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[CPAP] First week of CPAP: experience & questions
#11
RE: First week of CPAP: experience & questions
Welcome to the board.

Looking at your charts a min pressure of 9  cmH2O should be used.  4-20 is a range that is often prescribed to see what the machine does then adjust.  It is time to adjust.
Most of your CA seems to be in the Sleep Wake Junk (SWJ) zone.  
Because you mentioned Central Apnea we would really like to see a copy of your sleep studies.  That is a flag that can impact our advice.

If you can please post your Sleep Studies.  They will help us.

Sleep-well
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#12
RE: First week of CPAP: experience & questions
reasonably good scores Smile

if these were my charts, I would set:
1. ramp. set my ramp start pressure to 8 and ramp time to 10 minutes
2. pressure. set min to 11 (my median is about that for all 3 nights). max pressure still ok at 20, but you probably won't go above 15.
3. CFlex. set my flex to x2 to see if it is more comfortable.

Wait at least 3 days on each setting, some suggest longer like at least a week.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#13
RE: First week of CPAP: experience & questions
2. Is it normal to sleep less during early CPAP days? My normal sleep time was 7-8 hours, but now it is 5-6 hours.

Let me echo Hydrangea. There's a reason I chose "twoextrahours" for my username. Used to sleep 9-10 hours a night, and needed afternoon nap as well. Now generally 7 hours and no nap.

You are only three days in, so expect further changes as your body adjusts. For me, it was quite cyclical, several good nights then several bad nights, but eventually settled down. The biggest thing was extremely vivid dreams, REM rebound the doc says after many years of deficit, but after two months those settled down too. Just keep at it, there is a new life in it for you.
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#14
RE: First week of CPAP: experience & questions
(06-13-2017, 01:48 AM)bonjour Wrote: Welcome to the board.

Looking at your charts a min pressure of 9  cmH2O should be used.  4-20 is a range that is often prescribed to see what the machine does then adjust.  It is time to adjust.
Most of your CA seems to be in the Sleep Wake Junk (SWJ) zone.  
Because you mentioned Central Apnea we would really like to see a copy of your sleep studies.  That is a flag that can impact our advice.

If you can please post your Sleep Studies.  They will help us.

Sleep-well
Thanks bonjour. Read about SWJ and now I am beginning to understand the charts better. I will post the sleep study reports.
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#15
RE: First week of CPAP: experience & questions
(06-12-2017, 11:18 PM)sskblr Wrote: Thank you all for the kind replies, they are very helpful. I am already learning a lot in this forum.

@silversnore @DeepBreathing : I downloaded data from SD card and ran SleepyHead. Here are the images:
[As a new member, I cannot post links, please add http:// to the links below.]
imgur.com/NJ4VwGY
imgur.com/zSnv99p
imgur.com/rOP1YKQ

@Sleeprider : Yes, makes sense. I have been prescribed 14 cm pressure and 4 cm start is indeed low. CPAP supplier set it for me and I am yet to explore the settings. Thanks for the link to tutorial. Current settings:
PAP Mode : APAP(Variable)
Pressure Min: 4 cmH20, Max: 20 cmH20
Flex level: x3
Flex mode: C-Flex+
Ramp pressure: 4 cmH20, Ramp Time: 5 Minutes

I read the mask setting primer on this board and made some strap adjustments last night. Today's AHI was 5.x (data not yet downloaded into SleepyHead) and felt much more comfortable with the mask than the past 3 days!

Thank you,
sk

Pressures of 4-20 are the default full range of the machine.  That is not setting the machine, it is setting you up for failure.   If a doctor prescribes 14 cm pressure, that should be the setting, or perhaps within a narrow range around that in Auto mode.  Given a titration of 14, I would suggest a pressure range of 9-14.   I think if you let your doctor know the settings you received on the machine, he would not approve.  

A couple more notes here.  With centrals you may eventually move to a different type of machine if the centrals persist.  Using Flex at +3 tends to aggrevate CA, and I think you will eventually need to move to +1 or off.  Ramp is not therapy. I would encourage you to start ramp at higher pressure, however the 5-minute time is good.
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#16
RE: First week of CPAP: experience & questions
my previous post mentioned a ramp start at 8 for 10 minutes, but I did not catch that you had already set to 5 minutes. that is a-ok.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#17
RE: First week of CPAP: experience & questions
(06-13-2017, 08:12 AM)Sleeprider Wrote:
(06-12-2017, 11:18 PM)sskblr Wrote: Thank you all for the kind replies, they are very helpful. I am already learning a lot in this forum.

@silversnore @DeepBreathing : I downloaded data from SD card and ran SleepyHead. Here are the images:
[As a new member, I cannot post links, please add http:// to the links below.]
imgur.com/NJ4VwGY
imgur.com/zSnv99p
imgur.com/rOP1YKQ

@Sleeprider : Yes, makes sense. I have been prescribed 14 cm pressure and 4 cm start is indeed low. CPAP supplier set it for me and I am yet to explore the settings. Thanks for the link to tutorial. Current settings:
PAP Mode : APAP(Variable)
Pressure Min: 4 cmH20, Max: 20 cmH20
Flex level: x3
Flex mode: C-Flex+
Ramp pressure: 4 cmH20, Ramp Time: 5 Minutes

I read the mask setting primer on this board and made some strap adjustments last night. Today's AHI was 5.x (data not yet downloaded into SleepyHead) and felt much more comfortable with the mask than the past 3 days!

Thank you,
sk

Pressures of 4-20 are the default full range of the machine.  That is not setting the machine, it is setting you up for failure.   If a doctor prescribes 14 cm pressure, that should be the setting, or perhaps within a narrow range around that in Auto mode.  Given a titration of 14, I would suggest a pressure range of 9-14.   I think if you let your doctor know the settings you received on the machine, he would not approve.  

A couple more notes here.  With centrals you may eventually move to a different type of machine if the centrals persist.  Using Flex at +3 tends to aggrevate CA, and I think you will eventually need to move to +1 or off.  Ramp is not therapy. I would encourage you to start ramp at higher pressure, however the 5-minute time is good.

I am curious. Why would you suggest this range ? The OP has been prescribed a pressure of 14 - I would have thought a setting of 13.5 to 19 would probably be more ideal ? 
I don't mean to derail OPs thread but I am prescribed a pressure of 10 - so my range is between 9.5 to 15 and I would like to make sure I am not doing something wrong.
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#18
RE: First week of CPAP: experience & questions
(06-16-2017, 01:33 AM)BHappy Wrote: I am curious. Why would you suggest this range ? The OP has been prescribed a pressure of 14 - I would have thought a setting of 13.5 to 19 would probably be more ideal ? 
I don't mean to derail OPs thread but I am prescribed a pressure of 10 - so my range is between 9.5 to 15 and I would like to make sure I am not doing something wrong.

We each have stated what we would have done if it were our charts - review the data, then pick the range that makes sense based on experiences.  titration in a sleep lab is a one night thing where most people have variations from night to night.  looking at 3 nights actual all night data gives us a better approximation.

I do not see how ideal, in this circumstance, is to go to higher setting than titration value (14,15,16,17,18, and 19), since effective treatment seems to have been gained at median pressure of 11, and patient is susceptible to pressure onset CA events.

Please tell us what your (median pressure) and (90% pressure) is over the past week.  If they are both under 10.5, you might have a case for reducing your minimum pressure.

Good luck,

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#19
RE: First week of CPAP: experience & questions
(06-13-2017, 01:48 AM)bonjour Wrote: Welcome to the board.

Looking at your charts a min pressure of 9  cmH2O should be used.  4-20 is a range that is often prescribed to see what the machine does then adjust.  It is time to adjust.
Most of your CA seems to be in the Sleep Wake Junk (SWJ) zone.  
Because you mentioned Central Apnea we would really like to see a copy of your sleep studies.  That is a flag that can impact our advice.

If you can please post your Sleep Studies.  They will help us.

Sleep-well



I could finally scan and post my sleep study report.

Sleep study: imgur.com/a/lJ6cc


Titration sleep study: imgur.com/a/V8hFi

Thanks for all the help.
-sk
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#20
RE: First week of CPAP: experience & questions
(06-12-2017, 12:11 PM)Hydrangea Wrote: I'll chime in about the sleep hours.  For me, yes. I went from sleeping 10-12 hours a night (and never feeling rested), to sleeping 7-8 hours (and feeling rested).

My "problem" when I wake up now, after 5-8 hours, is that my brain is on *and thinking clearly*.  In the past, if I wake up feeling that way, I know I need to get up and be productive. So now I'm trying to retrain myself that if I wake up like that after just 3-5 hours, I really do need to go back to sleep.

It's weird, adjusting my mindset.  For the past 20 years, I thought more sleep = more rested.  But now I'm learning that better quality of sleep = more rested.
Absolutely.
My work schedule, and being a "night person" tends to dictate my sleep hours on work nights, but on weekends, if we had nothing planned, we would sleep until noon or sometimes later.. going to bed around 1am.  Used to be alert and OK at work, but the drive home in heavy traffic was a challenge, and I would tend to nod off in meetings

On therapy, I feel great on my work night 6 hours, but weekends, I actually find it hard to sleep longer than 7-8 hours.

When we have apnea events constantly interrupting our sleep, our bodies tend to become accustomed to not getting enough/quality sleep and we do tend to try to "catch up" on days that we have no obligations... which we actually can't do, damage caused by lack of sleep is not repaired, what we are actually doing is attempting to get a full night despite the apnea.
-- Rich
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INFORMATION ON FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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