New APAP user without sleep study looking for advice

Pugsy wrote: ↑

Wed Apr 28, 2021 9:12 am

The pressure pulse events don't mean anything so ignore them for now. It's just the machine trying to figuring out what is going on with what it senses is happening with the airway. Pressure pulses are used to help distinguish open airway events from collapsed airway events.

Flow limitations...19 isn't a horribly high number but flow limitations could mean some airway collapsing going on that doesn't grow up to be a full grown OA or hyponea. So we watch them with one eye.

Auto adjusting mode includes the pressure probes...1.5 cm (approx) increases in pressure to just test things out and not necessarily because the machine is thinking there is a problem.....so part of your overall pressures seen are those probes in action.
But the response during the pressure probes does tend to make me believe that the machine is wanting to fight something.

Those little spikey saw tooth pointy increases you see? Those are the pressure probes in action but you also see some flattening of the increase and even sometimes a little pressure probe on top of the plateau. The pressure isn't changing rapidly but it looks rather rapid at this scale. If you were to zoom in on the pressure graph you would see the pressure actually changes more slowly.
So the pressure probe "spikes" I expect to see but the pattern of spikes as well as the pressure change at 10:30 really makes me think that OSA or at least some airway issue is going on.

I know you would like a definitive answer since you are trying to use the machine to know for sure if you have OSA or not and unfortunately there is therapy value even at 4 cm pressure so the absence of a high AHI with these rather low pressures doesn't really mean much. BUT....based on what I see here the machine is indeed responding to something going on that it doesn't like in the airway and it only responds to obstructive stuff....

Let me go try to find a report that doesn't show much change and you can get an idea what I am talking about. Your change isn't huge but it is there especially after the 10:30 mark which is probably REM stage sleep kicking in. It's very common for OSA to worsen in REM and have us need more pressure during REM. I am that way myself....in non REM sleep I had maybe 12 to 15 OAs...but in REM I had over 50 apnea events. This was documented in a sleep lab setting.

Pugsy wrote: ↑

Wed Apr 28, 2021 9:30 am

You need more time using the machine and hopefully getting more solid blocks of sleep without power failures messing with your sleep using cpap.

I think you do have some sort of OSA going on based on what I see the pressure doing and now you say you slept somewhat better and actually feel better as well.

You will probably benefit from a little higher than 4 cm minimum like you started with but couldn't really evaluate well because you were still in the "I can't sleep well with all this crap on me"....but with time you will get there.

The hardest part to all this......Patience.
We all want immediate answers and immediate results and unfortunately it rarely works out that way.

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 9:34 am

could it be possible that the machine is increasing the pressure when there it detects a high leakage from the mask? Because I notice that sometimes when the leak rate graph goes up the pressure goes up in the graph around the same time as well.

Pugsy wrote: ↑

Wed Apr 28, 2021 10:02 am

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 9:34 am

could it be possible that the machine is increasing the pressure when there it detects a high leakage from the mask? Because I notice that sometimes when the leak rate graph goes up the pressure goes up in the graph around the same time as well.

The leak rate goes up because the pressure going up causes the vent rate to go up.
The machine reports total leak and total leak is composed of the mask's expected vent rate or also called intentional leak rate PLUS any excess leak.

These machines do NOT increase the pressure in an effort to fix leaks. They just don't do it and in fact in some situations they will actually reduce the pressure in an effort to better control a large leak.

Now you are having some excess leak issues (some even into the large leak territory briefly as flagged by the machine as large leak) but those leaks are NOT causing the pressure to increase at all.

In all mask paperwork is a graph of the expected vent rates/intentional leak rate at certain pressures. Vent rates always go up with pressure increases.
Respironics machines simply report that vent rate (ResMed machines don't) and while it can look like a massive leak it really isn't.
This often confuses ResMed users when they see a Respironics leak report because it is so different from what they see.

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 10:11 am

So the pressure has nothing to with the leak rate

Pugsy wrote: ↑

Wed Apr 28, 2021 10:27 am

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 10:11 am

So the pressure has nothing to with the leak rate

Well...yes and no...pressure does affect the leak rate but only so far as to the expected/normal vent rate as it pertains to total leak reported.
More pressure means more vent rate which is a part of the total leak rate but more pressure doesn't mean the machine is trying to fix a leak with more pressure.

It's quite normal to see a variation in total leak graphs when varying pressures are seen.
Now your variations in total leak...a little more than the normal vent rates at time so some excess leaking is going on and sometimes enough to venture into large leak territory. Not for long though and not long enough to really matter unless the leaks are waking you up.

gadgetmaniah wrote: ↑

Fri Apr 30, 2021 3:26 pm

My sleep data for yesterday. Not as good as my previous sleep (though still not too bad). I can see that the average pressure remained about 6 cm, so I've increased the minimum pressure to 6 cm on the machine to see if that suits me better. Even though it's only been a few days on the CPAP for me, I already do feel a lot of difference. The only thing is that I still have that lingering sleepiness feeling in my head and eyes (not sure if anyone relates to this feeling), but I am hoping that will go away gradually.

zonker wrote: ↑

Fri Apr 30, 2021 4:18 pm

gadgetmaniah wrote: ↑

Fri Apr 30, 2021 3:26 pm

My sleep data for yesterday. Not as good as my previous sleep (though still not too bad). I can see that the average pressure remained about 6 cm, so I've increased the minimum pressure to 6 cm on the machine to see if that suits me better. Even though it's only been a few days on the CPAP for me, I already do feel a lot of difference. The only thing is that I still have that lingering sleepiness feeling in my head and eyes (not sure if anyone relates to this feeling), but I am hoping that will go away gradually.

yup. see the pressure line? it goes up to six and pretty much stays there. so give it a head start.

it takes awhile to get the full benefits of cpap. so hang in there; it's coming.

good luck!

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 10:11 am

I guess I'll focus on improving my sleep for now and see how it goes.

Good Sleep for CPAPers

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free OSCAR (or the free SleepyHead), to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

ChicagoGranny wrote: ↑

Fri Apr 30, 2021 5:02 pm

gadgetmaniah wrote: ↑

Wed Apr 28, 2021 10:11 am

I guess I'll focus on improving my sleep for now and see how it goes.

Yep, don't forget the things that CPAP doesn't treat. ------>

Good Sleep for CPAPers

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free OSCAR (or the free SleepyHead), to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

gadgetmaniah wrote: ↑

Fri Apr 30, 2021 4:33 pm

Thank you!