Ok, I gotta change something...

SleepIsHell · Post by **SleepIsHell** » Sun May 11, 2008 3:21 pm

You should stick with CPAP to diagnose what's wrong, IMO.

What is your Leak Rate? If there's no change in leak rate, then bump up the pressure by 1, and see how it goes.

If there is an increased Leak Rate, then tighten your mask, and keep it at the same Pressure.

But do not try to diagnose this with APAP. Use CPAP. Much easier to debug.

yardbird · Post by **yardbird** » Sun May 11, 2008 4:07 pm

Published leak rate at 9cm appears to be 30 L/min
My average for one night at 9cm without auto was 40 L/min. That was with one large leak period lasting 8 minutes so I'm sure that's having some effect on the average. Keep in mind I'm still getting used to the full face mask. Using the Swift I was opening my mouth and just expelling air so that was causing some issues. That's why I wanted to try a full face mask.

bumping the pressure UP by one is contradictory to what I'm seeing in the data. 10cm is where my WORST numbers are. It really looks (from the data) like I should step DOWN one to 8cm.

But here's the catch, and maybe this is why SnoreDog suggested upping the high limit on auto and going back to auto...
If I have the upper limit set to 10 and the machine can't go higher, it would almost make sense that this is where the "bad numbers" would accumulate. Top of the scale. Can't go anywhere.

I think I'll try tonight at 8cm straight CPAP. If that doesn't improve things significantly then I'm going to "open it up" - set it on auto ranged from 7 to 15 and see if it shows me any data to support changing my setup.

That's why I bought an auto machine, right? To let it try to help me through the magic of algorithms

Snoredog · Post by **Snoredog** » Sun May 11, 2008 5:16 pm

[quote="yardbird"]I've never had a problem with centrals. You think I'm wrong trying this at straight 8cm without auto?

You think I should just let the auto "do its thing" and see where that goes instead?

yardbird · Post by **yardbird** » Sun May 11, 2008 5:54 pm

Snoredog,

Ok I think I see what you're saying. On auto, the graphs show a flow limitation, immediately followed by a snore or snores, Pressure goes to max (of 10 at the time) and then settles back down. Then I have a few .... let's say 20 minute periods... where I get flow limitation then snore, pressure max, then a "swarm" of OA and snores. Withing the swarms of OA I may see a hypopnea or 2 if the swarm lasts 15 to 20 minutes.

There are less severe events where I see a flow limitation, pressure rise, not necessarily to max, no snores and then pressure comes back down.

On straight CPAP set at 9cm it doesn't appear to record flow limitations. However the snores are FAR more frequent. Over a span of about 2 hours they become more and more frequent until they become like a solid red bar and once they get to that stage I get a swarm of OA, sometimes lasting over half an hour. The time at which they STOP is when I woke up enough to peek at the clock. That happened 3 times and I woke up and peeked at the clock 3 times. And the timing is just about right on as far as I can tell.

Writing this out this way has me rethinking this. I think you're right. The machine needs to go to higher pressure to splint the airway. I think I'm going to scrap the 8cm cpap run tonight and go to a 7 - 15 range auto ( it was set at 6 to 10 before).

Mask switch - I love my Swift, but my mouth kept opening and I just can't bring myself to tape my mouth shut. I react to every adhesive they've ever put on me. I'd hate to have that happen around my mouth and I'm afraid to experiment. My nose is clear and I have no difficulty breathing through it. I have suffered severe nerve damage in and around one side of my neck (and upper inferior traps, pecs, ... I'm kinda lopsided) and I think the atrophy affected some of the muscles that we depend on to be toned enough to maintain an open airway. I'm not carrying a lot of weight. I'm 5'11" and 195 lbs. But I can literally snore when I'm awake. I practice meditation. In some deeply relaxed meditative states I snore! I can hear it! hehehe.... when I'm asleep I never hear myself snore (but my wife sure does... and my kids tell me II can drown out the TV when I'm upstairs in bed and they are down in the living room)

I'm going to try that 7 - 15 range and check my card in the morning and see what we've done.

ozij · Post by **ozij** » Sun May 11, 2008 5:58 pm

You're making a lot of sense, yardbird.

O.

yardbird · Post by **yardbird** » Mon May 12, 2008 5:30 am

I think we're getting somewhere.
Auto, range set 7 to 15
AHI = 4.6

Average Leak 36.1
Large leak Zero! (I did some adjusting on the UMFF)

OA: 2.7
H: 1.9
VS: 9.4

Quite a difference. It only went to 15cm for 5 minutes, but there's a non-responsive OA/Hyp there (Encore Pro show 12 during the 5 minutes). I don't recall ever seeing non-responsives in my data before. My 90% number is at 13cm. 90% Auto 12.9 - Average Auto 9.8.

So... leave it alone for a few nights and get more data? Or knock that 15 down to 14?

Guest · Post by **Guest** » Mon May 12, 2008 5:44 am

Without knowing where the events occurred and some of the other details, I'd be inclined to bring the minimum pressure up to about 10. If they're happening at pressures below that, it would preempt some of them and bring your AHI down.

Just my opinion.

Den

ozij · Post by **ozij** » Mon May 12, 2008 5:52 am

I'm with Den on this.
O.

CentralScrutinizer · Post by **CentralScrutinizer** » Mon May 12, 2008 7:27 am

I had a VS of 118 last night... my AHI was under 2 (as it always is)...

In my case... vibratory snores have almost no impact on my AHI... I'm running straight 8CM, I perhaps could do better with snores at higher pressure, but then I tend to get air in my stomach and all the unplesantness that comes with it...

I did sleep without my mouth taped last night... I think that's why the snores went so high... the last high snore rate was also when i slept without my mouth taped...

yardbird · Post by **yardbird** » Mon May 12, 2008 7:59 am

OK... just for you guys, I'm gonna install Windows XP in a partition so I can print to pdf or something ... hehehe... I run Encore Pro in a WinXP VM in linux and haven't figured out how to save the information in the reports to a pdf.

I could do a screen shot maybe that shows the graph and plots the events, .... hmm... have to see if that would be readable as my screen resolution is 1680 x 1050 and it might look kinda small.

So I want to look for what pressure I was at when the snores started? Or when the OA swarms occurred? I'll have to look to see if the pressure starts rising when the snores reach a certain point or if the pressure goes up in response to the OAs. ... right?

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NightHawkeye · Post by **NightHawkeye** » Mon May 12, 2008 8:08 am

yardbird wrote:I could do a screen shot maybe that shows the graph and plots the events ...

That's what I do. It works great for posting. Just size the image appropriately on-screen before taking the screen shot.

yardbird wrote: .... hmm... have to see if that would be readable as my screen resolution is 1680 x 1050 and it might look kinda small.

Not a problem ... Same display resolution I'm using ...

Guest · Post by **Guest** » Mon May 12, 2008 9:29 am

CentralScrutinizer wrote:I had a VS of 118 last night... my AHI was under 2 (as it always is)...

In my case... vibratory snores have almost no impact on my AHI... I'm running straight 8CM, I perhaps could do better with snores at higher pressure, but then I tend to get air in my stomach and all the unplesantness that comes with it...

I did sleep without my mouth taped last night... I think that's why the snores went so high... the last high snore rate was also when i slept without my mouth taped...

Wimp! When I started, I was having snore indexes of well over 200. I don't know HOW, but one night I had an index of 600......it was almost a solid red line across the report.
Somewhere along the way, I developed a routine for making sure my nasal passages were clear before going to bed.......and that, along with increasing the pressure a bit, got the (SI) numbers down to (usually) less than 1.0.
They're STILL "healthy" if I get a Large Leak some nights.

My AHI has always been about the same, whether I used a pressure of 10, 11 or 12.......no correlation to snores. This is one of the reasons I started out with a data-capable CPAP (REMstar Pro 2)......I had read that the Autos triggered on Snores......and I KNEW I had a serious snoring problem and didn't want the machine to be chasing snores (changing pressures) if it wasn't necessary. It's true.....they do......and that's one of the reasons I use single-pressure CPAP mode.

Den

Snoredog · Post by **Snoredog** » Mon May 12, 2008 9:49 am

[quote="yardbird"]OK... just for you guys, I'm gonna install Windows XP in a partition so I can print to pdf or something ... hehehe... I run Encore Pro in a WinXP VM in linux and haven't figured out how to save the information in the reports to a pdf.

I could do a screen shot maybe that shows the graph and plots the events, .... hmm... have to see if that would be readable as my screen resolution is 1680 x 1050 and it might look kinda small.

So I want to look for what pressure I was at when the snores started? Or when the OA swarms occurred? I'll have to look to see if the pressure starts rising when the snores reach a certain point or if the pressure goes up in response to the OAs. ... right?

yardbird · Post by **yardbird** » Mon May 12, 2008 10:06 am

I'll have to look for that functionality in Encore Pro. If I can save it as a pdf I can set up a share between the VM and the linux host and save the file there, retrieve it with the linux host, edit it as needed and upload/attach it.

I have 2 XP VMs... one can print to the printer and one can't. Haven't really looked into that too much. The printer is connected network-only. No usb. I'll figure it out. It sure would make this easier if you could see what I'm looking at.

Snoredog · Post by **Snoredog** » Mon May 12, 2008 10:16 am

[quote="yardbird"]I'll have to look for that functionality in Encore Pro. If I can save it as a pdf I can set up a share between the VM and the linux host and save the file there, retrieve it with the linux host, edit it as needed and upload/attach it.

I have 2 XP VMs... one can print to the printer and one can't. Haven't really looked into that too much. The printer is connected network-only. No usb. I'll figure it out. It sure would make this easier if you could see what I'm looking at.