Newbie need advice

Hi all. In just completed my second week on my cpap and need some help.

I have a Phillips Responics System One machine and a Golife mask. I have been able to tolerate the mask and use it through the since since the beginning.

My initial sleep study showed an AHI of 47. The first night on the machine I dropped to a 22, and continued to drop slowly through the first week. The lowest number I have gotten is a 7, which was about a week ago. I was already feeling a little disappointed not to see my numbers get below 5, then this week my numbers shot back up to 31 one night, then down to 13, and last night back to 15. I was feeling much better initially, but the past two mornings (with the AHIs of 13 and 15) I have woken up feeling pretty crappy again!

I guess my question is is it normal to have these up and down numbers at first? Should I call my tech support person now, or give it some more time? I suspect I have had undiagnosed apnea for several years. Also I am a teacher, and this week was our first week back to school, so it's been a majorly stressful week, one which I would normally not be having a good nights sleep.

Thanks for any help and advice!

What is your pressure setting and how was it determined? Are you getting the numbers off the machine's LCD or have you got the software you need to look at the full data on your computer? If you've got the software, can you tell us what the distribution of the events? Are they mainly OAs and Hs? Or are there a lot of CAs mixed in?

For most people with a good titration study, the AHI does drop to below 5 within the first week or so. For many people with a good titration study, the AHI drops below 5 immediately. If it stays above 5 for an extended period of time at the beginning of therapy, it is well worth it to contact the sleep doctor's office and let them know what's going on.

My pressure setting is 5. I'm not sure how it was determined. I am getting the readings from the LDC display.

A pressure of 5 is on the low side. There are people who only need minimal pressure to keep their OSA under control, but for many people a bit more pressure is needed. Given that your AHI remains rather high, I suspect that 5cm is simply not enough pressure to adequately control your OSA.

When you had your diagnostic study, did the tech come in an put a mask on your nose during the night? If so, then what you had was a so-called "split-study" and the second half of the study (with the mask on) was used to determine the pressure.

If you did NOT have a split study, then usually the titration (the process of figuring out what pressure you need) is done in one of two ways:

1) A second sleep study in the lab, which is called a titration study. You wear the mask the entire night and the tech manually adjusts the pressure in response to the events you have.

2) A week or two autotitration trial with an APAP in your own bed. The data is down loaded at the end of the trial and typically the pressure is set at what's called the 90% or 95% pressure level.

Sometimes a doc just "guesses" at a pressure without any kind of titration data (bad practice). Sometimes a doc will set a low pressure on a CPAP before the formal titration study so that the person can start using the machine at home and start getting used to the whole idea of having air blown down the airway while sleeping with a mask. And then the titration study is typically scheduled for a week to a month after the start of therapy and the pressure is adjust appropriately.

Do you know whether your PR System One Auto is set to APAP or CPAP mode? If it's set to APAP (Auto) mode, it may be that your doctor is doing an autotitration trial.

Robysue, thanks so much for getting back with me. I have a feeling my doctor just guessed on the pressure setting, since none of the things you mentioned seem to have happened. Based on what I'm reading here, and the way I'm feeling the past two days, I went ahead and called my tech guy to talk about what's going on. One of the things he mentioned as increasing the pressure setting. He is going to pull to my info at his office and take it from there. Thanks again!

Any other advice???

What are your leak rates? If you have a bunch of em', it will affect your therapy.

Sheriff

1day 14%, 7 days 7%, 30 days 6%.

Poly Anna,

Those "Percent time spent in Large Leaks" are technically not enough to be seriously interfering with the quality of your therapy, but they're plenty large enough to be potentially interfering with the quality of your sleep in terms of sleep continuity.

You should consider downloading the Sleepy Head software so that you can look at the leak line itself and find out whether there is some kind of correlation between the events and the leaks.

Polly Anna wrote:Based on what I'm reading here, and the way I'm feeling the past two days, I went ahead and called my tech guy to talk about what's going on. One of the things he mentioned as increasing the pressure setting. He is going to pull to my info at his office and take it from there.

Make sure he gives you a print out of the data. He will be using a program called Encore Pro. You can contact Pugsy if you want to get your hands on either Encore Pro or Encore Basic so that you can see exactly what data your tech sees.

Also---if there has been NO attempt at titrating you, I would suggest that you push the sleep tech to set the machine in APAP mode with a fairly wide pressure range at the start--I'd suggest 6-20 since we already know that 5cm is not providing adequate treatment. And have the tech pull the data off the machine after a week or two so that both he and you can see what pressure level the machine thinks you need.

Great! Thanks!