CPAPtalk.com

Hello to all.
I'm a newbie from overseas (oltremare) and I have followed you for many weeks. I hope you will forgive my language mistakes; I will do my best.
After polysomnography, the doctor has prescribed to me a auto-CPAP with pressure titration to 13,9. The setting of auto-CPAP is: pressure min 4 and max 16.
I have read many things in these pages, but I still have many doubts. I would like your opinion about my graphics, especially on my flow limitation. I think they are too many events, but no doctor here will control my data for another 6 months. Alone I can not understand this!
I have already raised the minimum pressure at 6.00 but I think to raise even more. What do you think? It's a good idea?

Thank you.

Your English is fine and completely understandable. (I'm a newbie too.)

You have so many hyponeas that I think IF you sleep on your back you should try to not do it - put something in behind you to keep it from happening and you may have very few apneas. You could raise your pressure a little (to maybe 7 or so) but probably not a lot more.

if you look at your pressure graph, you will see that once initiated, your pressure often does not fall below 9. Probably the lowest pressure to maintain your airwya. I would set the minimum to 9.

You might want to raise your minimum so that it is closer to your needed pressure. You median pressure is around 12 but your minimum is 6 so it has to work to figure out where it should be and in the meantime you have flow limitations.

Try bumping up your minimum 1 point at the time - so tonight set it to 7 and have it there for a couple of nights and see what happens.

The reason to start at 7 for a couple of nights is comfort too, get your body into training for dealing with a higher constant pressure.

Thank you for advice.
Do you think that increasing the minimum pressure, will decrease the number of events flow limitation?
Or it is not a very serious problem?

Oltremare wrote:Thank you for advice.
Do you think that increasing the minimum pressure, will decrease the number of events flow limitation?
Or it is not a very serious problem?

Yes because of the algorithms used by the internal software, it doesn't increase the pressure immediately. Flow limitations can cause problems including arousal.
But for your own comfort increase a little every night and keep an eye on it, you may not need to increase it too much.

The flow limitation graph is a bit ugly and yes...increasing that minimum pressure should help reduce the ugliness of the flow limitation graph. How important it might be to reduce the ugliness is really unknown though...a lot depends on how much of an impact those flow limitations are making on your overall sleep quality and what is causing the flow limitations.

Do you by chance have any chronic nasal congestion issues? If so, then the pressure increase may not help because the flow limitation is more from chronic nasal issues and not the actual part of the airway where it is wanting to collapse where cpap pressures actually hold open the airway.

What does your snore graph look like?

About the hyponeas...you aren't having very many of them despite what the pie chart looks like...if you only had one hyponea all night long and that was all you had the entire pie chart would show the blue hyponea color and it means nothing. The pie chart is a whole pie and it just reflects the % of each event as a slice.
If you had 1 hyponea and 1 Obstructive apnea then the pie chart would be half the hyponea dark blue and half the light blue for obstructive apnea.
If you look at the events graph on the top right...you didn't really have very many hyponeas at all as evidence by the 0.84 hyponea index....which is an hourly average.
Over 8 hours you had less than 1 per hour ...that's nothing at all to worry about.

I also think that a minimum of 9 cm pressure (up from that 5 starting point) would very likely help the flow limitations to reduce as long as they aren't nasal.

It's not a critical issue though but flow limitations can cause arousals and poor sleep quality and in general affect how we feel during the day...so I think they are worth trying to reduce when seen like yours is seen.
To give you an example of what a flow limitation graph looks like when flow limitations are well controlled I will share one of mine with you to give you an idea...now don't think that yours just has to look like mine because it doesn't but yours could be maybe cleaned up a little. Now will it help how you might feel...don't know but it might and thus worth trying and won't hurt anything to at least try.

Here's one of my "bad" nights. Which is really pretty boring.
Clinical correlation is needed when assessing your flow limitations meaning how do you feel your therapy is going? Are you sleeping soundly and waking feeling well rested? If so then those flow limitations you are seeing may not be that big of a deal. Now if you are waking often during those 8 hours of sleep and in general feel horrible during the day then trying to reduce the FLs might help...can't guarantee it but it is worth trying.

OKCSleepDoc wrote:if you look at your pressure graph, you will see that once initiated, your pressure often does not fall below 9. Probably the lowest pressure to maintain your airwya. I would set the minimum to 9.

I agree with the Doc........setting minimum to 9.
Keep watching the reports to see where your flow limitations are the least. You might be one of those folks who exhibits more flow limitations (reflex reactions) to pressure increases........the more pressure applied increases FLs to some point till they drop off.......maybe you're awake at that point ( ? ).

But, I'd also consider limiting the maximum pressure (for the time being) to maybe 13 cm. Depending on what those reports look like, you may then want to keep lowering the maximum (and/or increasing the minimum slightly).

I suspect your ideal, single, therapeutic pressure may be between 9 and 12. Your actual "events" (apneas and hypopneas) are really pretty minimal, so your goal may be to get sleep that isn't disturbed by pressure changes.


Den

.

Tonight i'll Follow your tips. Here is almost midnight.
Happy new year to all.

Oltremare wrote:Tonight i'll Follow your tips. Here is almost midnight.
Happy new year to all.

Happy New Year to you, too.


Den

.

Oltremare wrote:Hello to all.
I'm a newbie from overseas (oltremare) and I have followed you for many weeks. I hope you will forgive my language mistakes; I will do my best.
After polysomnography, the doctor has prescribed to me a auto-CPAP with pressure titration to 13,9. The setting of auto-CPAP is: pressure min 4 and max 16.
I have read many things in these pages, but I still have many doubts. I would like your opinion about my graphics, especially on my flow limitation. I think they are too many events, but no doctor here will control my data for another 6 months. Alone I can not understand this!
I have already raised the minimum pressure at 6.00 but I think to raise even more. What do you think? It's a good idea?

in my experience, people who apologize for their english usually are better at using the language than some people who grew up with it. yours is fine.

I'm going to go out on a limb, after looking at the chart and suggest a minimum of 11, simply because when your pressure drops down around 9-10, something happens that causes it to jump back up... it's better to just head that off in the first place, and put your minimum pressure just above where you tend to have events.

many lazy/ignorant doctors/suppliers just leave the auto machines set at factory defaults, but that's not a good way to use them, because they don't 'learn" what you need, they just keep trying to get back to the minimum pressure set, with the assumption that it was set by someone with care who knew what they were doing. and that's often not the case.

Ok, I have finished celebrating the new year.
I am very impressed by your comments and I really very grateful! I could only imagine the little things on my therapy. Today you have helped me to open my eyes! In my country people are dull and it is "forbidden" to check the data of the CPAP. Woe to you! Your great experience demonstrates that some things, with good sense, you can make them.
Thanks for your time for me. I do not have nasal problems and the snore graph is more beautiful. but I believe that my sleep is not optimal.

I will try to Raise the minimum pressure up to 9 for a few days later, I'll try to lower the maximum. One thing at a time.

Thank you all.

palerider wrote: in my experience, people who apologize for their english usually are better at using the language than some people who grew up with it. yours is fine.

My English is really not very good, is the school level! I find it difficult even to understand what you write. I use widely translators online. I hope not to write ridiculous things ...

Your English is superb no matter how you are getting it done. A lot more easily understand than what I often have to muddle through from people whose first language is English.
And I guarantee it is better than what I would be doing if I was using some sort of online translator to try to communicate to you in your native language.

If for some reason you don't quite understand what we are saying.....just ask for maybe rewording so that the meaning is maybe clearer. I tend to forget that you can't read my mind to understand what I mean...sometimes it's clear in my head but doesn't come out so clear in my typed words.