Encouraging APAP progress so far...

[jmaziarz]

The last two days I have been away from the computer for the most part and not checking my data. This morning, after sleeping the entire night I was excited to get up and review the data from the previous few days. Here, I thought, could be a possible turning point. Evidence that my therapy is working. Data points to show that my little bit of knowledge and determination is paying off. Proof to my doctor that I am on the right track.

In the darkness of my bedroom I groped behind the machine for the now expected 1/4" of data card sticking out of the slot. To my shock, it was not there! I checked again. And again. Thinking that I may be dreaming I turned on the bedside light to look with my eyes. Dreaming I was not. Disappointed, I took a deep breath I realized the data card was where it had been all weekend - in the card reader. It is certainly Monday.

[Wulfman]

The last two days I have been away from the computer for the most part and not checking my data. This morning, after sleeping the entire night I was excited to get up and review the data from the previous few days. Here, I thought, could be a possible turning point. Evidence that my therapy is working. Data points to show that my little bit of knowledge and determination is paying off. Proof to my doctor that I am on the right track.

In the darkness of my bedroom I groped behind the machine for the now expected 1/4" of data card sticking out of the slot. To my shock, it was not there! I checked again. And again. Thinking that I may be dreaming I turned on the bedside light to look with my eyes. Dreaming I was not. Disappointed, I took a deep breath I realized the data card was where it had been all weekend - in the card reader. It is certainly Monday.

Don't ya just hate it when that happens?!?!
Quite a few of us have done that......so, you're in good company.

Den

[jsmythe]

Yep, like Den said, "Quite a few of us have done that", don't feel like you are in the lonely boat doing this...
Also, it is not a good idea to remove the card as soon as you wake up or get up. The M Series have a history of not giving you any data if you remove the card too soon. It probably thinks you are on a potty break or something, and is waiting to resume recording. I try to make it a habit to wait at least 30 minutes, turn off machine (as another poster suggested), remove card. Then after getting my data, have reader in hand, Exit Encore, remove card, put back in machine, turn on machine. If by chance, I go to bed and start to turn on machine and it wont work or is off, then I know I forgot the card.

[jmaziarz]

Good suggestions. I've been thinking about how I could develop a process that would help me to remember. By "turning off the machine" do you mean unplugging the power?

[Wulfman]

After my ONE TIME in the early months of my therapy, I made it a habit to take my card back to my CPAP immediately after I've downloaded it........and then, each night, out of habit, I run my hand along my machine checking my card slot, humidifier and hose connections before putting my mask on.

Den

[gasp]

Good suggestions. I've been thinking about how I could develop a process that would help me to remember. By "turning off the machine" do you mean unplugging the power?

For me it means pushing the center button of my AFlex. I too wait 30 minutes - usually more like an hour - before pulling the card so the machine knows I'm not returning for more sleep.

[jmaziarz]

The last few nights have not been good. I have been waking up dead tired. I had increased my minimum pressure from 10 to 12 last friday. Last night I lowered the minimum pressure to 11. I think the majority of my problem is my mask getting "whopper jawed" in the night. I have a friend making me a custom CPAP style pillow so hopefully that will help.

[Hawthorne]

jmaziarz - I look at your data and am confused. Your AHI is pretty good. You said you lowered your minimum to 11 last night but your data shows some time spent at 9 and 10. I am guessing that your ramp is set at 9. Am I right? With a 90% of 14 (meaning you are spending 90% of your night at 14 or less) and you spend most of your night at 11, it may be that your pressure range needs to be narrowed some. I'm thinking you are having the trouble I used to have before I narrowed that range. Your pressure jumps around alot during the night and I think you may not be sleeping well, being somewhat roused when the pressure changes (and maybe leaks happen because of the pressure rise). A lot of apneas are happening at the higher ranges (34.4 at 17 cm). There is also that 17.1 Hypoapneas at 16. They may be induced by the higher pressures. I am not that experienced but think that ramp at 9 or 10 (if you need ramp) and a range of 11cm to 15 cm might be better. There may have been a bit of a leak issue there though and it may have caused your pressure to rise although the leak rate doesn't look bad and the rise may have been caused by the rise in pressure. Can't tell, for sure, which came first - the pressure rise or the leak rise. It does look like your pressure rose and then your leak rate went up.
I hope someone who has more experience than I, will look at your data and comment on what I said here.

[Wulfman]

I'm wondering what your reports would look like if you were to go to single pressure (CPAP mode) at 11 or 12.

The question is.....Are the pressure increases causing more events or are more events (including leaks) causing the pressure increases?
The pressure increases are not getting rid of your apnea events and we don't know if they could be occurring during deeper sleep or REM.

When you say you're "waking up dead tired".......that might be a clue that the pressure changes are disturbing your sleep.

Den

[Hawthorne]

Thanks Wulfman! At least is looks like I am on the right track with my suggestions about the data here. I always hesitate to comment because I'm pretty new at this data stuff.
I appreciate your comments, which suggest that my comments were not too far "off base"!

[Wulfman]

Thanks Wulfman! At least is looks like I am on the right track with my suggestions about the data here. I always hesitate to comment because I'm pretty new at this data stuff.
I appreciate your comments, which suggest that my comments were not too far "off base"!

No they weren't......in my opinion. For the best therapy with an Auto, the pressure range (usually) ends up being pretty narrow. Leaks and snoring can wreck therapy with an Auto......and pressure changes can wreck sleep for some of us. So, when you get the pressure range narrowed down so far, you can also select a specific pressure to see how single-pressure compares.

Best wishes,

Den

[jmaziarz]

You said you lowered your minimum to 11 last night but your data shows some time spent at 9 and 10. I am guessing that your ramp is set at 9. Am I right?

Yes, you are right. I found the initial pressure of 12 (or 11) difficult to fall asleep with. I've decided that I am going to post my settings in my profile signature. Hopefully I can keep it updated.

With a 90% of 14 (meaning you are spending 90% of your night at 14 or less) and you spend most of your night at 11, it may be that your pressure range needs to be narrowed some. I'm thinking you are having the trouble I used to have before I narrowed that range. Your pressure jumps around alot during the night and I think you may not be sleeping well, being somewhat roused when the pressure changes (and maybe leaks happen because of the pressure rise). A lot of apneas are happening at the higher ranges (34.4 at 17 cm). There is also that 17.1 Hypoapneas at 16. They may be induced by the higher pressures. I am not that experienced but think that ramp at 9 or 10 (if you need ramp) and a range of 11cm to 15 cm might be better. There may have been a bit of a leak issue there though and it may have caused your pressure to rise although the leak rate doesn't look bad and the rise may have been caused by the rise in pressure. Can't tell, for sure, which came first - the pressure rise or the leak rise. It does look like your pressure rose and then your leak rate went up.

So if I may summarize. That data does not have a high enough resolution to tell if the leak is causing the increase in pressure or the other way around. In either case, the increase in pressure correlates with the increase in apnea and hypopnea events. You are saying that the problem may be with my range which is currently set at 11 - 20. You suggest decreasing the maximum pressure to 15.

For my benefit so I can attempt at an understanding, why would decreasing the maximum pressure have an effect? If I were to decrease the maximum pressure to 15, that would prevent my pressure from going above 15? Are you reasoning that since the increase in apnea and hypopnea events may be caused by the increased pressure, cap it at 15?

Thanks for having a look at my data and commenting, I appreciate it.

[jmaziarz]

I'm wondering what your reports would look like if you were to go to single pressure (CPAP mode) at 11 or 12.

Good question. After my last titration study (1-year ago) I was prescribed a CPAP pressure of 12. I tried straight CPAP at 12 using the same mask I'm using now (Mirage Liberty FF) and the results were awful. I was a zombie. Granted I didn't have a data recording machine to verify what was happening.

[Snoredog]

if your AHI has not improved by increasing the Minimum pressure, you might as well go back down with that pressure where it was more comfortable, less noise and easier to tolerate.

[Hawthorne]

Yes, that's why I suggested lowering the upper pressure and making the range narrower (capping it at 15). Those higher pressures seem to be causing a lot apneas and hypoapneas (or it's your leak rate - but it LOOKS like you higher pressures MAY be causing the leak rate to go up so you get apneas and hypos because of that). With your 90% being where it is, you are spending 90% or less of your night at that 90% pressure and the higher pressures MAY be inducing apneas while you may not need to be that high. Looks, to me, like you don't need the higher pressures and they are causing a problem. You are feeling wiped out during the day because of all those events at those higher pressures. By lowering the maximum, you won't go that high and will likely see fewer apneas and hyponapneas and an even lower AHI. You will HOPEFULLY feel better during the day too.
I'm really sharing what happened with me when I narrowed that pressure range. I was getting an AHI of 3 or 4. Now I am getting under 1 most of the time and under 2 all of the time and feeling lots better.
I pass it on because it may work for you! That's what I hope. That's my opinion.
Others have been in to suggest other things too. You need to experiment, keeping the same setting for a week at a time and checking data-- unless you feel really bad at a particular setting. Then you would change it sooner.