Suggestions needed on intrepretation of APAP data. Thanks.

Slpyhed · Post by **Slpyhed** » Sun Sep 25, 2005 3:46 pm

I have recently started using the Encore software augmented with Derek's additional download. I was first set up with a CPAP at a setting of 7cm. I now have a Remstar Auto and have tried different settings ranging from 4cm -20cm and now trying to narrow the low and high settings. I have the C-Flex set at 1 and humidifier at 2. No ramp setting. I still am tired during the day and would like some advice on my results below.

Thanks.

Treatment mode: APAP 6.5 - 9.5 cm. H2O
Apnea/Hypopnea Index (AHI): 4.8 events/hr.
Usage: 8.52 hours
Total Obstructive Apneas: 6
Total Hypopneas: 35
Total NR Apneas: 0
Total Snores: 22
Total Flow Limitations: 0
Total Time in Apnea: 60 sec.
Fraction of Night in Variable Breathing: 41.9%
Obstructive Apnea Index (OAI): 0.70
Hypopnea Index (HI): 4.11
NR Apnea Index (NRAI): 0.00
Snore Index (SI): 2.6
Flow Limitation Index (FLI) 0.00
Average Apnea Duration: 10.0 sec.
Average pressure: 7.6 cm/H2O----------90 percentile pressure: 8.5 cm/H2O

Slpyhed

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 4:17 pm

First of all, I am far from the resident expert on this, so I will just give you my observations. I, too, am on Encorepro, My Encore and Remstar Auto.

Your numbers aren't bad. You spent a very little amount of time in apnea and your flow limitations were incredibly great. It seems you probably just want to lower the hypops a bit, which aren't terrible, either.

Since you were titrated at 7, I am wondering where your hypops seems to occur most, at what pressure? And I noticed that you chose to have the bottom number at 6.5, 1/2 cm below your titrated pressure. What made you choose that as a starting place? But before you make any changes at all, first note at what pressure(s) the hypops seems to be happening most. Also, I would be interested to know how long you've had the settings at this configuration. If it's only been a day or two, leave it alone for at least a week and see what happens over the course of the rest of the week. Things change all the time and the figures you're seeing now may not be the same type of figures you'll see in a few days from now.

In any event, I'm sure a lot of people on this site would trade places with you with the numbers just the way they are. But if you're not feeling well, and haven't been yet, I can understand your desire to make a change.

Slpyhed · Post by **Slpyhed** » Sun Sep 25, 2005 4:43 pm

Thanks for the reply.

I have had the settings at this range for 10 days. Prior to that I had the settings at a low of 5cm to a high of 11cm.

The Hypopnea highs were experienced at 6cm and at 11cm. With the lowest range being between 7cm and 9cm. Hence my reasoning for switching my pressure range to 6.5cm-9.5cm.

Thanks

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 4:58 pm

You may want to try, then, 6-12, maybe even 13, if you were still getting hypops at 11. I think the fact that you are not allowing the pressure to be high enough to stop the hypops could be why the hypops are more than you'd like. If you only allow it to go to 9 and you were getting them at 11, seems to me like you need a higher top number.

This is just my opinion. Like I said, I am far from the resident expert on this subject here. But I would turn it up a notch at the high end. You have nothing to lose if you and your mask can tolerate the higher pressure but possibly good results. Worst comes to worst, you didn't need it and it didn't hurt anything for the trying.

Slpyhed · Post by **Slpyhed** » Sun Sep 25, 2005 5:07 pm

I guess I am just confused as to what controls hypops, controlling the lowest high end number, or a having tolerance by setting at a higher range. I have read here that if you have a setting too high it might cause runaway hypops.

Slpyhed

rested gal · Post by **rested gal** » Sun Sep 25, 2005 5:39 pm

I have read here that if you have a setting too high it might cause runaway hypops.

Slpyhed, I don't think that would happen.

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 5:45 pm

The fact that you were titrated at 7 and have it set at 12 is not too high, plus you were getting hypops at 11. I think they meant if you leave yourself wide open, from like 5-20, you could get "runaway" hypops. There would be nothing wrong with putting your settings from 6-12, in my opinion.

Slpyhed · Post by **Slpyhed** » Sun Sep 25, 2005 5:46 pm

Thanks for clearing that up for me. I think I will take your advice and try a 6cm to 12cm this evening.

Thanks!

WillSucceed · Post by **WillSucceed** » Sun Sep 25, 2005 5:48 pm

Slpyhed:
I don't currently use a RemStar Auto and I'm no expert on the software so please take my comments with more than a grain of salt. Having said this, I'd suggest pushing up your lower pressure a little so that you reduce the snoring and the hypopneas.

My thinking is that our sleep can be fragmented by micro arousals caused by pressure changes as easily as by hypops/apneas. If you increase the lower pressure some, you may find that many of the snoring and hypop incidents will be prevented. You will likely get used to the increased lower pressure and may find that you feel better rested during the day. This worked for me ->autoPAP says I don't need to be at 8 as my lower pressure, but at 8, my AHI is less than 1 per hour and I feel great during the day.

I'm not a Dr., just my experience talking. Hope this works for you.

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 5:56 pm

And I'd listen to Will before you listen to me. He knows far more than I do on the subject of autos (and I don't mean cars).

SLPYHED · Post by **SLPYHED** » Sun Sep 25, 2005 6:02 pm

Very interesting Will, so let's say I was titrated at 7cm. Your rationale is that maybe I try a pressure of say 8cm. I have had my low at 7.5cm before with no problems.

I know you are not a doctor, but I trust the likes of you and the regulars on this site more so than I trust the advice of two different docs I have encountered.

So if I try a low of 8cm than a high of 12cm would seem to cover my needs since I never entered into this high of pressure range when I had the machine wide open to 20cm.

Thanks

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 6:07 pm

slpyhed,

I'm sure I can safely answer that you don't need the high set at 20. That is far too high for someone titrated at 7. I was hesitant to suggest 13.

WillSucceed · Post by **WillSucceed** » Sun Sep 25, 2005 6:15 pm

Anything that wakes us up, whether it be our heart racing and a blast of adreneline in response to snoring/hypopnea/apnea or, being wakened by the pressure increase from our autoPAP as it tries to respond to the snoring/hypopnea/apnea, can contribute to us feeling unrested (is this a word?) during the day.

If you increase the pressure so that snoring is prevented and, possibly such that hypopneas are prevented, you will have fewer arousals. Bear in mind that it is NOT the pressure that wakes us, but the CHANGE (increase) in pressure. This is why CPAP is still the gold standard. If you can tolerate the pressure that prevents all of your snoring/hypopnea/apnea (this will be the titrated pressure that the sleep lab suggests) you should sleep soundly through the night, undisturbed by snoring/hypops/apneas AND undisturbed by pressure change.

Some users (I'm one of them) try to raise their lower pressure to a level that prevents most snoring/hypops/apneas AND makes for a narrow range for the machine to work within. Further, if you have a 420E, (I don't know about the other machines) you can set the machine to work in increments of .5, rather than 1.0. For me, this narrow pressure range (8-12) is well suited to prevent most events (8 does this for me) and, in those few instances when I need it, the machine goes up to about 11. I wake feeling rested and have a great day.

Hope this helps.

WillSucceed · Post by **WillSucceed** » Sun Sep 25, 2005 6:19 pm

so let's say I was titrated at 7cm

Guesss I did not answer your question very well. If you were titrated at 7, and you have your auto set for 7-13, you should not need more than 7. I'd question the validity of the titration study.

Not-withstanding, I'd still suggest that you try raising your lower pressure some, and leave it at this increased pressure for about a week. Take a look at your data and see how you do. If possible, try to use the same mask every night and not make any other changes in your treatment so that you can see what the change in pressure accomplished.

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 25, 2005 6:20 pm

WS,

You've meantioned a few times that CPAP is the best way to go, yet you use auto. Is there a reason for that? And I think there are some on this site who disagree on that theory, but then I went and read Yoga's post tonight on what her doctor told her about CPAP being the best, too and why.viewtopic.php?t=4793

I am going to go for my straight 10 again tonight. We'll see what happens...nice to know, though, we have options at least.