My CPAP-to-APAP Experience

GaryG wrote:BB, knowing your results can improve like this by simply changing the settings has to be reassuring. I'd stay at 14 for at least a few days, and if you were considering increasing the pressure, perhaps you can do so without going up to 15 (can you do 14.5)? (On my ResMed Auto, I can do 0.2 increments). Sometime fine tuning can help.

BleepingBeauty wrote:Yep, I'm feeling encouraged. I'm done fiddling for awhile and will be staying put now at 14cm so I can make up for the lost time with some steady, sound sleep. And yes, the Respironics machines run in pressure increments of .5, so I can try 14.5 if/when it looks again like I'm having too many events. Thanks, Gary.

It depends on how you feel. Certainly you're feeling better than you were with your recent APAP trial. So you need to keep it where you are for a bit. But in my case, I found I wasn't satisfied, and wasn't feeling all that great while reducing my AIs down to even 1.0. I only started feeling better getting my AI's under 0.5. (Had a super night again last night with AI = 0.1). So yeah, hang out a bit at pressure = 14. But I don't like your AI of 1.4. Numberswise, probably ok. But I'm too super geeky to accept less than perfection, or as close as I can get to it. But if you wish to be super geeky and still itchy for fiddling, you might try pressure of 14.5 down the road and see how results compare. But yeah, hang in there at 14 and collect some data, and good luck. And for your sake, I hope you're not as obsessive and compulsive like me chasing the numbers.

Muse-Inc wrote:Sounds like ya found a good pressure! Congrats!

Thanks, Muse. We'll see how things go at 14 for awhile, with fingers crossed.

GaryG wrote: It depends on how you feel. Certainly you're feeling better than you were with your recent APAP trial. So you need to keep it where you are for a bit. But in my case, I found I wasn't satisfied, and wasn't feeling all that great while reducing my AIs down to even 1.0. I only started feeling better getting my AI's under 0.5. (Had a super night again last night with AI = 0.1). So yeah, hang out a bit at pressure = 14. But I don't like your AI of 1.4. Numberswise, probably ok. But I'm too super geeky to accept less than perfection, or as close as I can get to it. But if you wish to be super geeky and still itchy for fiddling, you might try pressure of 14.5 down the road and see how results compare. But yeah, hang in there at 14 and collect some data, and good luck. And for your sake, I hope you're not as obsessive and compulsive like me chasing the numbers.

I do! But everything is relative. For weeks, my AHI was running from 3-5+, so AHI of 2.4 (AI of 1.4) is a big improvement in my data! In fact, since I started using the Hybrid mask in late September, 1.4 AI is the lowest I've seen at fixed pressure.

We'd all like to see zeroes on our data. That might happen occasionally, but I just don't think it's realistic to expect results like that on a regular basis, so I'm not chasing that goal. Sleeping soundly and seeing a lower AHI makes me happy. So no, I'm not "super geeky" with respect to the numbers; as long as they're reasonable and I feel like I'm sleeping well and feel rested when I wake up, I'm good.

BB, Your numbers look fine to me and I have a good feeling about the direction you're now taking. Finding the "sweet spot" was a little harder for me as the caregiver with little input. I know I obsessed about getting it all "perfect" but strangely enough, perfection was not getting an AI=0. I took all the experts' recommendations seriously which never included getting a AI=0, and began to understand what they were trying to accomplish for my husband, a comfortable pressure, acceptable leak rate, AHI within a reasonable range and seeing improvements in his daily life. Once everything fell into place his AHI settled into the 1.5 range(sometimes lower,sometimes a bit higher) with AI and HI pretty even. I do know from our own experience the few times he had an AHI=3 he felt and I saw the difference. BTW, we went back to cpap at 11.5cm last night after 6wks on auto at 11-13 and although it's only one night, the machine and his breathing seemed quieter, leak rate lower,AHI=1.0. And he seemed "perky" again this morning.(Do men get perky?) I think I've finally convinced myself that cpap is better for Mike although the pressure may need some adjustment back up to 12cm which I won't obsess about anymore if necessary. Good luck and good sleep. Dori

Sorry for the late response. More power outages here lately, and my internet connection has been pretty shaky. Apparently, my ISP tower is in operation, but the power company is having a problem keeping the juice going to the tower.

Got our first snow of the season today, of the heavy, wet variety. Sure looks pretty (as long as I don't have to shovel it).

DoriC wrote:BB, Your numbers look fine to me and I have a good feeling about the direction you're now taking. Finding the "sweet spot" was a little harder for me as the caregiver with little input.

Thanks, Dori. I feel good about it, too. I can feel the 2cm difference in going to 14 from 12, but it hasn't been a problem. My leak is good (47 for all three nights so far, when 46 is the intentional rate) and the line is fairly flat (as it used to be). I'm going to tighten the headgear just a little, as I'm able to hear some slight hissing at this pressure; but overall, it's going well so far.

A "little" harder to get this therapy dialed in correctly for someone else who just happens to be tight-lipped about how he feels? (David Copperfield, step aside. Dori can make apneas disappear! )

I know I obsessed about getting it all "perfect" but strangely enough, perfection was not getting an AI=0. I took all the experts' recommendations seriously which never included getting a AI=0, and began to understand what they were trying to accomplish for my husband, a comfortable pressure, acceptable leak rate, AHI within a reasonable range and seeing improvements in his daily life. Once everything fell into place his AHI settled into the 1.5 range(sometimes lower,sometimes a bit higher) with AI and HI pretty even.

No argument with those goals. All I want to accomplish is more consistent good nights. Since I started using the Hybrid about ten weeks ago, I've had 20 nights with an AHI >5. I was looking to improve that. During the APAP trials (and continuing now with 14cm), the vast majority of my nights result in an AHI in the 2's. So far, so good.

I do know from our own experience the few times he had an AHI=3 he felt and I saw the difference. BTW, we went back to cpap at 11.5cm last night after 6wks on auto at 11-13 and although it's only one night, the machine and his breathing seemed quieter, leak rate lower,AHI=1.0. And he seemed "perky" again this morning.(Do men get perky?)

I think anyone in your presence would get perky, Dori.

I think I've finally convinced myself that cpap is better for Mike although the pressure may need some adjustment back up to 12cm which I won't obsess about anymore if necessary. Good luck and good sleep. Dori

I like CPAP better. I just sleep more soundly at one pressure, and it seems Mike does, too. Still, it's good to have the APAP, if only because it allows us to check things occasionally if circumstances warrant it.

Thanks for helping me sort through my APAP results and for sharing your experiences with Mike's therapy, Dori. You've obviously done a lot of homework, and it's paid off in Mike getting such effective therapy that you can easily tell when he's not up to par for some reason. That's awesome.

Just wanted to post an update on my progress.

I tried several nights at 14cm, but the numbers were all over the place, and I didn't feel as rested as I would like. So I opted to go back to the beginning (12cm) and start with incremental increases in my fixed pressure.

For the past three nights, I've been using 12.5cm. Leak rate should be about 43 LPM. So far, the reports look good, and I feel more rested. (I've seen an AHI below 2 only twice before since I started using the Hybrid in late September, so seeing AHI of just 1.8 on my second night is awesome. ) There's a lot more snore being recorded, but it doesn't seem to be disturbing my sleep.







Fingers crossed that the improved therapy continues.

This does look quite good! I AM glad you are feeling more rested too.

I see, on the 28th, the third night, that the snores were half what they were on the first 2 nights, so even that is going in the right direction!

Hope this continues!!!

Yeah, I'd just focus on the AHI and ignore the snores. That's another problem with using APAP mode......it puts its focus on the snores and flow limitations......thinking they're going to lead to other events and starts jacking up the pressures.
Very few (if any) of your apneas are preceded by flow limitations.
I'm not sure if we covered this in the past, but if your head position is where your chin is closer to your chest, it could make apneas (and other events) more likely. If you can sleep with your head tilted slightly back so as to try to keep your windpipe in a straighter line, you may see less events.


Den

Thanks, Hawthorne and Den. I'm liking my results so far.

Wulfman wrote:Yeah, I'd just focus on the AHI and ignore the snores. That's another problem with using APAP mode......it puts its focus on the snores and flow limitations......thinking they're going to lead to other events and starts jacking up the pressures.
Very few (if any) of your apneas are preceded by flow limitations.
I'm not sure if we covered this in the past, but if your head position is where your chin is closer to your chest, it could make apneas (and other events) more likely. If you can sleep with your head tilted slightly back so as to try to keep your windpipe in a straighter line, you may see less events.


Den

That's a good point, Den. I use a TempurPedic pillow, which features a "neck roll" in its construction that cradles my neck and keeps the top of my head a little lower than my chin, so I think my neck is pretty much in line with my spine when I sleep. But without a video camera, I have no idea how much my head position might change while I'm sleeping.

I suppose I could wear one of these to bed if I was really having a problem. (What's a little more "gear?" )



Thankfully, I'm not there. Yet. (knocking wood)

BleepingBeauty wrote:

At least your neck would stay warm! Slept in one of these for several yrs to keep neck aligned and prevent me from having to wear my TENS unit on my shoulders every day.

BB, glad to see those great AHI, FL, and leak numbers. So do you happen to know whether that machine-recorded VS is ordinary snore versus less common vocal-chord "noise" that might also score as VS?

http://www.google.com/search?hl=en&q=pa ... f&oq=&aqi=

Muse-Inc wrote:

BleepingBeauty wrote:

At least your neck would stay warm! Slept in one of these for several yrs to keep neck aligned and prevent me from having to wear my TENS unit on my shoulders every day.

I've worn a cervical collar several times in the past, and I still have one floating around here somewhere. They sure do come in handy when your neck's outta whack for whatever reason. Thankfully, I haven't had to use it in quite some time.

-SWS wrote:BB, glad to see those great AHI, FL, and leak numbers. So do you happen to know whether that machine-recorded VS is ordinary snore versus less common vocal-chord "noise" that might also score as VS?

http://www.google.com/search?hl=en&q=pa ... f&oq=&aqi=

Thanks, -SWS. And nope, no idea. I've asked the pets, but they're not talkin'.

The only way I can determine what's happening while I'm asleep is to record myself with a video camera, but I don't own one. Perhaps I'll start asking around and see if I can't find one to borrow.