Too Soon To Tell ???

Slinky · Post by **Slinky** » Sat Feb 17, 2007 2:53 pm

We adjusted my xPAP pressure to 8 cms w/an EPR of 2 on 08 Jan 07.

My stats from 08 Jan to 04 Feb (197:30 hours/28 days) were:

95% Pressure 7.4
Leak 0.59
AHI 17.5
AI 0.8
HI 16.1
Time In Apnea 0.3%

05 Feb we added 2L of 02 (but then thanks to humidifier I missed one night of use and only slept w/xPAP & 02 less than 4 hours for 2 nights)

My stats from 05 Feb to 16 Feb (76:35 hours/12 days) were:

95% Pressure 7.4
Leak 0.60
AHI 14.2
AI 0.5
HI 12.5
Time In Apnea 0.1%

I generally judge how I'm doing w/xPAP by how rested I'm feeling - but - this darn humidifier bit w/the COLD weather we've been having has my sinus all messed up so, naturally, I'm not feeling all that great a good share of the time.

As happened when we tried the AutoPAP loaner (then humidifier problems) and when we upped my pressure from 6 cms to 8 cms and now again when we added the 2L of 02, I had 2-3 nights of good sleep and good stats and then ..... things would go to heck in a handbasket for one reason or another. Talk about sabatage!!!!

Linda3032 · Post by **Linda3032** » Sat Feb 17, 2007 3:03 pm

You're right - that is a mess.

Looks to me from the HIs, that the pressure is too low. Let's hear what others think.

Slinky · Post by **Slinky** » Sat Feb 17, 2007 3:12 pm

That's kinda what I was thinking too, but I see my sleep pulmo on the 5th so have argued back & forth w/myself whether to set the pressure to 9 or be a good old lady and wait to see him. Since he has suggested an AutoPAP, then opted for the 02 instead (I have COPD), I'm hoping he'll script a Resmed S8 Vantage on the 5th. I just don't know if he wants to be bothered tangling w/my DME about an Auto after (by then) 5 months on this capped rental S8 Elite.

JimW · Post by **JimW** » Sat Feb 17, 2007 9:38 pm

Slinky wrote:That's kinda what I was thinking too, but I see my sleep pulmo on the 5th so have argued back & forth w/myself whether to set the pressure to 9 or be a good old lady and wait to see him.

Of course, you could be 'kinda' good and raise it less than a full cm - maybe 8.4 or 8.6. The usual disclaimers about being cautious, making sure there are no contraindications, etc. all apply, of course.

You might also check and see where the bulk of the hypopneas are occurring - whether early in your night, middle of the night, etc. It might also be interesting to see what would happen if you lowered EPR to 1, if you can tolerate that. Maintaining a slightly higher pressure on exhalation could result in fewer hypopneas. Your AI numbers look quite good, though.

Slinky · Post by **Slinky** » Sun Feb 18, 2007 8:20 am

GOOD thought on lowering the EPR! I didn't think about that. The sleep lab had suggested that I drop the EPR from 3 to 2. I'm thinking I"m gonna just shut the EPR off altogether. I did find it helpful at first on 3 but after a few weeks found that 2 was more comfortable.

Altho my sleep pulmo knows that I have the software and reader AND can access the Clinician's SetUp menu I'm trying to be a "good girl" and not take a chance on irritating my sleep pulmo who's a pretty good guy by playing w/the pressure. At least not yet. Gotta keep him happy in the hopes he will stick w/his earlier decision that I have an AutoPAP as I would like a Resmed S8 Vantage - but NOT enough to pay $825 for just it! I'd buy the Remstar Auto w/C-Flex w/integrated humidifier first if I gotta pay for it myself.

Slinky · Post by **Slinky** » Sun Feb 18, 2007 8:36 am

Thanks to this darn sinus irritation I can't really see where most of my hypopneas tend to occur. They are rather all over the map right now as near as I can tell. Maybe someone w/more experience w/sleep stages and graphs can determine that. Unfortunately, I "still" haven't figured out how to post a page from AutoScan or for that matter how to post ANY scan type image (whatever you call them).

For last night, it "looks to me" like the first apnea occurred about 1 1/2 hours into sleep, the 2nd about 3 3/4 hours into sleep, the 3rd about 4 1/2 hours into sleep and the last about 6 1/2 hours into sleep which was about 45 minutes after a bathroom trip. Gratifying too that the stats are coinciding w/the gradual improvement in my right nasal passage and sinus.

The longest hypopnea occurred 2 hours after going to sleep. And they all lasted less than 30 seconds.

Hmmm. One thing is apparent, at least the last 3 nights, my hypopneas seem to lengthen in duration about every hour, then drop and start rising again to peak at the next hour, then drop, etc. etc.

Interestingly, the apneas all occurred at the lowest leak rates. Hmmm, wouldn't that suggest NOT raising the 8cms of pressure? Dang! I'm still just outta my league here yet. But I'm larnin', I'm larnin'.

Oh! Last night's averages:
Pressure 8.6
Leak 0.68
AHI 10.2
AI 0.5
HI 9.7
Time in Apnea 0.1%

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, Hypopnea

Wulfman · Post by **Wulfman** » Sun Feb 18, 2007 10:47 am

Slinky,

Do you have "settling" enabled on your machine? And if so, is the amount of time sufficient to get to sleep?
If you're NOT using settling, you might try it. Theoretically, it should lower your hypopnea numbers (or at least give a truer number) by waiting until you're asleep to count them.
That's the way I understand what it does anyway.

Best wishes,

Den

Slinky · Post by **Slinky** » Sun Feb 18, 2007 11:13 am

Thanks, Den. No Settling on the Elite, its not an Auto and my understanding is Settling is only available on the Autos. I've looked thru the Menus for Settling and can't find it tho just to be sure.

Wulfman · Post by **Wulfman** » Sun Feb 18, 2007 11:24 am

Slinky wrote:Thanks, Den. No Settling on the Elite, its not an Auto and my understanding is Settling is only available on the Autos. I've looked thru the Menus for Settling and can't find it tho just to be sure.

Well, I didn't know for sure...... Seems kind of odd that it wouldn't be available in the Elite, too. Now I just learned something about that machine.

Thanks,

Den

Slinky · Post by **Slinky** » Sun Feb 18, 2007 2:37 pm

Ha! You know what just might make sense of the rhythm of these hypopneas???

THE HEATING CYCLE OF THE HUMIDIFIER!!!

I just took a two hour nap. I vaguely remember kind of waking part way thru but didn't look at the clock so can't swear by how long into the nap it was. But when I woke the second time my snozz was COLD! And my right snozz and sinus miserable and full and now that I'm up and my snozz is warming it is dripping and sneezing and I'm blowing LOTS of yech. And its all a healthy, clear, no color, yech, so it is NOT a sinus infection. I dozed off on my back and I woke on my back so I don't "think" I ever made it over on to my right side for it to be a positional thing. Altho I can't swear to that.

BEFORE I order an Aussie heated hose I'll discuss this w/my sleep pulmo but I'm thinking mebbe I'm right on this hunch. Whachoo guys think? I wonder if the Elite heats the Humidaire on a regular schedule or if it heats according to sensor and need. Anyone know?

Does anyone know about the "heating cycle" of the Respironics' integrated humidifiers?

Wulfman · Post by **Wulfman** » Sun Feb 18, 2007 2:51 pm

Slinky,

I think on the Respironics machines it's just "ON" and trys to maintain a certain temperature based on the humidifier setting.

But.......I'm interested with your cold nose during your nap. Were you saying that this was "good" or "bad"?
I use passover (cold) humidification all the time and my nasal passages will frequently start draining within about 20 minutes after getting up in the morning. It really clears things out and feels good to have clear nasal passages/sinuses.

Den

Slinky · Post by **Slinky** » Sun Feb 18, 2007 3:12 pm

For ME, it is a BAD thing, Den. I've found that no humidifier and the passover humidifier cause problems for me. It turns out that I need some heated humidification. We found that out when I was given the loaner AutoPAP but no humidifier by my DME. My sleep lab was able to come up w/a passover (non-heated) humidifier and that helped some but NOT enough. When a friend loaned me a F&P HC 100 stand alone heated humidifier that solved the problem and I didn't need to run it very high, only on 2. BUT that was BEFORE this cold snap here in MI.

What I've run into is a very sore and painful right nasal passage AND right sinus every morning. By noon everything is fine until I spend some time on the PAP again. And this part of it has only started w/this cold snap here. BUT - the hypopnea pattern goes back to every night since I obtained software and reader capabilities.

JimW · Post by **JimW** » Sun Feb 18, 2007 9:34 pm

Slinky wrote:Hmmm. One thing is apparent, at least the last 3 nights, my hypopneas seem to lengthen in duration about every hour, then drop and start rising again to peak at the next hour, then drop, etc. etc.

As I understand it, the hypopneas are summed by the hour, then drop back to zero at the beginning of the next hour on the graph. (Actually, the blue lines at the bottom of the graph represent AHI, not just hypopneas; each time you have either an apnea or an hypopnea within that hour, it raises the blue line one 'step', then the blue line goes straight across until you have another event. At that point, it goes up one more 'step.')

I believe that, with the Elite, you're talking about ramp time, not settling time. When you look at your graph, if you don't have a fair cluster of events within the first fifteen to thirty minutes of turning the machine on, then using ramp likely wouldn't affect the recorded events much. (This is assuming that you're not currently using the ramp.) When I look at my graphs, using APAP without settling, I often have large clusters of events within the first fifteen minutes of starting the machine, whether that's at the start of the night or after being up for a few minutes.

Slinky · Post by **Slinky** » Mon Feb 19, 2007 5:19 am

Thank you yet again, JimW. I have had the Ramp turned off for quite some time and my graphs don't start out "bad". Last night I turned the EPR off too (I had had it on 2) and I slept somewhat better. At the risk of dumping my Elite and Humidaire 3i on the floor I pulled it as close to the head of my bed as possible so that I could get more hose under the blankets w/me and just those few inches helped as well.

I haven't downloaded the night's data yet as hubby is still sleeping but I did check the Efficacy data on the LED screen and my AI was good but my HIs were still in the teens.

blarg · Post by **blarg** » Mon Feb 19, 2007 6:35 am

One thing you can try as an experiment, since you don't have settling apparently, is set your ramp pressure to your CPAP pressure. It won't be recording during the ramp time, and because the ramp is your main pressure, you could fake the settling feature.

I have my auto's ramp set to the min pressure, so that if I wake up and it's on the max pressure I can just press ramp to get it back to the min so I can fall asleep more easily.