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[CPAP] record - think it should be better, suggestions how to improve?
#1
Question 
My father has been using CPAP for about 4 years. I just recently found out that his AHI numbers seem kind of high (8.6 average for last year, vary from 4 or 5 up to 17 or more).
Also not sure if the level of periodic breathing detected by the machine is a concern. (He is in his 80s.)

Just got SleepyHead and looked at data from his machine, not sure if there is problem, and if so, not sure what he should do about it. He hasn't seen anybody in sleep medicine for 2+ years. He now has an appointment in a month or so, but wanted to get bit of understanding to be prepared for the appointment, and anything that would help him in meantime.

Philips Respironics System One (60 Series)
RemStar Auto with A-Flex (560P)
A-Flex x1
APAP (Variable) Min 7 Max 20 (cmH2O)
Ramp starts at 4 cmH2O

Humidifer - he puts water in it, but does not have heater turned on.

Full face mask (Quattro FX)

SleepyHead 0.9.8-1

Average over last year:
AHI 8.59
Obstructive Index 4.91
Hypopnea Index 3.01
Clear Airway Index 0.66
Flow Limitation Index 0.49
RERA Index 2.92
% of time in Cheyne Stokes Respiration 2.11%

Leak Statistics
Average Leak Rate 1.35
90% Leak Rate 4.00
% of time above Leak Rate threshold 0.49%

Average Pressure 8.69
Min Pressure 4.00
Max Pressure 17.70
90% Pressure 12.00

Average time in Apnea 27 minutes (4.3 to 70)

Attached is what seems like a typical night.
(About average AHI, shows clumps of OA and Hypopnea, some CSR).
Please let me know if need more information.
(However I seem to be at my storage limit, and it would not let me post links to external photo site.)

Thank you


Attached Files Thumbnail(s)
   
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#2
If you want to show us some more, just put a ! sign in front of the address, then we will pick it up from there....

example -

!http://www.apneaboard.com/forums/attachment.php?aid=1549 does not show as a link.

whereas http://www.apneaboard.com/forums/attachm...p?aid=1549 shows as a link.

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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#3
Seeing his summary stats and his one night snapshots, a few things come to mind:
1) He is hitting the reset button a bunch of times. That puts his pressure back to ramp start of 4.
2) his start pressure of 7 is not cutting it to prevent obstructive events or even hypopnea events.
3) His CA index is real low so that is good.
4) His Periodic breathing is 2.1%. Clinicians don't treat it unless it's more than 3% consistently. So that is a plus as well for him.

A few things to try:
1) eliminate his ramp (by either reducing the ramp time OR increasing ramp start pressure, probably both).
2) His a-flex setting is fine for now.
3) Raise his lower pressure range from 7 to a level where you don't see ugly clusters of obstructive events. You may want to do it gradually - 0.5 cm at a time for a few days. And repeat.

This should make his numbers better. I am sure other apnea board members will have more better suggestions and will chime in soon.
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#4
hi, and welcome sleepymoggie.

It mostly looks fine.

Just looking at May 26, it shows that at least some nights your father has woken up and pressed the ramp button. I can imagine that he does not want to ride it out at the pressure it got to. Perhaps you can ask him what issues at night he remembers, if there is anything he just can't stand (ie. spurts, mouth dryness, tickles, the machine coaxing his breaths, soreness in limbs, need to turn over). These will help him form the discussion with the doc.

The basic recipe for setting your CPAP finds its way into most threads, because we want to do better and often don't know how as a 'newbie'. Mostly they say do almost every change slowly over days to weeks, to increase the start pressure above the median but below the 95% pressure, change ramp to start higher and length to shorter, and to monitor results.

In that spirit, I think two basic things I would do at this time are:

Raise min pressure from 7 to 8. (eventually looking at being above 8.69 annual average)
Raise the ramp start pressure to 6.

Then, I would see if there was something particular that was causing me to waken, and try to resolve that.

Other things might occur to us when we see a few more charts.

Other notes: Specifically, I do not think leaks, periodic breathing, or clear airway apnea are of any concern at all. RERA is fairly high, this probably indicates that there are shorter halts in breathing that are not being counted as apneas. I would take a look around clumps of RERAs to see if there are start-stops that are not labelled as apneas (exa. between 0500 and 0540 on May 26). I am inclined to believe there may be a connection to REM sleep during that period.

By the way, how does he feel? Does he generally feel healthy and rested?

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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#5
Hi sleepymoggie,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you and your father with CPAP therapy.
trish6hundred
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#6
(06-21-2015, 06:47 PM)quiescence at last Wrote: If you want to show us some more, just put a ! sign in front of the address, then we will pick it up from there....

QAL

Thank you for the suggestion, unfortunately it does not appear to work.
For instance I tried to post (but without the extra spaces)
! h t t p ://postimg.org/image/56c571jpb/

But it will not let me.
Looks like I need to post several garbage posts just to get my post count above the set threshold. Is there a standard thread for posting such garbage so it does not mess up the rest of the board?

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#7
you did what I hoped you would do, so I can reconstruct the address and view the image.

(oh and post it, he he, too)

http://postimg.org/image/56c571jpb

[Image: eUBJp7P.jpg]

I could only do it by copying your image and renaming it.

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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