Pressures all over the place. Now what do I do?

Goofproof · Post by **Goofproof** » Fri Jul 07, 2006 3:17 pm

Snoredog wrote:Gone in the wrong direction? Go back.

Note: If you set your Min. pressure to 9cm, the machine will NOT record anything below that 9cm value, so you are basically now blind with what's actually happening. Move your Min. pressure back down to 6cm so you can see what is happening.

You may be blind but there's nothing to see, If you are running at 9 cm, all event that could have been treated at a lower pressure were treated by the 9 cm pressure, so there would be no untreated events under 9 CM to view.

Putting up with a higher pressure than the lowest you can get by with, allows the APAP to respond quicker to events and employ more precise control with less chanch of overaction. Jim

Guest · Post by **Guest** » Fri Jul 07, 2006 4:11 pm

Goofproof wrote:
Snoredog wrote:Gone in the wrong direction? Go back.

Note: If you set your Min. pressure to 9cm, the machine will NOT record anything below that 9cm value, so you are basically now blind with what's actually happening. Move your Min. pressure back down to 6cm so you can see what is happening.

You may be blind but there's nothing to see, If you are running at 9 cm, all event that could have been treated at a lower pressure were treated by the 9 cm pressure, so there would be no untreated events under 9 CM to view.

Putting up with a higher pressure than the lowest you can get by with, allows the APAP to respond quicker to events and employ more precise control with less chanch of overaction. Jim

Goofproof · Post by **Goofproof** » Fri Jul 07, 2006 4:32 pm

PM me your E-mail, I'll send you something to think over. Jim

Goofproof · Post by **Goofproof** » Fri Jul 07, 2006 8:31 pm

Opps! I've been here waiting for a PM from GuEsT, thinking he only wanted to read, not think.

Then I realized being the Guest he can't comunicate by PM. Sorry I wasn't paying attention. Jim

Snoredog · Post by **Snoredog** » Fri Jul 07, 2006 8:39 pm

Goofproof wrote:PM me your E-mail, I'll send you something to think over. Jim

that was me, no need to PM me or send me anything, just give me the study name I probably already have it.

Goofproof · Post by **Goofproof** » Fri Jul 07, 2006 9:04 pm

It's my study, it's not in the Journal, unless they are monitoring my e-mail. Which they probably are. Scully will clear me. Although my study didn't have a government grant, it does show a trend of response of APAP cause and effect, and a way to control it.

I wish they put a knob to control sensitive on the unit. I also wish the Encore Pro software had a overlay feature so you could align the graphs stacked and transparent. Jim

Snoredog · Post by **Snoredog** » Sat Jul 08, 2006 12:02 am

[quote="Goofproof"]It's my study, it's not in the Journal, unless they are monitoring my e-mail. Which they probably are. Scully will clear me. Although my study didn't have a government grant, it does show a trend of response of APAP cause and effect, and a way to control it.

I wish they put a knob to control sensitive on the unit. I also wish the Encore Pro software had a overlay feature so you could align the graphs stacked and transparent. Jim

roztom · Post by **roztom** » Sat Jul 08, 2006 2:53 pm

I believe my incremental stepping of the pressure 5-6,6-7, 7-8, 8-9, 9-10, 10-11 accomplished determining if the pressure raises were event triggered or the pressure increases were causing the events.

Clearly the pressure was causing the events. The algorithm was raising pressure based on snore or??? and then an event would be recorded, at the higher pressure. I questioned if the event was the cause of the pressure rise in APAP or the event was recorded because of the pressure raise.

The data clearly indicates less recorded events at 9cm. My AHI was 1.4 over 5 days at 9-10 CM at 10-11 AHI 1.8 at 6-7 cm AHI 5.0+ ,7-8 cm 6.0+,
SO in APAP 6-11 my AHI would follow the same range, my AHI would vary with the pressure.

TO reiterate: In APAP I got the same AHI across the pressure range (According to MyEncore AHI/Pressure) as I did when I set the APAP to 1 CM increments.

In APAP with the range opened up when the machine would respond to triggers the pressure it was transversing was causing the events. When the machine spent time at 7-8 while in APAP mode my AHI would be bad. I would read the time at pressure in EncorePro and see the AHI jump at the various pressures. When I locked the pressure down to one cm increments I had almost the identical AHI at those specific pressures. At 9-10, I had a minimum of events whether it passed thru there in APAP or fixed at 9-10cm.

Ergo: The pressures were inducing the events.

The question of what type of events is open to discussion. We can't determine that based on the data collection ability of the Auto, but it is clear that pressure is the issue. Whether these are some form of Central, I don't know - probably or Nervous System destabilization as SWS suggests - the net is the same. The pressure is inducing the response.

What is a bit counterintuitive is that it seems to happen at lower pressure, stop or drops to a minimum at 9-10 cm and then increases again. IT is strange that it is prevalent at a lower pressure as well as a higher pressure. Centrals tend to be higher pressure events, not lower.

Maybe this is the oscillations SWS refers to. There is no way to tell, and even if we knew, what could we change in the therapy?

I seem to demonstrate that pressure can be a culprit for some as well as a solution. For me anything outside of my "sweet spot" generates events - pressure does not seem to clear them and many pressure ranges seem to create them, other than my sweet spot.

As SWS said, I may be a rare bird but it is important to be conscious that APAP and variable pressure therapy may be counter productive for treatment of certain individuals.
When some on this board can't figure out their APAP, my experience may be worth noting.

Best,

Tom

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, auto, APAP

Snoredog · Post by **Snoredog** » Sat Jul 08, 2006 7:48 pm

[quote="roztom"]I believe my incremental stepping of the pressure 5-6,6-7, 7-8, 8-9, 9-10, 10-11 accomplished determining if the pressure raises were event triggered or the pressure increases were causing the events.

Clearly the pressure was causing the events. The algorithm was raising pressure based on snore or??? and then an event would be recorded, at the higher pressure. I questioned if the event was the cause of the pressure rise in APAP or the event was recorded because of the pressure raise.

The data clearly indicates less recorded events at 9cm. My AHI was 1.4 over 5 days at 9-10 CM at 10-11 AHI 1.8 at 6-7 cm AHI 5.0+ ,7-8 cm 6.0+,
SO in APAP 6-11 my AHI would follow the same range, my AHI would vary with the pressure.

TO reiterate: In APAP I got the same AHI across the pressure range (According to MyEncore AHI/Pressure) as I did when I set the APAP to 1 CM increments.

In APAP with the range opened up when the machine would respond to triggers the pressure it was transversing was causing the events. When the machine spent time at 7-8 while in APAP mode my AHI would be bad. I would read the time at pressure in EncorePro and see the AHI jump at the various pressures. When I locked the pressure down to one cm increments I had almost the identical AHI at those specific pressures. At 9-10, I had a minimum of events whether it passed thru there in APAP or fixed at 9-10cm.

Ergo: The pressures were inducing the events.

The question of what type of events is open to discussion. We can't determine that based on the data collection ability of the Auto, but it is clear that pressure is the issue. Whether these are some form of Central, I don't know - probably or Nervous System destabilization as SWS suggests - the net is the same. The pressure is inducing the response.

What is a bit counterintuitive is that it seems to happen at lower pressure, stop or drops to a minimum at 9-10 cm and then increases again. IT is strange that it is prevalent at a lower pressure as well as a higher pressure. Centrals tend to be higher pressure events, not lower.

Maybe this is the oscillations SWS refers to. There is no way to tell, and even if we knew, what could we change in the therapy?

I seem to demonstrate that pressure can be a culprit for some as well as a solution. For me anything outside of my "sweet spot" generates events - pressure does not seem to clear them and many pressure ranges seem to create them, other than my sweet spot.

As SWS said, I may be a rare bird but it is important to be conscious that APAP and variable pressure therapy may be counter productive for treatment of certain individuals.
When some on this board can't figure out their APAP, my experience may be worth noting.

Best,

Tom

Goofproof · Post by **Goofproof** » Sat Jul 08, 2006 8:22 pm

I am a person that responds to the normal rule, as I increase my pressure, Snores go down and AHI goes down too, until I reach my limit where centrals cause AHI to start back up. For me this point is 16 CM, and 15.5 is my CPAP Sweet spot.

Aflex at 13 to 16 is my best setting for me, proven by numbers.

My conflict is I have two FF Masks, a ComfortFull and F & P 431. The comfortfull gives me the best AHI and other numbers, but is uncomfortable to wear. The F & P 431, is more comfortable leaks less and is cooler, more air flow or a different flow, but it raises my AHI on auto and CPAP both, AHI is still under 5, but sec in Apnea and duration both go up quite a bit.

So on Aflex the F & P feels better but my 90% rate climbs to the top limit, which I set to prevent known central problems. Bummer! Jim

roztom · Post by **roztom** » Sun Jul 09, 2006 9:00 am

SnoreDog:

I do understand APAP and how it works. When I run with a wide range I have very similar AHI as at the different fixed pressures. My overall AHI is much higher with the range then when I restrict it near my sweet spot.

There just aren't the events recorded around 9-10 cm for me. COnsider at 6-7 cm my AHI runs over 6 at fixed pressure.

This tells me that in APAP events are triggered by the pressure. I understand that snore and FLI cause pressure bumps. I see the pressure bump and then I see the event marks, not the other way around.

When I chart the pressure /AHI graph the AHI tracks with the pressure. The fact my AHI is higher at 6,7,8 then at 9-10 and then above 10 is higher than 9-10 is the disturbing part.

IF I set my APAP 5-14 or whatever it doesn't go over 11 but the AHI can be terrible, up to 9 one time but it has never happened at 9 cm or at 9-10 cm. Sure at 9-10 cm I can have a bad night once or twice around 3.0 AHI but that is ok. My average is under 2.0, 1.4 at 9cm and 1.7 at 10 cm. Outside of that range, other than 5 cm (hard to breathe) the AHI is bad or at least worse.

I think I've made a good case for the inadequacy of APAP at least in my case and I certainly acknowledge that there may be other systemic influences going on for me which are impacting my therapy that others don't experience. I am not against APAP, on the contrary I started with a CPAP and lobbied my Doc to get an APAP. I wanted to run at a lower pressure than my titrated 9cm so I set it to 6 cm ont he low end and from 6, 7 & 8 cm my AHI's were bad. When I eliminated the 6,7 & 8 my AHI was minimal. When I got to 9 cm it is the best and 9-10 range is ok. over 10 the AHI jumps up again.

I was shocked that my treatment went so poorly on the APAP and I've spent almost 5 months trying to figure it out. This is my conclusion based on meticulous dissection of the data.

Whether they are centrals or just the fact my brain is not signaling me to breathe at certain pressures are among the possibilities.

AS much as the data is subject to its limitations, I believe I have gotten to a confident hypothesis regarding what the data is telling me. My xPAP must be restricted to a narrow range, almost like a CPAP and for whatever reason, pressure is inducing events to be recorded the actual underlying causes other than pressure cannot be determined, only therorized.

The key here is not why, though we would like to know, but that it is happening and it is related to specific pressures. As the APAP traverses pressure it is triggering AHI.

Controlling and limiting the pressure range is limiting the events. This demonstrates to me that an APAP may not be the best choice for treatment if it is left open to self titrate. For me the best treatment is with a restricted prewssure range.

Thanks for your input and interest,

Tom

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, APAP

Snoredog · Post by **Snoredog** » Sun Jul 09, 2006 2:44 pm

roztom wrote:

The data clearly indicates less recorded events at 9cm

You know what you should try Tom?

Limiting your HIGH or Max. pressure setting to 9.0cm pressure. I believe you said in one of your other posts this pressure was the 2nd dip seen in your numbers.

I still think you should lower your Min. or floor pressure back down to 6.0 or 6.5cm if you can tolerate it that low. You woud then have a range of 6.xcm to 9cm. You should be able to tell overnight if that is better.

roztom · Post by **roztom** » Sun Jul 09, 2006 2:54 pm

Snore:

I've tried the lower range pressure but my AHI shoots way up at 6,7 & 8 cm and drops sharply at 9cm and then climbs sharply above 10cm. It looks like 9-10 cm or straight 9cm, CPAP for me.

Thanks for your suggestions. I'd like to be able to have a lower initial pressure but my AHI suggests otherwise.

Best,

Tom