Do you make changes to your therapy in any certain order?

ozij · Post by **ozij** » Tue Jul 22, 2008 10:23 pm

It is my impression that Bill did get his leaks under control.

Bill, I would try to add 0.5 to the minimum, and see what it does to comfort, indexes, and 90% pressure. When the pressure is just a bit too low, you get a small number of residual events, the machine raises the pressure after they occur (that's true of any events) - and then, eventually cycles back to the lower pressure. All that makes for restless sleep. I think its the combination of snores and pressure cycling that cause the main disruptions.

Wulfman wrote: Don't overlook trying straight pressure (CPAP mode) to get BOTH......best AHI and comfort.

That's also a good idea, though the question is where? I'd take a week or two at the min=12.5 to see what the 90% is then.

Caveat: The change in pressure may make the air dryer, so adding a little bit of humidity may help.

A doctor who says "use it at 4-20" and doesn't add "and report how you feel so we can adjust it" isn't doing much for his patient - and probably never found out how the machines work in real life.

O,

Billmanweh · Post by **Billmanweh** » Wed Jul 23, 2008 12:09 am

DreamStalker wrote:Did your sleep study show you as being sensitive to central apneas?

Also, not clear how you got where you are. Before making changes to your pressures you need(ed) to get the leaks under control. Making changes on data that includes leaks is the wrong way to go about it.

I don't know the answer to the first question. In fact, I don't even know what that means.

I feel like the leaks are under control. I'm still getting some leaks according to the encore pro results, but nothing noticeable to me. That is, it's not waking me and I'm not noticing any leaks as I go to sleep, etc.

DreamStalker · Post by **DreamStalker** » Wed Jul 23, 2008 6:45 am

Billmanweh wrote:
DreamStalker wrote:Did your sleep study show you as being sensitive to central apneas?

Also, not clear how you got where you are. Before making changes to your pressures you need(ed) to get the leaks under control. Making changes on data that includes leaks is the wrong way to go about it.
I don't know the answer to the first question. In fact, I don't even know what that means.

I feel like the leaks are under control. I'm still getting some leaks according to the encore pro results, but nothing noticeable to me. That is, it's not waking me and I'm not noticing any leaks as I go to sleep, etc.

You are likely never to notice leaks while you are asleep. Can you post a typical full details report from your smart card like this one?

viewtopic/t33320/Help-wdata.html

Central apneas are not caused by obstruction of the airway and increasing pressure may make them those types of apneas worse if you are susceptible to them. If you are susceptible, it will be noted in your sleep study report ... get a copy of that report as you are entitled to have it for your own medical records.

Billmanweh · Post by **Billmanweh** » Wed Jul 23, 2008 4:55 pm

DreamStalker wrote: You are likely never to notice leaks while you are asleep. Can you post a typical full details report from your smart card like this one?

viewtopic/t33320/Help-wdata.html

Sure. This is a pretty average night for me;

DreamStalker · Post by **DreamStalker** » Wed Jul 23, 2008 8:32 pm

Well, your leaks don't look too bad (as you indicated).

Your AHI numbers are not too bad either. Of course we all usually like to see just how low we can get them.

Your pressure does seem to be topping out at your max pressure setting.

Since you don't know if centrals are an issue for you, you could raise the max pressure up to 20 cm for one night and check your data to see if AHI goes up ... if it does, then centrals will cause you problems with APAP mode. If AHI stays the same, then you can probably start raising you min pressure until AHI goes as low as it can (all the while keeping your leak rate the same or better). Then from your plot you can then lower your max pressure accordingly.

At that point you can narrow the range between min and max pressure settings or go straight CPAP mode and find what pressures give you the best AHI.

Snoredog can best help you for optimizing your pressure to minimize AHI as he seems to be sensitive to central apneas.

On the other hand if you are feeling good with the treatment and don't want to jack with it, just leave it as is.

Billmanweh · Post by **Billmanweh** » Wed Jul 23, 2008 9:22 pm

Sounds good. I think I will raise the max pressure tonight and see how that goes. With it at 15 I max out at 15 just about every night.

Ok, thanks, I'll try that for a few nights and post back with the results.

Billmanweh · Post by **Billmanweh** » Sat Jul 26, 2008 2:36 pm

I spent the last two nights with the upper range pressure set to 18 and these are the results;

All my other numbers basically stayed the same; AHI, FLI, SI, leak rate, etc. Maybe I just had the upper level set a little too low. I think I'll try ~16.5 or so, because it seems to very rarely bump up above that. And then experiment with raising the lower level a little at a time.

Wulfman · Post by **Wulfman** » Sat Jul 26, 2008 2:40 pm

On the other hand, your best AHI was at the setting of "13".
It's also where you spent most of the time, too.

Den

Billmanweh · Post by **Billmanweh** » Sat Jul 26, 2008 2:49 pm

Wulfman wrote:On the other hand, your best AHI was at the setting of "13".
It's also where you spent most of the time, too.

Den

But, correct me if I'm wrong, if I had just been set at a straight 13, there still would have been events that didn't clear with a pressure of 13? There was some reason that the pressure increased at times?

Wulfman · Post by **Wulfman** » Sat Jul 26, 2008 3:01 pm

Billmanweh wrote:
Wulfman wrote:On the other hand, your best AHI was at the setting of "13".
It's also where you spent most of the time, too.

Den
But, correct me if I'm wrong, if I had just been set at a straight 13, there still would have been events that didn't clear with a pressure of 13? There was some reason that the pressure increased at times?

My guess from looking at only the summary there was it could be snores or leaks......because your AHI events got worse as your pressure went up. The question that needs interpreting is: "which caused which?" (Did the events cause the pressure responses or did the pressure responses cause the events.)

Look what happened at the pressure of 17.

You've still got events that are not clearing at pressures HIGHER than 13, too......in fact MORE of them.

Den

DreamStalker · Post by **DreamStalker** » Sat Jul 26, 2008 3:09 pm

If you notice on your details plot above, the leaks seemed to correspond with a rise in pressure. So a possible reason for APAP response is that you sprung a leak ... caused event ... APAP sensed event ... APAP raised pressure.

Or you may well be one of those who are a bit sensitive to central apneas. Call your doc and ask him for a copy of your sleep study ... charts and all not just a summary.

I think Den's suggestion is good for now. You may fair better with straight CPAP with a pressure around 13 cm. You may be one of those who cannot get their AHI under 1.0 ... at least not very often.

But at least now you know that APAP with too wide a range does not help your condition very much. Unless you are having issues with stomach gas or your weight has changed significantly, CPAP may be better for you than APAP.

Billmanweh · Post by **Billmanweh** » Sat Jul 26, 2008 3:19 pm

I wish there was some obvious correlation where the pressure increases are, but I'm not seeing it. It all just looks very random to me.

roster · Post by **roster** » Sat Jul 26, 2008 3:22 pm

Billmanweh wrote:I wish there was some obvious correlation where the pressure increases are, but I'm not seeing it. It all just looks very random to me.

For me titrating with apap was difficult. I found it easier to try different straight cpap settings over several nights until I found the optimum pressure. It seemed so much simpler than when I started messing with upper pressure and lower pressure and range spread.

My weak brain can only handle one variable per night.

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Billmanweh · Post by **Billmanweh** » Sat Jul 26, 2008 3:25 pm

Well, I'll keep playing with it. At least I'm able to use it all night, every night, which is a huge improvement from where I was a month ago. And my AHI is a steady ~3, so I figure everything from this point on is just gravy.