CPAPtalk.com

elena88 wrote:Hey, Dreamon, have a good night tonight!

Thanks, Elena. I plan to!

Den's been doing this for a long time -- a heck of a lot longer than I have! When you are ready to try straight CPAP, I think Den suggested starting at 10. I suggested 9-10, mainly because I think your leaks are raising your pressure with APAP. I'm also curious about whether you'd have less centrals at 9, and I also suggested that based on some experiments I've been doing on myself with APAP vs. CPAP. In my case, it appears that the CPAP pressure needed to prevent obstructive apneas is quite a bit lower than that indicated by my 95th percentile pressure on APAP. I thought that you could always start moving pressure up if you're seeing obstructive apneas at 9. But 10's a great place to start too. When YOU are ready. There is no big hurry, although I would like to see you wear your mask more hours each night.

REASONS WHY ELENA MAY BENEFIT FROM STRAIGHT CPAP:

• There would probably be less problem with leaks (although I think it would be very helpful to find out where those darn leaks are coming from too!).

• You may have less central apneas at lower fixed pressure, especially if they're being caused by the higher pressures of APAP and/or frequent arousals.

• I suspect that you are someone who is sensitive to APAP pressure changes.

• Assuming that CPAP at lower pressure was effective at preventing obstructive apneas, you would have less pressure throughout the night overall.

Remember, you can always try a new setting for a while and then change back if it doesn't work for you. Just give yourself time to adapt to changes before deciding something didn't work. This isn't a race....it's a journey. Go at the pace that's comfortable for YOU.

Hi Elena, I put some comments on your other thread, about the positional apnea and the CAs, but after rereading this thread pus all the recent advice, I need to amend what I wrote on the other thread.

Given all this info, and based on my personal experience I would also recommend trying a straight CPAP pressure, perhaps starting at the lower recommendation eg 9 cm (which hopefully avoids centrals). APAP mode really can wreck your sleep, it did for me! Majorly! I cannot tolerate it one bit. So a few apneas and hypops go by, that's ok for me, because I don't respond well to the changing pressure... and I bet that's what's messing up your leak rate too. At straight CPAP, you are less likely to have leak problems. (I feel like a parrot).

Forget the doc and that story for a moment, please listen to Den & DreamOn (they know what they're talking about!) and try straight cpap for a week and see how it goes. I bet after 3 days you will already have some useful info.

ps when I first got my cpap, the doc told me to start at 7 and could go all the way up to 10 if lower pressures didn't work. For months I experimented with various APAP settings... besides the fact that the apap mode wrecked my sleep, it was nearly impossible to determine a trend! Den has said it before, if you're trying to find a trend, that is very difficult to do in Apap mode because you have too many variables to deal with in one sleep session. So going to straight cpap lets you figure out exactly what's happening at each pressure level. And that's what you really want to know first, I would say.

Elena, when we first started we had a heck of a time on APAP trying to figure out the best pressure settings. His 90% changed every night, his leak rate was horrible and he was having disturbed sleep with AHIs all over the place. I felt that the auto setting was an upgraded feature that must give better therapy, although I was not able to analyze and really understand the data at that time.Then after interpreting some of our reports Den concluded and others agreed that hubby was probably being disturbed by changing pressures and causing leak issues. He recommended CPAP at 12cms based on our data.(titration was 13cms). The change was pretty dramatic in our case, he slept comfortably for 8-9hrs,his leak rate and AHI dropped and as an added bonus it was easier for me to interpret the data. He's been doing well on auto with a very narrow range of 10.5-13(just "to see") for awhile now ,but I've set it back to cpap at 12cms this week. I may be off base but it seems with the heat wave we've been having his AHI was rising and we was a little more restless. Last night his AHI was back down to 1.0 and he seemed more comfortable. It's just my opinion but I think CPAP is a better option for most just starting until they get a real good grasp of the data reports(I'm still learning) Keep us posted.

Hi Dreamon!

I suspect that you are someone who is sensitive to APAP pressure changes.

I think you are right, as I am an uber light sleeper, maybe that is my problem!
I know you have been working on your pressures, and now I can see, some of us might do better on a MUCH smaller range or
straight cpap, I am going to try that if tummy sleeping fails..

Thanks for the reminder that is a journey, not a race.. Im very competative, and I just want to beat this apnea all to hell!
I know I can do that with my apap if I dial it in, like you all are showing me..

DoricC,
thanks you so much for sharing your experience with your husband. I know you watch him like a hawk to make sure he is as comfortable as possible...
It makes sense that a small range would be more comfortable, or cpap at the right pressure, especially for light sleepers or people who havin
other distractions or pains.

On a side note...
If my husband ever gets his sleep study, I know he would not mind the apap pressure changes, and he has slept thru
a burning bus, a fire alarm, and me vacumming under his nose while he was sleeping and had his head hanging over the bed..
I on the other hand, wake up if the dog looks at me..

Well, here are last nights graphs, it was SO hard to sleep on my stomach with the nasal pillows, and I tried to get comfortable. I turned the machine
off and on several times to get up. This is a stat page, a graph page, and one with the larger pressure graph, the sucker did go up, but it goes up
when Im awake too, but not that much.
Hope you all had a good nights sleep and have a great day!

Elena, here is your updated progress chart:



Notice your much lower Leak Rates (highlighted in yellow)! You finally got the leaks down to an "acceptable" level, below 24 L/min! This may be because you were opening your mouth when on your back, and not doing that so much on your stomach. Many of us do that. Or perhaps your nasal pillows weren't displaced as much if they were planted into your bed pillow last night. It would still be good if you could figure out where the therapy air is escaping (mouth or mask?), so you can fix that.

All along, regardless of sleep position, almost all your AHI has been composed of central apneas. Your obstructive apnea rate really hasn't been all that high. Your Central AI (and AHI) were much improved last night. This may be because you were having much less of a leak problem last night, so you slept more deeply. I do think that your centrals may be tied to your high rate of arousals. They may be because of the frequent sleep/awake transitions when you're not sleeping soundly.

Did you feel like you slept more deeply on your stomach? Do you feel physical discomfort when on your back that may be keeping you awake? I know that my back starts to bother me if I sleep on my back for too long. I'm more comfortable on my side/stomach. I'm wondering, what position did you normally sleep in prior to using CPAP?

After some time to get used to it, you may find the Falcon stomach-sleeping position comfortable. Here is a post that describes that, with photos: viewtopic.php?f=1&t=36738&p=319598#p319598. Note the bed pillow placement (none under head and one under upper body). You could try different configurations to find what's most comfortable for you.

You could continue with your stomach-sleeping experiment, while wearing your mask, and see how the results are over time. See if you can keep the leaks under control. Then go from there as far as other adjustments, such as pressure. It's my hope that as you sleep more deeply, you'll be able to get more hours of sleep.

Hi dreamon! thankyou for the lovely chart again! How was your night last night?

I did not feel like I slept well last night at all, but I put the little hose over my head last night instead of making it droop, so maybe
that helped my leaks, and being in the pillows too.

thanks for the link to the falcon position, I had read that, its great.. its hard for women because our breasts get in the way of laying on your stomach
without a bunch of pillows to prop you up..

I think I sleep all over the place, and have the worst time on my back because my tongue falls backward as soon as I fall asleep.
I just love to sleep without the machine, maybe because of the pressure changes. Tonight I will try straight cpap and see what happens..
Some of the leak lines that are high, or just mask adjustments in the beginning..

Maybe my biggest problem is the high rate of arousals, I wish I knew how to get a handle on those darn things..

thanks for the chart, youre a sweetheart!

How are you doing with your pressure range?

Is the S9 capable of distinguishing between obstructive and central hypopneas?

Hi: Elena



I have been reading your post for a while now,and some of the problems that you seem to have with your mask leaks, during your sleep sessions and i have one question.Is the Opus 360 the only nasal mask that you have try?
The reason that i ask is because i've try the Opus and even tho it is a comfortable mask i found it to cause more leaks during my sleep sessions than any of the other nasal masks,and i have,try three of them the Opus ,Swift Lt,and the Swift Fx my favorite. This is my own personal experience and i do understand that everyone is different so i'm just voicing my personal experience with the Opus it seems to be a good mask if youre not and active sleeper.It appears that you have had some really great advice allready I also want to thank you for the Heads UP on the Gadway Printsite i've try the download and it work's great i am also computer illiterated so that help a great deal . Thanks and good luck with your therapy i hope that you will get everything sorted out soon...

Phil

Um, the s9 software has a chart where it shows central, obstructive, and unknown events.. you can see them in my graphs..


sometimes you can link the centrals to leaks though, I have learned..

*************************************************************

I have tried lots of masks, but only the opus for nasal pillows, and the headgear is a little weird, so I have to use my hair to keep it down..
Maybe I will try that swift LT, Im going to buy a new nasal pillow mask here very shortly.. I just love the f and p nasal pillows.. sure hate those
accordion type ones..

oh so glad you can use the printscreen site, it sure makes it so much easier to get those graphs up!

FWIW, the Activa is really great for active sleepers, and I have no problems sleeping on my stomach with my face smashed into my pillow with that mask. Granted it's one of those accordion, not a nasal pillow, masks....

Also, you haven't ruled out mouth breathing yet? Girl, we got some work to do with you! Ok I hope the cpap experiment goes well, looking forward to your results.

Oh another question, exactly what kind of hose management system are you using? I don't like the sound of that "drooping" (anyway that word is just Wrong in ANY context ).

elena88 wrote:I did not feel like I slept well last night at all, but I put the little hose over my head last night instead of making it droop, so maybe
that helped my leaks, and being in the pillows too.

I had wondered if you were securing the Opus 360 tubing overhead (with the Velcro strap on the headgear), and forgot to ask you. I find that helps a lot with that mask. It may be that your tubing is pulling on your nasal pillows during the night. Are you using ClimateLine, SlimLine or regular tubing? I find that because the mask end of the ClimateLine is a bit heavier it tends to pull at my mask. I know you've mentioned that you suspend your hose with ribbon from your bed. You may want to evaluate whether that's giving you full range of motion, especially when you turn.

I think I sleep all over the place, and have the worst time on my back because my tongue falls backward as soon as I fall asleep.

Yeah, me too. My (rather large) tongue falls back. Also, my mouth falls open and I tuck my chin when I sleep on my back.

Maybe my biggest problem is the high rate of arousals, I wish I knew how to get a handle on those darn things..

Your thyroid imbalance may have something to do with this. I'm not sure. It sounds like you had difficulty sleeping even before using CPAP. I'm sure the therapy air mask/mouth leaks don't help either.

How are you doing with your pressure range?

My own situation is confusing. But my results are good, so I'm not going to complain. I do sleep pretty well. Except when I worry too much, which isn't very often.

The Swift nasal pillows masks were mentioned. Everyone's different, of course, but the Swift LT, LT For Her, and Swift II all didn't work for me. The Swift FX works fine, except that the small tubing hangs down and gets pulled easily. There are suggestions on various threads regarding how to secure the tubing overhead, like with the Opus 360. One thing I don't like about the FX is that the vented air comes out quite strongly, and it blows right on my arm.

My favorite nasal pillows mask is the AEIOMed Headrest, which a lot of DMEs don't carry. I do have to wear it over my PAPCap, though, because the headgear is too large for my head. Other people replace/modify the Headrest headgear and/or use tights to secure everything. If you haven't tried the Lab Rat Fixes for the Opus 360 to secure your nasal pillows and headgear, you may want to try that: viewtopic.php?t=15104.

Sleep well, and let us know how you do!

P.S. I just noticed that Echo suggested the Activa nasal mask. Elena, is that what you meant by "accordion type"? I use the Activa LT sometimes. It seals very well, and the straps can be worn quite loosely. I was going to suggest that you try it too, but wanted to see if you could figure out whether you're mouth-breathing first. Which chin strap do you use? Maybe you have a type that isn't effective (too stretchy), but for some people, a chin strap isn't enough, even if you also tape your mouth closed. It would help if you could figure out where you're losing the air from!

I'm not as familiar with the Resmed software but again it seems to me your arousals and disrupted sleep are being caused by your auto settings with changing pressures and leaks. Most people can't even breathe with a min pressure of 4. Your avg pressure seems to be around 10 and your 95th% is around 12 so you might try a straight pressure using any one of those numbers or maybe 9cm if that's more comfortable. If the pressure is too high to start with you might use the ramp until you get used to it. You'll need a few days of data at each setting before you make adjustments.

Hi there,
Cured the leak problem! It was the "drooping " hose! (sorry echo!) I now wear it up over my head, and it works much better with my ribbon
wrangler that way. I tried straight cpap at night last night so I could do a step up every night.. It was hard to get used to nine, but I did, so
tonite I will try 9.5 or ten..
I still feel pretty crappy when I wake up, but I will figure it out, got the leak problem pretty much solved though!

dreamon,
Im using the slim line hose for the summer..thanks for all the tips on the masks and such, and of course your lovely charts!

Hi Phil, thanks for the heads up on the opus headgear, I might try different mask soon

Hi DoriC,
Im going to try to work up to 12 in cpap mode in a few days, thanks!