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Anything more to tweak?
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Dyssomniac Offline

Members

Posts: 19
Joined: Dec 2014

Machine: System One REMStar 60 Series Auto CPAP
Mask Type: Full face mask
Mask Make & Model: AirFit F10
Humidifier: System One Heated Humidifier
CPAP Pressure: 4-20 cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #1
Anything more to tweak?
Hi all, I've been using a CPAP machine for seven weeks now, and things seem to be going quite well. I thought I'd relate my story to see if there's anything further you think could be tweaked.

I first had a sleep study 9 years ago at age 51 and tried a machine but had trouble tolerating it. At that time they said my apnea was mild and I didn't absolutely need to be treated, so I didn't pursue anything further.

As I turned 60 this year, however, my wife reported more "apnea events" (stopping breathing at night, followed by a sudden noisy inhale). Also, I found myself very tired during the day, with difficulty staying alert even during morning meetings. So I had another study (this time with a device at home), and they reported my AHI was 29.9.

I was given a Philips-Respironics 60 Series REMStar Auto machine with heated humidifier and a mask with nasal pillows to try. With this gear, my wife said there were long periods where I was making a whooshing sound (i.e. mouth hanging open and air leaking out). So the clinic changed me to an Airfit F10 full-face mask. They set the air pressure to 4-20 cm variable. I also got a copy of SleepyHead and started looking at my data.

I noticed a big difference between sleeping on my back vs side. When I slept on my back, my AHI for the night even using the machine was up in the 8 to 11 range. If I stayed on my side, it was down around 2 or 3. I asked the clinic about the numbers from my sleep study this year. It turned out that when I slept on my side during the study, my AHI was 0. However, when I slept on my back it was 59.8. Since I spent half that night on my back vs side, my total AHI came out to 29.9. (For what it's worth, I'm 6'1" and 180 lb, so weight doesn't appear to be an issue.)

I therefore started making an effort to stay on my side as I used the CPAP machine. The full-face mask was a reasonable fit, but I found it hit the pillow as I stayed on my side. Also, my nose gets kind of itchy, and to itch it with a full-face mask I have to stop the machine and take off the mask. The clinic therefore gave me a ResMed Mirage Liberty mask to try -- this combines nasal pillows with a cup-type shape that fits over the mouth. I had a hard time breathing through my nose with this mask, however, so I didn't stay with it long. It appears there is a second set of nasal pillows included with it, so it's possible I could improve it if I experimented with it. Meanwhile, though, I went back to the F10 full-face mask and found myself getting used to it.

Around this time I also got a CMS 50D+ oximeter to check out my oxygen as I slept. I smoked for 15 years as a young adult, but quit 25 years ago; now at age 60 my oxygen % is typically around 96 both day and night. The oximeter showed that when I slept with the CPAP, it would hover mostly around 96, only occasionally dipping to 94 or so, never lower than 92.

Now in my seventh week of using the machine, things are going well. I'm used to sleeping on my side (though I turn a couple of times each night to alternate the side), and the F10 mask seems fine. This week I've been getting AHI numbers for the night for the first time under 1.0 -- the lowest ever was 0.58, and other nights it's been 0.72 and 0.90, though it's gotten up to 2.05 and 2.19 a couple of nights. I hardly ever have any Cheynes-Stokes breathing -- the main thing seems to be hypopnea and RERA events. I feel alert during the day, and my wife says she doesn't hear me and she sleeps better than she has in years.

So I'm tempted to call this a success story and just go into cruise mode with this current configuration. But there are a couple of points I've wondered about:

-- Some CPAP users tell me it's difficult always to sleep on their side, and they think it's better to adjust the machine in order to hit good AHI numbers regardless of their sleeping position. Some have suggested trying a higher minimum pressure (on my machine the minimum is currently 4 cm). Does this seem worth pursuing, or if I'm happy sleeping on my side is it important?

-- Although the F10 mask seems pretty fine now, I still wish I could itch my nose during the night without a lot of re-rigging. I hear about other mask options, such as some designed for mouth breathers. However, my clinic has a limited number of masks to try, and after several requests I haven't been able to get them to give me a written prescription so that I can buy my own if I want to.

Thanks for any thoughts on the above, or anything else that might be worth discussing from my story.
(This post was last modified: 12-21-2014 11:55 AM by Dyssomniac.)
12-21-2014 11:51 AM
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PaytonA Offline
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Monitors

Posts: 3,013
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #2
RE: Anything more to tweak?
Your results sound good to me but i have one question. What has your 95/90% leak rate been?

If the leaks have been in good shape while your AHI is low it does not look to me like there is a "need" for further tweaking. There are those who feel the need to tweak even with AHI=0 three or four nights a week. it is the counter point to, "If it ain't broke, don't fix it". Some people use the engineer's version of that saying, "If it ain't broke, break it, then fix it". Or "If it ain't broke, fix it anyway".

Sleep well,

PaytonA
12-21-2014 02:39 PM
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Dyssomniac Offline

Members

Posts: 19
Joined: Dec 2014

Machine: System One REMStar 60 Series Auto CPAP
Mask Type: Full face mask
Mask Make & Model: AirFit F10
Humidifier: System One Heated Humidifier
CPAP Pressure: 4-20 cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #3
RE: Anything more to tweak?
Hi Payton, thanks for the thoughts. Where I work, we call it "buffing the chrome" (making something that's already pretty good glisten that much more brightly).

SleepyHead says that, for the past month, my average leak rate is 0.35, my 90% leak rate is 1.00, and my % of time above leak rate threshold is 0.00%.
12-21-2014 02:59 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #4
RE: Anything more to tweak?
Personally Id go into clinical settings on the machine and enable the Opti start feature. i have the same machine as yours and use this anytime I change mask types. After 30 hrs the machine will pick the optimum starting pressure based on your data its collected.


Ive no doubt it will pick a higher number than 4cm. It basically just narrows the range it has to climb to get to the pressure it runs at most of the time so it doesnt take as long for it get to a pressure that does anything. If that is 4 cm then it will leave it at that. If its 6 7 8 cm thats what it will pick.

When it does it will start at the pressure but drop back to your preset 4 cm if no events happen for a while. To get it to start and stay at that start pressure youd need to go back into clinical settings and reset your min pressure to the one it choose as its optimum starting pressure for you.

Has always worked very well for me when ive used that feature and ahi has always dropped as a result. If you dont know how to enable it and want too, PM me.
12-21-2014 03:03 PM
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Dyssomniac Offline

Members

Posts: 19
Joined: Dec 2014

Machine: System One REMStar 60 Series Auto CPAP
Mask Type: Full face mask
Mask Make & Model: AirFit F10
Humidifier: System One Heated Humidifier
CPAP Pressure: 4-20 cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: Anything more to tweak?
Thanks, Ghost, I'll check out the opti feature. I obtained a copy of the clinical manual, so it shouldn't be a problem to work that out.

On my better nights, the machine's pressure stays between 4 and 6 cm all night. But some nights with more events it gets up to 7 or 8 cm.

I do notice that, although some clusters of events occur in the middle of the night now and then, by and large the events that cause the AHI to go up are in the periods of time when I'm falling asleep or waking in the morning. Particularly in the morning, I usually wake up initially at least 45 minutes before I actually get out of bed and turn the machine off. So a lot of that breathing is when I'm actually conscious. My breathing *seems* regular to me, but maybe there is something about the pace or depth that causes the machine to log an event.
12-21-2014 09:57 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #6
RE: Anything more to tweak?
Ive looked at my and my wifes waveforms enough now to able to tell when we are awake or asleep pretty much.

Pattern is constantly erratic awake then drops into a regular consistent waveform asleep unless roused or an event happens.

Ive had her machine and mine flag stuff that I knew for a fact I was awake. Same with her.

So I usually toss out the junk I know I was awake even though the machine flagged something being fooled by me holding my breath while turning over yawning in the mask etc. So yeah the machine will sometimes flag something with you awake.\

I personally dont see how you live with the machine on 4cm. I have to have a min of 7 to get enough air. Wife has to have at least 7.5 or she smothers. The sleep lab started me on 8cm. Final scrip called for 6 but that didnt last long till I was at 8.5 to 10.5 min depending on mask.

Opti start Id say runs you up to 6 cm maybe 7 based on what your saying your machine runs at. My pressures are considerably higher at max
12-21-2014 10:36 PM
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Dyssomniac Offline

Members

Posts: 19
Joined: Dec 2014

Machine: System One REMStar 60 Series Auto CPAP
Mask Type: Full face mask
Mask Make & Model: AirFit F10
Humidifier: System One Heated Humidifier
CPAP Pressure: 4-20 cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #7
RE: Anything more to tweak?
(12-21-2014 10:36 PM)Ghost1958 Wrote:  I personally dont see how you live with the machine on 4cm. I have to have a min of 7 to get enough air. Wife has to have at least 7.5 or she smothers. The sleep lab started me on 8cm.Final scrip called for 6 but that didnt last long till I was at 8.5 to 10.5 min depending on mask.

Opti start Id say runs you up to 6 cm maybe 7 based on what your saying your machine runs at. My pressures are considerably higher at max

At the very first of using the machine I was concerned about having a sensation of being starved for air, but I got used to breathing at the 4 cm level and now prefer it. If the machine gets up to 8 cm, the increase in air pressure almost always wakes me up and I toggle the machine off and on to get it back down to the 4 cm level. But I'll see what feels comfortable with the opti start.
12-21-2014 11:30 PM
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herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #8
RE: Anything more to tweak?
Also note that quite a few of us just plain don't like the pressure much below 8 (or for some 6) so if it doesn't screw anything else up you might just ENJOY the mask more at 8.

This may be even more true for my nasal pillows since they ALSO HOLD MY NOSE PASSAGES OPEN and allow me to keep my mouth shut and my nose clear all night long (something not true for me before CPAP or if I skip CPAP.)

Your mileage may vary (YMMV) but for me this is about the least.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
12-22-2014 06:34 PM
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