Weekly Status

[Pugsy]

I agree with John...about the bilevel thing. Have we ever talked about it? I don't remember.
I was thinking that I pointed you to my bilevel experiment thread a while back but maybe I didn't.
Here it is just in case I didn't.
viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

Maybe the comfort of bilevel would enable you to rest better, sleep better or maybe like me....sleep about an hour longer with no other changes that I could find. That extra 45 minutes to an hour really makes a difference in how I feel overall during the day.

[khauser]

Thanks both of you ... I will mention it to my doctor Tuesday. That would figure since I just bought a new apap. But I was thinking something similar last week.

[khauser]

This week's batch. I am seeing EXCELLENT results. Snoring is down, events are lessining as a whole, AND I am feeling it! I'm beginning to think that the Aloha mask I got wasn't such a bad idea!! Still VERY intrigued by Sleepweaver, but for now I'm not changing it.

Last week I bumped min and max. This week I'm leaving min alone, going to bump max to machine's max (only 2cm away from it anyway, and I've noticed that different night's I'm not going near the current max of 18, or topping out, so I'm going to open 'er up and see what happens).

EDIT: Forgot to mention that along with the min/max changes, I enabled AFlex and that had an unexpectedly positive response...

2/24:


2/25:


2/26:


2/27:


2/28:


3/1:


3/2:

[khauser]

One more image. I got this from Encore, because SH data is corrupt so Trends don't show correctly. I think you'll all agree that this is a good thing!



NEWBIES: This is the kind of results you too can get if you work with the wonderful people on this forum!. Special thanks to Pugsy, my personal Sleep Coach (I hope your husband is OK with that title ... )

[MyIdaho]

Kevin,
Do your have the flow limitation graph as well? I'd like to see review your data. We have pretty similar builds and our other measures are pretty similar so I'm just curious if we have similar flow limitations.
Thanks, Rick

[khauser]

Hi Rick,
Respironics' machines don't provide detailed Flow Limitation graphs ... it does show FL events on the Event Flags and the Flow Rate graphs. Also, I can view the various graphs during specific events, so, for instance I can do this:



If I knew more about what points you wanted graphs I'd be happy to oblige....

[MyIdaho]

I'm using Rescan and Sleepyhead with my S9 machine. Below I've posted the flow limitation graphs from the last few nights. I have not seen anyone else's FL graphs and was wondering how ours compare. Of course we can't compare... Sorry, didn't realize that FL was not portrayed on Respironics...

[Pugsy]

I've posted the flow limitation graphs from the last few nights. I have not seen anyone else's FL graphs and was wondering how ours compare.

Here is an example of what my FL graph looks like from my S9 VPAP. This is the way mine look 99.9% of the time.

[sleepstar]

Results are looking good

You do seem to have a bit of snore though. Wouldn't really expect any on CPAP. But you are on an automatic so it seems to titrate upwards to treat that

If your pressure doesn't bother you, and you don't get aerophagia or other problems, maybe increasing your minimum pressure a bit would be helpful.

Have you ever set your machine on fixed pressure? You need quite high pressures 90% of the night, any lower than 15 doesn't look effective.

[MyIdaho]

I've posted the flow limitation graphs from the last few nights. I have not seen anyone else's FL graphs and was wondering how ours compare.

Here is an example of what my FL graph looks like from my S9 VPAP. This is the way mine look 99.9% of the time.

Hmmm, yours are much nicer than mine.... Wanna trade? Sorry. My pressure range is set between 15 and 18 cmH2O. The median is usually 16.5 to 17.2 and 95% is 17.9 cmH2O. Should I consider increasing the pressure? I never have any reported centrals on Rescan and my AHI is usually between 0.5 and 1.5 events/hr. I generally sleep pretty well with 50 to 60% of my sleep time as deep sleep (as measured with Motion X sleep, app uses the accelerometer in my Gen 5 Ipod). I do still have days where I get tired in the morning even though I get 7.5 to 8 hrs of sleep during the work week. Thanks for any advice Dr Pugsy!

[sleepstar]

I've posted the flow limitation graphs from the last few nights. I have not seen anyone else's FL graphs and was wondering how ours compare.

Here is an example of what my FL graph looks like from my S9 VPAP. This is the way mine look 99.9% of the time.

Hmmm, yours are much nicer than mine.... Wanna trade? Sorry. My pressure range is set between 15 and 18 cmH2O. The median is usually 16.5 to 17.2 and 95% is 17.9 cmH2O. Should I consider increasing the pressure? I never have any reported centrals on Rescan and my AHI is usually between 0.5 and 1.5 events/hr. I generally sleep pretty well with 50 to 60% of my sleep time as deep sleep (as measured with Motion X sleep, app uses the accelerometer in my Gen 5 Ipod). I do still have days where I get tired in the morning even though I get 7.5 to 8 hrs of sleep during the work week. Thanks for any advice Dr Pugsy!

Your AHI is great.
If you're still a bit tired though, have you ever set your machine in fixed pressure mode?
I find it can sometimes be more effective than auto set. Especially on high pressures.

[MyIdaho]

Hmmm, yours are much nicer than mine.... Wanna trade? Sorry. My pressure range is set between 15 and 18 cmH2O. The median is usually 16.5 to 17.2 and 95% is 17.9 cmH2O. Should I consider increasing the pressure? I never have any reported centrals on Rescan and my AHI is usually between 0.5 and 1.5 events/hr. I generally sleep pretty well with 50 to 60% of my sleep time as deep sleep (as measured with Motion X sleep, app uses the accelerometer in my Gen 5 Ipod). I do still have days where I get tired in the morning even though I get 7.5 to 8 hrs of sleep during the work week. Thanks for any advice Dr Pugsy!

Your AHI is great.
If you're still a bit tired though, have you ever set your machine in fixed pressure mode?
I find it can sometimes be more effective than auto set. Especially on high pressures.

I ran it in cpap mode for first 30 days. Pressure setting was 15 cmH20. For the last 73 days I've used apap mode with a 15 to 18 range. If I tried cpap, what pressure would you recommend, use 17 (median) or even go up to 18? Leaks are well controlled and I actually spend alot of night very close to 18 already... Thanks!

[sleepstar]

Depends on how you feel about the pressure. Does it bother you? Feel too high? Any bloating?

If not, id say go for the 95th percentile. Maybe put EPR or CFlex (EPR on Resmed, CFlex on respironics) on 2-3 for some comfort too (makes it easier to breathe out, it drops the pressure a bit)

If it feels too high you can always change back to autoset

[MyIdaho]

Depends on how you feel about the pressure. Does it bother you? Feel too high? Any bloating?

If not, id say go for the 95th percentile. Maybe put EPR or CFlex (EPR on Resmed, CFlex on respironics) on 2-3 for some comfort too (makes it easier to breathe out, it drops the pressure a bit)

If it feels too high you can always change back to autoset

I'm pretty well adjusted and comfortable with this pressure. No noticeable bloating but occasionally have a couple small burps in the morning... I neglected to mention that I have always used an EPR setting of two. I'll try changing it tonight. Thanks!

[Pugsy]

For the last 73 days I've used apap mode with a 15 to 18 range. If I tried cpap, what pressure would you recommend, use 17 (median) or even go up to 18? Leaks are well controlled and I actually spend alot of night very close to 18 already..

Are you still using EPR set at 2? If so, that is allowing whatever pressure is being delivered at the time to drop by 2 cm and it may be quite enough to not do such a great job at preventing the flow limitations. The flow limitations may or may not be the reason for sometimes not feeling so great but it sure wouldn't hurt anything to try to reduce them to see if it helps or not.
Using a higher pressure in cpap mode (near your 95% pressure) and EPR of 2 would allow for a little more higher and consistent pressure overall in hopes of maybe preventing those flow limitations a little better.
Either that or use APAP mode with minimum a little higher and maximum a little higher since your 95% pressure is pretty much right at your maximum and that means you are very likely spending quite a bit of time at the maximum or very near it.

Some people happen to have their pressure set so close to what is needed full time that the reduction in pressure that EPR affords drops the pressure enough to allow FLs to happen and/or apnea events.
Sometimes we suggest to people that they turn off EPR and see what happens but I wouldn't want to do that if it were me and I was looking at 17 or 18 cm pressure...talk about a hurricane.

So yeah, either straight cpap mode at 17 cm with EPR of 2 or 3 or apap mode with an increase in minimum to say 16.5 or 17 and maximum of 20 and keeping EPR at 2 or 3...might as well open it up to 20 and see what happens if you aren't having any problems with the higher pressures if they happen.
Sometimes if the minimum pressure does a more effective job the maximum doesn't fluctuate quite so much.

Flow limitations are something the machine when in APAP mode will normally try to "fix" with more pressure.
If you look at your graphs you may see a correlation between times of those really high FLs and pressure increases.