Swim_Bike_Run wrote:Well, that officially sucked. Not sure why, but I just had trouble exhaling all night. Tossed and turned, woke up often and felt like mask was constantly leaking. I did not get a chance to make the adjustments mentioned on here, but I can only imagine that they might have been just as difficult, given the recommended titration pressure (10) was even higher than I was going to have it at (9.0). Here is a recap:
Went to bed at 12:30AM ish.
Used CPAP Mode with pressure of 9.0
Starting pressure of 6.0
Ramp - 5 minutes
ERP - 2 (unchanged from previous 5-6 nights)
Review from the night - trouble falling asleep, felt like I was a but clogged up but not 100% certain since I never took the mask off. Felt like I could not really exhale at all and constantly found myself opening my mouth to get a full exhalation or full breath of air. A little frustrating. Woke up many times to fidget with nose pillows. I use the small size and at times they seal fine and feel ok and other times they don't. Not sure why. I do have the Softgel nasal mask coming on Monday so I am anxious to give that a try.
Woke up about 7 AM feeling awful. Figured I had made it 7 hours (whether I slept much or not) with mask on, so I took it off and set it on table and went back to sleep. Slept ok for 3-3.5 more hours and work up about 10:30 AM. Laid there for half hour talking with wife, who is pregnant, so there is lots to talk about. Checked and recorded my numbers for the night. Here they are:
Under Clinical Efficiency Results from MACHINE (not resscan software - that does not arrive until Monday):
PRESS: No Data
Leak: .36L/s
AHI: 12.5
AI: 2.8
HI: 9.7
Smart Data:
Mask Fit: excellent
Pressure: 7.6
Usage: 5.5 hours (not sure what this means - since I had mask on for almost 7 hours)
I am still learning how to interpret data although I know the "technical" definitions of AHI, AI & HI. This was night # 10 for me overall. First 7 nights were avg between 3.5 AHI - 5.6 AHI. The next two nights were 7.5 and 8.6 respectively and then last night was 12.5 so I am clearly on the wrong way down a one-way street. Need to get this trolly turned around. Since I hade a slight increase in AHI on nights 8 & 9, I thought changing to CPAP from Auto might help but clearly it did not.
Overall - feel like crap. Groggy, with a little headache and not rested at all, especially given the fact that I was in bed for almost 11 hours. Nose was clogged so I did the neti pot this morning and that helped a bit, but I still have a major fog and grogginess going on. Not looking forward to today, feeling hazy all day that is.
Does anyone have any thoughts on what the results are indicating? I can understand the leakage part and that needs to be addressed, but I am not versed enough to know why my AHI jumped so much and really the true difference between AI and HI and how to understand their numbers relative to how I feel. My HI is much higher than normal...what does this mean exactly? I definitely think I should switch back to Auto Mode (5-15) ..those were the settings for first 9 nights. I just did not know why I had decent numbers for first 6 nights then had two nights that worse a little worse.
Thanks in advance....Happy New Year!
Brian
Hi Brian,
First, we all have "bad nights", even on CPAP -- sometimes for no discernible reason at all. So, you can't really judge changes after only a night or two. Since last night was New Years Eve, maybe you had a few drinks? That can affect our breathing.
We have discussed the leaks, and the fact that they could be coming from the mask itself, your mouth, or both. So that is something to troubleshoot, as your leak numbers are near the leak threshold. Excessive leaks will affect your
other numbers (AHI, AI, HI). And you'll feel lousy. You may have the wrong size of nasal pillows, your headgear may need further adjustment, you may need to use the "lab rat fixes", or perhaps you need a different style or brand of mask. Most DMEs allow you to exchange masks within 30 days or so, so you may want to consider trying something else. And you may want to try a chinstrap and/or mouth taping (instructions on this forum elsewhere) to make sure therapy air isn't escaping from your mouth, especially when you're deep asleep and may not realize it's happening.
Also, check that you have the correct mask name in your APAP machine. It should say "Swift". If that's wrong, it can affect the leak rate number.
AHI (hourly apnea-hyponea index) is made up of AI (hourly apnea index) and HI (hourly hypopnea index). It's the AI that matters the most, as that's closure of your airway (greater than 75% decrease in ventilation). The apneas can cause your oxygen levels to decrease, so you want that number as close to zero as possible. Hypopneas are partial airway closures (a 50 to 75% drop in ventilation). With the ResMed machines, an HI under 10 is okay, as they are said to "overscore" hypopneas.
I think once you get the leaks figured out, your numbers will look better. And you should feel better too.
But, for comfort, this is what I'd try:
CPAP Mode with pressure of 10.0
(increased from 9.0)
Starting ramp pressure of 7.0
(increased from 6.0, as sometimes it's more difficult to breathe at lower pressures)
Ramp - 20-30 minutes
(from 5 minutes - this way, pressure increases more gradually and you're more likely to be asleep when it reaches full pressure of 10)
EPR - 2
(you can keep this the same for now)
Also, check the Exhale setting. Their are two choices: Med or Fast. I'd choose Medium, but everyone's different. Consider your humidifier settings too. Give yourself a few days to adjust to the changes.
It's also very common to concentrate on your breathing too much in the beginning. I think sometimes that causes some hyperventilation, and probably rebreathing of carbon dioxide. So try to relax (easy to say, I know). Maybe put on some soothing music or nature sound CDs. Or read with your mask on to distract yourself. I remember that for quite a while it seemed that my exhales were much shorter than my inhales. That bothered me a lot, and it kept me from falling asleep sometimes. But, over time, my breathing evened out, and now I get to sleep quickly and sleep solidly. I know that I had to learn to "trust the machine". It's there to help us.
Like I said earlier, there's no reason to hurry this. Take your time before you change things. There's no need for perfection, and it may take a while to see full results. Trust me, there will come a point when this seems easy as pie and you won't even
realize you're breathing into a mask.
I look forward to hearing how things go for you. We are here if you need us!
~ DreamOn