APAP Expectations??

Greetings:

As some of you know I have recently switched from a Remstar CPAP Pro 2 to a Remstar APAP with C-Flex.

While I only have 6 nights with it (so the data is limited), I am curious about what you think about my observations so far.

The pressure just seems to sit most of the time just above the minimum.

When I Hypop/Osa's most of the time the pressure doesn't change.

A few times the pressure changed but there once was an event and others times there were no events identified.

The bigger issue is that my Hypop/OSA do not fo rthe most part seem to be triggering any response (with a few exceptions) from the machine.

As the pressure goes up my OSA/Hypop's are increasing.

I was titrated at 9 but it seems I should be lowering my pressure. Currently I'm set at 7.5 - 13. I started APAP at 6 - 14. It has gotten up to 11 briefly but nothing was going on. It seems the OSA/Hypop's just happen indiscriminately with mostly no response. I raised the lower numnber thinking that maybe it should be closer to my titrated number but my AHI got worse.

I'm thinking of lowering my low number to 5 to see if that drops the AHI lower.

I do accept the possiblity that I don't have a decent data sample at this point but the machines response to my events seems not connected.

Am I missing the boat here?

Thanks,

Tom

I can't tell what came first the chicken or the egg?

There are nights with OSA's like 16 and the machine doesn't respond.

Other nights no OSA's and the machine is up and down a few times.

I tried raising the low pressure (from 6 to 7.5) thinking maybe the machine had too far to go to respond but the Hypop's/OSA's went up.

Not sure what to make of it.

Tom

roztom wrote:There are nights with OSA's like 16 and the machine doesn't respond.

Any chance you can provide the chart for us to see, Tom? The devil is in the details. Mouth breathing, maybe? Have you set up MyEncore yet? If so, it will provide more info on leakage than you can get from Encore Pro alone.

roztom wrote:Other nights no OSA's and the machine is up and down a few times.

My guess is that these the APAP is doing its job just fine on those nights when it's going up and down.

roztom wrote:Not sure what to make of it.

The devil is in the details. Pictures would help. How do you feel?

Regards,
Bill

HI Bill:

i feel pretty good, overall.

Last night I had a bunch of OSA's & feel good. LOL

I don't know how to put a chart up otherwise I'd show it to you.

My leak is very low (24 ish)- I am using a chin-strap - it's like putting my head in a touniquet.

I'm thinking of lowering my pressure a few nights and see what gives.

It just seems my numbers are independent of where the pressure is - and that makes no sense to me.

Tom

roztom wrote:I don't know how to put a chart up otherwise I'd show it to you.

You have to put the picture up on a website. Your ISP will provide you space. Also, there are lots of free websites you can use. You can use any FTP program to upload the pictures. WS-FTP still offers a 30-day free version you can use.

roztom wrote:It just seems my numbers are independent of where the pressure is - and that makes no sense to me.

With nothing else to go on, I think I'd start asking the question of why the APAP isn't responding on certain nights. What's different in the set up between nights. Big leak maybe - you'd see it with MyEncore, but not in Encore Pro.

Regards,
Bill

Bill:

Leaks are not the issue.

Makes me wonder if my Hypop's/OSA are random.

However, when I was titrated AHI went to zero at 9 cm but I have Hypop/OSA at 9 cm.

I guess I'll need more data.

Either way I AM sleeping better and feeling better - no compliants there.

I just thought the machine would be more proactive.

Tom

Tom,

How were you doing on the Pro 2?
What pressure were you at?
Were you using the Encore Pro/MyEncore software with it?

If it were me, I'd start by setting the APAP at your previous fixed pressure and monitor it for a week or so.....then start expanding the range if that pressure isn't doing the job.

I kind of have the same suspicion that you're mouth-leaking.

Best wishes,

Den

Thanks fore the comments:

I do not believe I'm mouth-leaking.

My leak avg is under 25 with no LL's and I'm also using a chin-strap.

At my titrated level 9 cm I still had a fair number of events 6 -8 per night though my AHI jumps around.

Now my AHI is acceptable - under 5.0 but it's all over the place and I don't see the correlation with the presure and the AHI - yet.

Also, the machine just hangs out most of the time right near wherever I set the low end of the range. DOesn't seem to matter much if I am having Hypop's & OSA's.

Maybe I'm not giving the machine the que's it needs to respond?

Thanks,

Tom

Thanks Tom.

After I posted, I re-read your reply to Bill and particularly about the leaks.
So, I guess you can rule out the leaks.

When you speak of 6 - 8 events, are you referring to both apneas and hypopneas?
I know MY "numbers" can be all over the place at times, too. That's one reason I kind of like a fixed pressure.....it's the one "constant" in this therapy. I can't blame the machine for how I slept the night before.

Best wishes,

Den

6 on avg apneas plus 6-10 Hypop's and I snore like a hound.

As the pressure goes up, it seems the number go up - not exactly what I'd expect.

I'm going to lower the bottom pressure and see how it looks.

I was titrated at 9 but I still have a lot of Hypop & Osa there eventhough I'm under AHI 5.

I wonder how volitile the events are independent of the pressure?

Is the "sweet spot" suppossed to be where your 90% pressure is at?

Tom

Tom,

I just looked at my AHI vs. Pressure chart, and my AHI also looks all over the place like a roller coaster. In my own case, I am pretty sure that there are not enough data points yet to really know what it means.

I compared some of the spikes and valleys with my chart called "Hours." That chart shows that I have had very few hours so far at some of the higher pressures (even tho my 90% is in the higher pressures). For example, on my AHI vs. Pressure chart, it looks like I go way up the chart at a pressure of 17, then way back down at 18, but when I look at "Hours" I see that my cumulative time at each of these pressures is maybe 15 minutes at each pressure, compared to hours at some of the other pressures.

With more time and data, I hope the peaks and valleys will either smooth out or start to show some real pattern.

Maybe that is what is going on with you also, since you said that most of the time your machine is sticking to the lower pressures.

Take it or leave it, as always.

Moogy

Yes, Moogy:

I think I need more data points.

I looked at my AHI/Press graph and it shows the lowest AHI 0.7 at 7 and then shows it shooting up as the pressure goes higher. 3.2 at 11.

I know AHI under 5 is ok I'm just trying find the "spot."

At 10 & 11 cm my Hypop's go to zero but my OSA keeps rising.

Maybe with 30 data points (the minimum for statistical validity) it'll make more sense. Right now I only have 6.

Tnx,

Tom

Not everyone has a sweet "spot". Your condition can also change from night to night, due to allergies, positional sleep changes etc. Having a glass a wine with dinner can sometimes impact the number of events seen.

Your 90% pressure should end up pretty close to what your lab titration was if that was a typical night for you. Keep in mind that found pressure is what treats 90% of the events seen. Pressure may be lower/higher in treatment of the other 10%.

Look at the bottom of your Auto Daily reports. The data below corresponding with pressure changes will tell you what worsens or gets better as the pressure increases. You should also see the Remstar's sampling going above the 90% pressure, if events don't lessen with higher pressures it drops back down. You may even see it spend a period of time at that higher pressure.

Snores seem to cause a problem with many machines, snores take place during inhale and there seems to be a fine line between them and a full apnea. Look at your sleep data, you may see a pattern of hypoapnea, snore then apnea along the timeline. The Remstars are very sensitive and can pick up and log snores even if they are inaudible to your mate.

Your leak data is low at 24LPM, so I wouldn't worry about that being a problem. If you see some spikes in leak rates that can indicate a mouth or mask leak, these would go above 75LPM.

Also do the math, your AHI scores of .7 etc. are about the best you can hope for, if you calculate your own AHI score from the data you'll see it may only be 2-3 events added that increase your score of concern. If I had to say there was a sweet spot, that would be at the pressure you spend the most time (in minutes) at. But if you limit the machine to that pressure then it can allow those events seen at higher pressures to go untreated.

Remember most SDB events will take place during REM sleep and it may take you several hours of sleep to reach that point. I wouldn't set the low pressure any lower than 6cm especially if your using the cflex feature. What is usually seen is a lowering of HI or hypoapneas by increasing the bottom pressure unless you have UARS (large Uvula or palatal flap), then the number of events seen may even go up with increased pressures.

Snoredog wrote: Also do the math, your AHI scores of .7 etc. are about the best you can hope for, if you calculate your own AHI score from the data you'll see it may only be 2-3 events added that increase your score of concern.

Exactly. What he just said. Don't chase daily numbers, you can't manage sleep apnea well enough to know how to avoid 2 events here and 3 events there in an otherwise effective treatment.

My advice...pick a setting, run with it for two full weeks and see what it averages and ranges over the interval. Then if you think something needs to change you'll have a chance of figuring it out.

I'll leave it alone for another week and see how it looks.

Thanks everyone for your input.

Tom