New chart for review

[palerider]

as I said pressure is at 13 and 20 epr at 3. What do you think should be my next step? should I continue a slow-but-steady elevation of pressure settings or perhaps bring down my epr setting next?

You have been told what to do, you haven't done it.

hey bro if you're not going to take a more positive attitude than the one you've been displaying I'd appreciate it if you just stay out of my posts. There's no need for condescension and snippiness. I got enough on my head and I come here looking for compassion and support not your attitude.

Sure, whatever you want.

All I cared about was getting you to sleeping better, bro.

Well you've got a lousy " bedside manner" when in fact I have been doing what you've told me and have increased my pressures. Because I'm not doing it at the pace that you suggest doesn't mean that I'm not doing it..

I'm not at your bedside, I'm not here to pamper your feelings, I'm "Dr. House". I'm here to try and get you the best possible sleep. Of you don't like my "manner", I'm happy to stop trying to help. There's other people that you'll hopefully find less abrasive.

You've been delaying doing what has been suggested, and instead just asking tons of questions... I've got nothing against helping to educate new people, in fact I love it, but you've been confrontational from the word go...

If that's your way, that's fine, you do what you want, but be aware it wears on people's patience, and you may drive away people that get tired of trying to help you.

I wish you the best of luck.

Ps, I'm not your "bro".

[djams]

In this latest chart, there's 2 good examples of how the machine responds. You mentioned the first (pressure increase in response to FL). Then at 1:45 you've got the OA cluster and there's an entirely different type of response.

Here's the criteria(resmed). You can see that FL's are high priority. Depending on severity of FL.

*documented*:
OA/hypopnea response: Increases pressure based on current pressure every 10 s of apnea: increment max 3 when pressure is 4. Increment drops linearly down to 0.5 when pressure is 20.

Flow limitation response: S9/Air10
: uses 3 breath average FL index. Increment typically around 0.6/breath for severely flow limited breaths. Lower increment if lower FL index, high leak or as pressure increases further above 15;

Snores: S8–S9: increment max 1/breath. Lower increment if snore is less severe, high leak or as pressure increases further above 10 S10: increment max 0.6/breath for a loud snore otherwise same as S9.

[JBarizona]

Last nights chart...AHI 3.2 best ever. Lowest number of events ever. Least time spent in apnea ever. Pressure never reached top of maximum. Leaks numbers remain good...Maybe 13 is my lucky number? I feel decent but sometimes I wonder if there is a psychology in play each morning when I wake..If i see a good AHI number on my machine I feel better, if it's a bad number I feel worse. Not sure how much is in my head and how much is physical. Nonetheless, it's nice to see numbers going down. Not sure if I should raise minimum to 14 yet. It's been suggested that this might improve my numbers even more, but it's also been suggested that when you reach acceptable numbers (below 5) to let those settings "bake in " for a while and see if there is further lowering.

[Dog Slobber]

Maybe 13 is my lucky number? I feel decent but sometimes I wonder if there is a psychology in play each morning when I wake..If i see a good AHI number on my machine I feel better, if it's a bad number I feel worse.

Don't look at your numbers right away.

Get up, do your morning stuff, see how you feel. Then look at your numbers.

[Pugsy]

When I was new to therapy I made a point of not looking at the numbers until the evening.
I do think that there is a strong chance of creating a self fulfilling prophecy when we look at the numbers first thing...so I always wanted to avoid that chance myself.

One day about 4 months into therapy I finally had the "miracle"...felt like super woman the whole day.
Didn't look at my data numbers until that evening. Thought for sure that I must have had a 0.0 AHI night.
Man was I ever surprised to see a big fat 10.2 AHI there. Go figure.

[zoocrewphoto]

Back when I started, I would keep a diary on the computer. I would put a comment of how I felt I slept, and how many hours I thought I slept and how many wakeups. That night, I would add the comment of how I felt during the day and then check the data for actual sleep data. I found that ahi (almost always below 1.5) didn't matter if it was 0.1 or 1.5, but did make a difference if I went 6 hours, woke up, then 2 hours. Or 3,3,3; etc. The longer I went before the first wakeup seems to be my best indicator of my sleep quality. Sleeping 6 straight (and that's it) is still better than 5 hours, wakeup, then 2 hours.

[JBarizona]

Maybe 13 isn't my lucky number after all..AHI and total number of events a bit higher after last night...soo many centrals...As usual, feeling sorta tired...definitely not refreshed...guess I will try 14 minimum pressure and see what happens...

[JBarizona]

Back when I started, I would keep a diary on the computer. I would put a comment of how I felt I slept, and how many hours I thought I slept and how many wakeups. That night, I would add the comment of how I felt during the day and then check the data for actual sleep data. I found that ahi (almost always below 1.5) didn't matter if it was 0.1 or 1.5, but did make a difference if I went 6 hours, woke up, then 2 hours. Or 3,3,3; etc. The longer I went before the first wakeup seems to be my best indicator of my sleep quality. Sleeping 6 straight (and that's it) is still better than 5 hours, wakeup, then 2 hours.

I think you're right about that Zoo. Feeling tired today and had 2 wake Up's that I was conscious of...got up took off the mask for a minute went to the men's room came back. I think I definitely feel better when I have a long stretch of sleep with no conscious wake-ups

[JBarizona]

Interesting experience at the sleep doctor today. Had my 8 week follow up. Explained to him that the initial pressures he set we'rent doing the job and that I had sought out advice here in this forum. Mentioned to him that most of the advice I have been receiving here focused on raising significantly my minimum pressures in order to prevent events from happening in the first place. I had been initially focused on raising my top pressures thinking that that was the best way to stop events...so the advice I received here to raise my minimum pressures has been good advice. Since I raise my minimum pressure 213 I have not had a night above 4.5 Ahi going on a week now....before I told the doctor about my recent success I specifically asked him if raising the bottom pressure is the real key to preventing events and he said no. He said it was all about the top pressure. How could a sleep doctor be so misinformed seemingly? Why would he say this? Yes I've heard from people that doctors and respiratory therapist are really clueless and it's us the users that know it better etcetera etcetera....Looking Back Now it was so obvious that raising the minimum pressure was what I needed to do. Again, how is a seemingly educated and intelligent sleep doctor not agreeing with this idea? Anyway then I gave him the results of the increase in my minimum pressure and he didn't have much to say after that. It was strange.... For the record my first 49 days on CPAP I only had 4 days below 5 Ahi....the last six days on CPAP with my minimum pressure raised to 13 I have not had a night above 5....normally I'd say who gives a fart what the doctor says but after all he is a doctor so I suppose I'm a bit concerned why he wouldn't think minimum pressure is the key to preventing events from happening in the first place....naturally we want to take our doctor's advice but it's the advice I've received here that's so far at least has proven most effective..

[Okie bipap]

Unless the doctor is also a CPAP user, they seldom really know how the machines work and what adjustments should be made. To them, any thing under an AHI of 5 is good. Most of us strive for an AHI of less than 1. When I first started, the therapist I was working with used a CPAP machine as did her husband. She gave me a few good hints about comfort items,but did not say anything about changing my own pressure. After finding this forum, I decided to take charge of my own therapy. The first time I went in for a check and they saw I changed my pressure settings, they told me I shouldn't be doing that. However, once they saw how much better I was doing with my settings, they quit complaining about me making changes.

[JBarizona]

So I'm posting charts for the last two nights...have some questions about leaking and flow limit......on sleepyhead, it shows these last two nights were two of my worst for flow limitation....but AHI was decent.....is there any correlation between good/bad flow limit and good/bad ahi? as for leaking, as you can see there was some very steady leakage both nights, but again good AHI (for me at least)...one of the nights i had some major mask leak as defined by sleepyhead and the other night I had zero major mask leak...also, my median leak has typically been 0.0 but both of these nights the median leak was 1.2...if you look at the graphs and the numbers, how critical is all this leakage? I know the dr's say as long as you dont spend too much time above a certain leak level then it's ok...but does all this steady leaking affect AHI? can the leaking have an effect on the cpap machines ability to accurately flag events? I ask because last night was the only night up to this point where i had zero flagged Obstructive apneas...which is surprising considering it's never happened and i had 6 beers last night..

[JBarizona]

and the other chart..

[Pugsy]

Are you experiencing any nasal congestion? Sometime nasal congestion will show up as ugly flow limitations.
So need to rule out nasal issues first.

Your leaks aren't bad at all and if they don't wake you up I wouldn't worry about it. I guarantee that your leak graphs is much prettier than mine.

[JBarizona]

No nasal congestion..

[Julie]

Try posting on nights when you don't have six beers... they make a big difference!