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emmagoldman44 wrote:Just found this conversation - very informative and helpful process. You are so great, Pugsy. What a wonderful resource you are

Also I am super jealous of your sleep data that you put up!!!

One question for SleepyMcgee, just curious: about how long are your hyponeas? ie., 1 - 2 seconds or 3 - 4 seconds or what?

For a hyponea to be scored by *any* PAP machine it has to last at least 10 seconds, same as on a formal, in-lab sleep test.

Wanted to post another night of data. feeling pretty lousy today. Even after 9.5 hours of sleep. Ugh.

Interesting: Whenever I have a flurry of hyponeas, there seem to be leaks...Same when there are pressure increases...EXAMPLE: from about 3:15-4AM there were a bunch of Hyponeas paired with leaks but no pressure increases...Perplexing...I wonder if the machine is seeing leaks are hyponeas for some reason? There are very few instances where there is a hyponea WITHOUT a leak at the same time...Either way I'll be a zombie for Halloween again...YAY!!!

SleepyMcgee wrote:.I wonder if the machine is seeing leaks are hyponeas for some reason?

no. totally different flow conditions.

I'd say you need to raise your pressure. your machine should be doing that, but the respironics are not responsive enough for some people.

palerider wrote:

SleepyMcgee wrote:.
I'd say you need to raise your pressure. your machine should be doing that, but the respironics are not responsive enough for some people.

I've raised it steadily from 4 to 8.5 now...I can continue to up it but there doesn't seem to be any impact on AHI so far...I wonder if any other settings would help (flex etc).

Thanks

FWIW I agree with PR...on both counts.

But remember that part of that increased leak line is increased vent rate...not all of it but part of it pertains to what little pressure increases are being done...that's why you see some little blips on the leak line when you see the pressure probes. Remember that the top leak line includes the vent rate and the vent rate increases a little with the pressure increase. I am not saying the increased leak is 100% related to vent rate all the time...but it does play a factor in the movement of that total leak line.

I don't know what to make of the AHI...it's not responding to the increases in minimum pressure you have done as we would expect it to respond.

I think I would like to see you try a fixed pressure...say at 10 cm..set the minimum to equal maximum in apap mode and see what happens.
I don't know what it will do but it's obvious that this way isn't working so great. Why not try something really different?

BTW I am not nearly as bothered with the AHI (though admit to finding it a bit slightly annoying) as I am bothered with your feeling crappy.

Pugsy wrote:FWIW I agree with PR...on both counts.

But remember that part of that increased leak line is increased vent rate...not all of it but part of it pertains to what little pressure increases are being done...that's why you see some little blips on the leak line when you see the pressure probes. Remember that the top leak line includes the vent rate and the vent rate increases a little with the pressure increase. I am not saying the increased leak is 100% related to vent rate all the time...but it does play a factor in the movement of that total leak line.

I don't know what to make of the AHI...it's not responding to the increases in minimum pressure you have done as we would expect it to respond.

I think I would like to see you try a fixed pressure...say at 10 cm..set the minimum to equal maximum in apap mode and see what happens.
I don't know what it will do but it's obvious that this way isn't working so great. Why not try something really different?

BTW I am not nearly as bothered with the AHI (though admit to finding it a bit slightly annoying) as I am bothered with your feeling crappy.

I can try a set pressure again and see if it helps. I did it a week or so ago with no luck but it was only at 6. I agree, I wouldn't care what the AHI is if I felt great!!!!

There's a huge difference between 6 and 10...plus you really need to use it for several nights to get a fair trial unless the results end up being horrible (aerophagia, centrals, etc) which I don't think you will have a problem with.

Finally...as much as I hate to admit it, your crappy feeling may not be OSA related and we may not be able to reproduce the random "good" nights/days with tweaking the settings.
It may be related to a sleep architecture thing or something else. Maybe some nights you get better quality sleep and it isn't related to OSA or therapy.

Pugsy wrote:There's a huge difference between 6 and 10...plus you really need to use it for several nights to get a fair trial unless the results end up being horrible (aerophagia, centrals, etc) which I don't think you will have a problem with.

Finally...as much as I hate to admit it, your crappy feeling may not be OSA related and we may not be able to reproduce the random "good" nights/days with tweaking the settings.
It may be related to a sleep architecture thing or something else. Maybe some nights you get better quality sleep and it isn't related to OSA or therapy.

I'll try 10 min/max and see...And yes, agree on the 'may not be OSA'...Just want to figure out what it is! I feel like I sleep like a baby but I'm always exhausted. Prior to CPAP I did snore, ALOT, which brought me to the OSA idea...

Switching to a new pulmonologist and hope to get an appointment setup quickly. Need to figure this out.

SleepyMcgee wrote:

palerider wrote:

SleepyMcgee wrote:.
I'd say you need to raise your pressure. your machine should be doing that, but the respironics are not responsive enough for some people.

I've raised it steadily from 4 to 8.5 now...I can continue to up it but there doesn't seem to be any impact on AHI so far...I wonder if any other settings would help (flex etc).

in most cases, the answer to hypopneas, (and obstructives) is "more pressure". flex reduces pressure, (its effect is shown in the lower line on the pressure chart), so lowering flex has the effect of raising pressure a litle.

Pugsy wrote:I don't know what to make of the AHI...it's not responding to the increases in minimum pressure you have done as we would expect it to respond..

my thought, if he needs 10 (for example) for the hypos, then they're going to continue to plague at lower pressures, even though those pressures have been raised.

palerider wrote:

Pugsy wrote:I don't know what to make of the AHI...it's not responding to the increases in minimum pressure you have done as we would expect it to respond..

my thought, if he needs 10 (for example) for the hypos, then they're going to continue to plague at lower pressures, even though those pressures have been raised.

Not sure I follow?


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SleepyMcgee wrote:

palerider wrote:

Pugsy wrote:I don't know what to make of the AHI...it's not responding to the increases in minimum pressure you have done as we would expect it to respond..

my thought, if he needs 10 (for example) for the hypos, then they're going to continue to plague at lower pressures, even though those pressures have been raised.

Not sure I follow?

you said:

I've raised it steadily from 4 to 8.5 now...I can continue to up it but there doesn't seem to be any impact on AHI so far...

and Pugsy said the above.
my point being that whether your pressure is 4, or 8.5, if you have a less responsive machine, (and you do) then you're going to have events even though you've raised pressure, until you get your pressure up to the level that is enough, for you.

sometimes there's a decline in events as pressure goes up, sometimes it's more of an abrupt change, pressure a little too low, problems, pressure enough, much less problem, or almost none.

what pressure do you need? we don't know yet. if you had a resmed machine, we'd probably know, because resmeds are much quicker to action in most cases than respironics... which basically means that it's even more important to get the right minimum pressure with a respironics, because it's not going to find it for you as easily.

I follow.

I don't know that more pressure is the ultimate answer for the hyponeas for sure for everyone. It is of course the first thing we try because most of the time it works.
Hell, he may be like me and no matter how high I took the minimum I found out that the AHI had plateaued and didn't change.

At this point I would want to try to resolve the crappy feeling more than worry about the AHI. If the AHI was perfect 0.0 and he was still feeling crappy we would likely do this very same approach in hopes of getting lucky and consistently have more good nights/days in terms of how a person feels.

Hence going to higher pressure fixed...eliminate the pressure variable as a potential disruptive factor (just in case Den is right) and use a little more pressure all night long to see if it helps or not.
Won't hurt and might help and anything that "might" help is worth trying in my book.

Pugsy wrote:Won't hurt and might help and anything that "might" help is worth trying in my book.

well, the auto pressure isn't doing much, if any good, at this point

palerider wrote:well, the auto pressure isn't doing much, if any good, at this point

It sure as hell is sitting by and twiddling it's little thumbs isn't it?

I really wish he had a ResMed to try...I don't know that it would make any difference in anything but it might.
He might be one of those people who respond better to the way the ResMeds go about their job.

Maybe if he ever gets in the market for a back up machine a Resmed would be a good option to try instead of sticking with Respironics.