened the mask strap and went back to using a chinstrap.

Result: my AHI last night was precisely 0.78 - this is much lower than my lowest ever previous total. ALL of the data look really good, quite amazing in fact. The leak rate was essentially flat at about 35 - intentional leak with the ResMed nasal mask. I felt better upon waking that I have for a long time, many months in fact. I haven't had even the suggestion of a headache all day - again the first time in months.

Moral of story: DO NOT be satisfied with an AHI even as low as 4, especially if you experience morning headaches. The target AHI value varies between individuals - what works for some (in terms of daytime symptoms) may not cut it for others. Continue to experiment with different masks and put up with the minor inconvenience of a chin strap if there is any possibility of mouth leakage during the night. This has been a humbling experience for me I have to say. I am a retired Ph.D. biologist with a career in the pharmaceutical industry (oncology, cardiovascular, dermatology) and you'd think I would have shown more skepticism about my 'hypoglycemia-induced headache' hypothesis.

[PEF]

Good for you!!

[Guest]

Thanks for the reply. I had another good night last night but the data show that I need to keep working at it. No more complacency here - it feels great to wake up refreshed for a change.

[Pneumophile]

That was me - guess I needed my first cup of coffee this morning.

[SoarHigher]

Great that you are feeling better. I also know that your AHI can be low . . .below 5. . .but part of the night when you are awake and no obstructions, you get a false reading and believe you are doing great with your therapy. After 8 weeks of CPAP, I am not feeling as good in the day as I would hope, better than before therapy, but I have read this forum enough to know, it all takes time for your body to adapt. I went years with sleep apnea undiagnosed so have some time to make up for poor oxygen and feeling so tired all the time. My body doesn't know exactly what normal is for me. I am determined to feel better.

[Chevie]

that my 90% pressures are up from 9-9.5% to 10-10.5%

You mean cm H2O?

maybe from 4.5-5.5 down to 3.5 to 4.5

That doesn't seem like a significant difference. Remember, you are working with averages.

Standard advice: Start using Sleepyhead software and figure out what is really happening.

I am a retired Ph.D. biologist with a career in the pharmaceutical industry (oncology, cardiovascular, dermatology)

We have people here without HS diplomas and without the ability to use good grammar/spelling/punctuation who can help you optimize your CPAP therapy.

[Pneumophile]

You mean cm H2O?

Yes, my bad - post edited.

That doesn't seem like a significant difference. Remember, you are working with averages.

Indeed, and that is why I'm now looking at SleepyHead data every day. The last two nights my mean AHI has been 0.78 and 1.40. This does look like a significant reduction, probably due to chin strap use on those nights, but time will tell. I will need to follow all the parameters over time to get a good understanding of my issues; I see my sleep doc in about a month and that should help. I did this seven years ago with EncoreViewer but clearly didn't follow up enough and never did get AHI's <2 consistently. I got complacent; that won't happen again. I also plan to buy a recording oximeter - I see that those data can also be loaded into SH. I owned one once and used it quite a lot but the battery finally wouldn't recharge.

And yes, the hell with grammar and spelling - I want a good night's sleep back and every bit of good advice is welcome.
Cheers!

[Pneumophile]

Update after 7 nights on the new blower: all 7 nights have left me much more refreshed and energetic than any single night in the past 6 months on the old machine, or indeed most nights in the past year. The daily headaches have gone gone gone. Quality of life has shot up. This cannot be a coincidence, but what precisely is the explanation?

0.78 is still my lowest AHI for the week, the next lowest is about 2 and my average for the week is 2.5. The frustrating thing is that I cannot read the data on my old REMStar A-flex because my 32-bit machines all died years ago and EncoreViewer 1.0 won't run on 64-bit/Windows 10. When I borrowed a 32-bit computer today (Windows XP) I was able to load EncoreViewer but was unable to load a driver for the smart card reader. Why the heck is that? I'm no genius on computers but I do know how to download a blasted device driver.

I really need to look at the data on that old CPAP card to compare with the new data if I'm to have any hope of figuring this out.

p.s. average 90% pressure for the week is now around 9.5 cm, with an average pressure of about 8.5 cm - not much different from the pressure values on the old machine which of course can easily be viewed on the screen.

[Pugsy]

You and use EncoreBasic on your newer computer and it will/should work with the old SmartCard and the Infineer card reader.
http://www.apneaboard.com/forums/Thread ... nly-thread
It should have the driver software included in the install to simplify things.
If it doesn't you can go to the Mako website (they made the Infineer) and get the driver software.
I haven't been there in a while so I don't know about Windows 10 but they used to have up to Win 7.
If I remember correctly Basic works on both 32 and 64 bit computers.

[Pneumophile]

Thanks Pugsy. Yesterday I tried downloading the Mako Infiniteer driver and was told that Win 10 wasn't supported. Maybe this isn't true, I'll look again. I'll try downloading Encore Basic but I'm not sure that it (and the driver) will run on Win 10.

Getting some good REM sleep these days doesn't mean I'm any more patient with blasted computers

p.s. my current sleep doc told me that HE can't look at the smart card data from the old blower. Would you believe THAT????
p.p.s. Thanks for your great work on this forum - very helpful. I've been reading your stickies and learning.

[Pugsy]

Basic will work on this Windows 10 laptop (upgraded from Windows 7) but it's been a long, long time since i have had to try to use it with the Smart Card and the Infineer reader. Just haven't had the need.
I didn't know if Mako ever did anything beyond Win 7. Haven't been over there in a long time either.

Basic will work with the Smart Card IF you can get the computer to recognize the card reader.

[Chevie]

I really need to look at the data on that old CPAP card to compare with the new data if I'm to have any hope of figuring this out.

I could be misunderstanding what you are trying to do. But, many people here worry over past data and even their sleep study. I found this useless worry and useless activity. The only important thing is how you are doing now and are you doing the things necessary to have an excellent CPAP therapy going forward.

I would take a long walk instead of worrying over an old CPAP card.

[jnk...]

. . Moral of story: DO NOT be satisfied with an AHI even as low as 4, especially if you experience morning headaches. The target AHI value varies between individuals - what works for some (in terms of daytime symptoms) may not cut it for others. . . .

The second part of your moral is especially important, since many will never get low AHI reports from a home machine but will still get great benefit from PAP therapy. Get AHI as low as possible, but no lower.

. . . Continue to experiment . . .

I agree wholeheartedly that trying things is important when symptoms continue. However, there is also the human-nature principle that when one has a hammer in one's hand, every problem starts to look like a nail. Some with optimal PAP therapy continue to have other related health issues that CAN'T be solved by tweaking PAP therapy. It is possible for them to lose valuable months attributing everything to AHI when human health is, by its very nature, multifactorial.

[Chevie]

Get AHI as low as possible, but no lower.

Only a liberal arts major would understand.

[jnk...]

Get AHI as low as possible, but no lower.

Only a liberal arts major would understand.

lex parsimoniae