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#11
(10-18-2016, 11:16 AM)SnoringMark Wrote: ............Would I be better off not being able to get back to sleep (less overall sleep) or shutting off the machine after the bathroom break and getting a few more hours of "lower quality sleep"? I'm not sure which way is best, to meet long term goals from a therapeutic perspective.
Most veterans here say we should use the equipment even for brief naps. I'm not sure it's so important. I suppose it depends on how much oxygen deprivation there is while sleeping untreated. (Which can be tested with a recording oximeter.) I have the same problem, and sometimes, I do leave the mask off for the last couple hours. Doesn't seem to affect how I feel during the day or the progress of the therapy. One thing I would do is keep it on for a few of those "awake state but peaceful" sessions, so you'll have baseline data for the awakened state. (Make sure the machine is off during the bathroom break, so there'll be two distinct sessions on the time line in SleepyHead. Then you can turn off the second one to get the true AHI for the night. Don't do this expt if you are in "insurance compliance mode".) Be aware that there most likely will be apneic events. These data may be useful for comparison with sleep state data. Examples: compare awake vs. sleep periods in the Respiration graph; compare 3-minute Flow Rate windows for CA event asleep vs CA awake.

Be aware that the veterans tend to ignore the respiration graph, indeed most tidal channels. I agree they're not useful for optimizing pressure. But I do feel tidal data can contain clues - circumstantial evidence from which to build a theory explaining our sleep patterns, and hence make reasoned late-stage therapy decisions.

Anyway, as others say, the main thing to anticipate is getting sufficiently comfortable with the treatment so mask & pressure tolerance ceases to be an issue.

-Ron

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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#12
Once again, thanks very much for the responses here. I learn something new with each response. Prior to this thread I thought "clear airway (CA)" was a good thing and wasn't really looking at it. I didn't know that this was basically Central apnea. I also didn't know that the Sleepyhead software allowed for looking at separate sessions on a given night. For instance last night I had an AHI of 4.01. But now I can separate the 5.5 hours I slept (AHI 2.03) from the hour I tried to get back to sleep after a bathroom break (AHI 14.23!!!) I have a lot to learn, but I think the important thing as stated above is to just hang in there and get use to everything and see how things evolve in the future. I hope others are learning something from this also.
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#13
Yes, it can be incredible the results you get during short, fragmented sleep. :| Went from an AHI of 2 to an AHI of 14, the former being a 3-4 hour session of "straight" sleep and the latter being a short "nap."

Pushing through the periods of insomnia and the waking up regularly due to discomfort/hyper-awareness during the first few weeks seems to be key to seeing a benefit.
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#14
Talking about learning something new. I just found out I can create a new session by turning the machine off and back on. Then go into SleepyHead and turn off that session. All numbere are re-calculated. Thus you can get better trends and make better decisions.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#15
    Hi everyone, it's been about 2 1/2 weeks since I made the recommended setting changes to my DreamStation Auto. It is set on APAP 13 min/13 max and flex1, not using ramp. My AHI has been as low as .72 and as high as 5.89, with an average of 3.53 since I made the changes. I am becoming more accustomed to the therapy as time goes on. Should I be thinking about making additional changes to lower my AHI further or should I be satisfied with the AHI I have? What changes should I make? I am putting up a screenshot of a "representative" night for the changed settings time period.
Thanks for looking! Mark
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#16
Mark, your AHI is mostly hypopnea and some CA. The snores, flow limits and obstructive events suggest the hypopnea is mostly obstructive. If you're game to try some variation in pressure, try 12 minimum 14 maximum. This would let us correlate any residual events to pressure, and may clean up the H, OA and snores. I think you've given the fixed pressure a fair shot, and a try at some auto-CPAP is probably in order.

Bigger question is, how do you feel with the pressure currently? Are you getting better rest? On sleepyhead, it might be interesting to see a zoom on the flow line when you are sleeping well. There is still an odd long inspiration to short expiration that is curious. Also, you can probably turn off the event chart for BND (have no idea what that is, but you don't have it).
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#17
SnoringMark,

There is still some clustering of events and some snoring going on. It also looks like at the beginning of the night there may be a cluster of "sleep transition" events that should most likely be "discounted" in the sense that they probably would not be scored on a PSG as real sleep disordered breathing events because your body was still in the transition to persistent sleep.

If your AHI is often above 4ish AND you don't think you are waking up feeling as rested as you should, it may be worth increasing the pressure just a smidgeon. In other words, if you don't have any problems sleeping with your current pressure of 13cm, you might want to see if increasing the pressure to 13.5cm or 14.0cm breaks up the clusters and reduces the snoring.

And your leak data is just fine: There's no need to worry about leaks being a significant problem as long as leaks don't wake you up.
Questions about SleepyHead?
See my Guide to SleepyHead
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#18
Thank you both (Sleeprider & robysue) for the replies and suggestions. I am currently very comfortable sleeping with the pressure set at 13. After the initial blast of air, the machine settles in to my breathing pattern (or maybe it's me who settles in) and I don't notice the pressure very much, in fact sometimes when I wake up, I check to make sure the machine is still on. I believe I wake up quite a few times to adjust the face mask which has a habit of "farting" when it starts to leak. I'm still not getting as many hours of sleep as I did before the CPAP. However, overall I feel pretty good in the morning, but do tend to want to dose after dinner, which I try not to do, so that I'll sleep better when I go to bed.
To a degree I think my AHI numbers are somewhat misleading because of the clusters that are recorded when I am trying to initially fall asleep and when I return from the bathroom. I mentioned this before (earlier post), and to some degree I guess everyone's numbers are affected to some degree in a similar manner.
I am going to try some changes in the pressure as both of you suggested, and go with the 12 min / 14 max and see how that goes.

Thanks very much, Mark
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#19
Mark, a part of the idea of using the pressure range, is that you have very good results most of the night. During those quiet times, a slightly lower pressure may be more comfortable and equally effective. Using the small range, lets the machine increase pressure as needed, and that tends to work for a lot of us. Good luck and let us know how things work out. The quality of your sleep is far more important than the perfection of your data. Always do what is best for yourself; we are just here to offer ideas.
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#20
Sleeprider, thanks for the additional comments. I'm wondering if too many of us (me), get too hung up on the numbers (AHI) etc. I have a friend who has been "papping" for years, and he has no idea what his AHI is. When I mention my numbers his response is "but how do you feel?". So I get what you are both saying.

I've only been on the new setting for two nights and don't really notice very much difference. (AHIs 2.26 and 5.02) The pressure seems to be running mostly at the minimum setting of 12. I know it's too early to draw any conclusions.

Thanks, Mark


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