Your feedback is appreciated on my SH data

[listener]

I'm about 19 days in now, and feeling much better. I'm comfortable with the mask and sleeping better than I have in a long time. Not sleeping great, but better. I think I could make some improvements though and I've attached some screenshots from SH in hopes that you can guide me in the right direction.

Some quick details:
- initial AHI via a home study was 28
- pressure WAS 5-15, and I just changed it to 6.5-15 with a very minor improvement in AHI (based on only 1 night at 6.5). Insignificant at this point with only 1 day at the new setting.
- average AHI over the 19 days is 6.73. With the pressure increase last night it was 5.98. Again, insignificant at this point.
- humidifier at 2, heat at 1.
- 90% pressure is 9.9 over the 19 days, average pressure is 7.39.
- the Nuance Pro mask is working well, comfortable, no large leaks, and I keep it on all night long.
- ramp at 10 minutes, I don't have an issue with the pressure either way.
- C-Flex is set at 3. I've changed it and don't seem to be affected much.

If you need more data or would like to see some areas zoomed in, just let me know. I used Dropbox with links, I hope that's OK. Thank you in advance!

https://www.dropbox.com/s/w7hwnhst9u1g8 ... -14_01.JPG

https://www.dropbox.com/s/voa80m4n5j3q9 ... -14_02.JPG

https://www.dropbox.com/s/b4l43ulo2bhzm ... -14_03.JPG

https://www.dropbox.com/s/eq1euymzi5f01 ... -14_04.JPG

[Jim-Bob]

I'm about 19 days in now, and feeling much better. I'm comfortable with the mask and sleeping better than I have in a long time. Not sleeping great, but better. I think I could make some improvements though and I've attached some screenshots from SH in hopes that you can guide me in the right direction.

I think the most promising thing to try would be to take minimum pressure setting up to a level that would prevent events from occurring. Something like 10 or even 11. Since 6.5 clearly doesn't prevent hypopneas and apneas. So if you aren't bothered by the pressure, I think doing something like min10.5-max15.0 could very well bring your AHI quite a bit lower.

Paul J

[JDS74]

I would be a little more cautious about the pressure increase.
Your 90% number is less than 10 cm H2O. The average pressure is less than 7.5 cm H2O.
A gradual approach would be to increase the EPAP to 7 cm H2O and wait for a few days to see what happens.
Then, if there is progress and no significant number of CA's show up, move it up to 7.5 cm H2O, etc.
Sometimes a small change in the EPAP number is all that is needed to suppress the Hypopneas that you are seeing.

[Pugsy]

I think the minimum pressure is still sub optimal. Not sure where it needs to be but I would try 7.0 and see what happens.
I am thinking around 8 cm minimum but I always advise people to go up slowly when they are this close (AHI close to 5 and it's mostly obstructive in nature) because sometimes a small change makes a big difference and we might get lucky and not need as much minimum pressure as we first thought. Hurts nothing to go up slowly.

[Ishtar]

https://www.dropbox.com/s/eq1euymzi5f01 ... -14_04.JPG

What does the number in (parenthesis) mean? I see it on my events and keep wondering.

[Pugsy]

What does the number in (parenthesis) mean? I see it on my events and keep wondering.

For ResMed S9 users that number in parenthesis is the duration of the event in seconds.

For PR System One users that number is a close approximation to duration of the event. Respironics machines don't/can't record event duration like the S9 machines do. Instead they use a sort of marker system. It's close to duration but not exact. Sometimes we see 8 or 9 in parentheses with the PR S1 machines and they can't be 8 seconds in duration because they have to be 10 seconds to meet criteria.
If you zoom in and try to count the event duration it will be close though. Close enough to realize if it says 8 in parenthesis that it likely barely met the 10 second definition and if it said 30 then it likely was real close to 30 seconds.

[Ishtar]

Ah, thank you. A lot of (1)'s in snoring. A lot that are higher but lots of (1)'s.

[FromOZ]

Your 90% number is less than 10 cm H2O. The average pressure is less than 7.5 cm H2O.

Just curious (this is my situation obviously) if my SleepHead stats for past month are:

Code: Select all

Average Pressure             9.47
Min Pressure                 8.00
Max Pressure                14.00
90% Pressure                11.50
Average EPAP                 6.47
Min EPAP                     5.00
Max EPAP	                 11.00

Where my machine is set on APAP 8-14 with continuous EPR of 3. This would suggest that my minimum pressure is too low? Also the max pressure delivered by APAP is the max pressure dialled into the machine, the thought being that if the max pressure was set higher then the S9 APAP algorithm might go above the (current) 14.00 cmH2O setting.

BTW I sleep supine — yes I know it's not the ideal but if I start on my side within a very short space of time I'm on my back

[Jim-Bob]

I would be a little more cautious about the pressure increase.
Your 90% number is less than 10 cm H2O. The average pressure is less than 7.5 cm H2O.
A gradual approach would be to increase the EPAP to 7 cm H2O and wait for a few days to see what happens.
Then, if there is progress and no significant number of CA's show up, move it up to 7.5 cm H2O, etc.
Sometimes a small change in the EPAP number is all that is needed to suppress the Hypopneas that you are seeing.

There is no EPAP setting on the OP's machine. It is an APAP, not a BiPAP.

And the 90% stat is not a number that gives much information about what pressure settings are optimal. Obviously, if the starting pressure is quite low (definitely too low), and the OP's events occur preferentially in a certain sleep stage, or a certain sleeping position, then the 90% number can be waaaay below any therapeutic pressure.

Paul J.

[Pugsy]

Where my machine is set on APAP 8-14 with continuous EPR of 3. This would suggest that my minimum pressure is too low? Also the max pressure delivered by APAP is the max pressure dialled into the machine, the thought being that if the max pressure was set higher then the S9 APAP algorithm might go above the (current) 14.00 cmH2O setting.

Trying to establish pressure needs by just evaluating the 90/95% pressure numbers isn't ideal. The 90/95 % numbers are easily skewed and I really don't think that short term evaluation gives a good overall picture of what is going on. Long term (talking months) is probably a better way to go.

There's more to it than just % numbers...there's AHI and there's how we sleep and how we feel.
Just because a machine hits the maximum doesn't mean we just have to give it more room to go higher. Sometimes it isn't that big of a deal and sometimes going higher in the maximum can leak to problems with leaks, centrals or aerophagia. So sometimes giving the machine more room to roam causes more problems than it fixes.

90/95% numbers are not the holy grail of numbers. They can be useful for trying to come up with maybe a cpap pressure if someone wanted to go to fixed cpap pressure.
I have some examples in a thread here on the forum. I am short on time right now but I will try to find it later.

If the AHI is higher than we would like to see and it is primarily obstructive in nature then the first pressure we look at to change would be the minimum pressure. Often when the minimum pressure is set more optimally we see that the 90/95% pressure numbers actually reduce because the machine is preventing better instead of working so hard to fix something. Prevention is easier than fixing.

[FromOZ]

Where my machine is set on APAP 8-14 with continuous EPR of 3. This would suggest that my minimum pressure is too low? Also the max pressure delivered by APAP is the max pressure dialled into the machine, the thought being that if the max pressure was set higher then the S9 APAP algorithm might go above the (current) 14.00 cmH2O setting.

There's more to it than just % numbers...there's AHI and there's how we sleep and how we feel.
[...]
If the AHI is higher than we would like to see and it is primarily obstructive in nature then the first pressure we look at to change would be the minimum pressure.

Thanks Pugsy!

If my AHI numbers will help here are mine for the past 45 days (since I started using the beast [CPAP machine])

Code: Select all

AHI                           1.05
Obstructive Apnea Index	    0.54
Hypopnea Index	             0.22
Clear Airway Apnea Index	   0.28

As you can see my indices are not that bad, given that I had >60 untreated AHI

Also I 'convinced' my doctor to use APAP + EPR. They just wanted to go with straight CPAP of 14. Having worked previously in the medical field I tend not to be overawed by doctors

[listener]

Thank you so much everyone. I'm going to start ramping it up by 0.5 and stay at each setting for a few days before increasing. Away we go!

I did find out last night that rolling onto my back isn't good with the Nuance mask. My mouth opens and all hell breaks loose! I'm mostly a side sleeper and do well with the mask that way.

Thanks again!
Jay

[palerider]

Where my machine is set on APAP 8-14 with continuous EPR of 3. This would suggest that my minimum pressure is too low? Also the max pressure delivered by APAP is the max pressure dialled into the machine, the thought being that if the max pressure was set higher then the S9 APAP algorithm might go above the (current) 14.00 cmH2O setting.

yes, if you need higher than 8/5 (which is what you get with pressure 8, epr 3) to keep you from having apneas, then you're just causing yourself to have a few more as the machine wanders it's way up to the pressure you need.

and, yes, if it spends a lot of it's time around 14/11, then it might want to go higher, however, if your ahi is very low, then you might not get much benefit, and/or, it might not need to go much higher.