Need help in finding "Sweet Spot" on my M Series

ksp · Post by **ksp** » Wed May 14, 2008 8:29 am

I was titrated at 9 at my sleep study and since getting an M Series AutoPap have been collecting data at various cpap and autopap ranges. I'm looking for some experienced chart readers to assist me in zeroing in on my best cpap and/or autopap settings. I seem to think I do better on straight cpap but would like to find the best setings for both and then proceed from there. So with that said, please find below the links to the various reports I have uploaded to Issuu. Hope this works.

Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7

Pressure VS AHI
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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

bdp522 · Post by **bdp522** » Wed May 14, 2008 4:12 pm

From what I see...I'd try cpap at 9 for a week. Ya gotta get those leaks under control. Did you notice that the straighter(and lower) the leak line, the better your AHI? I think the leaks are your biggest problem. If you can fix most of them you'll be doing great!

Brenda

SleepIsHell · Post by **SleepIsHell** » Wed May 14, 2008 5:10 pm

Yes, I think you need to do two things.

1. Tighten your mask more to lower your leaks.

2. Stick with CPAP. Look at your data. you've had a couple of nights with very good AHI < 5 with CPAP. On Auto, you're all over the place. Stick with CPAP at that pressure.

And please, let us know if you've found a solution.

ksp · Post by **ksp** » Wed May 14, 2008 6:59 pm

I don't really know where the leaks are coming from as I don't notice much but I do have it kind of tight but will mess with it some more. I was thinking the same as you guys,,,,seems I get better numbers with cpap rather than auto.
I noticed you suggested 9 but my auto would suggest higher maybe around 10.5-11 as it seems AHI is lower when using cpap. I am willing to try anything b/c I have not noticed any great improvememnt using this treatment. It does keep my heart arythmia(spelling) in check,

GumbyCT · Post by **GumbyCT** » Wed May 14, 2008 8:12 pm

Start documenting your sleep position -when you go to sleep & when you wake up. If you are like me, when you toss n turn you are causing mask leaks.

Also look into using RG's straps made from tights. I use knee high panty hose but that helped me alot. That may give you more idea on how to get your leaks down.

I think your sweet spot may be right around the 9-11 but in APAP the leaks are throwing everything off.

I do like that Issuu for displaying Encore results.

Good Job,
GumbyCT

ksp · Post by **ksp** » Wed May 14, 2008 9:06 pm

I am a side sleeper and do move from side to side b/c I get a little sore but don't move near as much since starting cpap. I have noticed I can sleep on my back more now that the air is being pushed down my throat!!!!
I don't usually fall asleep right away and the events that occur early are probably me just clearing my throat and things of that nature. I think they throw my numbers way off too. I use a quattro mask presently. Is there another that seals better?

Goofproof · Post by **Goofproof** » Wed May 14, 2008 9:13 pm

Back sleeping gives you a higher AHI, and requires a higher pressure to clear events. Jim

bdp522 · Post by **bdp522** » Thu May 15, 2008 5:30 am

Finding the mask that seals best is the hardest part. What works for one, won't work at all for another. The only way to know what mask will work best for you is to try other masks and see how you do.

Brenda

ksp · Post by **ksp** » Thu May 15, 2008 7:00 am

After looking at my leak rate compared to the rates listed in the manual which are 32@8 and 41@12, it doesn't seem to me that my # of around 40 would be too bad or am I missing something? I realize it goes up when you move I suppose and the mask shifts and causes a leak but wouldn't that be normal to a certain extent? I will check into the panty hose thing I guess and see what happens. Anyone have a picture of that? I have read about it but don't really get how to do it.

bdp522 · Post by **bdp522** » Thu May 15, 2008 7:09 am

You want to get your leak line as flat as possible. Those high leaks will cause problems.

Brenda

bap40 · Post by **bap40** » Thu May 15, 2008 8:19 am

I was titrated at 10cm during my sleep study. After I got my A/Flex, I ran it in auto for quite a while. Finally decided with the help of this board that my range actually needs to be around 12-13cm. So I set my machine back to CPAP at a pressure of 12 and have been having great results in straight CPAP, with a higher pressure than titrated. Now, saying that, I do have occassional leaks with my mask, but most of the time lately it is do to me changing positions and now I hear it and push my mask back into position. It is tight when I go to sleep with no leaks. So conclude it is due to being pushed out of place and that seems hard to fix.

All in all seems like straight CPAP was/is the key for me.

ksp · Post by **ksp** » Mon May 19, 2008 7:21 am

Thread was updated with a Week 7 report and a Pressure VS AHI chart. See first post in this thread. After examining the data I have decide to try straight cpap @ 10.5 and C Flex @ 2. Any comments on this setup? I have also started to use a Liberty mask to try something different. So far so good although I don't much like the lines it leaves on your face in the morning. Padacheeks, here I come!!! I currently have a Quattro Large and I think I may really need to try a Medium to seal better hence the trial of the Liberty.

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

Guest · Post by **Guest** » Mon May 19, 2008 11:38 am

ksp,

The quattro does run a bit large. Also, when I used it for a number of months I found that tighter was *not* better. It took a little patience but once I was lying down, I put the Quattro on my face with straps, hooked it up and then once running, I pulled if off slightly and let the pressure pull it onto my face. It sometimes took a few tries to get the right spot, but once I did, the pantyhose tights leg stabilized it for side sleeping and it was great most nights. The Quattro padacheek helped, as did some Mack's silicone ear plug putty for the bridge of my nose.

Mindy

ksp · Post by **ksp** » Mon May 19, 2008 11:44 am

the pantyhose tights leg stabilized it for side sleeping

Would you happen to have a picture of the pantyhose fix?

Snoredog · Post by **Snoredog** » Mon May 19, 2008 12:44 pm

11cm appears to be your ideal pressure, notice you use Ramp at the start, that is fine if it helps you get to sleep.

THe AHI vs Pressure report confirms what the other reports show, you always want a pressure where the events seen going forward are on a downward trend vs an upward trend.

You effectively can use a pressure range of 8.0 to 11 cm and be fine. Your snore increases as you get to 12 cm along with greater SDB events seen.

It also appears (from the reports) that you have positional changes which may account for the differing ranges seen.

If you set up your machine in the Auto mode with:

Auto:Ramp Pressure=6.5
Auto:Ramp timer=30
Auto:Min=8.0
Auto:Max=15

the above would give you the least pressure yet maintain you in your ideal therapy range of 8.0 to 11.0 cm.

The way the above settings would work is:

Put on the mask, machine starts at 8.0cm
Press the Ramp button it drops from 8.0 to 6.5 then increments back up towards
Auto:Min every 5 minutes, so after 5 minutes it will be at 7.0, after 10 minutes at 7.5 after 15 minutes at 8.0 and in the beginning of your ideal pressure range.

That AHI vs. Pressure report is the best one to look at, it simply shows you what the historical trends have been, you can see what happens under increased pressure and reduced pressure. If you use a pressure which shown on that chart indicates events are on a decline that is your ideal pressure. You can also see what happens if you allow it to trend higher.

that is a Derek / James Skinner contribution report, not anything from Respironics.

Another good thing is: it doesn't matter if the machine goofed and responded to central apnea and scored them as obstructive. Because AHI from that machine may include both types. Use the ideal pressure and both types of events go down which is what you are looking for.