Data interpretation and a few questions

Hi all,

I'm totally new to this forum and it has been a revelation I probably put in 20+ hours in exploring and reading everything that seemed interesting and useful. I got a lot of useful information and hints that I am already using or plan to use in the future, so first of all thank you! You truly are a fountain of knowledge and also support

But as a new hosehead (love the term ) I have a few questions, especially regarding my results that I get from the machine.
I have been using the machine for almost two weeks now and I am wondering about a few things. I think I have resolved most of the leakage issues, I feel quite comfortable with the mask and I'm not waking up too much because of it. Perhaps a few times because of the hose limiting my movement or sounds of it scraping the bed (thinking of getting a holder and a hose snuggle). The issue is I'm still not feeling that great and I think the data also represents that. I'm still tired and not rested. There is definite improvement from what I was experiencing before. The first thought after waking up is no longer when I'll be able to take a nap, I can get to work safely without drowsing behind the wheel and also at work I'm not constantly fighting to stay awake even on slow days. I also understand that this is a process and it depends a lot on the person but still I would like to get your input on my data, since my AHI is above 5 and most of it is oAHI. What is strange to me is that when I had my titration I felt like I was in heaven the next day. No tiredness, woke up like a charm, was actually smiling the whole day (one of the best birthdays in a long time ). And also my AHI vas 4, 1 oAHI and 3 cAHI. Now my AHI is 7-10 with oAHI 6-9, which worries me. Also looking at the pressure chart it seems that I have a lot of time under full pressure (not sure if this is an issue or not).
The pictures below are from this past night. I have a Lowenstein machine so I'm not quite sure if I have the correct data in the pictures. You can also see more information for the past week (after I fixed the leakage issues) in the provided link (together with graphs per day): https://we.tl/t-myEgTEq8ol

Thank you in advance for all your input and wisdom. Any comment/suggestion is more than welcome.

Welcome to the forum.

I am not all that familiar with your exact machine but the general principle behind auto adjusting machines is the same no matter what the model.

It appears that you are using settings of 5 minimum and 12.5 maximum and the machine is hitting the maximum for prolonged periods of time.
Parts of the night you need more pressure than the 12.5......parts of the night it appears that maybe you do well with around 7 or 8...kinda hard to tell from the graph.
Usually when we see pressure needs change like this it's because of either supine sleeping or REM stage sleep or maybe a combination of both.

First thing I would do if this were my report is give the machine a higher maximum and see if the machine could better prevent those obstructive apneas and hyponeas simply with being able to go higher if it could.
More pressures is what is used to prevent OAs and hyponeas.
If that didn't do the job...then more minimum to give the machine a better head start to going to where it needs to get to to best hold the airway open.

Thank you for the answer, Pugsy.

Yeah, the basic functionality should be the same

I forgot to post the device settings. I have a minimum of 4 and a maximum of 12.5.

This is exactly what I was thinking. I have another issue though. How to bring this up with my doctor... The data I'm getting is not something that they intend for me to see as I'm using a pirated version of the program that is probably distributed only to doctors and distributors. I don't know the doctor well enough as this is a specialist and I saw her only twice basically. Should I just take the plunge, explain myself and send the data or is there any other way to go about this? Does anybody have some similar experience that they could share?

If you don't ask the answer is always ....no.
Why not just ask?

Maybe start out with "I am not feeling so great, would you check the data and see if there's anything that could maybe explain it"
Play dumb...

There's always the option to just do it yourself....the doc may not even notice if the maximum was changed.
Happens all the time here in the USA...no one even notices. Somebody changes something and they go see the doc and they get a pat on the back and off they go with "see you next year".

If you got your hands on the software I just imagine you also know how to get to the clinical menu to change the settings yourself.
If not I think the instructions can be found here.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

OK here is an update

I wrote to my doctor about the results that I'm getting, comparing them to the titration, together with how I'm feeling, asking for suggestions, and hinting at changing the settings. I also suggested another visit if necessary. Here is the reply:

Dear mr. XXXX

You have a control date set for 10th March 2020. When you come in please bring in your machine and we will have a more detailed discussion. Don't burden yourself with numbers and values but use the machine as it was explained to you. AHI values are dynamic and can change depending on different factors such as eating a big meal too late, consuming alcohol, having a cold etc - up to 10-12 AHI is still OK. It takes a certain time to get used to the machine and the mask.
Machine settings are set specifically for you and only you. If you access the setting menus and accidentally change some of the parameters can cause you health issues.

BR,
...

Seems a bit of a fu*k off answer to me. Could be just my subjective opinion. I wrote back to them to perhaps reconsider and explain some stuff in more detail. Still very polite

What "bugs" me is this last line that talks about me changing the settings. I never insinuated that I would do such a thing in my first email. Is this perhaps a hint of sorts? Not taking responsibility but do whatever you want?

Also if I were to change settings, what would you suggest? First start with the upper limit and raise it by one cm to 13,5?

Thanks again!

Hi grube386,

"Up to 10 – 12 AHI is still OK."

Somewhere in my filing system I have a text passage, copied from the net nine years ago and from a doctor, a sleep medicine specialist, telling other doctors that the target for treatment was getting the AHI under 10.

Only if the patient had heart disease, lung disease, hypertension, diabetes, kidney problems, and so on should the taget be under 5.

Here, in the UK, medical opinion seems to have sharpened up since then. Nowadays, under 5 is the target for every sleep apnea patient.

I suggest, with respect, that your doctor is a little out of date, and could consider updating his database.

HI rick,

From what I have been reading it seems to be the same with the under 5 target. Also I have hypertension, so...

I think I will go the "rouge" route and take care of things myself. Sad though that when presented with facts and numbers some are still unwilling to do something in the patients best interest just because they don't want to admit they were a little off with an estimation somewhere.

Well.....after probably telling him where to go...
I would at least raise the maximum and see if allowing the machine to do what it wants to do is enough of a change to get better results.
If that doesn't work then a little more minimum.

The machine won't go anywhere without a darn good reason. I keep mine essentially wide open. It rarely goes anywhere near the max available but it can if it needs to.

Thanks again Pugsy!

So if I raise it +2, this should not be an issue. Then if it's still too low and I'm still hitting the max, I'll raise the low end and tweak it until I get the desired results. Does this sound like a good plan?

"Up to 10 – 12 AHI is still OK."

Over the numbers, the question is always... How do you feel ? You can feel better with 12 ahi than 2 ahi if you get the 2 ahi score with mask on for 5 hours without sleeping at all. Numbers are what they are.... But believe in me, if you sleep like a baby for 7 hours... You'll feel much better with low ahi than 10-12 ahi.

I would just open the max up to 20.
See where the machine wants to go. If it goes to 14...having more available hurts nothing. Doesn't change response or anything like that.
Kinda like having a car that shows 120 mph on the speedometer....doesn't mean a thing if you never go over 80.

Then if the AHI doesn't come down, once the machine can go to where it might want to go, that is when I would increase the minimum.

Only OAs and hyponeas can be expected to reduce with more pressure.
Central apneas...no...so you have to ignore them unless you see an unusually large number of them.

Pugsy wrote: ↑

Thu Oct 03, 2019 8:36 am

I would just open the max up to 20.
See where the machine wants to go. If it goes to 14...having more available hurts nothing. Doesn't change response or anything like that.

Another vote for setting the max to 20, and stop preventing the machine from responding to your needs.

OK, time for an update and more questions

I have taken control of my therapy into my own hands but with no success I have taken the advice given here and opened my top pressure to 20 cm which is not basically never reached. I have also raised the bottom setting to 8,5 cm. The results are still basically the same, perhaps a tiny bit better, but I'm still in the 5-10 AHI range. Should I raise the low setting even higher?

Here are my settings and results from today. I am not using soft start as I don't need it. I fall asleep as a baby (the one good thing of having OSA )

Yep....a little more minimum pressure.
You keep inching your way up (3 or 4 nights at each change) until the obstructive events reduce to your satisfaction.

Remember sleeping position can impact the results and we don't sleep the same each night either.

OK, I'll try going up more.

You're telling me? I bought a camera to record myself