Plenty of hypopneas. New to CPAP with a couple questions

Snoregone Conclusion · Post by **Snoregone Conclusion** » Fri Nov 02, 2018 11:52 am

Sooner or later I'll get back to my own thread and fill in the story, it's a weird one due to the sleep study company hosing things up...

My take-home sleep study was a 3 night 6 hours per night thing, and they picked just one night out of 3 to analyze. I note that whichever night it was, was NOT a bad night with nocturia which would indicate desats that got below some unknown threshold.

Even so, I ended up being at 90% oxygen over 50% of the time. Overall RDI average of 6.2, some peak 10 minute average (extrapolate to hourly) of about 50. What was my AHI? .9. Seems more like UARS (regular doctor had me take the sleep study, was puzzled with numbers, agreed to prescribe machine after discussing options, saying not everything in medicine is 100% absolute). The only time in years I can remember sleeping on my back is during the sleep study time, and that took effort.

While my sleep is still very fragmented (I usually wake up about every 90 minutes to be WIDE AWAKE at the end of a sleep cycle), it's been far more restful and restorative using the machine, even though the mask solution isn't fully worked out, etc.

And yes, my issues likely have been life-long, and progressed over time to be what they are today: it didn't happen overnight, it happened over many nights! As such, Julie's guidance came across as insanely stupid, I won't apologize for that characterization, especially considering how she's behaved and assessed things in other threads. She should have known better.

tingull · Post by **tingull** » Fri Nov 02, 2018 3:17 pm

I'm not exactly sure what I'm looking at here, but I imported the data and on the left is the hypopnea section. Is that the number of seconds each event lasted in the parenthesis?

: SleepyHead_v1_0_0-beta-2__cb213cc_OpenGL___Profile__tingull_.png (184.49 KiB) Viewed 1719 times

palerider · Post by **palerider** » Fri Nov 02, 2018 3:23 pm

tingull wrote: ↑
Fri Nov 02, 2018 3:17 pm
I'm not exactly sure what I'm looking at here, but I imported the data and on the left is the hypopnea section. Is that the number of seconds each event lasted in the parenthesis?

No, your machine doesn't work that way.

Pugsy · Post by **Pugsy** » Fri Nov 02, 2018 3:29 pm

With ResMed machines the number in parentheses is duration of the event in seconds. ResMed machines actually measure duration.

Respironics machines do not measure event duration at all but instead they use some sort of marker system and the number in parentheses is those markers. They are probably related to event duration because years ago Respironics machine actually report a total time in apnea and they would need some sort of event duration data to calculate total time in apnea.
They don't report total time in apnea now.
You won't find it on an Encore report now.
Those markers do correspond very closely to event duration in seconds though. Might be a couple of seconds off but not enough to really cause much of a difference.

If you see 8 in parentheses (can't be 8 seconds because to earn a flag all events must last at least 10 seconds) it was probably a 10 second apnea event.
If you see a 30 in parentheses it's a safe bet that it was probably within a couple of seconds either way.
A while back I sat down and actually zoomed way in and counted event duration in seconds (probably looked at close to 100 events) to see how close the number in parentheses was to what I counted....sometimes it was spot on and sometimes it varied a couple of digits...

It's close enough that I am comfortable using it as event duration in seconds even though not technically something the machine itself gives us. Close enough for government work I always say.

tingull · Post by **tingull** » Fri Nov 02, 2018 3:41 pm

Thanks!

Is it not advisable to change the pressures myself, and wait until my next appointment with the sleep doctor and let them do it? My AHI ranges from usually from low 5's to high 12's. Its not been stable since I started a couple of weeks ago. But I don't want to get in some sort of trouble for upping the pressure.

Pugsy · Post by **Pugsy** » Fri Nov 02, 2018 3:54 pm

If you aren't comfortable changing the pressures yourself then don't do it.
Some people are comfortable doing it and some people aren't.

Me...I am quite comfortable doing a lot of stuff on my own.

I changed my pressures long before I saw my doctor for that first follow up.

It's only air....and the changes are actually very small. Did you know that even at max 20 cm the machine can't even blow up a balloon?

The worst than can happen...you might get some air in the gut issues with more pressure...called aerophagia and normally easily dealt with.
Or maybe more pressure triggers centals...it's not all that common but can happen. When it does we stop and regroup and discuss options.
Or the doctor gets his panties all in a wad...and that's more of an ego thing than medical thing.

You can't really hurt yourself with a little increase in the pressure...and you need it to better prevent the airway from collapsing.

tingull · Post by **tingull** » Fri Nov 02, 2018 4:02 pm

Thanks. I've always been sort of comfortable going rogue (within reason). I'll give it a shot at small increments and see how it goes.

tingull · Post by **tingull** » Wed Nov 07, 2018 4:56 pm

well, just to add a note: I upped the pressure by 1 and the mask blows off my face unless I'm in one particular position: straight, flat on my back. It's probably the mask cushion, and I've ordered a medium-wide to see if that helps. But I'm still in the 9-12 AHI and it shows it max's out the pressure setting, which is set to go 3 above (and below) the pressure that's set (which is at 8 now).

We'll see what a new mask cushion brings.

zoocrewphoto · Post by **zoocrewphoto** » Thu Nov 08, 2018 2:03 am

tingull wrote: ↑
Wed Nov 07, 2018 4:56 pm
well, just to add a note: I upped the pressure by 1 and the mask blows off my face unless I'm in one particular position: straight, flat on my back. It's probably the mask cushion, and I've ordered a medium-wide to see if that helps. But I'm still in the 9-12 AHI and it shows it max's out the pressure setting, which is set to go 3 above (and below) the pressure that's set (which is at 8 now).

We'll see what a new mask cushion brings.

What do you mean by 3 above and below?

Are you talking about the pressure and the exhale relief (which goes down from the pressure)? Are you talking about a set range? What is the machine actually set for?

For example, my pressure is set for 11-17. I use an exhale relief of 2. That means that when I inhale, the pressure is somewhere between 11 and 17, based on my needs. And my exhale pressure is always 2 below the inhale pressure. But there is no setting that can go 2 (or 3) above and below my pressure. I know there are some fancy machines that can do some sprecial stuff, but the machine listed in your signature doesn't appear to be one of those.

tingull · Post by **tingull** » Thu Nov 08, 2018 3:55 pm

In my machine I have a set pressure, say 7, there's a setting in it that the doctor set where it will go 3cm/h2o below (for exhale) and it can go up to 3cm/h2o if it feels I need it. So my range for each night always says 4-10. I put it up to 9 for two nights and it was a range of 6-12. It's always maxing out the pressure whatever number it's set at right now. And my AHI last night was 10.1, but I had the mask on the longest I've had it on since I started, so I felt pretty accomplished! Almost 7 hours!

palerider · Post by **palerider** » Thu Nov 08, 2018 6:51 pm

tingull wrote: ↑
Thu Nov 08, 2018 3:55 pm
In my machine I have a set pressure, say 7, there's a setting in it that the doctor set where it will go 3cm/h2o below (for exhale) and it can go up to 3cm/h2o if it feels I need it.

That's not how it works. You're talking about aflex, and it can drop pressure *up to* 2cm, if it's set to 3, (the 1, 2, 3 on *flex do not correspond directly to pressure reductions as they do in Resmed machines.

tingull · Post by **tingull** » Thu Nov 08, 2018 7:15 pm

Well that’s how the tech explained it to me. It’s a fixed pressure machine that I set at 7.5 (they set it at 7) and this is what DreamMapper shows:

Pugsy · Post by **Pugsy** » Thu Nov 08, 2018 8:03 pm

Respironics has never done a per cm reduction when using the Flex exhale relief. Only ResMed machines can do that.
Respironics bases the actual amount of exhale relief on the air flow or in other words how forcefully you breath.
The most you can get in terms of relief or drop during exhale is 2 cm reduction and that's if you breath more forcefully.
It's always been the way that Respironics has done their exhale relief since they started offering it.
Maybe the tech was thinking ResMed machine or maybe they just assume that each setting relates to a per cm reduction.
From Respironics....

palerider · Post by **palerider** » Thu Nov 08, 2018 8:15 pm

tingull wrote: ↑
Thu Nov 08, 2018 7:15 pm
Well that’s how the tech explained it to me. It’s a fixed pressure machine that I set at 7.5 (they set it at 7) and this is what DreamMapper shows:

Tech's are notorious for

Not understanding things
inadequately explaining things
lying/being ignorant (your pick)

You'd do well to question everything that they tell you.

Whether the tech that explained it to you simply didn't know what they were talking about, or didn't care to bother to explain something somewhat complicated to you clearly is an unknown.

tingull · Post by **tingull** » Fri Nov 09, 2018 6:06 am

So could someone explain why the app says it had a max pressure of 3 above and below where the pressure is set at? I can’t seem to find an answer to that by reading the manual or searching around. Thanks

Plenty of hypopneas. New to CPAP with a couple questions

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