My CPAP-to-APAP Experience

Hawthorne wrote:I've been hoping you would post last night's data!

It's comforting to know that others here are kindred spirits and are just as excited to see what happens next as I am.

I am surprised that your 90% went up to 15 cm.

I am, too. I hope it's simply a matter of getting used to these settings and that I'll see a decrease in high pressure over the next few nights.

However, it is just the first night at this setting so it may be a case of, time will tell. Things look great for the first while during the night (almost 1/3 of the night). It seems that a leak issue set in at that time and that may be what raised the pressure after that. You had a failry nice "zipper" line for that 1/3 fo the night.

Things did even out at your last settings so it may be a wait and see.

True, which is why I'm not drawing any conclusions just yet. Just hoping it gets better.

I am also now thinking about raising that minimum pressure but I 'm not ready to make any suggestions yet!!

Fair enough.

Wulfman wrote:Got any idea what happened at the 2 1/2 hour mark that started the pressure increases in motion? Or, another way would be to ask what did NOT happen during the first 2 1/2 hours?

No idea, Den. I wish I had a video camera so I could see what's really going on. Living alone does have its drawbacks...

Part of the answer appears to be in the increased leakage at about that point in time. As you noted, the number of events increased during your higher pressures. I'm wondering about my thought the other night......if it doesn't have room to make three more pressure increases on an apnea before backing off, does it then not flag the event as "NR"?

Den

That's an interesting question, Den. I would love to hear from someone who's experienced this first-hand and can confirm that NRs are not recorded under those circumstances.

I use wipes on my mask between regular washings, but maybe I need to wash the whole mask more often at higher pressures in order to maintain a good seal all night. I'm washing the whole thing today, so we'll see if I get a better leak line tonight.

BleepingBeauty wrote: I'm washing the whole thing today, so we'll see if I get a better leak line tonight.

See how it goes. Could also consider lowering upper limit from 15 down to 14.5 to see if it cuts down on leaks at some point. But give current settings a few days.

May as well leave the maximum at 15 cm since Remstar machines round off 1/2 cms anyway.

My minimum is set at 10.5 cm and the report always starts at 11 cm. When I raised my maximum pressure to 13.5 from 13 cm, it went to 14 cm one night.

Here's Night 2 at 11-15cm. I'm aware of more brief awakenings at these higher pressures. I wouldn't say that I'm sleeping poorly, but I'm not sleeping as soundly as I'd like. Washing the mask seems to have made for a better seal, at least.

I'm the wrong person to comment here I think (noob), but I notice that at the higher pressure both here and prior results that the obstructive apnea number seems high at the higher pressure. Obstructive Apnea of 7.1 at 15 here and an OA of 7.7 at 15 previously.... Aren't these too high?

Well, all numbers are down except for Hypopneas and VS. The Hypopneas put your AHI up.

This is in terms of averages though. Looking at the "Daily Events per hour" section, you spent less time at 15 cm last night (12th - 218.5 mins vs 13th - 152.5 mins) but you spent less time at 11 cm. - more time at 12, 13 and 14 cm.- not a lot more but more. Washing the mask cushion every day seems to be helping the leak line. I found that my leak line is better if I wash my mask cushion/pillows every day.

I don't know! Maybe it is just too soon at this setting and we need more time. As long as the brief awakenings don't not become a problem, I would give this setting a couple more days anyway.

GaryG wrote:I'm the wrong person to comment here I think (noob), but I notice that at the higher pressure both here and prior results that the obstructive apnea number seems high at the higher pressure. Obstructive Apnea of 7.1 at 15 here and an OA of 7.7 at 15 previously.... Aren't these too high?

Yes, they are. Under 5 is considered successful, but we all want as few events as possible. Clearly, I'm not getting ideal numbers right now. But it's early, and I'll give it a few more nights at these settings (provided I don't start feeling a lot worse) for adjustment to see if things level out.

Hawthorne wrote:Well, all numbers are down except for Hypopneas and VS. The Hypopneas put your AHI up.

This is in terms of averages though. Looking at the "Daily Events per hour" section, you spent less time at 15 cm last night (12th - 218.5 mins vs 13th - 152.5 mins) but you spent less time at 11 cm. - more time at 12, 13 and 14 cm.- not a lot more but more. Washing the mask cushion every day seems to be helping the leak line. I found that my leak line is better if I wash my mask cushion/pillows every day.

Thanks, Hawthorne. Comparing just these past two nights is somewhat an exercise in frustration for me, because I don't see any clear pattern yet.

I don't know! Maybe it is just too soon at this setting and we need more time. As long as the brief awakenings don't not become a problem, I would give this setting a couple more days anyway.

Agreed. I'll keep these settings (as long as I can live with how I feel during the day as a result). I could've napped today.

BleepingBeauty wrote: I could've napped today.

Gotta watch those naps. I find the night after a nap my numbers go up. Probably cos I don't need as much sleep, and so I don't sleep as well.

GaryG wrote:Gotta watch those naps. I find the night after a nap my numbers go up. Probably cos I don't need as much sleep, and so I don't sleep as well.

I know, which is why I haven't let myself have one in a long time now. It really can screw up your normal sleep schedule. I haven't felt the need for a nap in awhile, but I'm feeling a bit more foggy these last few days. Still, the experiment continues because I want to know what works best for me, and that takes a little time.

To that end, here's last night's data:




The numbers look better, after three nights with these settings. 11cm seems to be falling by the wayside, as I'm spending less and less time there. But it's a bit distressing to see that I spent nearly half the night at the ceiling pressure; makes me wonder just how high it would go if given the chance. But as I said somewhere above, it is what it is. Interesting to note that I was at 14cm for about 1/4 of the night with no recorded events.

I'm feeling more "draggy" this morning, although I slept for a longer period of time last night and achieved better numbers. I plan to keep these settings for another two nights, but from what I'm seeing so far, I think my next trial run will be with a range of 12-16.

Does that seem prudent?

Your pressure line and your leak line are virtually synchronized. In other words, your leakage is predominately driving your pressure.


Den

Den, Is this what you mean by "runaway" pressure? So if machine was set to straight cpap at say 13 or 14 and BB had those leaks what might the result have been? Would it have affected the AHI? This is always a never-ending question for me!

Yes, the numbers are better - except for FL and your leak rate is up some. The leak rate may have to do with the fact that you are spending more time at your higher pressures and it may still be well in line.

It is quite a different picture today somewhat for the better, but I am thinking you may have to raise your minimum soon. What was your titrated pressure? I don't think I noticed that? Was it 12 cm?

The fact that you slept longer last night and did not spend nearly as much time at 11cm suggests, to me, you are needing a higher minimum anyway. The fact that your 90% is still 15 cm doesn't seem right to me. Apparently though, you do need to watch for centrals.

The data may well tell us a bit more with another couple of days. You may even begin to feel better as adjustments to this range continue, given that you seemed to sleep better last night.

DoriC wrote:Den, Is this what you mean by "runaway" pressure? So if machine was set to straight cpap at say 13 or 14 and BB had those leaks what might the result have been? Would it have affected the AHI? This is always a never-ending question for me!

Her pressures were not totally "out of control". In some cases, the masks are adjusted for lower pressures and as the pressures increase (for whatever reasons), more leakage occurs and the Autos keep increasing pressures. If her top pressure was not limited to 15, I suspect that the leakage might have gone higher. In her case, it sort of plateaued .
I can't say that the leakage had any effect on her AHI......the leakage wasn't high enough. But, it does appear to be driving the pressure increases.

Interesting chart/report.

Den

Wulfman wrote:Your pressure line and your leak line are virtually synchronized. In other words, your leakage is predominately driving your pressure.

Den

Thanks, Den.

I understand how leak can prompt an increase in pressure. But if my leak rate is within the expected range for these pressure settings (40-48 lpm), what more can I do to control it?

And what should my next step be? TIA

Hawthorne wrote:Yes, the numbers are better - except for FL and your leak rate is up some. The leak rate may have to do with the fact that you are spending more time at your higher pressures and it may still be well in line.

Right. I noticed the increase in FL, but the more important numbers are lower, so I'm okay with that. And yes, the leak rate is still within normal limits for these pressures.

It is quite a different picture today somewhat for the better, but I am thinking you may have to raise your minimum soon. What was your titrated pressure? I don't think I noticed that? Was it 12 cm?

Yes. Over my two years of therapy, I was at 12cm for the first year; my third sleep study in November of '08 resulting in a lower pressure of 10; then yet another sleep study in March of this year resulted in a pressure increase to 14; and last, but not least, my fifth study in June resulted in a return to 12cm.

The fact that you slept longer last night and did not spend nearly as much time at 11cm suggests, to me, you are needing a higher minimum anyway. The fact that your 90% is still 15 cm doesn't seem right to me. Apparently though, you do need to watch for centrals.

Based on this current data, I have to agree. (And so far, still good re: centrals.)

The data may well tell us a bit more with another couple of days. You may even begin to feel better as adjustments to this range continue, given that you seemed to sleep better last night.

Agreed re: the potential to better acclimate to this pressure range. I'm not sure I "slept better" last night. The numbers are better, for the most part, but I can't say I feel "rested." (But how I feel today could be cumulative, so I'm reserving judgment. )

BleepingBeauty wrote:And what should my next step be?

Darned if I know.......
Are you losing air around your mask somewhere? (Like around the pillows?)
I'm not familiar with that mask, so I have no suggestions as to whether it can be snugged up or not.

I'm seeing some correlation between the pressure changes and flow limitations......so I don't know if there's a cause and effect situation there or not. I know that flow limitations will cause pressure increases, but I've always wondered if pressure changes could cause flow limitations. (subconscious reaction to a pressure increase which causes the throat to close off)


Den