Sleeping but still feel exhausted. Data attached.

Yeah, that was U-G-L-Y last night.
It's really a shame that you've had so many years of inadequate therapy.
Needless to say, I'm in agreement to lower your pressure.

I was afraid of what increasing pressure was going to show, but like we've always said.......if you're going one way with your pressure and the numbers get worse, you're going the wrong way.

And, I hope some of the "Auto" (range of pressure) advocates will also see some of the virtues of using straight pressure while they're following this thread.


Den

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Yes, it is saddening and maddening to think of the preventable years lost. However, I get the feeling things are getting ready to turn around for you. After I left one sleep doctor's "care" I wrote him a letter detailing exactly what elementary issues his "expertise" had missed. Didn't help me, other than to vent, but I wanted to maybe help anyone else that he encountered by giving him a clue. Glad you're on your way to getting better.

kteague wrote:Yes, it is saddening and maddening to think of the preventable years lost. However, I get the feeling things are getting ready to turn around for you. After I left one sleep doctor's "care" I wrote him a letter detailing exactly what elementary issues his "expertise" had missed. Didn't help me, other than to vent, but I wanted to maybe help anyone else that he encountered by giving him a clue. Glad you're on your way to getting better.

What's really sad is that I go for months without doing anything about it. And any time I ask for help on this forum, the people have been a great help. But some days I can't muster the initiative to even plug in the data card and read the data. Part of that has to do with the hassle of using Encore on a 64 bit PC via a virtual machine. But now I have an old 32 bit system set up so I can easily read my data.

Ran at 14 cm last night. Better than 16 but not as good as 15. I made a chart comparing the data at 14, 15, and 16 cm. The 'N' is the number of data points at each pressure. At 15 cm I averaged the 3 nights data.
I'm thinking I want to set it at 15 for a few nights and see how I feel. I certainly felt better at 15 cm.

Last Night:


Trend Chart:


Encore Trend Chart:


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The goal is to feel better...not make perfect Math scores.
Give 15 a few nights of consistent use and let's see what happens.
You need 15 for the OA control...less and there are too many OAs.
So just swapping hyponeas for OAs with much more pressure reduction like to the 14. I was hoping that the OAs wouldn't rear their ugly head so soon and the Hyponeas would reduce a bit more markedly without the OAs popping up.

Pugsy wrote:The goal is to feel better...not make perfect Math scores....

When AHI starts getting under control, it might be nice to have an AHI of 0.0, but I have found many times that I'll actually feel more slept and rested on a night that my AHI goes up to 1.2. Yes, I might have a few extra apneas, but my body is actually relaxed enough to get deep sleep necessary for tissue repair. When my AHI is really low (0.3, 0.5), as often as not, my sleep has been light and I may not feel quite as rested. It's different for everyone, but that's been my experience. A few nights over 1.0 for me can mean better sleep.

However, when you're still with an AHI over 5, the idea really is to stay at one pressure for several days--even a week--to see how your body responds on average, unless your AHI goes up significantly (like from 7 to 13). I agree with Pugsy and Den. Settle on a pressure and let your body get used to it. Use smaller increments, like going from 15 to 15.2 and leave it for a week to hone in on your AHI sweet spot. Until you can get hold of an Auto, that's about the only way you can figure out the best pressure.

You fiddle too much with that thing and you'll go blind.... Oh wait,.. That's something else...

Maybe if you switch it back to APAP mode and set the minimum pressure and the maximum pressure to 15cm. That will be the same as CPAP mode but MAY report other events like "NR" (non responsive) and "FL" (flow limitations)......if there are any.


Den

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DreamDiver wrote:Use smaller increments, like going from 15 to 15.2

Only thing Respironics has are 0.5 increments...they don't have anything smaller like your ResMed machine. Bummer because it would sometimes be helpful to have a smaller choice. I don't think he wants to go higher than 15 until we determine if those hyponeas are central in nature or not but a 14.5 might be a number to try.

DreamDiver wrote:You fiddle too much with that thing and you'll go blind.

you had better be careful...don't want you going blind or getting writers cramp.

Wulfman... wrote:Maybe if you switch it back to APAP mode and set the minimum pressure and the maximum pressure to 15cm. That will be the same as CPAP mode but MAY report other events like "NR" (non responsive) and "FL" (flow limitations)......if there are any.

I do agree with this. The M series APAP mode will let you set minimum to maximum so that it will function like a cpap with a fixed pressure but will give you Flow Limitation data in apap mode....FL data is turned off in cpap mode so the 0.0 FL reports don't mean a thing in cpap mode.
I don't know if NR index is turned off in cpap mode...never checked into that part of things but the NR index wasn't high in the past in APAP mode...so I think it is a non issue anyway...but it would be nice to have the FL data.

Pugsy wrote:

DreamDiver wrote:Use smaller increments, like going from 15 to 15.2

Only thing Respironics has are 0.5 increments...they don't have anything smaller like your ResMed machine. Bummer because it would sometimes be helpful to have a smaller choice. I don't think he wants to go higher than 15 until we determine if those hyponeas are central in nature or not but a 14.5 might be a number to try.

DreamDiver wrote:You fiddle too much with that thing and you'll go blind.

you had better be careful...don't want you going blind or getting writers cramp.

Wulfman... wrote:Maybe if you switch it back to APAP mode and set the minimum pressure and the maximum pressure to 15cm. That will be the same as CPAP mode but MAY report other events like "NR" (non responsive) and "FL" (flow limitations)......if there are any.

I do agree with this. The M series APAP mode will let you set minimum to maximum so that it will function like a cpap with a fixed pressure but will give you Flow Limitation data in apap mode....FL data is turned off in cpap mode so the 0.0 FL reports don't mean a thing in cpap mode.
I don't know if NR index is turned off in cpap mode...never checked into that part of things but the NR index wasn't high in the past in APAP mode...so I think it is a non issue anyway...but it would be nice to have the FL data.

Yes it is (turned off)......and/or not reported.


Den

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Getting out of this thread.

Ran at 15 cm last night. High AHI. Lots of hypopneas. Did much better at 15 just a few days ago. I can't think of any other variables that have changed. Not taking any medications, going to bed about the same time, environment temperature about the same, no caffiene, no alcohol, no smoking, no unusual activity, no food after 630 PM. Everything the same.

Don't have much to offer except sometimes we just don't sleep the same each night and sometimes we all have bad nights at a pressure that has worked great for many, many nights.
We don't have a lot of time or experience at 15 cm to see which one of the nights is the most common.
Was the "better" night the norm and last night a fluke or was the "better" night a fluke?
This is why we suggest pick a pressure that seems to work and give it a few nights to see which way it is going to trend.

Which night was the fluke? Don't know until wee see other nights.
Personally, my thoughts....14 didn't work and you felt awful.
I would have tried 14.5 next before going back to 15 because even the 15 "better" night wasn't as good number wise as I would want to see BUT we are splitting hairs here..or trying to. the difference between 14.5 and 15 is unlikely to be a deal maker or breaker in your situation I am thinking...but as long as there are options to try....try them.

I keep seeing "patterns" and/or "clustering" which make me wonder what's causing them.
I'm also wondering if the machine is putting out the appropriate air pressure. That could easily be checked with a bucket of water and a ruler (that measures centimeters) along with either some tape or a marker to mark the length on the hose. If you do an Advanced Search on "manometer" with user "tomjax" there's an easy way to make one (it can be close enough for these purposes). Otherwise, if you're close to a DME or a hospital, someone may be kind enough to check the output for you.

Again, if you would set the machine to APAP mode and set the minimum and maximum pressure to the same setting, that would make it run like a CPAP but MAY show other events not displayed in CPAP mode.


Den

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Wulfman... wrote:Again, if you would set the machine to APAP mode and set the minimum and maximum pressure to the same setting, that would make it run like a CPAP but MAY show other events not displayed in CPAP mode.

That's in the plan for tonight...at 14.5 apap mode with min and max at 14.5 .....what the hell..might as well try it and will be keeping it at that for a little while until a way is figured out on how to get a machine that will give more comprehensive data so we aren't guessing so much.

I have it set for 14.5 cm in auto mode for tonight. I'll look into measuring the pressure. Thanks for that idea.