Ongoing journey to tweak my APAP range

[GaryG]

Now, I've been on and endless journey to get perfect numbers and feel great.
I've posted summaries of numbers from the jounrey since October 1st:

First of all, just on the face of it, the numbers look really good. So if I were feeling great, this would be the end of the story. But my problem is I don't. I'm still tired - not as tired. I've been on CPAP since late July - so it's been about 4 and half months.

My sleep doc thinks I'm wasting my time fine tuning at this point as my numbers are good. Instead he recommended I take caffeine before driving. To me, this doesn't seem too cool right now, as I've got acid reflux (seeing gastro doc this week to go over results from endoscopy).

And maybe it will take me a while to catch up on sleep loss from the past 20+ years...

Getting back to the numbers, I broke it up, based on my settings. Over time, there is a good trend in AI and AHI going slightly down. My doc would say these numbers are all the same within measuring error. What I find curious though is that my 95% pressure seems fairly the same whether my upper limit is 15 or 12, since I lowered my low range. I'm thinking of tweaking the range again, by upping the lower limit to 7 or 8.

At the end of October, I got another titration at the sleep center, and was told my range was 4-9. Which is why I tried to titrate from 4-15 during early November, to see how that would match my result. My results at home seem sightly different. But the lab was only one night.

I'm tempted to upper my lower range a bit, perhaps to 6.4 or 6.6. Any suggestions?

[Autopapdude]

Yep. I'd raise the lower from what you have to 8 or so. The machine would do less jumping around to find that magic pressure. The closer you can get your upper and lower settings, the more effective it will be in all likelihood. Your numbers are excellent now, but higher lower limit makes autopaps more responsive, and have to work less hard to avert events, as they're closer to that working pressure, and can respond faster. I think really low settings of 4-6 as starting pressure are not very valuable settings for most folks.

[GaryG]

Thanks. I changed my lower pressure to 8. I'll report back here after a few weeks to let you know how I'm doing.

[Wulfman]

Now, I've been on and endless journey to get perfect numbers and feel great.
I've posted summaries of numbers from the jounrey since October 1st:

First of all, just on the face of it, the numbers look really good. So if I were feeling great, this would be the end of the story. But my problem is I don't. I'm still tired - not as tired. I've been on CPAP since late July - so it's been about 4 and half months.

My sleep doc thinks I'm wasting my time fine tuning at this point as my numbers are good. Instead he recommended I take caffeine before driving. To me, this doesn't seem too cool right now, as I've got acid reflux (seeing gastro doc this week to go over results from endoscopy).

And maybe it will take me a while to catch up on sleep loss from the past 20+ years...

Getting back to the numbers, I broke it up, based on my settings. Over time, there is a good trend in AI and AHI going slightly down. My doc would say these numbers are all the same within measuring error. What I find curious though is that my 95% pressure seems fairly the same whether my upper limit is 15 or 12, since I lowered my low range. I'm thinking of tweaking the range again, by upping the lower limit to 7 or 8.

At the end of October, I got another titration at the sleep center, and was told my range was 4-9. Which is why I tried to titrate from 4-15 during early November, to see how that would match my result. My results at home seem sightly different. But the lab was only one night.

I'm tempted to upper my lower range a bit, perhaps to 6.4 or 6.6. Any suggestions?

Gary,

Have you tried CPAP mode (straight pressure)?

Are you using EPR? If so, what setting?

Some people with GERD (acid reflux) do better on straight pressure (although, some don't).
Every time I see someone complaining about not feeling well-rested on a range of pressures, I wonder if the pressure changes are disturbing their sleep.
It's pretty clear (to me) that your machine is hitting the 10 cm. ceiling most of the time (A10 algorithm).
Without seeing a ResScan report, it's hard knowing what's happening and when.
I don't see that your spreadsheet shows the HI numbers, but your numbers seem pretty good.


Den

[roster]

I've posted summaries of numbers from the jounrey since October 1st:

I do not use my summary numbers to change settings or make precise conclusions about my therapy. I study the daily details report to see when I was having events and what the pressure and mask leak was when the leaks occured.

When I am tweaking, I like to look at the daily details as soon as I arise. At this point there is still some recollection (quite imperfect recollection) of what was going on last night, such as, which positions I slept in, how well I seemed to sleep, what I ate the night before, what the bedroom temperature was, how I felt upon awakening, etc.

GERD can be disrupting your sleep architecture and as you know, needs to be controlled.

BTW, since my therapy has been optimized and stabilized, I only look at my reports two or three times per month. The exception would be if I have a bad night, I might run the report upon arising.

What position(s) are you sleeping in?

[Gerryk]

Gary your numbers look good, but as you said your not feeling well. My doc had lowered my lower number and I had to ask to have it increased but mine showed increased events. As far as feeling better, you do state your not as tired as you were before. I was on cpap for about nine 7-8 months until I started to feel better and the closer I got to a year the better I felt. I rarely take a nap and when I do try to take one I usually can't fall asleep. I am not tired when active or driving like before and only really get sleepy when I am very inactive.
It just may take you a little more time.

Gerry

[carbonman]

Gary, I'm w/wulfman. I think you need to raise your min. pressure.
It's not responding or not responding fast enough to events.
In my vast 5mths of experience w/this machine, I think your AI is way too high.
I don't really worry about the HI number.

Since I went to straight cpap w/EPR, this is a very typical night for me.


I don't think you can use the same line of thinking to set this machine that
is used to set an Mseries machine. It does not respond the same way.

Hope this helps.

[GaryG]

Have you tried CPAP mode (straight pressure)?

No. I agree, its something to think about, but I would think I need to zero in on a smaller APAP range before I'd go straight CPAP.

Are you using EPR?

No. I've never had difficulty adjusting to pressure, so not sure how this would help me. I mean, when the pressure rises, it doesn't wake me up.

Without seeing a ResScan report, it's hard knowing what's happening and when.

I can post a few nights here.

I don't see that your spreadsheet shows the HI numbers, but your numbers seem pretty good.

Spreadsheet shows AHI and AI, so in essence the HI is the difference.

[GaryG]

What position(s) are you sleeping in?

I generally try to sleep on my side, but sometimes I find myself sleeping on my back. So, mostly on the side.

[GaryG]

Gary, I'm w/wulfman. I think you need to raise your min. pressure.
It's not responding or not responding fast enough to events.
In my vast 5mths of experience w/this machine, I think your AI is way too high.
I don't really worry about the HI number.

I thought 1 or less was ok. Interesting.

Since I went to straight cpap w/EPR....

How did you figure out you needed EPR? And wouldn't it make sense to work with APAP and making the range smaller first?

[Wulfman]

No. I agree, its something to think about, but I would think I need to zero in on a smaller APAP range before I'd go straight CPAP.

It ain't that hard.......just pick one, set it and adjust from there (if necessary).

In your case, I'd set it at 10 cm.

An AHI of 1.0 or less (or there-abouts) is fine......but you indicated that you were still tired. The amount of time on the hose has something to do with that, but IF the pressure changes are keeping you from going into deep sleep or REM, you need to take that into consideration.


Den

[carbonman]

I thought 1 or less was ok. Interesting.
How did you figure out you needed EPR? And wouldn't it make sense to work with APAP and making the range smaller first?

Gary, I rarely have an AI greater than 0.2.
Usually 0.
I figured out I needed EPR by trying it.

I don't think you can titrate yourself w/these machines like you can an Mseries.
They don't respond the same way.

In looking at your graphs, you are having too many apnea events.
I would guess a cpap pressure of ~10 and go from there.

[GaryG]

C-Man. Thanks for your feedback. I'm still a bit leery of going from APAP to CPAP, as I'm not sure what makes it worthwhile to abandon APAP. I'm still showing incremental improvement.

Well, I see you're at CPAP of 12 with EPR of 1. What lead to a decision to go from APAP to CPAP? (I'm assuming you started with APAP, as you've got an APAP capable machine.). And how did you know to go to 12? Was this extrapolated from observed 95 percentile pressure numbers? And how did you know to choose 1 for EPR? Why did you choose EPR as opposed to simply tweaking the CPAP setting?

I mean, what were the characteristics of your results that directed you to a CPAP pressure of 12 with an EPR of 1?

I am interested in hearing of the process people go thru in analyzing their results. It may be in your DNA at this point, and may be hard to explain, but this would be helpful.

[GaryG]

An AHI of 1.0 or less (or there-abouts) is fine......but you indicated that you were still tired. The amount of time on the hose has something to do with that, but IF the pressure changes are keeping you from going into deep sleep or REM, you need to take that into consideration.

Den, how can I tell if I'm having REM sleep or not? I mean, after all, I'm sleeping ok (or I think I am). I'm not aware of waking up at higher pressure changes. I see my 95 percentile numbers make 10 a reasonable CPAP range to try, but I'm trying to understand why you'd recommend CPAP over APAP.

[carbonman]

I mean, what were the characteristics of your results that directed you to a CPAP pressure of 12 with an EPR of 1?
It may be in your DNA at this point, and may be hard to explain, but this would be helpful.

Gary, I guess the bottom line for me was/is/still is,
I only have so many brain cells left.
I don't have time to waste waiting for a doc, RT or sleep lab to
"give me the go-ahead" to tweak my therapy.

I was titrated at 8cm in a split study, ambien induced sleep.
I arrived at 12cm in the first 3mths of my cpap journey,
using an Mseries auto and directed by Snoredog(RIP) and wulfman.

When I got the S8, I quickly realized it would not respond to events
the way the M did, and because of that I was getting better sleep.
The pressure changes were not disturbing my sleep.

With the M, I could never make the transition to straight cpap....just could not do it.
When I experiment w/settings that I really don't know how I will respond,
I do it when it is NOT bed time. I make the adjustments when I have time to
lie down and experience the changes.......no pressure to go to sleep, just try it.
See how it feels. If it feels like it will work, give it a try for real.
It is the EasyBreathe combined w/the EPR algorithm that makes the
straight cpap work for me.

Get outside the box.....throw leery to the wind.
These are the unforeseen benefits that OSA and cpap bring to us.
The opportunity to expand our horizons.