Sleeping but still feel exhausted. Data attached.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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riveter
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Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 7:37 am

Could you folks take a look at my data from the last couple of nights and see if there is an obvious problem?

I can see my leaks are pretty high (should be about 54 for my mask and pressure), but my pressure runs about 19, so it is hard to stop it from leaking.
The steps starting at pressure of 10 are when I hit the ramp button.

I have been on CPAP for five years since I was diagnosed with severe sleep apnea. My prescribed pressure is 17. My sleep has never been good while on CPAP, but it was really bad before I went on CPAP.

(My machine is a Respironics M Series Auto. I have it set in my equipment profile, but it does not seem to show up in my posts.)

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Julie
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Re: Sleeping but still feel exhausted. Data attached.

Post by Julie » Mon Jul 08, 2013 7:41 am

What machine are you using (some do not appear even if entered in Profile lately)?

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DiverCTHunter
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Re: Sleeping but still feel exhausted. Data attached.

Post by DiverCTHunter » Mon Jul 08, 2013 7:45 am

Stupid question - Are you hitting the Ramp button to cause those pressure stair-steps or is your machine doing an auto off / auto on?
When in doubt, open the case. Remember: If you can't open it, you don't own it!

Prescribed APAP range - 6-10 cm/H2O, titrated at 8.
Current range - 9.0-11.5 cm/H2O - still searching for the magic "zero night" but averaging 2.2 AHI

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 8:24 am

I'm waking up and hitting the ramp button so I can get back to sleep.

(My machine is the Respironics M Series Auto.)

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DreamDiver
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Re: Sleeping but still feel exhausted. Data attached.

Post by DreamDiver » Mon Jul 08, 2013 9:00 am

riveter wrote:I'm waking up and hitting the ramp button so I can get back to sleep.

(My machine is the Respironics M Series Auto.)
If it's been five years, maybe it's time for you to have a new sleep study -- and a more modern machine -- especially with that high an AHI. AHI is considered well-controlled when it's below 5.0. Many of us don't feel we've been getting decent sleep until it's below 2.0.

Your leak rate is kind of high in places for the Quattro FF -- might want to look closer at that.

The fact that your pressure keeps ramping up to your highest pressure setting, and that the AHI is still high seems to indicate your pressure is too low.

I wonder if you wouldn't be better off with a bilevel machine at that pressure. I wonder if you might be better off with an S9 VPAP Auto BiLevel. It's algorithm is slightly different from the Phillips Respironics algorithm and may give you a better chance at sleep.

New sleep study?

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 9:18 am

DreamDiver wrote:
riveter wrote:I'm waking up and hitting the ramp button so I can get back to sleep.

(My machine is the Respironics M Series Auto.)
If it's been five years, maybe it's time for you to have a new sleep study -- and a more modern machine -- especially with that high an AHI. AHI is considered well-controlled when it's below 5.0. Many of us don't feel we've been getting decent sleep until it's below 2.0.

Your leak rate is kind of high in places for the Quattro FF -- might want to look closer at that.

The fact that your pressure keeps ramping up to your highest pressure setting, and that the AHI is still high seems to indicate your pressure is too low.

I wonder if you wouldn't be better off with a bilevel machine at that pressure. I wonder if you might be better off with an S9 VPAP Auto BiLevel. It's algorithm is slightly different from the Phillips Respironics algorithm and may give you a better chance at sleep.

New sleep study?
Those are some good suggestions. I had thought about a new sleep study. Too bad I can't get health insurance due to my sleep apnea (according to two insurance brokers I spoke to).
Do the BiLevel machines go above 20 CM of pressure?

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Wulfman...

Re: Sleeping but still feel exhausted. Data attached.

Post by Wulfman... » Mon Jul 08, 2013 9:31 am

Try a straight pressure in CPAP mode.


Den

.

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kteague
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Re: Sleeping but still feel exhausted. Data attached.

Post by kteague » Mon Jul 08, 2013 9:49 am

You may end up needing a new study, or more specifically, a titration on a bilevel. But for now, about your ramp... It appears to be about a half hour ramp - how long is it? How soon after hitting the ramp do you fall asleep? If you're awake the whole (or most of) the ramp period, that's fine. But if you are like me, I fell asleep quickly but woke up often, and hit the ramp button every time I woke up. What I didn't realize was that if I tallied up all those ramp periods over the course of a night, I was spending most of my night in ramp with non-therapeutic treatment. Based on your sleep habits, shortening your ramp time may be a good idea. Also, if you are fitting your mask to a pressure of 10, you can't know how it will respond at your higher pressure. I really think if you can resolve mask leak issues, increase your ramp pressure, and shorten your ramp time, you may be able to avoid another study. (It's the same principle for auto mode - when the lower end starts too low and the machine is restarted over and over, so much time is spend with suboptimal treatment.)

Hopefully some here who use the same mask as you and/or with higher pressures like you can help you with leaks.

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 11:01 am

kteague wrote:You may end up needing a new study, or more specifically, a titration on a bilevel. But for now, about your ramp... It appears to be about a half hour ramp - how long is it? How soon after hitting the ramp do you fall asleep? If you're awake the whole (or most of) the ramp period, that's fine. But if you are like me, I fell asleep quickly but woke up often, and hit the ramp button every time I woke up. What I didn't realize was that if I tallied up all those ramp periods over the course of a night, I was spending most of my night in ramp with non-therapeutic treatment. Based on your sleep habits, shortening your ramp time may be a good idea. Also, if you are fitting your mask to a pressure of 10, you can't know how it will respond at your higher pressure. I really think if you can resolve mask leak issues, increase your ramp pressure, and shorten your ramp time, you may be able to avoid another study. (It's the same principle for auto mode - when the lower end starts too low and the machine is restarted over and over, so much time is spend with suboptimal treatment.)

Hopefully some here who use the same mask as you and/or with higher pressures like you can help you with leaks.
Good call. I am spending a lot of time in ramp. The ramp time was set for 30 minutes. I just set it to 10 minutes, as I do fall asleep pretty quickly. I'll see how that works out tonight.
I have also changed my mask insert to see if I can get a better seal.
Thank you.

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Re: Sleeping but still feel exhausted. Data attached.

Post by DreamDiver » Mon Jul 08, 2013 11:13 am

riveter wrote:... Too bad I can't get health insurance due to my sleep apnea (according to two insurance brokers I spoke to).
Do the BiLevel machines go above 20 CM of pressure?
Yeah, that kind of sucks about insurance for us uninsured CPAPers. I can't decide whether this is ironic or not. In October/(November???), that's supposed to change when federal insurance changes kick in. We'll see if it's true for real or if it's "merely technically" true because nobody will be able to afford personal insurance with CPAP.

In the mean time, consider talking with the Georgia Insurance Commissioner's office and tell them you can't get insurance due to CPAP. SuperGeeky said that's what he did and was able to find insurance through a federal program with the Insurance Commissioner's Office's help after talking with them, if I remember correctly.

BiLevel machines usually go up to 24cmH20, if I remember correctly. You also get to set an exhale pressure larger than 3 cm difference from your upper pressure limit. They're made for people with higher pressures and those who really need more options for exhale relief than "C-Flex" or "A-Flex". Thankfully, someone will correct me if I'm wrong.

Wulfman's and Kteague's suggestions are usually darned solid. You can always go back to your preferred settings if results aren't forthcoming.

About the Quattro FF leak pressures:
At 17cmH20, your leak rate is compromised if it goes above 49.5L/m.
At 19cmH20, your leak rate is compromised if it goes above 52.5L/m.
(I used Excel to create a leak rate interpolator spreadsheet for any specific pressure on the Quattro Full Face mask between 4 and 20cm based on data from the manufacturer.)
Every time your leak rate goes over 50L/m your therapy is less effective. At 100L/m (in some instances) you may not be getting any reasonable therapy.

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 11:33 am

Wulfman... wrote:Try a straight pressure in CPAP mode.


Den

.
OK. I'll try 19 cm and post the results here.
Thanks.

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 11:42 am

DreamDiver wrote:
riveter wrote:... Too bad I can't get health insurance due to my sleep apnea (according to two insurance brokers I spoke to).
Do the BiLevel machines go above 20 CM of pressure?
Yeah, that kind of sucks about insurance for us uninsured CPAPers. I can't decide whether this is ironic or not. In October/(November???), that's supposed to change when federal insurance changes kick in. We'll see if it's true for real or if it's "merely technically" true because nobody will be able to afford personal insurance with CPAP.
Are you saying the insurance exchanges will be able to discriminate against us for pre-existing conditions? I thought not.

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Wulfman...

Re: Sleeping but still feel exhausted. Data attached.

Post by Wulfman... » Mon Jul 08, 2013 11:45 am

riveter wrote:
Wulfman... wrote:Try a straight pressure in CPAP mode.


Den

.
OK. I'll try 19 cm and post the results here.
Thanks.
Looking at the report you posted, a pressure of 15 cm. shows the lowest number of events. Now, we don't know if the events are driving the pressure or the pressure is driving the events....... BUT, if you have some other reports that show similar numbers for the pressure of 15 cm., you might want to start there instead of higher.

Do you sleep on your back?

Setting the machine at a single pressure will make it easier to adjust your mask for that pressure.

When I was starting out, my doctor wrote my prescription for 18 cm., but I found out right away that was too much pressure and set my machine for a much lower pressure (10 cm.) and found out I did very well at that setting before eventually moving up to 12 cm. So, I also know what it's like to deal with high pressure and serious leakage problems.


Den

.

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riveter
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Re: Sleeping but still feel exhausted. Data attached.

Post by riveter » Mon Jul 08, 2013 11:53 am

Wulfman... wrote:
riveter wrote:
Wulfman... wrote:Try a straight pressure in CPAP mode.


Den

.
OK. I'll try 19 cm and post the results here.
Thanks.
Looking at the report you posted, a pressure of 15 cm. shows the lowest number of events. Now, we don't know if the events are driving the pressure or the pressure is driving the events....... BUT, if you have some other reports that show similar numbers for the pressure of 15 cm., you might want to start there instead of higher.

Do you sleep on your back?

Setting the machine at a single pressure will make it easier to adjust your mask for that pressure.

When I was starting out, my doctor wrote my prescription for 18 cm., but I found out right away that was too much pressure and set my machine for a much lower pressure (10 cm.) and found out I did very well at that setting before eventually moving up to 12 cm. So, I also know what it's like to deal with high pressure and serious leakage problems.


Den

.
I sleep on my side.

Here's my data for the past week:
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Wulfman...

Re: Sleeping but still feel exhausted. Data attached.

Post by Wulfman... » Mon Jul 08, 2013 1:52 pm

Considering the amount of time you spent at 15 cm., it still shows that it would be a good place to start and work from.
So, that would still be my recommendation of where to set your pressure.


Den

.