Newbie: How am I doing based on Sleepyhead results? I have questions! Thank you!

Hello All,

Thank you for providing this resource! As a new CPAP user, it's a bit daunting to figure things out.

I've done a ton of reading on this forum, and online in general. I have used my CPAP every day for the last 3 weeks.

I was diagnosed with "Moderate" apnea after an at-home sleep test. I believe the AHI number the doctor mentioned was 24 (not sure why I don't have that in writing somewhere...)

I have a follow up scheduled at the 60 day mark, but that seems pretty far off before making (or asking the dr to make ) adjustments to my therapy.

I'm using the Philips Respironics, DreamStation, Auto CPAP (500X110); I tried the Dreamwear Nasal Mask, but I have nasal congestion (which I've had for many years, I believe related to allergies), so found myself having trouble breathing enough just through my mouth. So I switched to a Small Dreamwear Full Mask, which I've found to be pretty comfortable (though I am concerned about leak rate, which seems to fluctuate a lot, plus drooling (which is not a huge issue, just an annoyance)).

I have noticed the following benefits since starting treatment:
1. Less waking up, less bathroom visits (many nights no visits at all and maybe 1 - 2 awakenings). This is a bit less waking, and reduced bathroom from an average of 1-2/night.
2. No heartburn. I had one very minor heartburn evening, but otherwise none at all. This is down quite a bit from normal, which can be 2x/week or so (depending on stress level I believe, plus of course, food/drink).
3. Overall I feel less tired, so more energy! While I still take naps on weekends when possible, I generally feel more energy than before I started.
4. I know I'm healthier!

My biggest question is around AHI. If I was, in fact, around 24, I seem to be averaging around 12 (per Resperonics data), and 9.81 per Sleepyhead. But I've read that most people try to get as close to zero as possible (though this may not fit for everyone, nor need be possible). Also concerned about Mask Leaking (seems to vary pretty greatly per night) and if I'm using the best possible choice for me.

I'm attaching my chart and summary. I've tried to follow the directions as to how to present these, so hopefully I did a good job (I'm very achievement oriented!)

I appreciate any help from the forum, and I'm grateful this form exists, and that there are so many supportive people here.

Thank you!

Bones2k

Bones2k wrote: ↑

Sun May 05, 2019 12:01 pm

Hello All,

Thank you for providing this resource! As a new CPAP user, it's a bit daunting to figure things out.

I've done a ton of reading on this forum,

Please read a bit more:
viewtopic/t158560/How-to-post-images-for-review.html

Welcome to the forum.
Next time you post images of your reports...omit the snore, AHI and respiration rate graphs which will allow you to make your other more useful graphs larger and easier to evaluate. All you really need in terms of graphs are
Events
Flow rate
Leak
Pressure.

Assuming you were actually asleep for the bulk of the night shown .....You need more minimum pressure than the 5 you have it set at right now. Not sure how much more but I suspect at least 8 cm ...maybe even more.

Your leaks aren't bad at all. A lot of the movement in the leak line is simply the way the machines reports leaks. Respironics reports total leak which is excess leak PLUS the mask expected vent rate which will vary with pressure...more pressure equals more vent rate.

Here's what I tell people when they see the red line statistic that scares the devil out of them.

Disregard that warning from SH. Your leaks are NOT excessive.
Instead the statistic reporting the % of time in large leak is based on a ResMed calculation number and that number won't work for your Respironics machine.
Open SH and go to Preferences and then the CPAP tab. SH Defaults to a red line leak threshold of 24 L/min which is a ResMed leak number...won't work with your machine. Your red line threshold number is more like 75...so change the 24 to 75 or just turn off that statistic by removing the check mark.

If you hit large leak territory it will show up in the top events line on the events graph....LL
I can tell by your max leak rate...you never hit large leak territory.
So quit worrying about large leaks.
Now if any leak wakes you up no matter how big or small then it needs to be fixed because it is disturbing your sleep....but at this point on this report...no large leaks.

All in all for a newbie report....really quite decent. Needs some AHI reduction which will most likely be easy to accomplish simply with a more optimal minimum pressure giving the machine a better head start on holding your airway open.

Thank you Pugsie. I appreciate the input.

Posting new report with just the topics you mention above, in case this is more helpful.

Do you think I should up my minimum on my own, or ask doctor?

Also, is my upper limit (assuming they programmed one into the machine) high enough? I'd think more pressure is likely to bring AHI down (though I understand that is not always true).

Also, when you say "All in all for a newbie report....really quite decent" what are the key variables you are looking at to come to that conclusion (so I may understand myself)?

Thank you!

Brad

Your maximum pressure setting....if you never reach it then it really doesn't matter what it is. No need to raise it from what it is now if you never hit what the max is now.

I can't tell you what to do about changing the pressure on your own or waiting for your doctor...that's something you have to be comfortable doing. Obviously I am comfortable doing a lot of things on my own but that is something you have to decide if you want to do it or not. I can tell you what I would do...but that's as far as I would go.
Some people are comfortable managing their own therapy and some people ar.en't but I will say this....don't do anything without fully understanding what you are doing and why you are doing it and what to expect and you are okay doing it.
Don't do something just because someone on some forum says "you need to do so and so".
I can offer suggestions as to what it might need to be based on my past experience but I can't come over to your house.
What I prefer to do is educate people so that they can figure out what they need to do to accomplish goals...and not just say "change to so and so pressure".

There is a huge learning curve though...and I have a 10 year head start on you.
The all in all comment....mainly because you are new and even though the AHI is too high...at least you slept and you are noticing some improvements even with a less than stellar AHI. You didn't come here with a report showing only 3 or 4 hours of sleep and saying you didn't see any improvement at all and you don't see how in the world you can do this stuff.
The only thing really needing work is the AHI and that should respond quite nicely with more minimum....and one problem to fix is a whole lot better than half a dozen problems to try to fix.

I took the initiative to adjust my settings after lots of reading and advice from this forum..
At first my Dr. Was not happy about it, but I calmly explained to him my rational for making the changes and what I had done..

Afterwards he was much more comfortable with me making changes since I had obviously educated myself. ( with help from this forum)
He worries about patients making changes willy nilly based on nothing

Vinny V wrote: ↑

Mon May 06, 2019 8:06 am

He worries about patients making changes willy nilly based on nothing

I would worry about that myself.
My doc was also okay with me taking control of things once I explained why I did something and what I was looking to accomplish.
A good doc will welcome an educated proactive patient.
A not so good doc will get his panties all in a wad because he has a serious God complex power control freak issues and doesn't like for patients to think for themselves. Those kind of docs are my "former" docs.

Thank you for the ongoing replies.

I just spoke with a technician at the doctors, and asked about my AHI and settings.

She said that based on the data she's looking at, Mask Fit is her biggest concern due to high leakage.

She said one day there was a 3 hour leak.

When I look at Dream Mapper, it does go up and down daily, with some days in the 90%s and others in the 60s.

Based on Pugsy's first comment you said:

---- If you hit large leak territory it will show up in the top events line on the events graph....LL
---- I can tell by your max leak rate...you never hit large leak territory.
---- So quit worrying about large leaks.

I generally like the Dreamwear full face mask, but have not tried others. She has me coming in, in a couple of weeks (due to my travel), to try other masks.

I'm curious why she focused on leaks, where you said you're not seeing large leaks.

Thank you!

From your SH summary, it looks like you do have some large leaks. Check at the bottom left on you Daily page to see if the LL flags are turned on. You should see green/black, not red/black. (I just learned this from Pugsy.) But even if you have LLs, your technician should have paid attention to your AHI. Did she have anything at all to say about it?

She just said we need to look at the leak, as pressure won't matter if there is so much leaking. She seemed to be suggesting less leak, better pressure, better AHI. But did not address AHI at all.

Bones2k wrote: ↑

Mon May 06, 2019 11:00 am

I'm curious why she focused on leaks, where you said you're not seeing large leaks.

She's seen other reports...I have seen only this one above.
Now maybe the large leak flags were turned off and that's why we don't see any on the events graph...so check to make sure.
You may have some large leaks but I seriously doubt that 63% of the night was in large leak.

Large leak territory for Respironics machines is somewhere up around 80 to 90 L/min total leak. It varies with the pressure.
So a good bit of the up and down of your leak graph line is simply because the pressure goes up and down so much.