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Joy, your 90% pressure of 13 cm score, really translates to "13 cm and under" managed to cover you 90% of the time.

Also, if you're interested, this might be a great thread to give a general summary of how you think your overall APAP treatment seems to be going. Is your residual AHI consistently under 5 or 3, for instance? Overall perception of sleep quality, etc. Are there any Encore numbers or even symptomatic factors that really seem to be fluctuating vastly?

The index (AHI)is there to help us compare breathing events per hour when sleep length is different.
A total of 8 apneas for 4 hours of sleep is different from a total of 8 apneas for 8 hours of sleep. Granted, they are both less that the proverbial 5 - but using the indexes makes any discussion far more precise.

That 90% number is the 90th percentile, and as Babbette once said, it means that you spend only 10% of your night at higher pressure.

As -SWS says, that chart becomes very helpful when things go wrong; especially so when the pressure range is wide open at the bottom. You can then see how much time was spent at the lower pressures (Minutes at Pressure) and what happened then. I don't think the following is meaningful on your narrow range, Joy, but even here, you have an example of residual snores appearing at 12 - and disappearing at 13, and the balance of A to H changing as the pressure rises (more H, less A) which is to be expected. When a person uses a low minimum, the chart can help them elimnate pressures that are too low.

AHI per pressure can be misleading when MaP is very short.

That's the first I've heard of a Respironics not letting you set Min=Max. Try changing the order of things -- if you started with setting the MAX, and attempted to bring the MIN up to it, try starting out with setting the MIN and bringing the MAX down.
O.

As Den correctly pointed out... the 90% pressure number means you spent ninety percent of the time that night with the machine blowing THAT pressure and pressure(s) BELOW that pressure. It also means you spent ten percent of the time with the machine blowing MORE than that pressure.

Joy, when I look at my Encore Viewer or Encore Pro reports, I go straight to page 4 where the graph you posted first appears.

I never even glance at the "Daily Events Per Hour" table chart below the graph.

I take a quick look at the Sleep Therapy Daily Details graph.
A quick look to see:

1. does the pressure line look like it's staying on my minimum pressure most of the time?
2. does the leak line look reasonably low most of the time, with no Large Leak black blocks appearing?

Then I glance at the rightside margin of the page to see:

3. is my AHI below 5.0
4. is the average leak rate reasonable

That's all I ever look at...each night's graph.

I don't bother to look at the last first three pages or the last two pages of my reports. I look only at the "Daily Details" graphs, and it's only a very quick glance at that. When a quick one or two second glance shows my graph looking very much like yours, pressure-wise, leak-wise, and AHI-number-wise, I go right on to the next session's graph. As -SWS said, effective treatment makes for a happily boring looking graph.

Your session looks ok to me, Joy.

"OA" on the left side of the graph means "Obstructive Apneas" -- the little green tick marks are the individual events the machine called "apneas." Some of the green marks are thicker than others. The thicker green marks denote more than one apnea happening in quick succession. The thinner green marks are the single apneas.

The OA line on the graph is showing more than just 8 apneas. Possibly 10 or 11 apneas. No big deal though, because the "OA" number (the obstructive apnea "index", actually) shown at the right side of the graph averaged out to only 1.1 apneas per hour.

Even though a couple of your OA marks were thicker than the others, I'd regard your obstructive apneas as scattered and random since you didn't have dense solid blocks of bunches of them hitting one after another after another after another...etc. I wouldn't worry about a few scattered random OA's being marked. Your overall AHI is very nice at well below 5.0.

Lookin' good, Joy!

JoyD talkin' 'bout me wrote:she suggested that since my software won't show Flowrate & Snoring Vibrations on fixed CPAP, I might want to set my minimum & maximum pressures the same on Auto, mimicking fixed CPAP. I've found that my machine won't let me do that, though I believe I can set it one full number apart. I've been meaning to get back to her on that, but as yet have not done so.

I think I said it won't show "flow limitations" data in CPAP mode. I don't know if cpap mode shows vibratory snore data or not, but it definitely would not show "flow limitations", which auto mode does.

ozij's right -- any Respironics autopap can be used "a la cpap" in auto mode by setting the minimum and maximum pressures for the same number. I just now tried setting my Auto with A-flex to same max/min pressure and ran into the same thing you did, Joy... I couldn't make the max go down to the same number as the min. A bit more fiddling showed me why:

If A-Flex is turned on, the max pressure will not let you run it down to match the min pressure. The max can be run down to within two cms (like max 15 if the min is set at 13) but that's as close (within two cms) that A-Flex will let you put them together. It maintains that two cm settings separation no matter whether A-Flex is set at 1, 2, or 3.

Just go back to the place in the menu that lets you turn on C-Flex OR A-Flex. Turn on C-Flex instead of A-Flex. Then you can set the two pressures on the same number.

JoyD. wrote:

Rooster wrote:
Her OA for the night was 8.
Her OAI was 1.1.

So you're multiplying the hours I slept by the OA's per hour . . .

No. I am just counting the tick marks on the chart beside OA. There are about 8.

RG is correct, if some of the tick marks are thicker that means more than one apnea in close succession. So you could have 11 apneas on the chart you posted.

You are doing well.

Note though, that those heavy lines representing a number of apneas and hyponeas in a row (clusters), happened while you were awake. They don't really count. I'm noting where they are on the "therapy flags" section of your report. They were all around when you were up and awake. Other than that, your night was great! Since they don't count really, your whole night was great!!

.
SWS, Ozij, Rested Gal, Rooster & Hawthorne,

Thank you for your experienced input . . . your excellent "teaching" has taken me to a new level of understanding my software. I appreciate your help so much

And RG, I just fiddled this morning again with my settings . . . and realized, yes, I am limited to a minimum of TWO cm. difference between Max & Min settings while on AFlex. I'm happy to learn your discovery that I need to switch to CFlex in order to get a "fixed pressure" setting using Auto.

SWS wrote:
Also, if you're interested, this might be a great thread to give a general summary of how you think your overall APAP treatment seems to be going. Is your residual AHI consistently under 5 or 3, for instance? Overall perception of sleep quality, etc. Are there any Encore numbers or even symptomatic factors that really seem to be fluctuating vastly?

Yes, thank you, SWS. I'll take advantage of that offer!

As a background, my Diagnostic PSG is summarized:

"The Respiratory Disturbance Index is 29.8 -- there were 195 hypopneas & 8 apneas during 6.85 hours of sleep. Respiratory events are much worse during REM sleep. Oxygen saturation dropped below 90% for 28 minutes of the night and dropped as low as 84%." I took Ambien 10mg to help initiate sleep. There was a lack of slow wave sleep, but I did have 16.4% of my sleep time in REM sleep (normal 20-25%). I did notice on his report that I DID NOT have any central or mixed apneas.

Now that I have completed two months on XPAP (wow, it seems more like four ... but then, I've been obsessed day and night ... I expect to get a life soon ) . . . I will make these observations:

1, I've FELT better since day one. I no longer sleep most of the day, in fact, I feel alert and fully functional with no tiredness. That in itself is a LIFE CHANGING thing!

2. Just before having a sleep study I changed physicians. I'm really blessed to have FINALLY found an excellent Internal Medicine Physician who practices "complementary medicine". After 10 years of traditional medicine, she decided her patients were not benefiting from drugs and more drugs . . . got out her Krebs Cycle, and decided to get to the source of their problems. She's fabulous. Getting on CPAP is only ONE of the many wonderful things she has already done for me. Another is finding out I carry the LP(a) phenotype of the LDH cholesterol fraction, so I am on Niacin & my hormones are being tweaked (drugs won't improve LP(a).

3. I mention #2, because she believes CPAP will be helpful in getting me down from 3 BP meds to one or none. I've seen some lowering of my BP, and expect more. Also I had a TIA a few years ago, so I am thankful to be oxygenating my brain with CPAP

4. From the beginning (Starting on day 2, I changed my initial fixed CPAP setting from 6 to 10 to 12), my AHI's have generally been below 5, and my 90% pressure 12-13. When my sleep doc changed me to an Auto (after only 2 hrs of intermittent sleep during the Titration =T. Pressure 13) . . . I changed the setting from 4-20 to 11-20. I have tried three masks: ComfortLite 2, Swift LT/Her, & deconstructed Headrest - all with nasal pillows. Of the three I have had the best numbers with CL2 (usually below 3, using Auto 11 or 12 to 16. I'm currently using the CL2 while I experiment at finding either my sweet spot on Auto or my ideal setting on Fixed CPAP. I'm currently on Auto, set at 12-16, Ramp 11 for 10 minutes. That was my setting for the chart I posted

The times the AHI has gone between 6-7 have been those times I had bad leaks and my pressure shot up to 18 giving me a jolt. I've learned how to control leaks for the most part. (I tape & use a simple chin strap as well as coat the nasal pillows with Lanolin regularly.)

5. I have learned through trial and error . . . that taking 3 mg sublingual Melatonin gives me a much more consistent sleep. (I also like to take it regularly because of it's anti-aging benefits.)

6. I also have realized since CPAP that I need to discipline myself NOT to eat two hours before sleeping so my GERD tendency will not rear its ugly head. Since practicing that discipline, GERD has not been a problem during CPAP. (I do have the benefit of self-adjusting the head of my bed with a remote). My first month on CPAP I was eating before bed, and I believe a good part of my fluctuations and arousals back then were from GERD.

So, I feel very positive about my first two months of CPAP experience. At the same time . . . I AM CONVINCED THAT THIS POSITIVE EXPERIENCE AND ITS GOOD RESULTS IS DIRECTLY RELATED TO MY GOOD FORTUNE IN DISCOVERING "CPAPTALK.COM" . . . I just feel bad for all the people who are either undiagnosed . . . or . . . who are diagnosed but don't have the support of this forum.

Once again, thank you ALL!

Joy

In regards sto the mask leaking. I know I have posted this many times bu this is what has worked for me. I use RMZZZs cloths on my mask. Now, I do have a full mask (ResMed Quattro) but they do make them for nasal masks as well.

These cloths cut my leakage way down and I feel the cloths make the mask more comfortable to tolerate.

By the way, I do not work for the company Rmzzzs. I just like their product enough to let folks know that it works for me. It is bad enough to have to wear a mask to bed each night after 70 years of not having to do so. Might as well make it more comfortable.

charliemack wrote:In regards sto the mask leaking. I know I have posted this many times bu this is what has worked for me. I use RMZZZs cloths on my mask. Now, I do have a full mask (ResMed Quattro) but they do make them for nasal masks as well.

These cloths cut my leakage way down and I feel the cloths make the mask more comfortable to tolerate.

By the way, I do not work for the company Rmzzzs. I just like their product enough to let folks know that it works for me. It is bad enough to have to wear a mask to bed each night after 70 years of not having to do so. Might as well make it more comfortable.

Here is the link: http://www.remzzzs.com/

JoyD - You are doing very well! You are certainly "getting" all the info from your reports quickly! I have read your other posts and knew you would!

I'm glad to have been of some help-- BUT I have to credit all the help I had from forum members -- and still learning!

You have been a big help to others on this forum too and I know you will continue to be.

Like you, I credit cpaptalk.com for my good therapy and I, too, feel badly for the undiagonsed people and the diagnosed ones who haven't found this forum!

I was one of those who didn't find this forum right away and didn't really get involved in it right away. When I did, things got so much better quickly!

This forum is the best!

Great thread!! I'm trying to figure out the data on the resmed software myself so this has been great!!

I kinda laughed at the get up to pee comment because I was looking at mine this morning and trying to correlate a few things. I was rather...shall we say...methane filled during the night last night and I noticed that I think the machine was registering when I was holding my breath to pass gas as hypopneas!!

I was thinking...boy, I better not show my data, they are going to figure out just how gassy I really was!

Joy, I think we should all be taking health lessons from you. Your descriptions---of both CPAP treatment and a holistic approach---sound just wonderful to me!

I agree that some or all of your initial fluctuation might have been related to late-day snacking and GERD. Then, of course, somewhat gradual adaptation to pressure may have factored in as well. Kudos on your proactive and self-advocating treatment approach! Love your doctor's philosophy as well!

-SWS wrote:Joy, I think we should all be taking health lessons from you. Your descriptions---of both CPAP treatment and a holistic approach---sound just wonderful to me!

Joy has become one of my behind the scenes support friends. We are even Swift II for Her penpals (My small nasal pillow went to her in exchange for her xs nasal pillow.) I've been 100% compliant with my XPAP use, have achieved 0% leakage with my mask, and am completely committed to using XPAP to help me. Yet because of preexisting and complicated body problems, I'm not yet near where I need to be in my XPAP therapy. But this forum and also the encouragement and support of folks that I have met on this forum, has helped me not to feel so alone in my real life as I work with doctors and around some doctors, to get the treatment I need.

BTW, Joy...your bathroom story including fixing the blinds was funny...I feel like I have entered a whole new world of funny stuff that I would never have noticed if I wasn't living the XPAP life.