Crunching(and understanding) the cpap numbers???

reducha · Post by **reducha** » Sun Jan 20, 2008 12:14 pm

Hey everyone! After years of refusing to submit to cpap use,i finally bought one. Had endless months,of taking it off in the night,,but finally i've been able to keep it on all night. Most days i feel good now,,after 15 years of apnea,,but occasionally,i wake up feeling terrible and like i've had no sleep at all.I don't understand this . I enter all the nightly numbers in my sleep diary and they register my apnea events. so why would i still wake up feeling like i've had no sleep at all???Last night was another one.

My numbrs last night were:
pressure: 8.0
leak: .54
AHI: 3.6
AI: .1
HI: 3.5
I'm currently using the ResMed AutoSet Spirit
How can i still be feeling completely exhausted and rotten in the morning if my machine is registering my apneas as under control during my sleep session???
any ideas are greatly appreciated. thanks..Tim

Slinky · Post by **Slinky** » Sun Jan 20, 2008 12:27 pm

My first thought is what other sleep disorder(s) might you have?

When was, or did you ever have, a sleep evaluation and xPAP titration?

Your Leak rate is too high.

What mask are you using? What Mask Setting?

What are your pressure setting ranges or is your pressure set at? Are you running in straight CPAP mode or in auto mode? If using your Spirit in straight CPAP mode are you using EPR and at what setting?

Keep in mind that reported pressure is the pressure AT OR BELOW which you spent 95% of the night. And the reported leak is also a 95% rate, not the average nor the high rate.

A high leak rate causes it to raise pressure, using EPR lowers pressure a good portion of the night.

Wulfman · Post by **Wulfman** » Sun Jan 20, 2008 12:44 pm

What Slinky said.......
Nasal mask user?
Mask setting in the machine correct? If so, your mouth is falling open at night and your therapy air is exiting there. (my guess)
Big leaks = No therapy.

Den

rested gal · Post by **rested gal** » Sun Jan 20, 2008 1:12 pm

What Slinky said, and what Den said...and...

Even if cpap treatment is doing its part of the job fine, and even if there are no other sleep disorders like PLMD (Periodic Limb Movement Disorder) going on, a person could have other health problems causing them to feel bad, tired, rotten. Thyroid problems for example. Or untreated/undertreated GERD disturbing sleep. Or arthritis pain disturbing sleep.

Could also be something as basic as simply needing a good vitamin/mineral supplement.

Could even be an old mattress that's seen better days and needs replacing.

reducha · Post by **reducha** » Sun Jan 20, 2008 9:59 pm

Thank you all for that prompt reply!!! So,,the info i neglected to mention is that i have no other sleep disorders. My last sleep study was done 1.5 years ago. My mask is the resmed mirage swift nasal pillows, the mask setting is swift.
My pressure ranges are sset at min: 6 max: 14 The machine is sset to autoset mode. The EPR setting does not get mentioned/listed while in autoset mode. I have the smartset feature turned on so the machine comes on automatically when i breath into my mask. And i tape my mouth shut, so it stays that way till the morning.
I'll have to google xpap titration seeing as i don't know what that is yet,, and if i want another sleep study, it'll take another year, because i'm temporarily living in Dubai, and no sleep studys arre available here.

I'm hoping that might be of some help to this very frustrating problem.

thank you! Tim

Slinky · Post by **Slinky** » Sun Jan 20, 2008 11:20 pm

A sleep evaluation is a sleep study in a lab w/ wires, etc. but no xPAP equipment.

A titration study is a sleep overnight in a lab w/xPAP equipment. Sometimes both are done the same night & called a "split-night" study.

So: you have the Resmed S8 AutoSet Spirit in auto mode, use the Swift nasal pillows and your pressure setting range is 6 cms to 14 cms.

That SmartStart feature is a PITA in my personal opinion and I don't use it. I'm a big girl, I can turn the xPAP on or off when I put my mask on or take it off. I don't like how long it runs before it wises up and shuts off when I take my mask off.

Okay, so another titration study isn't in the cards whilst you are in Dubai. You might need to tighten that pressure range then. But I'm getting outta my league w/pressure change advice - except USUALLY the best range is just a 3-4 cms spread. RestedGal and Wulfman are more experienced w/pressure changes.

Gerald · Post by **Gerald** » Sun Jan 20, 2008 11:34 pm

Tim.......

You may be feeling crappy because you may still not be getting enough O2 while you're asleep.

The whole reason for CPAP therapy is to get your blood O2 saturation level up to or above 93% all night....every night.

I can recommend a SPO 7500 recording Pulse Oximeter. It comes with good software as standard equipment.....and it'll tell you if your CPAP machine is doing the job....or not.

My honey was surprised to find that her O2 level was below where it should be.....even though her AHI was lower than yours.

You might spend $500 or so purchasing the SPO 7500, but that's less than another sleep study.....and, anyway, you can't purchase a sleep study in Dubai.

After you've run an Oximeter study every night for two or three weeks, you'll pretty well know where you are in your therapy.

A recording Oximeter will give you quantifiable feedback......the next morning......and you can correlate the way you feel with the O2 saturation levels the previous night.

Hang a gauge on yourself (a recording pulse oximeter) and I predict you'll figure out (real quick) why you're feeling crappy.

Gerald

Moby · Post by **Moby** » Mon Jan 21, 2008 1:04 am

I'm not a doc or a sleep tec, but I have the same machine and mask as you.

If it were my decision, I would increase my lower pressure to 8.

I have read many times here on the forum that 6mm H2O is too low. If your machine is starting at 6 and is allowed to drop down to 6 on occasion, those are all times you are getting insufficient pressure (probably) and hence at risk of OSAs.

regards

Di

reducha · Post by **reducha** » Mon Jan 21, 2008 10:18 am

Thank you all so much for your feedback. I have had all the sleep studys you've mentioned, a few times.
I'll try raising the minimum pressure to 8 for now and see how that goes.
Until now, i've never heard anyone mention this"spo 7500 recording pulse oximeter" but i'll consider it, anything arriving over here in dubai takes at least a month to arrive anyways.
I did look at one online,,but what i don't understand is,,if it's attached to my wrist and finger for pulse rate,,how the heck can it diagnose my oxygen/air flow quality to my brain??
thanks for all your input. peace..Tim

Gerald · Post by **Gerald** » Mon Jan 21, 2008 10:39 am

Tim.....

Your move up to 8 cm looks smart to me. I think you'll see a decrease in HI because you'll be preventing them before they have a chance to start.

The SPO 7500 measures O2 saturation in your blood. It also records your pulse. It does not record "flow". It senses the amount of O2 in your blood by comparing the color of your finger with a light source in a little finger-cup that you wear all night.

In the morning, you download the info recorded in the wrist unit....to your laptop.....which then crunches the numbers.....and prints out a 3-page report.

Whenever I use my 7500, I set it to record my pulse and O2 level every 2-seconds....for the whole night. It's a very good little tool.

Short of having another sleep test......where they make you wear an Oximeter, by the way.....using the 7500 is the lowest cost way I've found to help me REALLY know how I'm doing.

Remember....an O2 saturation level of 93% or more all night....every night...is what you're shooting for. If you have no way of measuring your O2 level while sleeping, you're flying blind.

Just looking at our AHI scores gives us only an idea of how we're doing. A CPAP machine's whole purpose is to get our O2 level up where it should be....by preventing obstructions in our breathing. We can have a "nice" score of AHI 2.5 and still find that the blood saturation level for O2 is below where it should be. This is why you sometimes read on this forum about people who just can't understand why they're still feeling crappy....even though they think they're doing everything "right".

If they aren't checking their O2 level while they're sleeping, they're just guessing.

Gerald

Gerald

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

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

Wulfman · Post by **Wulfman** » Mon Jan 21, 2008 10:42 am

If you do a search on the Internet for "pulse oximetry", you'll find numerous links.....including how it works. Here's one:

http://www.nda.ox.ac.uk/wfsa/html/u05/u05_003.htm

Den

reducha · Post by **reducha** » Tue Feb 12, 2008 8:51 am

Thanks everyone for your input!
Now, i've found someone to ship me an spo recording pulse oximeter to here in Dubai,, its just gonna take a little while.
In the meantime, i raised my minimum pressure to 8 and there has been no change. last nights reading was
pressure: 9.4
leak: .70
ahi: 6.0
ai: .7
hi: 5.3
now, i know you'll insist i get my leak numbers down, but i've had no luck since i started this. I'm on small nasal pillows because the salesmen recommended them when he seen me, he said i had small nostril holes,, but i bought medium ones and tried them as well,,it didn't lessen my leak rate. So i went back to the small ones.

I'm wondering if i should raise my minimum pressure to 10 now ,,but i'm skeptical if that pressure won't be so high as it will make it near impossible to sleep with that much pressure. My mask fit feature on my resmed auto spirit, automatically raised the pressure for three minutes to test mask leak, and that pressure seems kinda uncomfortable.

any ideas are greatly appreciated!! Thank you. Tim in Dubai

boynedoc · Post by **boynedoc** » Tue Feb 12, 2008 9:33 am

IF you raise your pressure, I wouldn't take it to 10, but rather to 9 and then see what the results are. You'd be surprised how you are able to adapt pressure-wise over time.

Wulfman · Post by **Wulfman** » Tue Feb 12, 2008 9:36 am

Mouth leaking???

Den

Guest · Post by **Guest** » Tue Feb 12, 2008 11:10 pm

no mouth leaks,,it's taped shut, i was skeptical about the first time i read this, but a piece of scotch tape really does wonders! The down side is, it only works if you shave every day! hahaha

Mask

Additional Comments: SPO7500 recording pulse oximeter, resmed ultra-mirage full face mask

Mask

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