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[CPAP] New to the CPAP experience - questions
So I guess I'm now a new 'hosehead' is what I've heard it called? Smile

I've been using CPAP for a grand total of 6 days now, with the last 4 being the only ones I had meaningful use (over 4 hours). I struggled immensely with the pressure at first. I'm still uncomfortable with it, and still have to use 5mg of ambien (not something I use very often, and I'm aware it can impact my apnea), and I plan on not using the ambien after a couple more nights (I really don't like it).

Anyway, I'm using the Phillips Respironics dreamstation CPAP with humidity control, flex, and ramp. (I was successfully able to not use the ramp feature last night, and it is my intention to not use it for long if at all). My pressure is 14, and after looking at my data in sleepyhead (and on the machine itself), it is still showing a high AHI, though it has been dropping some every night. It started just over 10, went down a bit over a couple nights, and is now at 6.5. However, of particular concern to me is the number of centrals I am starting to see. I'm wondering if my pressure is too high, and I've been trying to learn the details of the stats I'm seeing, but the complexity to fully understand it? I'm not there yet.

Hoping for some insight. Thank you!

Not sure what sleepyhead file to attach. channels.dat?    
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Hi Penguin - Congratulations on using the CPAP for 6 nights in a row - not easy to do when you start out. I am no expert on reading SleepyHead and will leave it to someone else to answer your questions on that. However, if your AHI is steadily going down I'd say you are having good success. A 6.5 AHI is not bad. I realize that the experts say it ought to be under 5.0 to be considered "under control" - and some people routinely get really low results. But - for a new user - 6.5 is good! I've been using the CPAP for 4 months now and usually get an AHI under 5 - but not always. But - I have felt noticeably better the last 6 weeks - so stick with it and enjoy your improving health!
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Okay, I'll allow myself to be cautiously optimistic. Smile

So I've been looking around and found the recommended way to display my data. It isn't allowing me to post it, but I'll keep trying.

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See if the above link helps you upload your reports.
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Yea, I have the data all formatted, but it says I have to make 4 posts first. And then makes me wait like 800 seconds between posts. lol

So I'll post a couple more silly things here and see if it finally lets me.
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You should be able to post screenshots any time now.

Follow these instructions as it gives us the best data to look at. Leave off the calendar and pie chart and right side bar.


The one thing that stands out is that your are using an Auto Cpap set to straight Cpap mode. Why is that?

Your machine also has a feature called optistart, which when enabled will find your ideal 90% pressure setting. Once you determine that 90%'number, you can leave machine at straight Cpap or set to auto Cpap with a pressure range. Usually we advise to set the minimum pressure 2cm below the 90% number and 2cm above the 90%.

You may do better if you switch to Auto mode. Post some data and we will try to advise.
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Much appreciate the info. I'll try to attach the data. The reason my settings is where they are is because 'that's what the doctor ordered'. I'm definitely interested in doing this optimally. I have some anxiety about doing it myself as I'm not always able to be 'monitored', and I don't know is there are any real and immediate dangerous risks to doing my own settings (it is my breathing after all Smile ). But I also know I am just a number to doctors, and they will get me in and get me out with the bare minimum interaction they can get away. So I'm absolutely interested in learning and exploring options, as long as I know I won't be leaving my wife a widow. Wink Thank you for the help! (OOPS, just saw you didn't want pie chart. I missed that. I can do an edit when I get home later.)

[Image: 3i3IW76l.jpg]
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Thanks for posting. It's ok with the pie chart, but we can see more info on machine settings with it gone.

I notice a couple of clusters of Clear Airway events early on, but it could be that you rolled on to your back?? These usually clear up in time.

Your leak rate is a little high, but not too bad. Are you mouth breathing? Or it's possible you are having some mask leaks. If mouth breathing, try a chin strap. If you think your mask is not a good fit, you can try mask liners. Also don't adjust the mask straps too tight.

Your sleep is very fragmented, but it does take some time to adjust.

I understand if you don't want to upset your doctor, but in time you will have to figure out what works best for you. And no, you aren't going to make your wife a widow. Big Grin

You can order the Clinicians manual for your machine which will explain a lot of the settings that your doctor and DME would rather you didn't know. Smile

I'm sure someone else will have comment/suggestions for you. Hang in there, it does get better.
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I'd like to see you in auto mode for a couple reasons. First, your events are all clustered near periods where you are awakening as evidenced by a break in therapy. This is pretty normal, and clusters of CA may not be "real" in those circumstances. People hold their breath all the time when awake. Following those periods of disrupted breathing, you have smooth, if shallow respiration with no appreciable events for an extended period. Second, you have nearly zero flow limitations and snores. If you use the auto mode, the machine will usually only increase pressure with flow limitation, snores or periods of volume reduction (hypopnea) and most of the night, you are free of those.

Your fixed pressure is pretty high, and you will have to tell me if that is uncomfortable or a problem for you. As far as using auto mode, there really is no risk. You lived for years with no therapy, and the worst that can happen is we try auto mode with a minimum pressure that is too low resulting in some actual OSA during periods when you're actually asleep. So far, it looks like events only occur when sleep is disrupted.

Get the provider manual at the link at the top of the page for CPAP setup manuals. I think you would do well on Auto mode with a minimum pressure of 11 and maximum pressure of 15. Again, the machine will not increase pressure unless there is obstructed breathing. Not to get too far ahead, but a minimum pressure of 11 looks to be conservative, and there may be room to reduce that, but I think it's best to go slow. To change the pressure you just turn the control knob to setup, then press the knob and ramp button at the same time until you get a double beep tone. Turn the knob to settings and scroll to mode. Change from CPAP to Auto. Scroll down to minimum pressure and select, then scroll and select 11.0. Same with the maximum. I would leave everything else at default for now.

Using a variable pressure will let you see if there is a correlation of events, including arousals with a particular pressure. I suspect the CA will be reduced, and OA may also be reduced in auto mode. Let the settings work a few days then re-evaluate. You always have the option to return to fixed pressure. If you feel better about it, tell your doctor you would like to try variable auto pressure in a narrow range. He will either support that idea, or not depending on his inclinations. The important part is, you're not changing pressure far from the suggested titration result, which is probably the 90% pressure required to reduce OSA anyway. In other words your fixed pressure is set higher than you need for most of the night. That's why we use auto mode.
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Hi DynamicMaroonPenguin1961,
WELCOME! to the forum.!
I wish you good luck with your CPAP therapy and getting it fine-tuned to better help you.
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