Please help me understand these results

[RyanAUS]

Hi,

I have just started using a APAP machine (ZZZpap auto) with Flexifit 431 mask. I have not had an official sleep study conducted. My wife noticed that i had shallow breathing and that i seemed to stop breathing with continual waking through the night. I have been sufferring from post viral fatigue since Aug 2011 and the insomnia is a nightmare. At this stage i still require some meds to get me off to sleep. I thought the APAP would help with the fatigue and other symptoms. My software states that i have:

AHI: 82 index 9.43/h
Apneas: 1 index 0.11/h
Hypopneas: 81 index 9.21/h
Vibratory Snorings: 0
Average pressure 9.5
Average leak 8.9 (LPM)

I wake with headaches, fatigue, muscle aches, which i associate with low oxygen levels. I have been unable to get a proper sleep study as I am visiting the USA for the post viral medical issues and don't have the insurance while here to cover a sleep study. I always wake up constantly through the night and have trouble getting back to sleep, never really feeling that I enter a deep sleep.

Is there any advice anyone can give as to how I can lower these hypopneas? Do i need to increase the pressure, as it is currentely on APAP mode.
Thanks

[Pugsy]

APAP mode? What are your minimum and maximum settings?

Off hand with the AHI of 9...I suspect that the minimum pressure is not quite high enough and the machine can't get to where it needs to be quickly enough to prevent the events more effectively.
This is the most common reason that APAPs get a bad name. They are set wide open like 4 to 20 and starting at 4 doesn't give the machine a good enough head start.

Your average pressure is 9.5....If you minimum is 4 or 5 or 6....I would change it to 8 cm...see how things go. If 8 cm is too much to get used to right now...start going up slowly in 1 cm increments that are easier to adjust to and watch your data.

The minimum pressure is the most critical pressure setting. The maximum really doesn't matter because the machine won't go up there if it doesn't have a need to. If it never goes there it doesn't matter what the maximum is because it doesn't factor in to the equation.

[RyanAus]

Hi Pugsy,

Thanks for the reply

The APAP settings are set from 4-20 as you suspected. I will increase this minimum. I wanted to PrintScreen the image (graphs) here but I have no idea how to add an image onto this forum.

[Pugsy]

I think you will see an improvement with the increase in the minimum. I had similar AHI that you have when I used APAP with 8 minimum and when I increased it to 10 cm my AHI dropped to around 2. My overall average pressures on APAP (used 10 to 20 range) was around 12 cm. Sometimes it needed to go higher but time spent higher was brief. If you find the pressure changes themselves are disturbing your sleep...then we go with a much tighter APAP range or straight cpap..

To post an image of a report using a screen shot on this forum we have to host the image on the web (something like photobucket) and then use the IMG brackets to have the address of the image between the brackets..in our posts..then the image shows up.

Here are my standard instructions on how I do it.
Main thing is to save it as a jpeg file...upload to something like Photobucket...copy the address and insert the address between the IMG brackets.
If you don't have Snipping Tool and have to use regular screenshots..then you have to put them in Paint and save from there...or use a free screen shot program. I think Screen Hunter is used here by several members. If you have the Snipping Tool...so very easy to crop and get screen shot at the same time and save it easily.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[RyanAUS]

Thanks for the advice, above is the image with graph data.

[RyanAUS]

I notice that the hypopnea events occur throughout the night even at pressures above 10, would raising the minimum still solve this?

[Pugsy]

I notice that the hypopnea events occur throughout the night even at pressures above 10, would raising the minimum still solve this?

Yes. Having a higher minimum gives the machine a better head start or base point to be able to get to the pressures needed to prevent those hyponeas that are forming at the higher pressure.
I don't know exactly how the machine that you are using works in regards to speed of increasing the pressures in response to event triggers but the other brands of machines need to also have a better head start. These machines don't/can't go from 4 cm to 10 cm in a blink of an eye. They go up in stages of sorts and sometimes the events come and go before the machine gets to the best pressure needed to deal with them.

[billbolton]

I have not had an official sleep study conducted.

Without a sleep study and formal clinical diagnosis, you are pretty much into the realm of chasing shadows by going straight to APAP treatment. It may simply not be effective for whatever your Sleep Disordered Breathing issue actually is.

Given that it seems you have primarily been experiencing hypopneas rather than apneas, there's not a strong prima facie case that xPAP is a good treatment pathway for you

Please, please, please, have a Polysomnogram sleep study done .

Cheers,

Bill