My CPAP-to-APAP Experience

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

Hi, Hawthorne. Unless I read my mask's flow chart incorrectly, the leak rate for this pressure range should be from 42-48 LPM. So I think the leak rate is good. Last night produced the most erratic leak line so far in my APAP experiments, and I don't like seeing that, but the numbers are still reasonable.

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.

These results are a good representation of what confuses me about APAP data. If you compare one night to another, they're very different, and conclusions are difficult to draw. The first night, I spent most of the time at the lower pressures; the next night, I spent most of the time at the higher pressures; and the third night, I spent virtually the whole night at the peak pressure. Events happen whenever.

Do I need even more pressure? Or could it be that higher pressures may be inducing events? Beats me. The leak doesn't appear to influence anything.

Overall, my numbers are better. But I don't feel like I'm sleeping as soundly as I was at a fixed pressure. I've satisfied my curiosity that APAP is, at least, tolerable (with a small range, anyway), but I've determined that I don't want to run in APAP mode all the time. I much prefer the deeper sleep I seem to get at a fixed pressure, even if my numbers aren't so good.

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.

That sounds reasonable. I think I need a week or two at fixed pressure before I try Auto mode again. I tried a fixed-pressure trial at 13cm several weeks ago, but the results were quite mixed. Perhaps I'll try 14 for awhile and see how that goes.

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

Thanks, Hawthorne. As always, your input is appreciated.

-SWS wrote:

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.

I read something recently (don't ask me where) about ASV being pretty much a necessity when the PB percentage is 20% or more. Mine is quite often over 20%. Here's my PB data for the past three months:

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.

Where I am at the moment:

I'm going to experiment with different fixed pressures (14cm for now, 15 if need be after a little time adjusting to 14). If my results aren't any more conclusive than my APAP trials have been, I'm going to seek the opinion of Sleep Doc #3 and see if I can get my hands on an ASV machine for a couple of weeks (or have yet another sleep study done with ASV this time if he thinks that's necessary and/or more prudent).

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.

Thanks, -SWS! (And no argument there!)

BleepingBeauty wrote:I read something recently (don't ask me where) about ASV being pretty much a necessity when the PB percentage is 20% or more. Mine is quite often over 20%.

I really wouldn't try to compare "Variable Breathing" and "Periodic Breathing". I have a hunch that they're not the same thing.
My VB usually averages in the upper twenty's. Depending on which machine I'm using (and all are in CPAP mode and same pressure, so there is a "constant"), my nightly numbers can vary from the high teens to around 40 (one of my machines scores events differently than the others.....and the higher numbers are from that machine).


Den

Good charts!

Also bear in mind that PB data and VB data are not one-in-the same as Den mentioned. One is "periodic" and the other is "variable". But Respironics literature states plenty of non-periodic conditions that can contribute to what they call "variable breathing".

With that said, I still think an ASV trial some day would be a worthwhile experiment for you...

Wulfman wrote:

BleepingBeauty wrote:I read something recently (don't ask me where) about ASV being pretty much a necessity when the PB percentage is 20% or more. Mine is quite often over 20%.

I really wouldn't try to compare "Variable Breathing" and "Periodic Breathing". I have a hunch that they're not the same thing.
My VB usually averages in the upper twenty's. Depending on which machine I'm using (and all are in CPAP mode and same pressure, so there is a "constant"), my nightly numbers can vary from the high teens to around 40 (one of my machines scores events differently than the others.....and the higher numbers are from that machine).


Den

-SWS wrote:Good charts!

Also bear in mind that PB data and VB data are not one-in-the same as Den mentioned. One is "periodic" and the other is "variable". But Respironics literature states plenty of non-periodic conditions that can contribute to what they call "variable breathing".

You're both right, of course. I'm (apparently still) not firing on all cylinders just yet.

I may be tolerating a small range of adjusting pressures, but that doesn't mean APAP is working for me.

With that said, I still think an ASV trial some day would be a worthwhile experiment for you...

"Someday" is coming faster and faster all the time. I'll give myself a little time to experiment with a couple of different fixed pressures, but if I don't zero in on a more effective one relatively soon, I'm not willing to waste much more time wondering about ASV and its potential to give me the best possible treatment.

New year, new doctor? They say the third time's the charm...

BleepingBeauty wrote:[

I may be tolerating a small range of adjusting pressures, but that doesn't mean APAP is working for me.

BB,Of course I lost all of you at PB vs VB but your comment jumped out at me. Just to review a bit, we had all sorts of problems with auto settings and finally settled on cpap=12cms(thanks Den) for a year doing well. I've now been experimenting again with 11-13 for about a month and Mike was doing fine mostly at the lower range (I was determined to try for a lower pressure ) but the last 2 days he's back to 2 naps/day, he's hitting the max a little more and his leaks are a little higher although AHI is the same around 1.5. He doesn't seem as well rested to me but of course I don't get much feedback from him ("I'm fine"). I'll give it 1-2 more nights to see where things are heading and then will go back to cpap=12cm again. So what you said makes good sense for some people. I hope you get the right pressure dialed in maybe at 14cms.

BB, thanks for posting about your experience. Someday I'll understand more about the workings of apap vs cpap, but for now, I just accept that some people do better on one or the other, for a variety of reasons.

Your methodology and reports have been very interesting. I hope you figure out what works best for you, so you can feel well rested.

DoriC wrote: BB,Of course I lost all of you at PB vs VB but your comment jumped out at me. Just to review a bit, we had all sorts of problems with auto settings and finally settled on cpap=12cms(thanks Den) for a year doing well. I've now been experimenting again with 11-13 for about a month and Mike was doing fine mostly at the lower range (I was determined to try for a lower pressure ) but the last 2 days he's back to 2 naps/day, he's hitting the max a little more and his leaks are a little higher although AHI is the same around 1.5. He doesn't seem as well rested to me but of course I don't get much feedback from him ("I'm fine"). I'll give it 1-2 more nights to see where things are heading and then will go back to cpap=12cm again. So what you said makes good sense for some people. I hope you get the right pressure dialed in maybe at 14cms.

Dori, another thing to try, if you'd like to see how Mike does on a lower pressure is you can try and titrate the CPAP setting down incrementally, say to 11.8, and see if that makes a difference. There is nothing magic about a round number. (Take it from me, I'm at CPAP 10.4 ).

True, I've never tried 11.5cm(our machine only goes by .05 increments). I have a feeling that right now some of the experts are starting to shake their heads at me.

BB - I think your experiment with auto is near to being over -at least for now. Sounds like you are not getting good sleep even though you are getting good numbers and I still am concerned about the 90% also being the maximum pressure.

Glad to hear that your leak rate is within range - I don't know your mask. The data showed it increasing but glad to hear that the increase was still within range.

I don't know how you will do with a fixed pressure of 14 or 15 cm but, since your leak rate is within range, it might well be easier to keep the leak rate more stable (wouldn't be waking so often to adjust the mask when pressure goes up) with a fixed pressure.

If that doesn't work too well, more experimenting with an auto range might be in order.

Good luck!

I just read your post that came in while I was typing. I don't think the experts are shaking ther heads at you and I'm not either. I'm shaking my head trying to figure out what might help!

DoriC wrote:

BleepingBeauty wrote: I may be tolerating a small range of adjusting pressures, but that doesn't mean APAP is working for me.

BB,Of course I lost all of you at PB vs VB but your comment jumped out at me.

If you noticed, Dori, I got lost there, too. I'm in a state of confusion these days.

Just to review a bit, we had all sorts of problems with auto settings and finally settled on cpap=12cms(thanks Den) for a year doing well. I've now been experimenting again with 11-13 for about a month and Mike was doing fine mostly at the lower range (I was determined to try for a lower pressure ) but the last 2 days he's back to 2 naps/day, he's hitting the max a little more and his leaks are a little higher although AHI is the same around 1.5. He doesn't seem as well rested to me but of course I don't get much feedback from him ("I'm fine"). I'll give it 1-2 more nights to see where things are heading and then will go back to cpap=12cm again. So what you said makes good sense for some people. I hope you get the right pressure dialed in maybe at 14cms.

Mike's experience sounds similar to mine. I haven't felt bad during the day, but I don't feel as well-rested as I did before I started the APAP trials. Sounds like Mike's feeling the same; he's just not saying so. From what I know of you, Dori, you're very attentive and dedicated to Mike's successful therapy; so if he seems less well-rested to you, I'd say that's probably an accurate assessment. Even if he won't admit it.

Thanks for the good wishes. I hope tonight goes well, at least.

KatieW wrote:BB, thanks for posting about your experience. Someday I'll understand more about the workings of apap vs cpap, but for now, I just accept that some people do better on one or the other, for a variety of reasons.

Your methodology and reports have been very interesting. I hope you figure out what works best for you, so you can feel well rested.

I still find the data on APAP a bit confusing, because of all the variables. So posting about my experiments was good for me (because I got the good advice I was looking for about my results and where to go next) and good for anyone else who's still on the learning curve, like me. Thanks, Katie.

Hawthorne wrote:BB - I think your experiment with auto is near to being over -at least for now. Sounds like you are not getting good sleep even though you are getting good numbers and I still am concerned about the 90% also being the maximum pressure.

Yep, I've had 12 nights of ranging pressures, and I'm really starting to feel the accumulated "tired" now. I'll try 14cm for a few nights and see how I do. I hope things go well, because I share your concern about needing an even higher pressure.

Glad to hear that your leak rate is within range - I don't know your mask. The data showed it increasing but glad to hear that the increase was still within range.

Yes, the number was within range, but I didn't like the erratic nature of the leak line last night.

I don't know how you will do with a fixed pressure of 14 or 15 cm but, since your leak rate is within range, it might well be easier to keep the leak rate more stable (wouldn't be waking so often to adjust the mask when pressure goes up) with a fixed pressure.

I sure hope it works out the way you stated. I may still need to adjust the headgear a bit to accommodate 14cms, but we'll see. I'm hopeful that I'll sleep more soundly tonight, in any event.

If that doesn't work too well, more experimenting with an auto range might be in order.

Good luck!

Yep, I'm already thinking ahead to that possibility. Hopefully, 14 will work pretty well; if not, I'll try 15. And if that still doesn't work very well, I'm going to try a narrow lower APAP range. My initial titration indicated that 9cm was effective while on my side, and 12cm was suggested for when I'm supine. So that'll be the range I try if/when I try APAP again.

Thanks, Hawthorne.

Just wanted to say thanks to everyone for your advice and input during my APAP trials. I slept at a fixed pressure of 14 last night, and it went well. It wasn't a very long night, though; I apparently picked up some little stomach bug, which rudely awakened me early this morning. After the third trip to the bathroom, I gave up on getting any more sleep for today. I'm looking forward to tonight, though.

The numbers are good, my leak line is much flatter again, and I feel more rested today.



BTW, even though I can't really claim "success" with my APAP trials, I'm glad for the experience. I didn't feel as well-rested with APAP, but my numbers definitely improved. My AHI at 12cm was between 3-5 (and often over 5) before I started this; it was in the 2's for seven of the Twelve Days of APAP (hey, that sounds like a Christmas song! ), and my AHI last night was 2.4. I hope the trend continues.

BB - I'm so sorry that you caught a stomach bug! They are miserable!

Last night's data looks very good and you say you are feeling a little more rested. That's good too - especially when you are fighting this little bug.

Now that you have gone through the APAP exercise, and found a different fixed pressure, it is possible, after a few nights of adjustment that the data will look even better and you will feel even more rested! I'm hoping!

Take care of yourself and feel better soon - both in the tummy and in your sleep!

BB, knowing your results can improve like this by simply changing the settings has to be reassuring. I'd stay at 14 for at least a few days, and if you were considering increasing the pressure, perhaps you can do so without going up to 15 (can you do 14.5)? (On my ResMed Auto, I can do 0.2 increments). Sometime fine tuning can help.

Hawthorne wrote:BB - I'm so sorry that you caught a stomach bug! They are miserable!

Thanks. I've been feeling better as the day's worn on, so I hope the worst is over.

Last night's data looks very good and you say you are feeling a little more rested. That's good too - especially when you are fighting this little bug.

Now that you have gone through the APAP exercise, and found a different fixed pressure, it is possible, after a few nights of adjustment that the data will look even better and you will feel even more rested! I'm hoping!

Take care of yourself and feel better soon - both in the tummy and in your sleep!

I'm pleased with the data from last night (and with how I feel today).

Thanks for the well-wishes, Hawthorne. I'm looking forward to going to sleep tonight.

GaryG wrote:BB, knowing your results can improve like this by simply changing the settings has to be reassuring. I'd stay at 14 for at least a few days, and if you were considering increasing the pressure, perhaps you can do so without going up to 15 (can you do 14.5)? (On my ResMed Auto, I can do 0.2 increments). Sometime fine tuning can help.

Yep, I'm feeling encouraged. I'm done fiddling for awhile and will be staying put now at 14cm so I can make up for the lost time with some steady, sound sleep. And yes, the Respironics machines run in pressure increments of .5, so I can try 14.5 if/when it looks again like I'm having too many events. Thanks, Gary.

Sounds like ya found a good pressure! Congrats!