Sleepheros sleep-improvement Thread

[sleephero]

Hello,
I am new in the CPAP club. My father had it as well. He ignored it and died young ("55") on heart attack. I think I have it also since some years and it got worse as I got older. I have young kids and need to make sure that my sleep/health improves or at least stays constant.

I would ask if the experts could look to my data and tell me whats going on and may help me improve my situation ?

Attached is my sleep data from last night. I hope I did it correct according to the requirements, if not please let me know.

I slept "long" and didn't need to go to the restroom in between which was good.
Fitbit told me that I was awake two times between 12 and 1am but I can't remember it.

Thanks for any help.

[Pugsy]

Welcome to the forum.

You've included some stuff that isn't needed in terms of the graphs on the right side but no need to redo this image.
Review this thread for the format and the graphs that we like to see.
viewtopic/t158560/How-to-post-images-for-review.html

How did you come up with the 12 cm pressure setting? It's not enough.

Not sure how much you are going to need but probably around 15 to 17...might get lucky with less.

[sleephero]

These are the settings they gave me after 3 days in the hospital lab.
(2 weeks ago)

[esel]

Hi there and don't worry about doing right, right from the beginning, they cannot eat you

Ask and answer questions. And have fun.

It is likely you need some more pressure than the fixed 12 you have.
Can you set the machine into auto mode ? so people can see where the machine would like to go up to.

[sleephero]

No I can't change anything it's hospital locked.
The only thing I can change is to turn off/change the ramp, turn off EPR and change humidity level (currently 6).
I remember the last night in the hospital reading secretly the instructions for the night team "start at 8 go up to 11, max12". Maybe they never tested me for higher values ? (I don't know unfortunately as I forgot to ask for copies of my results and have to wait until they send me the summary).

[Dog Slobber]

Can you set the machine into auto mode ?

The Elite is a constant pressure machine.

No I can't change anything it's hospital locked.
The only thing I can change is to turn off/change the ramp, turn off EPR and change humidity level (currently 6).

There's no such thing as hospital locked.

The knowledge to do so is not made easily available and discouraged.

Here's a Youtube on how to access the clinical menu to change some of the settings.
https://www.youtube.com/watch?v=ktIo0KF0i8I

Your pressure settings will be similar, but not identical because the video is an Auto APAP machine and yours is a Constant CPAP machine.

You may want to google around for more videos and information, to increase your comfort level regarding changing settings.

[Pugsy]

Sounds like they simply didn't go higher than 12 cm and unfortunately you need more pressure.

You might want to read up on your machine. Here's the clinical manual which explains how to change things in your machine.
It's not locked...you just need to know the secret handshake to get into the clinical setup menu area.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

If you aren't comfortable changing things yourself then get in touch with your medicare care team and tell them that 12 isn't getting the job done and they need to do something about it.

[sleephero]

Thank you very much for the link how to change the settings.
As a newbie I am a bit reluctant changing it by my own.
Will discuss it with my wife.
So I count three people here thinking that the pressure is too low, am I right ? Any other data needed to confirm that ?

[Pugsy]

No other data unless you have other nights where the AHI is nice and low (below 3 or 4) at the setting of 12 and this report was a fluke rare bad night.

Simple and straight forward pressure is not doing a good job all night.

Might be related to sleep position...and if you were on your back a lot you might try staying on your side (which is easier said than done) to see if you don't need as much pressure when on your side.
Might also be REM stage sleep related.
It's common for OSA to worsen in REM or when sleeping supine and need more pressure at those times than at other times.

If you had a machine that could auto adjust the pressure based on need you could probably get by with 12 for part of the night and let the machine go higher only when needed.
But your machine model can't do that so you have to use higher pressures all night instead of part of the night.

If going higher than 12 causes a problems (like air in the belly issues or a lot of central apneas pop up) then we take a step back and re evaluate things. Chances of problems happening...not very high and right now you have a bigger problem with way sub optimal therapy.

[sleephero]

Ok thank you. No, all nights so far where above 10.
Highest was 20 or so.
I will probably go one mBar higher this night an let you know.

[sleephero]

Good Morning. Here are the results with 13cmH20.
I woke up 4 times where i needed some minutes to fall in sleep again and
I think I got Air in my stomach at those times. I remember burping.

[Pugsy]

I am curious....where are you located?

Those clusters are suspiciously looking like REM stage sleep.
Google "sleep stages" and look at the normal hypnograms and see the pattern to REM cycles.
I recognize it because my OSA is 5 times worse in REM and I would have seen reports similar to this myself long ago before I got the therapy settings optimized.
Its either going to be related to REM or sleeping on your back. Those about the only reasons for clustering of obstructive apneas and hyponeas.
Either way...strong argument for an auto adjusting pressure machine.

[sleephero]

I am in Germany.
I can present my results on Monday to the Sleep Lab Doc.
I strongly believe it’s back sleeping problem.
I can’t lay all the night on one side, I get Backpain after
couple of hours that’s why I probably move to back sleeping position.

For fun I will attach the Fitbit Sleep Zones analysis.
Don’t know if one is trusting the zones from it.

E6A03D13-5474-4A8C-99F5-53D61D51792F.png (314.4 KiB) Viewed 4498 times

At least there must be an improvement, i have the Fitbit more then half a year and the small red lines on top that are indicating short wake up where much (really much) more present over the last half year compared to this picture.

[Nick Danger]

I also used to get back pain when sleeping on my side. I find that putting a pillow between my knees eliminates the back pain that I get from sleeping on my side. Regular pillows work well, but if you experiment with a pillow and it does eliminate the back pain, you might be interested in buying a knee pillow for that purpose (makes it easier to shift from side to side because it is smaller than a regular pillow).

[Pugsy]

I had one of those FitBit devices until it died. For the most part fairly accurate or close enough. I know of for sure awake time (got up to let the dog out to pee) and it said I was sound asleep so I know it isn't perfect but for the most part (and compared to some of the other sleep estimating products) it's decent enough.

You might well be correct in that those clusters are supine sleeping related....in fact you might have both...supine and REM worsened OSA that need more pressure.

I asked where you were because you talked like you were somewhere else than here in the US and it helps us if we can understand where you are at because other parts of the world the medical community may do things differently. Doesn't help you much if I tell you how we do it here sometimes.

The fact is...you need more pressure during some parts of the night (whatever the cause) and other parts of the night you don't need as much pressure.
An auto adjusting machine is the ideal fix for this type of problem but you can most likely get it done with a fixed pressure machine but you will need to use much higher pressures all night to get that AHI down and break up the dense clusters. If it were just a random event happening wouldn't be so bad but you are having a lot of events within a relatively short period of time to get that much AHI and the density of the clustering we see.

A common complaint with higher pressures....aerophagia...air in the gut...belly pain...lots of burping and farting.
If this happens...even more reason to use the auto adjusting model to limit the time at the higher pressures as much as possible.
From my past experience....I don't see your AHI doing much in reduction or breaking up of the clusters until you are using probably at least 15 cm pressure. You aren't even close right now.