My CPAP-to-APAP Experience

Wulfman wrote:

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 aware of any leak, no. I don't know if minor leaks would wake me up, but they sure do stop me from falling asleep.

I'm not familiar with that mask, so I have no suggestions as to whether it can be snugged up or not.

I have no problem with the fit of the mouth cushion (with the intact chinflap) and never hear or feel any leaks from there. I use a variation of Whitebeard's Liberty lab-rat fix (viewtopic.php?p=280295#p280295) to keep the pillows in place. (I tried the tights, but they don't work for me. Maybe I'm not doing it right.)

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

Yep, I can see where many of the FLs seem to correlate with changes in pressure, but sometimes the pressure is going up and sometimes it's going down. It's hard (impossible?) to determine what's happening first. Chicken or egg?

In any event, I'll keep my present settings of 11-15 for another night or two, provided I don't feel any worse tomorrow. I'm pretty pooped at the moment, but I did some driving today, and not even a hint of drowsiness behind the wheel. So not too terrible.

Driving quite a bit without a hint of drowsiness, is a positive you can hang on to, as you continue your experiment. It's a very good sign!

I know you'll keep at it until you get it working well!

Hawthorne wrote:Driving quite a bit without a hint of drowsiness, is a positive you can hang on to, as you continue your experiment. It's a very good sign!

I agree, Hawthorne! Feels so good to be in control - of both the steering wheel AND my therapy.

I know you'll keep at it until you get it working well!

Thanks for the vote of confidence. I want to see these experiments through, whatever happens. Even if they're ultimately not "successful," I'll satisfy my curiosity about whether APAP can work well for me. My only trial experiences with an APAP (one at 4-20cm and the other a split-night goof by the tech who set the machine up) were not positive. So in truth, I've never used an APAP like others do every night, and it was high time I tried it.

If I eventually come to the conclusion that a fixed pressure is best for me, then I hope these pressure ranges will help me determine a more effective one. If not, I'll be back where I started, at 12. No harm, no foul, and at least one question answered.

BleepingBeauty wrote: In any event, I'll keep my present settings of 11-15 for another night or two, provided I don't feel any worse tomorrow. I'm pretty pooped at the moment, but I did some driving today, and not even a hint of drowsiness behind the wheel. So not too terrible.

That's great about the driving. Real test is stop and go driving. I find that to be the most challenging. And congrats for keeping the APAP going. (Its very tempting to change settings all the time. )

GaryG wrote:That's great about the driving. Real test is stop and go driving. I find that to be the most challenging.

I would think staying alert in stop-n-go traffic would be difficult for anyone who's tired. I haven't had to deal with "traffic" for a long time now, living in the boonies. My biggest problem re: driving here (pre-effective therapy) was the straight roads. Humming along, sun beating down, feeling warm and comfortable, and then my eyelids started closing. I used every trick I could think of (caffeine, blasting the radio, blasting the A/C, opening the car windows, stopping if need be) to stay awake.

And congrats for keeping the APAP going. (Its very tempting to change settings all the time. )

Thanks. They say patience is a virtue. And although I've managed to find some patience with these experiments so far, I guess I'm not a very virtuous woman, because I would prefer to have everything "yesterday."

Here's last night (Night 4 of my 11-15cm trial):




I notice more time at 11cms last night, but that's a bit deceptive. It took me well over an hour to fall asleep (which is unusual for me) because I couldn't get the damned pillows to seat properly. Every time I thought they were positioned well, I'd move a fraction and I'd hear the slight hissing. Drove me nuts. You can't really see the blip on the data, but just past the one-hour mark, I actually shut off the machine, took off the mask, and changed the angle of the pillows. (I can only see that blip if I enlarge the pressure graph.) So I think I actually spent very little time at 11.

I'm going to up the min to 12, but I'll leave the max at 15 for now. I may very well need to increase the max, but I'm going to give myself a few more nights to acclimate to these settings before I have to start seriously readjusting my headgear to accommodate even higher pressures.

Even though my numbers are looking better (for the most part), I'm feeling more tired each day. I recall having to make several adjustments to the mask over the course of last night to stop the leaks. So it makes sense that I'm feeling more tired, since my sleep quality is being compromised. But I know it's temporary, so I'll carry on.

Either I'll discover a more effective fixed (or small range for APAP) pressure and adjust, or I'll abandon ship and go back to my comfortable (if not as effective) fixed pressure and sleep soundly.

This is not bad but, after 4 nights, it is definitely time to start raising that minimum. In my opinion, the data suggests that should happen. You will also be narrowing the pressure range slightly. I found that a very narrow pressure range works very well for me (I'm at 10.5 - 13.) I am getting AHI below 1 almost every night.

Here's hoping it works the same way for you! It's a matter of finding the right range for you!

Even if you do eventually go back to straight cpap, you may well have found a better pressure with the experiment.

I have tried straight cpap but I get better therapy with my narrow auto range, BUT, everyone is different!

On that report, my eyes keep being drawn to that area from hour 1.5 to 3.75......there are relatively few events there between the pressures of 12 and 14. In fact, if the "Daily Events per Hour" chart is worth anything, you spent a pretty fair amount of time (close to 1/4 of the night) at 14 and that was the lowest AHI.


Den

Hawthorne wrote:This is not bad but, after 4 nights, it is definitely time to start raising that minimum. In my opinion, the data suggests that should happen. You will also be narrowing the pressure range slightly. I found that a very narrow pressure range works very well for me (I'm at 10.5 - 13.) I am getting AHI below 1 almost every night.

Here's hoping it works the same way for you! It's a matter of finding the right range for you!

Agreed. I'll run from 12-15 for a few nights and see how I fare.

Even if you do eventually go back to straight cpap, you may well have found a better pressure with the experiment.

I hope that's the case.

I have tried straight cpap but I get better therapy with my narrow auto range, BUT, everyone is different!

Ain't that the truth!

Wulfman wrote:On that report, my eyes keep being drawn to that area from hour 1.5 to 3.75......there are relatively few events there between the pressures of 12 and 14. In fact, if the "Daily Events per Hour" chart is worth anything, you spent a pretty fair amount of time (close to 1/4 of the night) at 14 and that was the lowest AHI.


Den

Yes, I noticed that I've spent nearly a quarter of the time at 14cm for three of the four nights of this trial (and each of those nights produced really good results at that pressure). Maybe 14 will turn out to be my lucky number. Thanks, Den.

For my own ease of comparison (and for anyone else who's considering making a change), here are all four Daily Events Per Hour charts:






Comparing them like this makes it easy to see why any pressure experiment needs to be carried out for more than just a night or two before any conclusions can reasonably be drawn.

BB, thank you for sharing this experiment with us. It's quite fascinating and should be required reading for anyone experimenting with their settings. Showing the Daily Events all together makes it much easier to see what the experts are looking at and the reason for the recommendations. I'm eager to see what the 12-15 setting brings as I now think I understand the reasoning behind it. BTW, I can see the tiny blip where you took off your mask. Wishing you a restful night.

Oy!

A kind forum member pointed out via PM that I goofed when I posted my four Daily Events Per Hour charts above. (One of them is a repeat.)

Should have been:






Ugh. This is the second obvious flub I've made here today. (I think I'll refrain from posting again until I get some decent sleep.) In the meantime, don't mind me.

DoriC wrote:BB, thank you for sharing this experiment with us. It's quite fascinating and should be required reading for anyone experimenting with their settings. Showing the Daily Events all together makes it much easier to see what the experts are looking at and the reason for the recommendations. I'm eager to see what the 12-15 setting brings as I now think I understand the reasoning behind it. BTW, I can see the tiny blip where you took off your mask. Wishing you a restful night.

Thanks, Dori. I always learn when someone goes through a trial period re: a change they've implemented and posts their results, so I hope I can return the favor here. Having the veterans of the forum weigh in helps me understand how they read the data and reach the conclusions they do. And that helps me figure out what to do next.

P.S. Your eyesight must be really great if you can see that blip on the chart! I know where it is, and I still have to squint to see it.

At my age I'm glad something is still working! Keep us posted.

I decided to wait a few days before posting results again. I've been running from 12-15cms for the past few nights. My numbers are better, but my sleep quality is a bit compromised. It's not awful, but I feel the difference.

Anyway, here are the past few nights' data:

Night 1 at 12-15cm:



Night 2:



Night 3:



Two things seem obvious to me:

1. I need to explore a higher max pressure setting; and
2. I need to readjust my mask to handle a higher pressure, as it's showing more leak even with more frequent washing.

Is there anything else I should be taking away from these reports? I'm considering a run at 12-16 next, since last night I was bumping my head on the 15cm ceiling most of the time.

When all is said and done, I think I'll be best served with a fixed pressure (once I figure out what it should be), because I find I'm much more "aware" of my diminished sleep quality with a pressure range.

Well, your first night you spent more time at the lower pressures (12-13). The leak rate began to be a bit high.

The second night the majority of the night was spent at 14-15.

The third night again you spent the majority of the night at 14-15. Vs went a little crazy but only at 12-13. All events happened at 14-15. Pattern emerging? - maybe.

The leak rate is beginning to get a bit higher as you spend more time at the higher pressures, it appears.

I don't know but it appears that you MAY need higher pressures, either a higher but still narrow, range or a fixed cpap pressure. 14 and 15 seems to be emerging as your best pressures but cause more leaks.

Maybe the leaks are disturbing your sleep and spending some time ( 3-4 nights) at a fixed pressure of 14 or 15 may allow you to get control of the leaks better early in the night and not disturb your sleep as much. Then you might try a range again in auto, narrow but higher than 12 - 15.

I'm just thinking out loud on this now and trying to think what I would do!

BleepingBeauty wrote:When all is said and done, I think I'll be best served with a fixed pressure (once I figure out what it should be), because I find I'm much more "aware" of my diminished sleep quality with a pressure range.

Bear in mind the many underlying subtleties in sleep-related physiology that you can't manage to measure with your APAP data set...

As one example, CROWPAT, who also has a history of periodic breathing, had one of his worst nights of sleep with THIS clinically acceptable AHI of 4.0. That sleep session's 7% periodic breathing rate made him sleep and feel "rotten" the following day. And yet, the rest of his data doesn't look all that dissimilar to your data above, BB.

This is not at all news to you, BB.... But my opinion of complex SDB physiology in relation to APAP modality: almost never a great match. BiLevel can be better or worse, CPAP is usually better, and ASV tends to yield improved outcomes as well.

But I have learned by watching your experiments... So many thanks for posting those in detail! Good luck on the remainder of your current APAP pressure-range trials and good luck on your upcoming fixed-pressure experiments as well! That you have finally been able to perform these xPAP comparisons, to your own very clear benefit, is vastly better than your first year of "being kept in the dark" CPAP therapy.