Newby - Need help with charts

Hi all -

This forum has been so very helpful to new CPAP users. Background - Got my device on July 27, 2018 and have used religiously each night. Feeling better, less daytime drowsy and less exhausted by 9PM at night. API's pre treatment were 17-24 per hour. 24 when back sleeping. Pressure setting is 7 as per prescription. Use ramp and exhale relief is on, auto humidifier and heated tubes.

Some weird happenings 3 out of last five nights. Between 3:30 -4:30 AM several bunches of events. Normally wakes me up and I feel like air starved or unable to get enough air. Usually mess with the mask and try to make sure no leaks. Full armara view face mask.

Looking for insight and suggestions....

Welcome to the forum.

The 2 usual suspects for when we see clusters of events and the rest of the night things are pretty uneventful are sleeping on one's back and REM stage sleep or maybe someone is doing both and sleeping on their back and in REM stage sleep.

Both supine sleeping and REM stage sleep are well known to sometimes make OSA worse and/or cause a need for more pressure.
I happen to have the REM stage sleep thing where my OSA is about 5 times worse and sometimes I might need 6 to 8 cm more pressure to deal with the extra stubbornness of the REM apnea events. Now I could use fixed pressures like you are using now but to do that would mean I would have to use upwards of around 15 cm pressure all night just for 20% of the night I might be in REM. Let's see...start out with 7 cm during the night and let the machine auto adjust to 15 if it needs to or start out the night at 15 cm...no brainer there. 7 cm is so much more comfortable than 15 cm and I only use the 15 during the 20 % of the night I might need it.

So you can either switch over to apap mode and let the machine sort out the pressure needs or increase your 7 cm fixed pressure to something higher. How much higher we don't know...it might be just 1 or 2 cm more or it might be like me 5 to 8 cm more.

So my thoughts on what I would do if this was happening to me (and it did years ago when I first started therapy) would be to switch over to auto/apap mode and let the machine sort it out and then decide if you want to keep apap mode or go back to cpap fixed mode with a higher pressure.

My suggestion....auto mode...minimum of 7 where you are at now and maximum of 12 for right now...see how high it wants to go and lessen chance of it going higher and maybe creating aerophagia issues. Then see if we need to let it go higher.

If you don't know how to change modes/pressure.....the clinical manual explains how to get into the ultra secret location where you have the powers to change stuff.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

pyater wrote: ↑

Wed Aug 15, 2018 5:57 am

Hi all -

This forum has been so very helpful to new CPAP users.

Please review, and follow, the sticky at the top of the front page posts "Sticky: Newbies PLEASE READ BEFORE POSTING"

Especially #4

Thanks for the insight - I did cross reference those 3 nights with my fitbit sleep data and all three align with a REM sleep stage. I will try changing the settings.

Suggested changes made (APAP) Min 7 mx 12 and here is last night's charts - Tried to cleanup charts as per sticky...couldn’t figure out how to lose the pie chart...Feel better, looks like it only went to 8.56 on auto. Should I be concerned about Clear Air (Centrals)? I have been reading the CPAP therapy can lead to centrals....Only been on therapy since July 27th.

pyater wrote: ↑

Thu Aug 16, 2018 5:39 pm

Should I be concerned about Clear Air (Centrals)? I have been reading the CPAP therapy can lead to centrals....

No, you shouldn't.

"cpap can cause centrals" is probably the most overblown, overhyped thing about cpap.

Yes, it can, in a few people.. (6-15%, give or take). and even then, it's typically not a big deal.

If your CAI is under 5, ignore it.

Here are two recent Charts - Have been on APAP and new pressure range of 7 Min and 12 max since Wednesday night Aug. 15th. AHI's are good. Some nights I feel good and some nights still get woken up late in sleep cycle - Go to bed ~10PM and between 3:30 Am and 4:30 AM wake with feeling of hyperventilation or air starved. Based on Fitbit sleep data seems to align with REM sleep. Usually reset the mask stay up for a little while (takes a little while to recover). Not sure if it leak related. Wondering if someone can look at the charts and see anything. Here are Friday and Sunday night charts.

Your pressures are *very*low, if you're waking up feeling air starved, then raise the pressure by a cm or two, *or* turn EPR off. (That has the effect of raising base pressure)

Thanks - I have a question about the EPR setting on the Resmed Airsense 10. Mine is currently set to 3. Should I try ramping down to 1 or 2? I am not familiar with that setting.

pyater wrote: ↑

Mon Aug 20, 2018 1:40 pm

Thanks - I have a question about the EPR setting on the Resmed Airsense 10. Mine is currently set to 3. Should I try ramping down to 1 or 2? I am not familiar with that setting.

Lowering EPR has the effect of raising the pressure, change the EPR or change the pressure, one or the other.

pyater...where are your clinicians in all this pressure-changing picture? Are you communicating with your sleep doctor - respiratory therapists - regular doctor?

They really did go to school for a long, long time to become qualified to extend professional help - especially to CPAP newbies. Part of effective treatment is a good working relationship with your medical professionals. On this forum, we're here to support you in what your doctor has diagnosed and prescribed and to encourage you in the doctor/patient relationship.

I'm an OSA patient. I wouldn't want to depend on amateurs for my treatment decisions.

snuzyQ wrote: ↑

Mon Aug 20, 2018 10:19 pm

pyater...where are your clinicians in all this pressure-changing picture?
I'm an OSA patient. I wouldn't want to depend on amateurs for my treatment decisions.

We don't need some busybody coming in here and telling people "go talk to your doctor". This is a *SELF HELP* forum.

If you don't like "amateurs" giving advice, you're in the wrong place.

pyater….

There's also the matter of your medical chart. Your clinicians are not paying attention to any of the pressure changes you are doing unless you bring it to their attention and it gets charted into your record.. Nothing will get charted before you next meet with your clinician - even though your data is transmitted wirelessly.

Do you see how interacting with your clinician could really save your bacon - especially in a medical emergency where you require hospitalization. It will be in your chart that you use CPAP. The original doctors prescription will be noted and guess what? The pressures that they give you in the hospital will be the ones that were originally set. If you are unconscious, your outcome could be affected.

There are advantages to having a doctor look over your shoulder when it comes to your "self help". Patients are known to harm themselves in their quest for "self help". On this forum, we surely wouldn't want to bring harm, would we? As a newbie, as we once all were, we need to be carefully looked after with the big picture in mind.

You really can't have a big picture view without your doctor's involvement.

snuzyQ wrote: ↑

Mon Aug 20, 2018 11:01 pm

pyater….

There's also the matter of your medical chart. Your clinicians are not paying attention to any of the pressure changes you are doing unless you bring it to their attention and it gets charted into your record.. Nothing will get charted before you next meet with your clinician - even though your data is transmitted wirelessly.

Do you see how interacting with your clinician could really save your bacon - especially in a medical emergency where you require hospitalization. It will be in your chart that you use CPAP. The original doctors prescription will be noted and guess what? The pressures that they give you in the hospital will be the ones that were originally set. If you are unconscious, your outcome could be affected.

There are advantages to having a doctor look over your shoulder when it comes to your "self help". Patients are known to harm themselves in their quest for "self help". On this forum, we surely wouldn't want to bring harm, would we? As a newbie, as we once all were, we need to be carefully looked after with the big picture in mind.

You really can't have a big picture view without your doctor's involvement.

This new person has a lot of opinions, none of them are helpful here. This post in particular is garbage.

Ignore this person.

palerider…

I'm so sorry if I offended you. I can see that you've had many years on this forum and many posts that would hardly qualify you as an "amateur" in the realm of offering advice on a forum such as this.

When I wrote about "amateurs", I was referring to amateurs in the field of medicine - which we all are who have not graduated from medical school.

My comment was never intended as a slam against you. You know so much, I'm not sure I can add anything to you but I'm hoping you can respect and encourage the new ones on this forum who are reaching out to help others.

I'm trained as a nurse and have spent years in the field of health information technology, yet I would never put myself forward as if I were a medical professional. And I go see the doctor from time to time, too, because I can only be my own doctor sometimes and I know where that line is.

I wish you well palerider. I hope we can be friends.