First Sleepyhead Post

[QueSera]

I hope this is the place to post this. If not, I promise to do better next time.

I'm about six weeks into CPAP use, and I had my first follow-up visit with the doctor this week. I was sick for about half the month (bronchitis) but I'm better now, using a great mask (Amara View) and finally getting some sleep, so it's time to learn to review my results.

The doctor told me not to bother looking at everything, only number of apneas and leak rate. But I'm an information junkie, and I'd like to understand as much as I can. Fingers crossed: here's this morning's SH screen capture:



The only thing I see that I understand is AHI 12.57, and I don't know if that's an hourly average or the night's total. What should I be looking at? Looking for?

Thanks for any insight you can offer. I don't know how any new CPAPer can manage without this forum.

[Cardsfan]

AHI is the apnea-hypopnea index. Add the number of events of apneas plus hypopnea, divide by the number of hours slept. It is the average number of events you have per hour. Above 5 is when you get diagnosed with sleep apnea.
Being on CPAP, your AHI should be below 5 to be considered treated. The good news is, on this forum, you can learn to adjust your settings to get that number where it should be. Many on here get it to 1 or 2.

The top graph is your event flags. You get a little mark every time you have an event. By adjusting your pressure (using info. from the pressure graph) you can eliminate a good portion of the events.

With your AHI so high, I don't understand why your Dr did not adjust your pressure settings.

If you look at your pressure graph- it shoots up from the low setting of 4 and stays at 12. I would suggest raising your starting pressure of 4 to 8. At 4 you are getting the very minimal amount of therapy. And raising the upper pressure to 14. The statistics show your Med pressure is 11.16, so the machine wants to be there or higher to prevent the apneas. These are really small changes I am suggesting.

Note that raising pressure can increase Clear airway (CA FLAGS) events is some people, so we need to watch for that.

I know it's a lot to take in, but an AHI of 12.5 needs to be fixed.

[OkyDoky]

Here are some suggestions to help with your screenshots.
The pie chart doesn't give us very much info so you can turn it off by going to File - Preferences -Appearance - Uncheck Show event break down pie chart
That allows us to see the machine details on the left.
Also the pie chart doesn't give us very much info so you can turn it off by going to File - Preferences -Appearance - Uncheck Show event break down pie chart
That allows us to see the details on the left.
Also this site will help with posting where we can enlarge the image. https://sleep.tnet.com/reference/tips/imgur You have to sign in to Imgur then it will give you a menu where you choose Large thumbnail and copy the BB Code to your post.

Now to your screenshot. The AHI is an hourly index. It takes the total Apneas + Hypopneas and divides it by the total hours slept. While your number is high,
your screenshot shows at least 4 wakeups and some of those numbers are probably what we call sleep/wake/junk so we ignore those.
Also it shows that your settings are not cutting it. With a Min setting of 4 it lets some OAs occur before it gets up to a pressure to eliminate them. And with 4 wakeups where the machine was turned off, it started off at that 4 Min each time. You can also see that the pressure graph is at the Max pressure of 12 is where you were most of the night and the machine couldn't go higher even if it wanted to.
Did your Sleep Study show any Central Apnea? With what I see I don't think that is a problem. But I'm trying to figure out why your doctor choose these settings and why he didn't make any changes at your visit. He does seem to want to control but maybe as you learn more he will work in partnership with you.
Do you know what caused your wakeups?
If you have regular Obstructive apnea then I think you are going to need a Min pressure of 8 and increase the Max to 16. The Min pressure is the most important to prevent your obstructives and hypopneas and can be increased gradually while evaluating results. Many people have a suffocating feeling at the low 4cm pressure and feel more comfortable with a little more minimum. The Maximum pressure is where the machine will go only if you need higher pressure.

[Sleeprider]

QueSera, you are having a mixture of obstructive (OA), clear airway (CA) and hypopnea events, above acceptable levels for treatment. There are many breaks in our therapy which hints that you're not sleeping well and the pressure changes are disruptive. It's pretty clear your starting pressure of 4.0 is too low, and your maximum pressure is also too low to prevent the numerous OA events you are having. The machine is raising pressure to the maximum, and it is staying there. This is due to the large flow limitations that you included in the graph. At 6-weeks I don't think these problems are a matter of adapting, and you need to start trying some things to lower the AHI and obvious sleep disruption.

I think you are going to need a pressure range of about 8.0-14.0 to control the problems. We will want to watch if the higher pressure increases CA significantly. Your leak rate is quite high, and it would help to know what mask you are using so folks here can help you with that part of the problem. The image you posted does not contain information to show if you are using EPR (exhale pressure relief), so let us know what that setting is as well.

I think your comfort and sense of well-being are important considerations aside from the numbers. So, how do you feel and are things better so far with the APAP therapy? You need the pressure increase, so let's start there, and work on leaks.

[Cardsfan]

Airfit N10 nasal mask is in her profile pic-- to sleep rider.

[LSAT]

The machine shown in your profile is the Elite, but Sleepyhead indicates that it is an Autoset. I agree with the suggestion to increase your pressure.

[QueSera]

Thank you Thank you Thank you!

I'm going to raise my pressure to 8-14 now, and go up to 16 tomorrow, probably. I'll go over the Imgur settings before I post another screenshot, too.

I tried a few masks and settled on the Amara View hybrid. I'm not a mouthbreather, but the pressured air leaks out my lips, so the hybrid is a good fit. I'll be working on the leaks I still have, too.

In addition to my apnea issues, I have had terrible insomnia most of my life. 2 to 4 times a month I have a night when I just never fall asleep at all. Waking up only 4 times during a night is like an A++ for me! Even so, I'm very hopeful that finally treating all of it together will be making a big difference.

[OkyDoky]

I'm going to raise my pressure to 8-14 now, and go up to 16 tomorrow, probably. I'll go over the Imgur settings before I post another screenshot, too.

Watch on Sleepyhead and if the maximum at 14 is not topping out at the maximum on the graphs and letting obstructives/hypopneas happen, you won't need to increase it.

[Cardsfan]

Do you know how to work your comfort settings? Ramp and Exhale Relief Pressure (ERP) can help, especially at higher pressure settings.
Whatever changes you make, live with them a few days before evaluating.

[Sleeprider]

Thank you Thank you Thank you!

I'm going to raise my pressure to 8-14 now, and go up to 16 tomorrow, probably. I'll go over the Imgur settings before I post another screenshot, too.

I tried a few masks and settled on the Amara View hybrid. I'm not a mouthbreather, but the pressured air leaks out my lips, so the hybrid is a good fit. I'll be working on the leaks I still have, too.

In addition to my apnea issues, I have had terrible insomnia most of my life. 2 to 4 times a month I have a night when I just never fall asleep at all. Waking up only 4 times during a night is like an A++ for me! Even so, I'm very hopeful that finally treating all of it together will be making a big difference.

We always encourage new users to take it one step at a time, and allow time for things to settle. This is actually a pretty big change in pressure, so give it a week before deciding to make additional changes. If you feel like you are fighting to exhale, you can turn on EPR, otherwise, I would not change that at this time as it just adds to the complexity of trying to figure out what works.

A good night sleep is dependent on being able to breath. Your arousals and breaks in therapy are probably related to the apneas and RERA (respiratory event related arousals) you are having, and there were no doubt more of those before you added CPAP. As you get better control of these events and leaks, sleep will get better.

[palerider]

I hope this is the place to post this. If not, I promise to do better next time. {url]{img]http://i.imgur.com/L30obyFl.png{/img]{/url]

excellent first attempt.

a couple things on the actual mechanics of the post, don't enclose it in 'url' links.
DO continue picking 'large thumbnail' then
DO pick 'linked bbcode' from the imgur menu, instead of just 'bbcode'.

good arrangement of the strip charts on the left.

I won't repeat the advice already given about pressure adjustments.

[cancun]

Thank you Thank you Thank you!

I'm going to raise my pressure to 8-14 now, and go up to 16 tomorrow, probably. I'll go over the Imgur settings before I post another screenshot, too.

I tried a few masks and settled on the Amara View hybrid. I'm not a mouthbreather, but the pressured air leaks out my lips, so the hybrid is a good fit. I'll be working on the leaks I still have, too.

In addition to my apnea issues, I have had terrible insomnia most of my life. 2 to 4 times a month I have a night when I just never fall asleep at all. Waking up only 4 times during a night is like an A++ for me! Even so, I'm very hopeful that finally treating all of it together will be making a big difference.

Not too big a deal but I think you picked the wrong machine for your profile, the one you chose is a straight CPAP and we know you have an APAP since you can use a range of pressure. I would just change that when you get a chance.
I love how excited you are about your treatment and wish you well.

[palerider]

Not too big a deal but I think you picked the wrong machine for your profile, the one you chose is a straight CPAP and we know you have an APAP since you can use a range of pressure.

that, and it says "autoset" on the posted chart

good catch.

[QueSera]

So I survived the night.

The doctor and the DME had said "Elite" many times, but yes, it's an Autoset, says so on the front of the machine, of course.

I slept comfortably. However, I can see that my AHI is still much too high and that I will probably need to increase my pressure from 8/16, maybe to 14/20 next. But I'm going to wait a few days before I do that. I looked at the pie chart and it showed virtually no large leaks, but the graph seems to show some. I'm going to try to use those moldable silicone earplugs tonight to fill in gaps around my nose and chin.

Also, Ramp and Climate Control are set to Auto, Pressure Relief and Smart Start to On.

Hopefully, this screenshot is properly posted. If not, I'll be tinkering with it.

[Cardsfan]

There is a product called mask liners, made to help with leaks. You can see them at http://www.padacheek.com and our host https://www.cpap.com. Mask liners also add to comfort as you don't have the rubber feel of the mask on your skin. Hopefully someone who uses your mask will help you with which one is preferred. I like pad a cheeks' because they last for months and stay attached well.

oh yea- glad you made it thru the night