djam's therapy thread

[djams]

Here is my first sleepy head data. I've been on treatment since 04/24, and resisting using SH because I'm afraid I'll obsess over it.

But I decided that if I can use it to make myself feel even better, it's silly to not use it.

My conclusion from this chart is that my upper pressure still needs to be raised. This seems obvious from the flat tops on the pressure graph. But I'd be guessing at what the correct upper limit should be. My initial upper pressure was 12, raised to 13 at my 1 month follow-up.

And some questions. If I zoom in on the problem areas, I can see some of my OA's are pretty long in duration. Like 40-56 seconds. Would this be considered a "normal" length for this event? Lower pressure - I have no idea what I might see on this graph that would indicate that the lower pressure should be adjusted. What would that look like, or is it present here? I adjusted my prescribed lower pressure from 5 to 6 a week or so ago, simply because when I put the mask on at night, I wanted more air. Probably not a valid reason.

Would love to hear any and all observations about the charts/data - to help me learn.

Thanks in advance!

20180625.PNG (163.67 KiB) Viewed 33359 times

[Okie bipap]

You could raise your upper limit to 20 which is the machine's maximum. This will allow the machine to go as high as it needs to. It may only go up 1 or 2 cm more. I would also raise the lower number. Try going up 7 cm. Others here will probably recommend a larger jump in the lower number, but I have found it less disturbing to my sleep to make small changes to the lower number.

[palerider]

My conclusion from this chart is that my upper pressure still needs to be raised. This seems obvious from the flat tops on the pressure graph. But I'd be guessing at what the correct upper limit should be.

Yes, you're right. As to the 'correct upper limit', in the vast majority of cases, there is no correct upper limit, set it at 20 and ignore it. If you need 14, and your machine only goes to 14, then it doesn't matter if the max is set to 14.2, 20, 25, or 30 (only a few machines go that high).

And some questions. If I zoom in on the problem areas, I can see some of my OA's are pretty long in duration. Like 40-56 seconds. Would this be considered a "normal" length for this event?

I'm not aware of any 'normal' duration... my concern is preventing them in the first place.

Lower pressure - I have no idea what I might see on this graph that would indicate that the lower pressure should be adjusted. What would that look like, or is it present here?

The min pressure is the important one to set, it needs to be high enough to prevent the majority of events... when you see a pressure trace like the one towards the end of your night, where the pressure jups up, then falls, then jumps up, then falls, that means that you've got the min pressure set too low... The machine will always try to get back to the min pressure you set... when it's too low for you, then you end up with more events. I usually look at what pressure it is just before it jumps up (zooming in is handy there) and set the min pressure just above that level.

I adjusted my prescribed lower pressure from 5 to 6 a week or so ago, simply because when I put the mask on at night, I wanted more air. Probably not a valid reason.

Totally valid reason.

[Pugsy]

You may have a strong positional aspect to your pressure needs.
Parts of the night your settings prevent the apneas from happening and parts of the night it is quite obvious that the machine wants to go higher but can't because of the limitation on the maximum.
I suspect you were on your back at those times. It's common to need more pressure when we are on our backs.
It's also common to need more pressure during REM stage sleep. I am not sure that when you turned the machine back on at 23:00 that you had enough time to go to sleep and get to first REM at 23:30 (normally takes around 90 minutes) and that's why my first thought was sleeping on your back.

If that were my report I would start simply by raising the maximum and see where the machine wanted to go and see if the AHI reduces if the machine can go higher. Might be all that is needed.
Might need a little more minimum but can't really tell until we see what might happen with just a little more room for the machine to roam.

Oh...anything you need to do for a comfort reason...that makes it a valid reason. If we aren't comfortable we don't sleep so great and the name of the game is getting good sleep quality by whatever means necessary.

[D.H.]

I agree with setting the max pressure to 20 (the machine max). You can put it back down if you experience either of the following:

1) Annoying noise, annoying leaks, or discomfort related to higher pressures. Note that minor leaks are compensated for automatically.
2) Clear airway events that seem to be associated with higher pressures.

[djams]

Wow, thank you all SO much. I really appreciate your willingness to help me out. Not to mention the dedication.

I do naturally want to sleep on my back, and I am a very heavy sleeper. When my wife could manage to wake me up to stop snoring, it was always to roll onto my side. I recall from my sleep study results that I spent 80% of the night on my left side. Go figure. Who knows what my AHI would've been if I'd slept on my back as usual. After reading here, I've been making an effort to fall asleep on my side. But I'm always on my back when I wake up.

I'm going to max out the pressure tonight, per everyone's advice. That make a lot of sense to let the machine tell me how much pressure I need. It's odd that the titration didn't come up with a higher number? Maybe their strategy is to ease me into it. Hopefully I'll be able to control leaking. Does the "run leak test" menu pick use maximum pressure?

I'll report back in a few days on how it goes.

And again, THANK YOU ALL!

Edit to add: especially appreciate the assurance that comfort is just as important as anything else.

[Pugsy]

It's odd that the titration didn't come up with a higher number?

Maybe it's just simply you spent most of the time on your side and higher pressures weren't needed on your side. They may not have had much time with you on your back enough to see the higher pressure needs.
I had something similar happen at my titration study except in my situation it was REM sleep where my OSA is worse and I need a lot more pressure. I only got 6 minutes of REM during my titration sleep study. I came out of that study with a recommended RX of 8 cm which works great for non REM but when I get in REM I might need 16 to 18 cm.
Not everyone will experience such big changes in pressure needs when supine or in REM but it's fairly common. Not rare at all.

[palerider]

It's odd that the titration didn't come up with a higher number?

Based on the number of people who end up here (and elsewhere) looking for help... titrations are often wrong.

[djams]

Here's my results after 3 nights on the recommended changes. Unfortunately I forgot to put the card back in the machine last night, so all I have is summary data.

I'm thrilled! Only downside so far is that I'm extra gassy in the morning. But that's no problem. I'm also including the results for my last night on the old settings, and the AHI history from myAirweb (which I should've included in my initial post).

The more I thought about it, the suggestions to raise minimum pressure seemed really important. So I raised both min and max.

Going forward, I see no reason at all to back off the upper pressure, and it looks to me like my lower pressure needs to end up in the 12-13 range. I'll start slowly sneaking up on that. Again, please correct me if I'm thinking wrong here.

Thank you all so much for your help. Without your advice, I would've continued as shown on the myAir chart until my next followup in September. I feel like near zero AHI's are possible on a regular basis in my future.

Unsure how many attachments I'll be able to add, so they may be continued in the next post.

Edit: Sorry about the size of the myAir chart. It was little-bitty on my phone.

[djams]

The rest

[palerider]

Going forward, I see no reason at all to back off the upper pressure, and it looks to me like my lower pressure needs to end up in the 12-13 range. I'll start slowly sneaking up on that. Again, please correct me if I'm thinking wrong here.

You're not thinking wrong. The max pressure is irrelevant for most people. Unless you're getting aerophagia, I can't see any reason for setting a max. all it does it keep the machine from being able to prevent OA/HA, flow limits and snoring, all things that are bad for you.

You may or may not need a min that high, At least 11 I'd think, though. sometimes though, enough min pressure will smooth things out so that you don't end up with the pressure jumping up as much...

keep at it

[zonker]

***TO THE NEWBIES***

please note what this smart user here did. the smart user came back and updated the post! this helps the experts here to keep track of what is going on with the posters therapy.

that is all.

[djams]

You're not thinking wrong. The max pressure is irrelevant for most people. Unless you're getting aerophagia, I can't see any reason for setting a max. all it does it keep the machine from being able to prevent OA/HA, flow limits and snoring, all things that are bad for you.

You may or may not need a min that high, At least 11 I'd think, though. sometimes though, enough min pressure will smooth things out so that you don't end up with the pressure jumping up as much...

keep at it

Will definitely keep at it. It's a great feeling that control of this therapy is in my hands(well, yours really). Was pretty silly of me to resist using SH. Although, maybe the timing was ok as it allowed me to get over my angst. A recommendation for max pressure would've freaked me out during the first couple of weeks.

Will return with updates as appropriate. Thanks again for your assistance.

[djams]

***TO THE NEWBIES***

please note what this smart user here did. the smart user came back and updated the post! this helps the experts here to keep track of what is going on with the posters therapy.

that is all.

Wouldn't make much sense to do it any other way. I do like being called a "smart user". You may become the first on my "friend" list because of that.

[djams]

Didn't think I'd be back so soon with an update. Last night's results surprised me though.

Fell asleep right away at start of night. Normal bathroom run at 11:30. Fell asleep on my side both times. Woke up at 2:30 on my back with my mouth hanging wide open, and dry as the Sahara. Laid there for a bit trying to decide if I'd be able to fall back asleep with the pressure I was feeling, quickly determined no, pulled the hose and let the machine do it's auto-off thing. Plugged the hose back in and fell asleep pretty much immediately, again on my side.

Then I pulled the data and find out that I spent 1.25 hours at max pressure. I'm pretty sure this is what woke me up, which isn't easy. As I've stated before, very heavy sleeper. I've been bumping the 20 pressure every night since my last update. Until now, it's been just a touch followed by an immediate drop.

I suppose an obvious question will be - did I go overboard celebrating the 4th? I did not. It's very rare for me to drink alcohol these days.

What I'm wondering is: If this continues, better to stay at max pressure with a brief wakeup? Or lower the max pressure and let the AHI go up? Not changing anything based on this one night.

One things for sure - Pugsy's comment above about a "strong positional aspect" were spot on.

Still no aerophagia symptoms, nothing uncomfortable anyways.