What is SleepyHead saying that can help me treat my apnea?

[Vinsan]

I have been faithfully using my Phillips Respironics System One PAP machine set on Auto with 8min and 10max since August 2, 2011. However, I’m somewhat confused and getting frustrated. I just don’t know where I’m at. In the last 10 days I have had 4 AHI readings at 10 and above and none below 5. I would like to start seeing some below 5 numbers at least.

Since I was having most AHI’s over 10, my doctor several months ago recommended I use settings on APAP Auto of 8 and 10 or go to CPAP with 9. I chose the APAP. I have my humidifier set on 2 and A-Flex of 3. . I’m using the Resmed Mirage Quattro Full Face which my doctor also recommended at that time.

I installed SleepyHead software about a month ago with the hope of being able to see my nightly numbers, it will help me zero in on any problem(s) and more importantly help me find an optimal APAP setting. My problem is, that after spending many hours looking at the data and other Cpaptalk forum posters discussing SH results, I still cannot figure out what the SH graphs mean to/for me and how I can use this information.

I have the SH Sleep Disorder Glossary, but I’m also having difficulty understanding the meaning of the Flow Rate graph and its relationship to the other SH graphs. Is there a source explaining each SH graph and how they relate? If not, can someone please give me some guidance?

I believe I’m having continuing trouble with leaks, I guess like many people, and know that until I get them under control I cannot expect to make real progress

I’m posting my last 2 night’s Event Flags, Flow Rate, Pressure and Leak graphs asking for help from members with interpretation and advice.

Thanks all.

Vin

June29th



June30th

[Pugsy]

I suspect your minimum pressure is just a tad too low. That is usually the case when we see some snores, flow limitations and obstructive events (apneas and hyponeas). You need to mentally remove the clear airway events because we don't treat them with pressure with your type of machine and they don't appear to be bad enough to worry about using a different type of machine. Large clusters of CAs when the rest of the night is unremarkable makes for a highly suspicious case for maybe awake events being flagged....so if you see a really large cluster like that first report...ask yourself if it is possible you were awake or not. The machine doesn't know if you are awake or not and will flag false positives sometimes.

CPAP at 9 might have been a better choice or move the minimum pressure closer to 9 to give the machine a little better headstart.

Area to avoid on the leak graphs is 80 to 90 L/min or above...sometimes you are below it and sometimes you aren't..so yes, leak does need a bit of work.

You might talk to your doctor about a slight increase in the minimum pressure if you aren't comfortable doing it all on your own.

[Vinsan]

Pugsy, thank you for the reply.

You suggest I consider moving the minimum pressure from 8 to 9 which you believe will be of help.

This would then give me settings of 9 Minimum and 10 Maximum. This seems to be a rather narrow range. Is this O.K.? What do you think?

Any other thoughts.

I much appreciate all you do,

Vin

[jwerley]

Hi Vinsan: I was having simiar problems as you.......My doc titrated me at 9 in my sleep study and put me on straight c-pap of 9. That did not work for me at all.....(AHI went up)....so I started (very slowly) moving numbers.....I felt that I needed more pressure as you do...so I wound up with 12 as my bottom pressure and 15 as the top...but the most important was the EPR, which would be the flex on your machine...I moved that down from 3 to 2 and that really helped....I am now sleeping through the night. I use nasal a nasal pillow mask, tape, and chin strap so no leaks. What I would do if I were you is just one thing for right now and that would be to move your flex down to 2 and see what happens.

Good luck,
Janice

[Pugsy]

I wouldn't do a full 1 cm increase... I would do a tiny 0.5 cm increase and watch things closely. Sometimes the least little change makes a significant difference for about a week...then maybe another 0.5 cm increase
You already have a really tight range on the APAP.. you do seem to bump up against the max for short periods of time.
If you are comfortable increasing the maximum to give it a little more room then you could see what 11 cm or 12 cm max allows. The machine won't increase the pressure if it doesn't have a reason.

BUT....I would work on leaks especially. You can't evaluate your reports accurately with this amount of leak.
Do you see the flat pressure lines? The totally flat lines where there are none of the saw tooth little probes?
Around 00:40 to around 01:15 and again at 2:00 for quite a while??? Note the large leak at the same time...your leak is excessive during these times and the machine is not sending out the little test probes like it is supposed to because it can't sense what is going on and we have no idea what is really going on during the time of large leaks and that prolonged flat line.
In other words the machine isn't responding like it is meant to because the leaks have confused it and it isn't sensing things properly.
5 minutes with leaks above 80 or 90 L/min isn't the end of the world but your leaks are large and prolonged...they can and will impact the machine's ability to function properly and possibly impact therapy.

BTW...changing Flex setting doesn't really lower the pressure like ResMed EPR settings do. Not in 1 cm increments.
Flex exhale relief is flow based and the lowering of pressure during exhale is much smaller and much more subtle.
Flex setting of 3 is NOT a 3 cm reduction at all. Don't expect the same type of response as Resmed users get when they use EPR because it is not the same type of reduction.
Though it wouldn't hurt to try it...
You can read about Flex and its flow based exhale relief here
http://aflex.respironics.com/