Another "first night" post from a first timer.

Unless you specifically pointed at the last night, the synthesis report averages all you data.

Compliance (h/d): 8h21min.......................the average hours per day

Events:............Number.....Index/h
Apneas:..............5.............0.3...........this is your apnea index - excellent
Apneas/CA:.........4.............0.2.......this is the index for the times you stopped breathing, and it wasn't because you were obstructed. Happens, for instatnce, when you turn from side.
Hypopneas:........22............1.3.......this is your hyponea idex - excellent too.
Hypopneas(FL):....5.............0.3..... the index Hypopneas concurrent with flow limitations. Once again a very good number.
Acoustical Vib.:...638.........38.2............. aka your snore index. You're still snoring.
Runs(FL):..........276..........16.5 and every now and then, you have a couple of flow limitations one after the other. You'll find the exact definition of a run in the manual.

You AHI, which includes AI, and both HI (with and without flow limitations) comes up to 0.3+1.3+ 0.3 = 1.9. 2.1 if you want to add the apeneas /ca = their origin is not clear.

Average pressure: 9.2 cmH2O
Low pressure: 4.0 cmH2O
High pressure: 13.0 cmH2O
Pressure efficient more than 90% of the time: 13 cmH2O

You seem to be running your APAP on a pretty wide range - from 4 to 13 (is that so?) You also reach a pressure of 13 more than 10% of the time (percentage between 11 and 100....) so that's what the machine recommends as your constant pressure.

If you click on one night in the synthesis screen, you'll get the night's average - it shoud be interesting to see whether your recommended pressure varies.

An aside: I also keep waking up when my machine reaches the (relatively) higher pressures. I think it's the noise - but it migh be the pressure change as such. In your place, I would definitely narrow the range by making the low pressure higher. Buy this is me - I'm not a doctor or RT or any such thing.

O.

ozij wrote:I'm not a doctor or RT or any such thing.

O.

Geez, O, you might as well be. I was very impressed by your explanation and how much you know and can pass along in an understandable way. Is this from experience or did you learn these facts from research?

Thanks O!

Yes the data was for 2 nights. 10/04 & 10/05.

Yes, the range is wide (and was recommended by billmyinsurance). RG had suggested I up the low end to 6 cmH2O as well. During my titration, my AHI went UP at 4 & 5 cmH2O! My recommended pressure was 7 cmH2O which is perplexing to me if the autopap is suggesting 13 cmH2O! I really like falling asleep at 4 cmH2O though. I'm not sure if falling asleep at 6 cmH2O would be as easy.

The first night I thought I woke up because of the higher pressure. The 2nd night I thought I woke up because of the combination of the higher pressure and the noise (from leaks) and now the 3rd night I'm blaming the heat as well from increasing the heated humidifier temp. I'm starting to think that I don't have a clue what's going on...

In my defense...in the middle of the night, I'm not exactly thinking straight or alert That's why I thought the software would be such a valuable resource. It should be completely objective data.

I'm looking forward to Night 4 & 5 being the weekend so that I can really try to focus on this!

NOzsnAZ

ozij wrote:You seem to be running your APAP on a pretty wide range - from 4 to 13 (is that so?) You also reach a pressure of 13 more than 10% of the time (percentage between 11 and 100....) so that's what the machine recommends as your constant pressure....

O.

On the synthesis report there is a bar graph that shows % of Time spent at each pressure level and my numbers are:

cmH2O = % of time
<4=0
4 = 0
5 = 4
6 = 5
7 = 12
8 = 20
9 = 14
10 = 13
11 = 13
12 =6
13 =13
>14=0

Yes, I do "reach" a pressure of 13 more than 10% of the time but it seems like I spend the "most amount of time" around 8-9 (34%). Does that variable not matter?? What would things be like if I had (as my prescription says) a CPAP at a constant 7cmH2O??

Excellent analysis, ozij!

NOzs, I was just taking a guess when I suggested "6" for your low pressure. Having seen your first two nights' statistics and reading ozij's post, I'd still recommend setting the low pressure no less than 6, or maybe even at 7 or 8. With the 420E you can set "ramp" to still start down at 4, to give you time to get to sleep.

Since you like being able to start out at a very low pressure of 4 (I'd feel suffocated down there!) your choice of machine - the 420E - is a good one for you.

Using a 420E, you can set a completely separate ramp setting for both time and pressure. You wouldn't be able to set a ramp at all with a Respironics REMstar Auto when using it in either auto mode or auto with C-Flex mode.

But, as far as the regular setting in the pressure range is concerned, I'd definitely set the lower pressure considerably up from the 4 you have it on now. I'd never have recommended such a low pressure as "4" for the low in a range for most people, but.... oh well. I'm not a doctor. As far as I know, neither are the support people who answer phones.

There was a study done in 2002 to see if autopaps could find an effective treatment pressure as correctly as do sleep tech manual titrations in sleep labs. The autopaps did.

The researchers initially set the autopaps at a range of 6 - 13. The people who received those autopaps received about 30 minutes of instruction. They were encouraged to change their pressures and shown how to do that. They received a followup phone call after they began using their machines.

The autopaps used in the study were now-outdated "Aria" machines by Respironics. Yet, even with those older model autopaps the people participating in that study were successful at auto-titrating themselves quite well at home. The 90th percentile pressure closely matched the pressure found in the sleep clinic titrations.

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure? Michael F. Fitzpatrick, Christi E. D. Alloway, Tracy M. Wakeford, Alistair W. MacLean, Peter W. Munt and Andrew G. Day

ozij wrote:If you click on one night in the synthesis screen, you'll get the night's average - it shoud be interesting to see whether your recommended pressure varies.

I did and it does. Day 1 it was 13 cmH2O and Day 2 it was 11.

Also Day 1 the acoustical vib was 459 while Day 2 was 179. (I was really tired Day 1)

Since it seems like I'm spending no time at all at 4 & 5, I will up the low end to 6 tonight.

NOzsnAZ
And then just keep it like that for a week - your body, and mind have to get used to this new way of sleeping and breathing, and your results may vary from one night to the other.

Lori,
I would say what I know comes from lots of reading (searching the net for peer reviewed articles, and reading older posts on forums) and some - almost 6 months' - experience.

Rested Gal
You are always so generous with other peoples posts... your own summaries are always such a consistent model of clarity!

O.

Also Day 1 the acoustical vib was 459 while Day 2 was 179.

That many acoustical vibrations (snores) are a definite indication, in my mind anyway, that the lower pressure needs to be raised. Glad to hear you're gonna do that. But I say that only because you're using a 420E rather than a REMstar Auto. Here's why:

Using the Respironics REMstar Auto with C-Flex, pressure 8-14, C-Flex set at 2, I usually saw a lot of ticks on the graph for "snores". Lots of them. Happened even with C-Flex turned off. Happened with both the integrated humidifier and the separate F&P humidifier. Raising my lower pressure for awhile to 9 and 10 (my usual "90th" percentile figure) did not get rid of them, so I took it back down to 8.

I thought back on Derek's experiments when he was trying out different things to see if the REMstar registered non-snores as "snores." Anyway, I paid them no attention since my AHI and how I felt was always fine.

Began using the 420E auto again - same pressure range 8-14. Just like the year when I was using a 420E before, no acoustical vibrations (snores) show up. Or at most a random one or two on an occasional night.

I thought all along the REMstar was wrong about my "snores." I trust what the 420E is telling me. Nice to see the phantoms "gone."

D'oh! I thought I raised the min pressure to 6 last night - but it turns out that I raised the initial pressure instead.

Of course the only way I was able to figure this out was by looking at the data from the software that showed I spent 8% of the time at 4cmH2O - another reason to have the software!

The intial pressure of 6 didn't bother me one bit so that confirms to me that bumping up the MIN pressure to 6 makes sense - and I have NOW done that.

My AHI has gone down from 1.9 the first 2 nights to .8 last night and including CAs it's gone from 2.1 to 1.0!!

I STILL have the question I asked earlier:

How would my numbers look if I had gone with the doctors recommendation and just received a straight CPAP with a constant 7 cmH2O???

My "results" indicate to me that that would have been a very poor solution for what is going on with me - especially considering that my 90% pressure has been 13, 11, 10 & 12 the four nights so far!

Another thing I've been wondering is that even after turning off IFL1, my pressure is still hitting 13 (6% of the time last night). Should I be increasing the MAX pressure to 14 to see if I need it? Is this what you would call "lab ratting" RG?

I STILL have the question I asked earlier:

How would my numbers look if I had gone with the doctors recommendation and just received a straight CPAP with a constant 7 cmH2O???

You can find out. Just set your autopap for a range of 7-7 for a couple of nights. Or change its operation mode to "cpap" at 7.

rested gal wrote:Hi Da,

But most of the time, mouth breathing or mouth air leaks are caused by the tongue simply not maintaining an airtight seal during the complete relaxation of sleep. A very dry mouth is often an indication of that.

Good luck!

Thanks Rested Gal! This hasn't happened much. I sleep with a fan on and I thought maybe that was causing the problem. LOL, the fan is so close to me that I can reach out and touch it. Good to know what was probably causing the problem.

I gotta get a manual so I can figure out how to get into my machine and see what the numbers are all about! LOL