High Clear Airways during sleep

Hi all,

I am slowly getting the fine tuning of the pressures to a point where I am sleeping okay. Albeit with a mask and hose affixed. Ha! Any thoughts on my data?



Thanks for all the support.

Jim

Hi and welcome to the board I'm not expert in reading charts but Your AHI could be a little better Ideally you want to see it below 5. Between 9:45 PM and 10:30 did you take off the mask and turn the machine off seems there was no data during this time. You have a lot of leaks going on and that could also be improved on.. Just need to figure out what is causing the leaks. How is your mask fitting? I also see 2 other times during the night where the machine was not used for short periods probably for a bathroom break it seems. Please be patient for others to analyze the chart

Your leaks aren't horrible...the majority of the time the leaks are below 24 L/min so unless the leaks are waking you up or contributing to the frequent awakenings...they aren't a problem.

You are still waking often...evidenced by the breaks in therapy that are shown. I bet a good chunk of those CAs are awake/semi awake breathing getting flagged.

It would be helpful if you kept most of your reports and questions in one thread instead of having multiple threads so that members can look back and review what has been going on and what has already been mentioned.

like these prior threads
viewtopic.php?f=1&t=104574&p=986590#p986590

viewtopic.php?f=1&t=104556&p=986195#p986195

viewtopic.php?f=1&t=104531&p=985990#p985990

OK, so you've increased your minimum and lowered your maximum to a range of 6 - 9 and your machine wants to take you to the maximum nearly immediately so you could increase the minimum some more, say up to 7+. At a max of 9, you have very few hypopneas and obstructive events, even though it looks like your flow limitations want to drive your max higher.
I still think your CA's could be arousals caused by disturbances resulting from either leaks, the change in pressure in the auto mode, or EPR. To determine if this is so, you could try eliminating these factors one at a time to see what happens. As Pugsy says, your leaks aren't high, but if they disturb you, they're too high. Some people are disturbed by the varying pressures of the Auto mode and some by EPR, many are not, you could be.
So, I would recommend: Switch to CPAP at 9, stay there for a few days, at least 3, then reduce or eliminate EPR if need be, again staying at one setting long enough to gather some meaningful data to try to asses whether or not you are being disturbed by the pressure changes or EPR.
You need to establish a base of data and make adjustments slowly. Give your body time to adjust to any changes you make. You are unlikely to make much progress by changing settings based on the results of one night.

I'm not Wulfman, but sometimes I can sound like him. Your data looks like you'd benefit from CPAP mode at 9.0. I think it would help with your arousals, which may reduce CA, and give you good therapy for OA and H. You could even keep a short 5-10 minute ramp from 6.0. It would be virtually no different from your current situation, but the machine would not be fluctuating, and that might be enough to stay asleep.

I''ve been reading and watching graphs on a few forums and I would definitely try Sleeprider's advice.

Been a few cases in the last few weeks where a straight pressure has improved the readings. 9 would be a good choice, or 10 later, as that is where it wants to go. I'm experiment and reviewing my stats to get my EPR settings where their best. Taken me 3 months to dial in my settings but there is hope if you put in the time reading and studying (thanks to all here) accompanied with the experimenting. They can debate this with their theories but the graphs tell the story, and you can always go back to where you were.

Pugsy wrote:Your leaks aren't horrible...the majority of the time the leaks are below 24 L/min so unless the leaks are waking you up or contributing to the frequent awakenings...they aren't a problem.

You are still waking often...evidenced by the breaks in therapy that are shown. I bet a good chunk of those CAs are awake/semi awake breathing getting flagged.

It would be helpful if you kept most of your reports and questions in one thread instead of having multiple threads so that members can look back and review what has been going on and what has already been mentioned.

like these prior threads
viewtopic.php?f=1&t=104574&p=986590#p986590

viewtopic.php?f=1&t=104556&p=986195#p986195

viewtopic.php?f=1&t=104531&p=985990#p985990

Pugsy,

I will follow your advice and post to one continuous thread.

Jim

Jay Aitchsee wrote:OK, so you've increased your minimum and lowered your maximum to a range of 6 - 9 and your machine wants to take you to the maximum nearly immediately so you could increase the minimum some more, say up to 7+. At a max of 9, you have very few hypopneas and obstructive events, even though it looks like your flow limitations want to drive your max higher.
I still think your CA's could be arousals caused by disturbances resulting from either leaks, the change in pressure in the auto mode, or EPR. To determine if this is so, you could try eliminating these factors one at a time to see what happens. As Pugsy says, your leaks aren't high, but if they disturb you, they're too high. Some people are disturbed by the varying pressures of the Auto mode and some by EPR, many are not, you could be.
So, I would recommend: Switch to CPAP at 9, stay there for a few days, at least 3, then reduce or eliminate EPR if need be, again staying at one setting long enough to gather some meaningful data to try to asses whether or not you are being disturbed by the pressure changes or EPR.
You need to establish a base of data and make adjustments slowly. Give your body time to adjust to any changes you make. You are unlikely to make much progress by changing settings based on the results of one night.

Jay,

I will make a few tweaks tonight. I think a constant pressure at 9 makes a lot of sense. I am aroused by a feeling of air starvation from time to time. I'm guessing it is the lower pressures that are causing that. When the pressure is up and I feel like I'm getting lots of air it feels better.

Thanks,

Jim

A trial change to CPAP seems to be the consensus among the posters. EPR and Ramp are comfort settings. In order to reduce the number of variables influencing your sleep,when you switch to CPAP you might want to turn both of them off as well, unless, of course, you find the result to be just too uncomfortable. The effect of both Ramp and EPR is to lower the pressure, something you may not need. Treatment is reduced during Ramp due to a lower pressure and EPR could be disturbing.
Whatever changes you make, if possible, you should stay with them for a few nights to allow your body to adjust and adapt before deciding to change again.

Hi all,

Here's how it went last night. Results seem better and I didn't wake up as often last night. I will repeat this for a couple of nights to get a base line. I think the leaks may be me breathing out of my mouth. I could try the full mask but do like the pillows much better.



Mant thanks for the feedback and support.

Jim

Looks better from the standpoint of sleep fragmentation, and you say you feel better. I would avoid changes for a few days before making any conclusions, but so far so good.

Sleeprider wrote:Looks better from the standpoint of sleep fragmentation, and you say you feel better. I would avoid changes for a few days before making any conclusions, but so far so good.

Thanks. No changes for a few nights.

Yes, the results look marginally better. Fewer CA's, OA's and Hypopneas, resulting in a reduction of AHI from 5.54 to 3.87 with fewer breaks in therapy. Flow limitations look good with a reduction in the 95% level. The leaks, though not exceeding the large leak line often, do look like they have the characteristic shape of mouth breathing and could be disturbing, leading to the CA's.
If the results remain similar for a couple more nights, because your flow limits and OA/Hyp are reasonably low, I would consider lowering the pressure from 9 to 8.6. A reduction in pressure should result in a reduction of leaks and possibly an increase in comfort (as long as Flow Limitations, OA, and Hypopneas remain controlled). I would also consider decreasing the EPR from 3 to 1 or off. Some people, though I think not many, do get better results without EPR.

Jay Aitchsee wrote:Yes, the results look marginally better. Fewer CA's, OA's and Hypopneas, resulting in a reduction of AHI from 5.54 to 3.87 with fewer breaks in therapy. Flow limitations look good with a reduction in the 95% level. The leaks, though not exceeding the large leak line often, do look like they have the characteristic shape of mouth breathing and could be disturbing, leading to the CA's.
If the results remain similar for a couple more nights, because your flow limits and OA/Hyp are reasonably low, I would consider lowering the pressure from 9 to 8.6. A reduction in pressure should result in a reduction of leaks and possibly an increase in comfort (as long as Flow Limitations, OA, and Hypopneas remain controlled). I would also consider decreasing the EPR from 3 to 1 or off. Some people, though I think not many, do get better results without EPR.

Jay,

Thanks for the suggestions. I will wait a few nights before making any changes. I like your ideas. So far so good.

Jim

Good to see the 9 working out for you and like you say, leaving it for a few days gives you a better idea of how you'll adjust to this setting. I don't think you can go lower than 9 but that is only because the auto migrated to 9 in short order and looked like it wanted to stay up there. I'd be more inclined to try ~9.6 or 10 as an experiment (down the road somewhere). I'm used to my 11cm pressure and don't find it uncomfortable, get to sleep in short order. Try Jay's advice first tho as he has much more experience . I wound down my EPR from 3 level and slowly to 'off'. Wish I had kept better notes, i'm experimenting with level 2 again and getting good results but it's only been 2 nights.

Experiment lots and keep notes, you'll be glad you did if your planning on optimizing. Enjoying your ongoing results, as I too learn from your experience, this is like a small hobby for me.

... g'luck Sirc