need help and feedback

I need some feedback on my sleep apnea numbers. I have been using my Respironics M-series auto machine for about a month now. After titrating various pressures it seemed like the best pressure was around 9 cm, so for the last week I have been trying a fixed CPAP pressure of 9 cm with C. flex.

My numbers are as follows. These are averaged over the last seven days.

Obstructive apnea index 1.5

hypopnea index 1.0

Average AHI 2.5

Average vibratory snore index 1.2

Average leak 33.7

Here's my question. I still don't feel terribly well rested in the mornings. Some of this is because I don't get quite enough sleep (which has nothing to do with sleep apnea, although wearing a mask doesn't really help.) But I have a sense that my sleep is still not that good quality. Should these numbers be better? I switched from auto titration because it was my sense that my brain registered the constant changes in pressure and I slept even more poorly.

Should I do a re-titration and using what pressure range?

Are there any tips for lowering my numbers even more?

Here is some of the data, the summary and a typical night. Thanks for any feedback you can give me.

PS How do people post the reports from Encore Pro or Encore Pro Analyzer, the graphs don't copy.


Sleep Therapy Long Term Trend
5/5/2009 - 5/12/2009
CPAP
9.0
Average Obstructive
Apnea Index
1.5
Average Hypopnea
Index
1.0
Average AHI
2.5
Average Vibratory
Snore Index
1.2
Average Max Leak
97.1
Average 90% Leak
41.8
Average Leak
33.7
Average Large Leak
0 mins.
Printed by Encore Pro - Version: 1.8.49
Page 3 of 10
5/13/2009

Your numbers seem pretty good to me, although the leak rate may need looking at.

It was about 6-7 weeks before I started to feel better when I got up in the morning. Most nights I am still not getting enough sleep, but I can tell that my mind is clearer.

Even though I am not getting enough sleep I tell myself that the sleep I am getting is good quality, and it is still very early days in my treatment. Even if you feel in the morning that you are not getting quality sleep, the figures suggest you are, at least from a not breathing point of view.

What you are doing seems to be working reasonably well according to the figures, so now all you have to do is fine tune.

By the way, I guess you know that fine tuning is for a lifetime, but hey, what price for a night of mainly breathing.

cheers

Mars

You may be breathing thru your mouth or leaking air. Try to eliminate mouth breathing. Try a cflex setting of one max. Run in the auto mode and check your reports. Set your low pressure at the 90% level. Set the high pressure at 20 to start. Your airway pressure goes negative if you breath thru your mouth then jumps up when it shuts. The changes can be disruptive and the cpap is not maintaining a continuous positive airway pressure so it is not working.

Ignore the high leak rate of 90% as when I get up to go to the bathroom in the middle of the night, I usually leave the mask hissing, so the average leak rate is close to the predicted rate for my mask.

Setting the high pressure to 20 worries me that I would be buffeted in the middle of the night. I can try it, but it seems like overkill. why do you recommend clfex of 1?

I don't think I am mouth breathing much, as my Optilife has a chin strap, but anything is possible.

First, that isn't a chin strap on the opti, it's just there to stabilize the mask. Second, chin straps don't work for everyone. They still allow air to get out thru the lips. If you may be mouth leaking you need to try a real chin strap or tape your mouth shut(some prefer poligrip strips to seal the lips closed), or a full face mask.
Look at the daily charts for your leak line. is it fairly straight or is it lots of hills and valleys? You want that to be as straight as possible and with in range for your mask. Even if the leaks aren't bad enough to impact pressure they may be enough to disrupt your sleep.

Brenda

remstarcpap wrote:Ignore the high leak rate of 90% as when I get up to go to the bathroom in the middle of the night, I usually leave the mask hissing, so the average leak rate is close to the predicted rate for my mask.

It might be a good idea to shut it off when you take the mask off so your numbers would be more accurate.

Setting the high pressure to 20 worries me that I would be buffeted in the middle of the night. I can try it, but it seems like overkill. why do you recommend clfex of 1?

You are trying to find your 90% and max reqd pressure so if you want you could start a little lower and bump it up as necessary.

I don't think I am mouth breathing much, as my Optilife has a chin strap, but anything is possible.

The majority of the problems that I have had with cpap were caused by mouth breathing or leaking. A chin strap was not enough to eliminate mouth breathing for me. If you think you are mouth breathing some you might be mouth breathing quite a bit. If you seal your mouth and try your cpap you will eliminate a variable that could be your problem. If that does not solve it try something else. Your pressure stays more constant with a setting of 1 which may help. If you get everything working good you could try a higher setting if you want and see if still works good.