Need Help with Better Sleep and Pressure Sets

ajack · Post by **ajack** » Wed Jul 03, 2019 8:10 pm

apap_user wrote: ↑
Mon Jul 01, 2019 10:26 am

ajack wrote: ↑
Sun Jun 30, 2019 7:58 pm
dreamstation machines, don't raise the pressure, if the timing of the events are not what the algorithm is using. You can get events that the machine doesn't respond it. I would follow basic procedure and raise the min pressure 1cm at a time, till the events subside
http://c398534.r34.cf1.rackcdn.com/DOCU ... Canada.pdf
Hello ajack, the titration pdf you linked is a great reference, thank you for providing it. I just read through it for the cpap titration and noticed the recommendation to reduce pressure by 1cm if central apneas persist. I was getting a few CA events a night at a max pressure of 14.0. By recommendation from raisedfist I did increase the setting for max pressure to 20 last night and had no CA events so that's a positive. But correct me if I'm wrong, doesn't that go against the titration guideline to reduce pressure by 1 and observe? I do understand raisedfist's reason for suggesting I raise the max pressure, since I was hitting the 14.0 max or approaching it in several instances.

You can see for most of the night 11-13 is enough, there are cluster OA happening that need 15.... because?? you are on your back, you may have tucked your chin, you neck may be bent forward and other reasons.

You have a choice..
If it's just back sleeping, I would raise the min pressure to 15 to resolve these events. You use the 95%. As long as the pressure is a bit below the max on oscar, you know you are not over pressure.
clinicians use 95% and max to set pressure with apap titration
https://aasm.org/resources/practicepara ... rating.pdf
OR
You keep trying and move to min 13 and try to minimise the things that cause the cluster OA/H and snore that raise the pressure. Then see what pressure the machine is using to clear them and use that as a min. So the pressure is above these events in the first place. See if you still need 15.

You have very little CA and aren't worth factoring in at this point. You also ignore the reference to CA/H. I would resolve your obstructive first, then look at CA, remembering that for most users, pressure induced CA resolve over 12 weeks

apap_user · Post by **apap_user** » Wed Jul 03, 2019 8:17 pm

palerider wrote: ↑
Wed Jul 03, 2019 12:05 pm

apap_user wrote: ↑
Wed Jul 03, 2019 11:39 am
Last night's report is below. Much better I think. I had to reduce the pressure back to 10.5, just to see if the cluster of OAs I was getting at 11 would go away and it seemed to be better , at least according to the chart.
*sigh* a change of 0.5 is negligible, it's better because you had a better night.

But, if you want to keep twiddling with the pressure every night.. that certainly is your right.

I'll take to the advice, thank you. Fingers off the pressure knobs now.
I'm still using the cervical pillow.

apap_user · Post by **apap_user** » Wed Jul 03, 2019 10:47 pm

ajack wrote: ↑
Wed Jul 03, 2019 8:10 pm

apap_user wrote: ↑
Mon Jul 01, 2019 10:26 am

ajack wrote: ↑
Sun Jun 30, 2019 7:58 pm
dreamstation machines, don't raise the pressure, if the timing of the events are not what the algorithm is using. You can get events that the machine doesn't respond it. I would follow basic procedure and raise the min pressure 1cm at a time, till the events subside
http://c398534.r34.cf1.rackcdn.com/DOCU ... Canada.pdf

Hello ajack, the titration pdf you linked is a great reference, thank you for providing it. I just read through it for the cpap titration and noticed the recommendation to reduce pressure by 1cm if central apneas persist. I was getting a few CA events a night at a max pressure of 14.0. By recommendation from raisedfist I did increase the setting for max pressure to 20 last night and had no CA events so that's a positive. But correct me if I'm wrong, doesn't that go against the titration guideline to reduce pressure by 1 and observe? I do understand raisedfist's reason for suggesting I raise the max pressure, since I was hitting the 14.0 max or approaching it in several instances.
You can see for most of the night 11-13 is enough, there are cluster OA happening that need 15.... because?? you are on your back, you may have tucked your chin, you neck may be bent forward and other reasons.

You have a choice..
If it's just back sleeping, I would raise the min pressure to 15 to resolve these events. You use the 95%. As long as the pressure is a bit below the max on oscar, you know you are not over pressure.
clinicians use 95% and max to set pressure with apap titration
https://aasm.org/resources/practicepara ... rating.pdf
OR
You keep trying and move to min 13 and try to minimise the things that cause the cluster OA/H and snore that raise the pressure. Then see what pressure the machine is using to clear them and use that as a min. So the pressure is above these events in the first place. See if you still need 15.

You have very little CA and aren't worth factoring in at this point. You also ignore the reference to CA/H. I would resolve your obstructive first, then look at CA, remembering that for most users, pressure induced CA resolve over 12 weeks

Hi ajack, thanks for taking the time. this was very guided and thorough. I couldn't have asked for a more detailed response. The explanations really helped me understand the reasons for your suggestions. I've promised to leave the pressures alone for now based on earlier feedback, then perhaps by the end of the week, seeing how things look I will approach the value of 15 and take it from there. If the higher pressure can help me eliminate those OA clusters, that would be huge.

apap_user · Post by **apap_user** » Fri Jul 05, 2019 3:58 pm

Just sharing results from my sleep study back in Feb of 2015 for everyone's reference.

Muse-Inc · Post by **Muse-Inc** » Fri Jul 05, 2019 8:09 pm

zonker wrote: ↑
Wed Jul 03, 2019 6:26 pm
...give your poor tired brain some time to settle in and become accustomed to the pressure changes. this may take some time to see just what the trend is and where your therapy needs to go...

In the beginning, it would take up to 3 weeks

for my brain to get used to a change. But, then, I am in the severe category with at least 9-10 years undiagnosed. My brain scans during sleep study were shocking graphs of huge jagged patterns -- my brain was desperate to wake me up to breathe deeper and just didn't want to be less hyper-aware/suspicious of any change.

zonker · Post by **zonker** » Fri Jul 05, 2019 8:51 pm

Muse-Inc wrote: ↑
Fri Jul 05, 2019 8:09 pm

zonker wrote: ↑
Wed Jul 03, 2019 6:26 pm
...give your poor tired brain some time to settle in and become accustomed to the pressure changes. this may take some time to see just what the trend is and where your therapy needs to go...
In the beginning, it would take up to 3 weeks for my brain to get used to a change. But, then, I am in the severe category with at least 9-10 years undiagnosed. My brain scans during sleep study were shocking graphs of huge jagged patterns -- my brain was desperate to wake me up to breathe deeper and just didn't want to be less hyper-aware/suspicious of any change.

yup. and it didn't help that my brain was convinced that i just needed to adjust RIGHT NOW because this cpap thing was supposed to be THE cure all.

while i'm annoyed that it took me what i considered a long time to get used to therapy, i'm now very happy with where i am.

more than anything, i want the people who come here to know what therapy can be and how it can help them.

apap_user · Post by **apap_user** » Sat Jul 06, 2019 9:45 am

palerider wrote: ↑
Wed Jul 03, 2019 12:05 pm

apap_user wrote: ↑
Wed Jul 03, 2019 11:39 am
Last night's report is below. Much better I think. I had to reduce the pressure back to 10.5, just to see if the cluster of OAs I was getting at 11 would go away and it seemed to be better , at least according to the chart.
*sigh* a change of 0.5 is negligible, it's better because you had a better night.

But, if you want to keep twiddling with the pressure every night.. that certainly is your right.

I've followed the recommendation to leave the pressure as set. The following screenshots are for 3 nights in a row at 10.5 min, 20 max.
For last night's data, I didn't actually fall asleep until 1am, so some of those clusters are false. Someone referred to them by the name sleep-wake junk.

apap_user · Post by **apap_user** » Sat Jul 06, 2019 9:48 am

Muse-Inc wrote: ↑
Fri Jul 05, 2019 8:09 pm

zonker wrote: ↑
Wed Jul 03, 2019 6:26 pm
...give your poor tired brain some time to settle in and become accustomed to the pressure changes. this may take some time to see just what the trend is and where your therapy needs to go...
In the beginning, it would take up to 3 weeks for my brain to get used to a change. But, then, I am in the severe category with at least 9-10 years undiagnosed. My brain scans during sleep study were shocking graphs of huge jagged patterns -- my brain was desperate to wake me up to breathe deeper and just didn't want to be less hyper-aware/suspicious of any change.

Wow, i'm sorry to say. That sounds terrifying. How long did it take you to dial-in/optimize your pressure values. Especially if it takes 3 weeks to settle into a change.
That sounds rough. I hope your sleep is far better now than it was when you started.

Muse-Inc · Post by **Muse-Inc** » Sun Jul 07, 2019 2:41 pm

apap_user wrote: ↑
Sat Jul 06, 2019 9:48 am
...
Wow, i'm sorry to say. That sounds terrifying. How long did it take you to dial-in/optimize your pressure values. Especially if it takes 3 weeks to settle into a change.
That sounds rough. I hope your sleep is far better now than it was when you started.

Adjusting to CPAP was pretty easy after the first 4 nights from hell (only slept during my 45 minute ramp

). I had slow but consistent improvements, then seemed to be backsliding after about 18 months. While I was able to start exercising again and start dropping hypertension drugs, I had a dataless brick and was clueless that things could be improved. I found this forum, got educated, people here convinced me I was now a mouth breather, got my sleep doc to loan me an APAP & recording oximeter. The difference in my sleep quality was amazing. Bought my Hybrid mask. When insurance wouldn't pay to upgrade my CPAP, I bought my S8 APAP. After a month or so, I had consistent numbers, so increased my minimum to be a few digits lower than my median pressure. I did not have to do a lot of tweaking to get low AHIs. Getting an APAP and understanding its data, getting doc's suggestion for a range, getting the right mask (very lucky to find 2 good masks right away) has made my hosehead journey relatively easy.

apap_user · Post by **apap_user** » Mon Jul 08, 2019 8:03 pm

Muse-Inc wrote: ↑
Sun Jul 07, 2019 2:41 pm

apap_user wrote: ↑
Sat Jul 06, 2019 9:48 am
...
Wow, i'm sorry to say. That sounds terrifying. How long did it take you to dial-in/optimize your pressure values. Especially if it takes 3 weeks to settle into a change.
That sounds rough. I hope your sleep is far better now than it was when you started.
Adjusting to CPAP was pretty easy after the first 4 nights from hell (only slept during my 45 minute ramp ). I had slow but consistent improvements, then seemed to be backsliding after about 18 months. While I was able to start exercising again and start dropping hypertension drugs, I had a dataless brick and was clueless that things could be improved. I found this forum, got educated, people here convinced me I was now a mouth breather, got my sleep doc to loan me an APAP & recording oximeter. The difference in my sleep quality was amazing. Bought my Hybrid mask. When insurance wouldn't pay to upgrade my CPAP, I bought my S8 APAP. After a month or so, I had consistent numbers, so increased my minimum to be a few digits lower than my median pressure. I did not have to do a lot of tweaking to get low AHIs. Getting an APAP and understanding its data, getting doc's suggestion for a range, getting the right mask (very lucky to find 2 good masks right away) has made my hosehead journey relatively easy.

You've come a long way. Kudos to you on your journey and do wish you continued success. Did you ever try a fullface mask like the amaraview or dreamwear? how do they compare with the hybrid masks which seem to insert into the nostril?
I hope to get to a point where my pressure is fully optimized with no further pressure adjustments necessary. Right now, there are good nights, there are not so good nights, and there are unspeakable nights like last night where leaks were beyond my comprehension. I thought I had reached a stage where I was getting consistently low AHI numbers, then I'm not sure what changed/happened. Hope to at least get back to that point or better, again. Coincidentally the pressures then for me were not alarming (see picture attached) by any means and sleep felt good.

apap_user · Post by **apap_user** » Mon Jul 08, 2019 8:26 pm

ajack wrote: ↑
Wed Jul 03, 2019 8:10 pm

apap_user wrote: ↑
Mon Jul 01, 2019 10:26 am

ajack wrote: ↑
Sun Jun 30, 2019 7:58 pm
dreamstation machines, don't raise the pressure, if the timing of the events are not what the algorithm is using. You can get events that the machine doesn't respond it. I would follow basic procedure and raise the min pressure 1cm at a time, till the events subside
http://c398534.r34.cf1.rackcdn.com/DOCU ... Canada.pdf
Hello ajack, the titration pdf you linked is a great reference, thank you for providing it. I just read through it for the cpap titration and noticed the recommendation to reduce pressure by 1cm if central apneas persist. I was getting a few CA events a night at a max pressure of 14.0. By recommendation from raisedfist I did increase the setting for max pressure to 20 last night and had no CA events so that's a positive. But correct me if I'm wrong, doesn't that go against the titration guideline to reduce pressure by 1 and observe? I do understand raisedfist's reason for suggesting I raise the max pressure, since I was hitting the 14.0 max or approaching it in several instances.
You can see for most of the night 11-13 is enough, there are cluster OA happening that need 15.... because?? you are on your back, you may have tucked your chin, you neck may be bent forward and other reasons.

You have a choice..
If it's just back sleeping, I would raise the min pressure to 15 to resolve these events. You use the 95%. As long as the pressure is a bit below the max on oscar, you know you are not over pressure.
clinicians use 95% and max to set pressure with apap titration
https://aasm.org/resources/practicepara ... rating.pdf
OR
You keep trying and move to min 13 and try to minimise the things that cause the cluster OA/H and snore that raise the pressure. Then see what pressure the machine is using to clear them and use that as a min. So the pressure is above these events in the first place. See if you still need 15.

You have very little CA and aren't worth factoring in at this point. You also ignore the reference to CA/H. I would resolve your obstructive first, then look at CA, remembering that for most users, pressure induced CA resolve over 12 weeks

ajac, please see the plots below for what happened the last 2 nights at the pressure of 13. Not sure what to do now. Last night was very uncomfortable. I think that's obvious from the mask leaks too. The continuous high pressure was almost intolerable for me, and I think it caused me to continue to fight the mask.

Pugsy · Post by **Pugsy** » Mon Jul 08, 2019 9:23 pm

Looking back on some of your older reports....I wouldn't have increased the minimum from the 10.5 if it were me.
I would maybe have increased the maximum like you did but I don't see any urgent reason to be using the 13...and it appears the 13 is causing problems anyway.

Just my 2 cents.

apap_user · Post by **apap_user** » Mon Jul 08, 2019 11:24 pm

Pugsy wrote: ↑
Mon Jul 08, 2019 9:23 pm
Looking back on some of your older reports....I wouldn't have increased the minimum from the 10.5 if it were me.
I would maybe have increased the maximum like you did but I don't see any urgent reason to be using the 13...and it appears the 13 is causing problems anyway.

Just my 2 cents.

I will try that. Thank you Pugsy.

ajack · Post by **ajack** » Wed Jul 10, 2019 6:34 am

apap_user wrote: ↑
Mon Jul 08, 2019 11:24 pm

Pugsy wrote: ↑
Mon Jul 08, 2019 9:23 pm
Looking back on some of your older reports....I wouldn't have increased the minimum from the 10.5 if it were me.
I would maybe have increased the maximum like you did but I don't see any urgent reason to be using the 13...and it appears the 13 is causing problems anyway.

Just my 2 cents.
I will try that. Thank you Pugsy.

How did it go, what is your chart looking like?
I doubt that 13 was causing any problems. If anything, there may be some positional apnea.

apap_user · Post by **apap_user** » Wed Jul 10, 2019 6:05 pm

ajack wrote: ↑
Wed Jul 10, 2019 6:34 am

apap_user wrote: ↑
Mon Jul 08, 2019 11:24 pm

Pugsy wrote: ↑
Mon Jul 08, 2019 9:23 pm
Looking back on some of your older reports....I wouldn't have increased the minimum from the 10.5 if it were me.
I would maybe have increased the maximum like you did but I don't see any urgent reason to be using the 13...and it appears the 13 is causing problems anyway.

Just my 2 cents.
I will try that. Thank you Pugsy.
How did it go, what is your chart looking like?
I doubt that 13 was causing any problems. If anything, there may be some positional apnea.

Hi ajack,
Thank you for following up. Can you please give me a little more information about positional apnea and how to identify it? I'm not conscious of my sleeping position, but i'm a back sleeper for most of the night.
When I stepped down to 10.5 again, the pressure chart for night 1 and night 2 are as shown with the latest one being the higher ahi value.
As an aside, today I went to my cpap supplies provider and will be trying a dreamwwear fullface tonight, instead of the amaraview which is what i used during the recordings below.
when i tried to use the amaraview with the pressure set at 13 it was very uncomfortable, by comparison the simplus f&p full face just leaked badly at a pressure of 13 for me.

Thank you.

Need Help with Better Sleep and Pressure Sets

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