Third night - going okay so far...input on my data??

Here is a copy of last nights sleepyhead data. So far I'm dealing with the mask pretty well, I've turned the ramp down to 5 minutes because I feel a little suffocated when the pressure is low.

The doctor guessed at my pressure as I haven't had a titration study yet. I'm wondering why he guessed at a set pressure instead of using the Auto function and prescribing a range.

I'm still feeling tired although I guess I can't expect to feel better right away. PRE- CPAP my AHI was 60, first night on CPAP 13, second night and last night in the 5-6 range - so getting better!

I woke up choking twice last night and I think, looking at the data that I'm snoring quite a bit still. My titration study isn't until October 10. Do you think I should leave things alone until then? I'm wondering about switching the machine to Auto or increasing my pressure a bit until I get the AHI under 5? Any input?

Straight cpap pressure at 9cm and EPR of 3?
That means for half the time during exhale you are only using 6 cm pressure. Probably letting some events sneak past the defenses.

Choices are...reduce or turn off EPR...increase straight cpap pressure to compensate some for the drop with EPR...or change over to APAP mode with likely a 9 cm minimum and give the machine a range to play with.

I think the idea for straight cpap instead of APAP mode was more to just get you used to using the machine and not use it to find suitable pressure since you are scheduled to have the titration study next month.
Variable apap mode pressures themselves can be disruptive for some people.
They were probably more interested in getting you used to sleeping with all this than they were about a proper pressure for effective treatment.

I can't imagine why an MD would just put someone on a standard CPAP pressure machine, guessing at a number without a titration study, and leaving it at that. I'd consider looking for another doctor.

I would definitely ask the MD right away if its ok for you to switch the machine to run in APAP mode. Or, if not, what's his reason for not doing so.

You have an S9 autoset so it should be able to fine tune a reasonable setting for you -- which the MD could then track and narrow down as time goes on. Then put you on a fixed CPAP level. Or give the S9 back and get a PR60 Auto A-Flex model that offers the Opti-Set mode which is like a virtual titration mode built in the software. (See prior posting on that issue.....)

What was the point of even prescribing a cadillac S9 Autoset machine if the MD was just going to set it and forget it like a cheaper fixed CPAP anyway?

OP is in Canada...they do things entirely differently in Canada.
In this situation the trial with the machine is just so the person gets used to having a mask on and using the machine and then the official titration study is done after the person is accustomed to using the machine. Best chance for good sleep and thus good titration study.

Also in Canada...it takes an act of God to get APAP RX okayed. The S9 Autoset is not likely to be the machine that ends up being finally supplied. Insurance is different and varies by province. Costs are totally different.
This is why we have so many Canadian forum members who buy from cpap.com.

You are right Pugsy things work much differently up here, although I do get to pick whatever machine I want. The S9 was one of the two fully data capable choices I had. Also where I live, sleep doctors are hard to come by. (Mine is 4 hours away and I do my appointments by video conference!!)


Thank you for your input, much appreciated!

You know if it were me (and we all know that I am a maverick) I would try APAP mode with 9 minimum and 13 maximum just to see where the machine wanted to go. I would just be too curious to not mess with things.
Normally I would wide open the max but that might be rather disturbing to sleep so maybe caution would be a smarter way to go.
That way if you do end up with a choice of machines that includes APAP you will have an idea how it works and what it wants to do and do you like it and want it.

Pugsy wrote:You know if it were me (and we all know that I am a maverick) I would try APAP mode with 9 minimum and 13 maximum just to see where the machine wanted to go. I would just be too curious to not mess with things.
Normally I would wide open the max but that might be rather disturbing to sleep so maybe caution would be a smarter way to go.
That way if you do end up with a choice of machines that includes APAP you will have an idea how it works and what it wants to do and do you like it and want it.

Comment,

Just a second, 13 cm max pressure, and 9 cm min, is my S9 Autoset APAP setting. I would not recommend such a jump from 9 cm CPAP.

Why not 11 cm max, 8 cm min, EPR = 3, Full Time, No Ramp?

TiredMominCanada has lots of hypos which need to be checked for causes. ResScan graphs could indicate it much better than the screwy SleepyHead. The Respiration Rate in SH shows (to me) unstable breathing. Could it be that a chinstrap could stabilize it somewhat?


p.s. Sleep doctors know very little about APAPS. Also, they are reluctant to prescribe it b/c APAPs are not used for titrations in clinics. Doctors care about their insurance.

avi123 wrote:TiredMominCanada has lots of hypos which need to be checked for causes. ResScan graphs could indicate it much better than the screwy SleepyHead.

That's hogwash. SleepyHead is reporting the same Hyponeas and obstructive apneas that ResScan would report.
You don't like SleepyHead....everyone in the world knows you don't like SleepyHead...just because you don't like it doesn't mean it is crap software. It's Beta software...again same thing we have said before...is it perfect? No, but neither is ResScan. ResScan often fails to give me detailed data when SleepyHead does. Once for 3 nights in a row.

I think 9 cm minimum for APAP mode because it is already proven that 9 cm isn't sufficient when EPR is used.
Maximum...13, 12 or 11 or wide open..the machine will want to go where it wants to go. It might only be 10, it might be 13...it might be 18 if she is like me.
Somehow I think if I had suggested 11 cm maximum you would come back with 13 maximum because you just love to nit pick anything I say.

To TiredMominCanada :
You are in the driver's seat. It is your choice how you want to address things IF you even want to address things.
You could increase the cpap pressure a little and continue to use EPR if you wish.
You could reduce EPR and/or turn it off if you wish and continue to use existing pressure.
You don't have to do anything. You can wait till your titration study for final RX.
You could switch over to APAP mode if you wish and still use existing EPR. You can use whichever maximum you want to use as well as whatever minimum pressure you wish to use. The minimum pressure is the most critical setting though.
If it can't get to where it needs to go quickly enough events will sneak past the defenses. We see this often.
The maximum...well the machine won't go where it doesn't think it needs to go. Just because a machine has a 20 cm maximum allowed doesn't mean it will go there. Now there are legitimate reasons for limiting the maximum like aerophagia or the actual pressures changes causing sleep disturbances. When that happens people have to compromise...give up something to get something else.
It really isn't my place to TELL you what to do. I can try to explain what happens and what your choices are and offer what I might do because of so and so but just because I would do something doesn't mean it is exactly what you should do. It all comes down to what you are comfortable doing or not doing.

Pugsy wrote:You know if it were me (and we all know that I am a maverick) I would try APAP mode with 9 minimum and 13 maximum just to see where the machine wanted to go. I would just be too curious to not mess with things.
Normally I would wide open the max but that might be rather disturbing to sleep so maybe caution would be a smarter way to go.
That way if you do end up with a choice of machines that includes APAP you will have an idea how it works and what it wants to do and do you like it and want it.

Hi TiredMom, "if it were me", I'd take Pugsy's suggestion. Sounds like a sensible plan with the least confusion. I'm not the expert here but it seems clear you need a higher minimum to help prevent those hypos and OAs and a 9-13 range seems reasonable by looking at your data. As for the EPR(exhale relief), you'll have to experiment with that and see what feels best for you. If you leave it on 3 remember your pressure will drop to 6cms on exhale and you may feel more comfortable with a lower EPR setting, it's a very individual comfort feature. Good luck and keep us posted.

As others have said, you very likely need more pressure. The only question is whether to do it by going auto mode and opening the top end of the range, or to just increase the pressure outright in CPAP mode.

Another thing to try would be to set the C-Flex/EPR to 1 or 2, but usually it's the in pressure that needs to be higher to clear obstructives.

Also, not sure whether it's purely based on your events and a bit too low pressure, but your breathing rate goes all over the map. I'd see if it clears up when your pressure goes higher.

Pugsy wrote:

avi123 wrote:TiredMominCanada has lots of hypos which need to be checked for causes. ResScan graphs could indicate it much better than the screwy SleepyHead.

That's hogwash. SleepyHead is reporting the same Hyponeas and obstructive apneas that ResScan would report.
You don't like SleepyHead....everyone in the world knows you don't like SleepyHead...just because you don't like it doesn't mean it is crap software. It's Beta software...again same thing we have said before...is it perfect? No, but neither is ResScan. ResScan often fails to give me detailed data when SleepyHead does. Once for 3 nights in a row.

I think 9 cm minimum for APAP mode because it is already proven that 9 cm isn't sufficient when EPR is used.
Maximum...13, 12 or 11 or wide open..the machine will want to go where it wants to go. It might only be 10, it might be 13...it might be 18 if she is like me.
Somehow I think if I had suggested 11 cm maximum you would come back with 13 maximum because you just love to nit pick anything I say.

To TiredMominCanada :
You are in the driver's seat. It is your choice how you want to address things IF you even want to address things.
You could increase the cpap pressure a little and continue to use EPR if you wish.
You could reduce EPR and/or turn it off if you wish and continue to use existing pressure.
You don't have to do anything. You can wait till your titration study for final RX.
You could switch over to APAP mode if you wish and still use existing EPR. You can use whichever maximum you want to use as well as whatever minimum pressure you wish to use. The minimum pressure is the most critical setting though.
If it can't get to where it needs to go quickly enough events will sneak past the defenses. We see this often.
The maximum...well the machine won't go where it doesn't think it needs to go. Just because a machine has a 20 cm maximum allowed doesn't mean it will go there. Now there are legitimate reasons for limiting the maximum like aerophagia or the actual pressures changes causing sleep disturbances. When that happens people have to compromise...give up something to get something else.
It really isn't my place to TELL you what to do. I can try to explain what happens and what your choices are and offer what I might do because of so and so but just because I would do something doesn't mean it is exactly what you should do. It all comes down to what you are comfortable doing or not doing.

Reply,

Instead of asking me why have I suggested the above, being a red head you keep attacking first. If you asked me, then I could reply that since her Doctor prescribed 9 cm on CPAP there must be reasons for it. You don't no the reasons but as usual you assume that you can disregard the Doctor's Rx. I am saying why not make a small change in pressure to be closer to 9 cm. If the the APAP would be set on 11 cm max and 8 cm min then the 95% would most likely be around 10 cm which is close to 9 cm. And not take a chance that the machine might go to 20 cm for any reasons. Also, an APAP is contra indicated to persons with congestive heart failure, lung disease such as chronic obstructive pulmonary disease, obesity hypoventilation syndrome, those who don't snore, and those who have central sleep apnea syndrome. About the chinstrap that I suggested, the idea was that a chinstrap by itself is often used to counter act snoring. It holds the tongue up and applies mechanical pressure on it. This and the higher air pressure might reduce and even eliminate snore.

Thank you all for the replies. Last night my AHI was 15 so I'm changing the settings tonight to Auto. The doctor just guessed at the 9 based on experience, nothing more - and to be honest I sometimes feel like I'm not getting enough air even at 9. I'll probably go 9 - 13 and see what happens. My throat is sore this morning. If I am opening my mouth will it show as a leak?

I want you all to know how much I appreciate your opinions on this!

Hi Tired,

Welcome to the club. If you open your mouth with a nasal mask it will show up as a leak. Further, you will most likely wake up with a dry mouth.

Take care, let us know how it goes,
-tino

Tino2You wrote:Hi Tired,

Welcome to the club. If you open your mouth with a nasal mask it will show up as a leak. Further, you will most likely wake up with a dry mouth.

Take care, let us know how it goes,
-tino

Comment,

That's why I use a chinstrap with my ordinary nasal mask and have almost zero leaks. Also, I use the elastic chinstrap to take naps without the machine. Without the chinstrap my tongue falls backwards into my throat which wakes me up.