CPAPtalk.com

DD, This line is awesome! May I quote you?
". . . is it even possible to give legally valid informed consent to CPAP treatment without adequate patient information about apnea,
its treatment, the effects of treatment, and how to monitor treatment? "
Couldn't the legal definition of "informed consent" be applied to judge "bricks" ILLEGAL, at least for first-time patients?

chunkyfrog wrote:DD, This line is awesome! May I quote you?
". . . is it even possible to give legally valid informed consent to CPAP treatment without adequate patient information about apnea,
its treatment, the effects of treatment, and how to monitor treatment? "
Couldn't the legal definition of "informed consent" be applied to judge "bricks" ILLEGAL, at least for first-time patients?

Quote away! I was actually thinking about the practice of providing bricks when I wrote that line.

Pugsy wrote:

sleepapnea123 wrote:Here is the chart from last night. I remember waking up twice, but still AHI came down a little to 8.7

Looking better...AHI numbers would be better if we had the CA index out of that AHI. It would be under 5.0 then.
If you look at the grouping of CAs...one at the first sleep onset and the second cluster after the break in therapy and another sleep onset....so most likely some awake/semi awake CAs both times. So mentally remove the Clear airway index when you are looking at your AHI for now.

Looks like you are still pegging the max for short times because of the obstructive events.
Now is the time were I would go more slowly with the increases if it was me. .5 cm to both EPAP and Max IPAP and other stuff the same. Also now is the time if I did a 0.5 increase now I would probably give it a few days before trying another so that I could start looking for trends and patterns. There's going to be some normal variations from night to night even without changing a thing. Even now after nearly 4 years I still might have a 0.5 AHI one night and the next night 3.9 AHI...and not change a thing...but overall long term my AHI is just a little over 1.2...so long term I have more lower AHI nights than higher.
And a couple of times the aliens pay a visit and I get an AHI over 6.0 I just laugh an shrug my shoulders because it's random fluke.

It's looking a whole lot better than your first reports ...

Welcome back pugsy. Yes its definitely looking better than my earlier reports, thanks to you . About the central's it does look like they occur when I am about to go to sleep either the first time or after a mid night break.

I will try increasing both EPAP and IPAP by 0.5, and give it a few days before I report back, unless they number's go really north.

I will have to say, my doc would have taken atleast 4 appointments spaced around a month apart to reach this point.

Drowsy Dancer wrote:Is it even possible to give legally valid informed consent to CPAP treatment without adequate patient information about apnea, its treatment, the effects of treatment, and how to monitor treatment?

Tracy Nasca said this in 2008:

“History has shown that providing equipment alone and without proper patient education has not resolved the alarming CPAP failure statistics. The devastating nature of untreated OSA and the resulting healthcare costs demand that CPAP compliance education and support be established as routine methodology for patient care.”--http://www.foocus.com/pdfs/Articles/SeptOct08/Duane.pdf

sleepapnea123 wrote: I will try increasing both EPAP and IPAP by 0.5, and give it a few days before I report back, unless they number's go really north.

Do keep me in the loop. BTW..just so you know that I mean it when I say that I have bad nights too.
I documented last night in another post if you are bored
viewtopic.php?f=1&t=87536&start=15

I will share this with you about my own experience when I changed to bilevel pressure machine (after over 2 years on APAP)
I got some pretty wild reports at first...would get a really nice low AHI for one night followed by something in the 4 to 5 to 6 AHI range for a few nights..then another nice low AHI night (like less than 1.0) and then have a few more okay or some ugly nights and all this was with zero changes to anything. Over about 6 weeks the trend changed...the AHI 1.0 or so nights became the predominant numbers and the ugly ones lessened in frequency. When I did the trend AHI for the first 3 weeks..the AHI was 4 something...second 3 weeks it was between 1 and 2 AHI with zero changes the entire 6 weeks.

So if you get some really good numbers at a setting that you come up with...don't panic if you have some not so good numbers along the way. It happens to everyone but especially when we are using something new. You are new to this therapy and it does take the body a bit of time to adjust to things.

Yup looked at your report as well. So the goal is to have low AHI nights on a more consistent basis than the High AHI night, which can occur randomly due to alien interference

sleepapnea123 wrote:Yup looked at your report as well. So the goal is to have low AHI nights on a more consistent basis than the High AHI night, which can occur randomly due to alien interference

Actually my number one goal doesn't have anything to do with the AHI...the AHI is a byproduct and a measuring tool to satisfy the clinical side of my brain's need to have some sort of measuring stick to fall back on.

My number one goal is to get good quality sleep so that my body has the best chance for the restorative powers of sleep to work. Good quality sleep (for me) consists of satisfactory number of hours asleep with minimal disruptions.
I use the AHI as a marker for possible sleep disruptions (and those nasty oxygen level desats).
If I feel decent...I don't care what the AHI is...be it 0.2 or 5.2. My own past experience has shown me that I start feeling less than decent around 6.0 AHI....okay at 4 to 5 AHI...but I also have other issues that mess with the quality of my sleep that are not related to OSA....pain being my major one and damned menopausal hot flashes are another. I thought I was pretty much past the hot flashes but here lately I guess the ovaries have decided to give things one last grand effort.

My own past experience has also shown me that I tend to feel better if I don't have clusters of events...so that's why I watch your clusters. All I have to draw upon is my past experience and what I read when I offer my ideas. I figure hey, clusters can be bad news...so let's try to limit them if we can. A random 30 second apnea event...not a big deal...Have 10 of them in 30 minutes and it can stress the body. So I don't get excited with a random cluster but I get excited if I see more than a random cluster. I don't know what it going on with your clusters...sometimes you need more pressure and sometimes you don't.
The 2 most common culprits for increased pressure needs are supine sleeping or REM stage sleep. Now I know my issue for my clusters is/was REM stage sleep. Numerous experiments with extreme measures to stay off my back did NOT eliminate my higher pressure needs..
For you I can't see a definite REM pattern (it's really hard to spot REM sleep because all we have to go on is the time frame where REM normally occurs)...now your sleep study reports might point to REM sleep being worse because they can document amount of time in REM and when the events occurred during REM because they have EEG data that we at home don't have.

We can't control REM...we need it so I just let the machine do its job.
Supine sleeping we can control to a certain extent and if your pressure needs were extreme only when sleeping on your back then we might talk about limiting your sleeping position but you are going to need higher pressures anyway so I don't see the need to talk about it right now. Now if you get a copy of your sleep study and it says...supine sleeping AHI 40 and side sleeping AHI 5...hey we might talk about it.

If you had told me first thing this morning after last night's change....Oh WOW I feel amazing....I slept great...I want to run a marathon today...then I might not have been so quick to think about another pressure increase...but you didn't...you were proud of the results but you didn't yet mention feeling hugely different. In all honesty I didn't expect you to. Right now all I want to do is get you to a point where the numbers point to a decent night's sleep so that the body has the best chance for the restorative powers of sleep to do their job...then we talk about what you feel.

Again...fix what is obviously needing fixing first...then see what is left over.
Will you ever see AHI 0.0? Probably about as often as I do and I can pretty much count them on one hand..so don't start making goals like that. You will drive yourself nuts.

So the short version to all this...AHI watching mainly for validation that we have optimal therapy on paper and thus no obvious explanation as to something screaming "fix me" so that we feel better.
The goal is to feel better, sleep better, not stress the body with a gazillion adrenaline bursts from suffocating....and not a perfect numerical score on an overnight test. The AHI is a measurement tool..it has its place but like you will see me say often....it ain't all about the numbers and I wish it was because it's real easy to get a perfect test score and it ain't so easy to always feel that perfect score.

But we have to start somewhere and AHI is where we start.

You're using only a mouth mask. Do you block your nose to eliminate the leak there?
You probably do not as is manifested by the upside down "U" shapes in the Leak graphs,
which usually indicate mouth leaks.

Sheriff Buford wrote:Alright... I want everyone here to put your hands up against the wall and spread em' Do you have anything that will poke, cut or stick me? mmm? What's this in your back pocket? Seems that I find myself sayin' this more and more with this current group...bunch of rascals!!

Sheriff

Sheriff, our 14 years old dog Harrier mix (male but it's the same in females) had surgery last month for the removal of the two Anal Sacks. One Sack was found cancerous but it has not spread. Total costs of surgery, ultrasound, X-rays, etc., was above $4K.

carbonman wrote:

SleepingUgly wrote:Also, when you hear the police banging on your door, flush your Clinician's Manual!

Now, can you imagine one person,
walking into their DME, sitt'n down, and resetting their cpap....
and walk'n out....
....they'd just think he was really sick.

Two people, can you imagine two people,
walking into their DME, sitt'n down, and resetting their cpap's....in sync....
and walk'n out....
...they'd just think they were crazy.

Now, three people.....three people...
walking into their DME, sitt'n down, and resetting their cpap's....
and walk'n out....
....they'd think it was an organization.......

....50...can you imagine 50 people a day...yea, I said 50 people a day,
walk'n into their DME, sitt'n down, and resetting their cpap's....
......with feel'n.....
and walk'n out....
...they'd think it was a movement.....

and my friends, that's what it is......

Sisters & Brothers of the Yahoo Hoserhood

Beautiful!

Thank you, Arlo!

Pugsy wrote:
So the short version to all this...AHI watching mainly for validation that we have optimal therapy on paper and thus no obvious explanation as to something screaming "fix me" so that we feel better.
The goal is to feel better, sleep better, not stress the body with a gazillion adrenaline bursts from suffocating....and not a perfect numerical score on an overnight test. The AHI is a measurement tool..it has its place but like you will see me say often....it ain't all about the numbers and I wish it was because it's real easy to get a perfect test score and it ain't so easy to always feel that perfect score.

But we have to start somewhere and AHI is where we start.

That makes sense.Not being too obsessed with AHI, but using it as an indicator for the greater goal of having better sleep.

FYI Last night was pretty decent with an AHI of 8.3. I actually woke up feeling quite good, and the AHI confirmed it was a decent night. I will give post the chart tonight.

avi123 wrote:


You're using only a mouth mask. Do you block your nose to eliminate the leak there?
You probably do not as is manifested by the upside down "U" shapes in the Leak graphs,
which usually indicate mouth leaks.

I used the nose plugs which come with the mask. It does an OK job of stopping Nose leaks, but I do have instances of them sometimes coming off during the night. I see some other people have tried other Nose plugs, and I will give those a shot to see if I can get the leaks further under control.