High Anxiety- Adjusting to CPAP Life

Oh... Side note:
The doctor wanted me to fight gridlock traffic, drive 45 minutes just to bump the pressure from 6 to 7. SO GLAD I found you people
THANK YOU,
Janine

OK, Since I'm seeing so much comment on my thread on you all not seeing enough data, here is a random night I picked out. I picked night because the AHI seems to fall into the mid-range for me. Some nights are 12 some rare nights a 4.7. Again, this is with the original DME suggested setting of 6 pressure, not the 7 Sept 2nd screenshot previously posted.
(Pugsy, Have you tried clearing your cookies to correct your problem with viewing screenshots? Might be cookies related):

I didn't really expect to see much (if any) improvement with the change to 7 cm...but it's hard to say for sure because our sleep changes from night to night and the AHI can vary substantially without any changes at all. So maybe last night was one of those nights. Would have maybe been ugly no matter what was done.

Do you have any idea what your doctor's plan is? How long he wants to try each pressure setting to see what happens?
Is the DME feeding him these reports or is he getting them directly?

Are you happy with letting the doctor dictate things or would you be comfortable taking a more proactive role in setting your pressure minimum? Do you think your doctor would get all upset if you did?

Regarding the absent images...your previous report that I couldn't see yesterday... I can now see just fine but the reports you just now posted I cannot see. I am thinking it has something to do with my internet service and download speed.
I am also having other issues that might be related to my internet service...like downloading stuff...it won't let me.

Good idea to try clearing the cookies though....I haven't done that...won't hurt to try and will try that shortly.

Thank You, Pugsy
OK, Here's my answers to your question:

Pugsy wrote:Do you have any idea what your doctor's plan is? How long he wants to try each pressure setting to see what happens?
Is the DME feeding him these reports or is he getting them directly?

He is saying: "Send the stick to me in 5 days for another appraisal." He's getting all the data directly from the stick that I USmail him (bullsh*t)

Pugsy wrote:Are you happy with letting the doctor dictate things or would you be comfortable taking a more proactive role in setting your pressure minimum? Do you think your doctor would get all upset if you did?

I would like to jump into "The Dark Side" and make some of my own adjustments as this HMO process is too slow. AND, There is the strong likelyhood that they are charging me a co-pay of $40 for each 2 minute read of the stick. Will he get upset? I have no idea... but I'll accept that risk

Pugsy wrote:Regarding the absent images...your previous report that I couldn't see yesterday... I can now see just fine but the reports you just now posted I cannot see. I am thinking it has something to do with my internet service and download speed.

Maybe 350kb image size is a bit large? What is the norm on this forum for screenshots. Also, I use my own domain as it's easier, but is set for "public" viewing... I hope.
Let me know, I want you all to see these and walk me through my problems.
Thanks

Janine... I think the problem with the images is related to where you host them to and my internet provider. It's having trouble connecting to some sites.

PaleRider just sent me an image of your last night's report and I could see it just fine from his hosting site. Loaded right up immediately.

I can still see your very first reports you posted but I can't see the last night's report or your most recent older example.
Not a big deal...if I really need an image I can get one from some one.

Your reports look so much like mine did when I first started therapy it's like looking in a mirror.
Do you know if your sleep study mentions anything about your OSA maybe being worse in REM stage sleep? That's what it looks like to me from what I see here. Just like mine did and my OSA was documented much worse in REM sleep. Not a big deal..fairly common in fact.

I don't think you are going to see much improvement until that minimum pressure is up in the 10 ish range. I would still recommend that a person make the transition to that 10 ish range in small increments though unless they were quite comfortable immediately at 9 or 10 starting point. Up to you if you want to be proactive or wait on your doctor to get you there. That's something you have to decide.
I also think that even with the 10 ish minimum you might see some spikes higher like you are seeing now but I don't think you will see as many of them and they probably won't last as long. Just speculation on my part but based on 5 years of seeing this sort of thing personally.

MyJanine wrote: Maybe 350kb image size is a bit large? What is the norm on this forum for screenshots. Also, I use my own domain as it's easier, but is set for "public" viewing... I hope.
Let me know, I want you all to see these and walk me through my problems.
Thanks

it's best to post a full res shot, because trying to read numbers and such on scrunched down images is really difficult sometimes.

I suggest using imgur.com, they're fast, and seem to work for pugsy. (I think her ISP may be having problems.)

plus you can easily do tricks like this, where you have a smaller thumbnail and clickthrough to full res:

OK, Imgur... Sept 2nd, last night's sleep:

And the Aug 16th typical sample night (imgur):

palerider wrote:

MyJanine wrote: I suggest using imgur.com, they're fast, and seem to work for pugsy. (I think her ISP may be having problems.)

plus you can easily do tricks like this, where you have a smaller thumbnail and clickthrough to full res:

Give me a minute or two to figure our your cool thumbnail image trick. Not seeing how on imgur. Thanks fo rthe coaching. My fastmail.com people were asking for an upgrade cost as I've store so many images and videos there.

MyJanine wrote: I would like to jump into "The Dark Side" and make some of my own adjustments as this HMO process is too slow. AND, There is the strong likelyhood that they are charging me a co-pay of $40 for each 2 minute read of the stick. Will he get upset? I have no idea... but I'll accept that risk

A girl after my own heart. I never want someone to do something that they aren't comfortable with AND know why they are doing it and not just because someone on the internet is saying to do it. That's why I go into detail explaining whys and why nots instead of just shooting you a number to try. I want you to learn and understand what you are doing and why and what to expect and not rely on a faceless name to tell you want to do.

If you want to make the leap to the dark side...I think that a minimum around 10ish is going to be a better tweaking point. How much above or below I don't know where that might be. Some parts of the night you aren't needing nearly as much pressure as other parts of the night and if your minimum was higher to start with then it might not even need as much higher pressure during those parts where you see the clusters. Right now the machine is working in "fix it" mode and keeps working hard to try to fix things that are happening instead of "prevent" mode where it can more easily get to where it needs to fix things.
The minimum pressure I think of as a baseline pressure to hold the airway open most of the time and still give the machine a chance to go higher if needed and get there quicker to hopefully get the job done.

So...if it were me..I would increase the minimum in increments that I was comfortable with until I started seeing reports that were more acceptable. We don't have to make a change and expect to find perfection with one change. It's kinda unrealistic to expect that anyway because we don't sleep the same way each night. What I like to do is get close fairly quickly and then fine tune based on long term (like 4 or 5 nights) data. Others try to cut to the chase and move quicker than I do and that's fine.

So you could leave the minimum at 7 for a couple more nights just to see if last night's ugliness was a fluke or not or move on upwards now. It's up to you and what you are comfortable doing. For some people a 1 cm change can seem like a hurricane and for others it's nothing. Since the primary goal is to get to sleep and some people can't sleep with the hurricane..that's why I suggest going up slowly...just in case there are comfort issues. If you want to try 8 cm tonight and 9 tomorrow night and you are comfortable with the increases...go for it. If it seems a little bit much in terms of comfort back off and use it 2 or 3 nights or whatever it takes so it doesn't overwhelm you. As much as these reports aren't so pretty...they are still better than without cpap even though you may not feel the improvement...the improvement is still there.

I tend to be very cautious when offering ideas to others...not something I always practice myself but it's just the way I am.

Welcome to the Dark Side...you have a lot of company over here.

Edit: I can see the images hosted at imgur just fine. Must be an issue with your hosting site AND my ISP...because I can see part of yours..like your first image.

Oh...when you have time you might want to change the red line leak thing in SleepyHead from 24 L/min to around 90 L/min.
The default is for ResMed red line and your large leak territory red line is going to be up around 80 to 90 L/min depending on the pressure used.

MyJanine wrote:

palerider wrote:

MyJanine wrote: I suggest using imgur.com, they're fast, and seem to work for pugsy. (I think her ISP may be having problems.)

plus you can easily do tricks like this, where you have a smaller thumbnail and clickthrough to full res:

Give me a minute or two to figure our your cool thumbnail image trick. Not seeing how on imgur. Thanks fo rthe coaching. My fastmail.com people were asking for an upgrade cost as I've store so many images and videos there.

there's a couple of tricks to it. if you hit 'reply' you can see the code... but what I do is start out by copying the 'linked bbcode' string that imgur gives you, and then to make it nicer, I put .png after the url= bit, and then add a l (lower case L) to the end of the url, before the .png in the img section.

I noticed that if you upload a full res pic to imgur, you get some string, like u2BvzvP as part of the url, pointing to a page on imgur with that pic if you put.png on the end, then it points to that pic directly, if you add a l.png, it gives you a large thumbnail of the pic, so

imgur.com/ u2BvzvP (no space) points to a page with the img that you can click on.
imgur.com/ u2BvzvP.png points to the pic itself, without the intervening page.
imgur.com/ u2BvzvPl.png points to an autogenerated large thumbnail.

make sense?

Pugsy wrote: So...if it were me..I would increase the minimum in increments that I was comfortable with until I started seeing reports that were more acceptable. What I like to do is get close fairly quickly and then fine tune based on long term (like 4 or 5 nights) data. Others try to cut to the chase and move quicker than I do and that's fine. So you could leave the minimum at 7 for a couple more nights just to see if last night's ugliness was a fluke or not or move on upwards now.

I think I'll give this 7cm another night or two and then move up, just to walk safely. So far I'm not experience any "hurricane" effect.

Once we arrive at better baseline pressure cm... will there be other adjustment we will be looking at?

Pugsy wrote:Oh...when you have time you might want to change the red line leak thing in SleepyHead from 24 L/min to around 90 L/min.
The default is for ResMed red line and your large leak territory red line is going to be up around 80 to 90 L/min depending on the pressure used.

Done, Changed to 90 L/min. My next screenshot in a day or two will have this in the settings.
Thank You!
Janine

PS:

palerider wrote: plus you can easily do tricks like this, where you have a smaller thumbnail and clickthrough to full res:

Thanks Again!

MyJanine wrote:Once we arrive at better baseline pressure cm... will there be other adjustment we will be looking at?

Not unless you end up with issues that haven't presented themselves yet....mainly aerophagia from the higher pressures or centrals triggered by higher pressures....or maybe if the pressures changing disturb your sleep but if you haven't had that happen now with them bouncing all over the place I doubt it will be an issue and as far as centrals popping up...again they haven't been a problem when you are spending so much time up around 18 cm..so I doubt they will be an issue.

Your Aug 8 night wasn't horribly horrible. We might be closer to optimal minimum than we first thought.
The median wasn't even 8 cm. The 95/90% pressure being so high...remember the definition...at OR BELOW. So don't worry so much about that data point. I have countless examples where my 90% number was 18 or 19 but long term...it was only 12.4. I had many more nights where it didn't go that high.

Your times where the clusters occur...could be REM stage sleep...could be supine sleeping ....could be a little bit of both.
I don't worry too much about what caused it...I just try to prevent it from being a problem. We have zero control over REM sleep anyway and unless someone doesn't ever sleep on their backs or can't or won't...what difference does it make since REM is out of our control anyway.

When in REM sleep our body/airway tissues relax...really relax and the chances for the tissues to flop more and obstruct our airway more increase...also increase the chances that whatever pressure had been working well to hold the airway open might not be enough. Same thing with supine sleeping only it's gravity that plays a big factor.

When I made the change from apap to bipap I had to do a bit of self titrating...took a couple of nights and I got a good enough report with AHI around 3...so I stuck with it for 6 weeks. Resisting the urge to change things when I had a bad night here and there because I knew that it would/could work. After 3 weeks the AHI that was trending at around 3 started reducing on its own..many more "good" nights than not so good nights. ...at 6 weeks my AHI was averaging less than 1.0 and that's without changing anything...bad nights were rare.
There is some truth to the "give it time" thing too....Though some things no amount of time will fix and an AHI of 9 with almost all obstructive...no amount of time will fix that.

Bad, bad night.... Wednesday evening/Thursday morning, took a Lorazapam around 10:30, but still woke up many many times
The default pressure is set at 7cm (I hope... set 2 days ago by me as per suggestions here). Here's my Sleepyhead:

Bad as in how? Just in general? Mask issues? Machine issues? Sleep issues?

I think it's time to move from 7 cm.. Unless you are having air pressure issues and having problems exhaling or breathing or anything related to the pressure being/feeling high.