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Comparing AHI between CPAP and For Her
#1
I exported the data from the Resmed app, plugged it into Excel, and created graphs for each period beginning with the plain AirSense 10 CPAP (aka "brick") and the AirSense 10 For Her.

Here.

The AHI is lower during the use of the plain CPAP set at a pressure of 7.0. It increases when I started fiddling with the pressures.
CPAP:
80 nights, Average AHI = 2.1,
with a slight increasing trend: y = 0.0097x - 412.62

For Her:
21 nights, Average AHI = 3.5
with a slight decreasing trend: y = -0.0029x + 125.41


So now I'm wondering if I should drop the minimum back to 7.0. Is a puzzlement (- a quote from the King and I, the Yul Brynner version)

                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#2
Have you filtered out sleep/wake junk? One thing to consider, of many, is that the pressure changes with APAP might be disturbing you and resulting in more slightly awake time or might even cause what gets recorded as an event. I've recently discovered that I seem to sleep better (wake up less) on CPAP versus auto mode.

Does raising the pressure cause more central apneas? What part of AHI goes up? Is that just your brain reacting to the change?

I'd worry less about numbers and more about "how do I feel?".
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#3
I keep waiting to feel great and it ain't happening, not even after over 3 months.

First, how does one identify sleep-wake junk?
Second, I was using the summary results from the CPAP - it doesn't provide any details to identify much other than minutes of use and the AHI.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#4
It has been more than six months for me and I feel good, but not great. I feel MUCH better than before CPAP, but I don't wake up refreshed and full of energy. I feel better when my AHI is below 2, so there might be something there. Or OSA might only be part of your problem.
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#5
(11-21-2016, 09:24 PM)Beej Wrote: The AHI is lower during the use of the plain CPAP set at a pressure of 7.0. It increases when I started fiddling with the pressures.
CPAP:
80 nights, Average AHI = 2.1,
with a slight increasing trend: y = 0.0097x - 412.62

For Her:
21 nights, Average AHI = 3.5
with a slight decreasing trend: y = -0.0029x + 125.41


So now I'm wondering if I should drop the minimum back to 7.0. Is a puzzlement (- a quote from the King and I, the Yul Brynner version)
It is possible that the AutoSet for Her is scoring more events because of sleep-wake-junk (SWJ) breathing and that the SWJ has increased because your body is not as comfortable with pressures that are constantly changing all night long.

You were titrated at 7cm and your long term AHI was around 2.1 when using straight CPAP at 7cm.

You are now using the AutoSet in Auto mode. What pressure range are you using? My guess is that your min pressure setting is now above 7cm since you are wondering whether you should drop the min pressure back to 7cm. So that raises some questions:

What are the actual settings you are using on the AutoSet?

Why did you raise the min pressure above 7cm on the AutoSet in the first place?

What is the breakdown of your AHI on the AutoSet into CAI, OAI, and HI? In particular, what's the biggest part of your AHI?

How many times have you changed the settings on the AutoSet in the 21 days that you've been using it?

You also write:
(11-21-2016, 10:13 PM)Beej Wrote: I keep waiting to feel great and it ain't happening, not even after over 3 months.
I feel your pain. I had a disastrous adjustment to CPAP and felt orders of magnitude worse on CPAP than before CPAP for the first four or five months due to a severe case of CPAP-induced insomnia. I started to notice some slight improvements in how I was feeling about 6 months or so into therapy, but I didn't really feel much better for over a year.

And I've never woken up feeling "great" as in feeling "on top of the world fantastic". But then I've never been much of a morning person in the first place.

Quote:First, how does one identify sleep-wake junk?
SWJ can only be guessed at by looking at the flow rate data. So it's impossible to tell SWJ in your CPAP data. But you can learn to use the flow rate data of the AutoSet to get a pretty good idea of when a cluster might be SWJ rather than a "real" cluster. A lot of it is simply tying a nasty cluster, often with a bunch of CAs, to a time frame when you were most likely not fully asleep. In other words, the more you toss and turn and doze in and out of sleep, the more SWJ breathing there is. In some people, the SWJ breathing is ragged enough to be flagged as sleep disordered breathing events even though they may not have actually been asleep (from and EEG point of view) when the event happened. In other people, the SWJ breathing is smooth enough to not be flagged very often. We tend to suspect SWJ if there are a whole lot of events scored right after you turn the machine on or right before you wake up enough to turn the machine off in the morning. Likewise if you know that you were tossing and turning for 20 or 30 minutes at a time when there are a lot of events, there's a chance the event cluster is SWJ.

Questions about SleepyHead?
See my Guide to SleepyHead
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#6
You asked
(11-22-2016, 12:59 AM)robysue Wrote: What pressure range are you using?
What are the actual settings you are using on the AutoSet?
How many times have you changed the settings on the AutoSet in the 21 days that you've been using it?

Here’s a link to the changes; I made gradual, small changes, rather than a jump and hold approach.

(11-22-2016, 12:59 AM)robysue Wrote: Why did you raise the min pressure above 7 cm on the AutoSet in the first place?
The pressure was going up higher and staying there, so there didn’t seem to be much point in starting lower if it was just going to increase anyway.

(11-22-2016, 12:59 AM)robysue Wrote: What is the breakdown of your AHI on the AutoSet into CAI, OAI, and HI?
(11-22-2016, 12:59 AM)robysue Wrote: In particular, what's the biggest part of your AHI?

Overview (Is that OK, or would you like me to make a chart? That's going to take some cutting and pasting; i'll get started.)
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#7
Beej,

I apologize for not getting back to you. Over the holiday week I was without internet.

Short version of my answer: You've been making too many changes and not leaving them in place to get any meaningful trending data. Our sleep is different each night and by leaving a change in place for only 1 or 2 days, it's difficult to see if something is just a "bad night" or if the settings are really inappropriate.

If this were my data, I would pretty much leave the settings at 8.8-10.0 with EPR =1 for at least a couple of weeks before changing the settings again as long as that's comfortable in terms of getting and staying asleep. And I'd resist changing the settings just because of one or two bad AHI nights.

If you're not as comfortable as you'd like to be when getting to sleep with these settings, you could go back to 8.4-10 or 8-10 and leave EPR = 1. Or you could leave the pressure at 8.8-10.0 and increase EPR to 2. And then leave it there for at least a couple of weeks. I'd make the choice on which thing to try based solely on comfort.

Yes, there's been a switch from your events being predominantly obstructive (OA+H) to CAs recently, but the overall AHI is well below 5.0 and so it doesn't really matter that you're seeing more CAs than you were earlier. Just keep an eye on them. My guess is that if 8.8-10 is a good pressure range for you in terms of comfort, the CAs will eventually become rarer.
Questions about SleepyHead?
See my Guide to SleepyHead
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#8
Thanks. I figured something was up.

I inched it up 0.2 cm at a time, rather than making full unit pressure changes after trying a big jump one night which was too much for me.

I've kept it stable for a while since then. I also just started a new medication for migraine which may or may not have an impact, so I'm trying to limit it to just 1 change at a time.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
Post Reply Post Reply
#9
(12-02-2016, 12:54 AM)Beej Wrote: Thanks. I figured something was up.

I inched it up 0.2 cm at a time, rather than making full unit pressure changes after trying a big jump one night which was too much for me.

I've kept it stable for a while since then. I also just started a new medication for migraine which may or may not have an impact, so I'm trying to limit it to just 1 change at a time.
If you don't mind me asking, what's the new migraine med? And is it a prophylactic med or a rescue med?

I also get migraines, and it took a long time to get my chronic migraines under control. And I was fighting that battle at the same time as dealing with a super nasty adjustment period to CPAP/BiPAP.

Questions about SleepyHead?
See my Guide to SleepyHead
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#10
(12-03-2016, 02:23 AM)robysue Wrote: If you don't mind me asking, what's the new migraine med? And is it a prophylactic med or a rescue med?

I also get migraines, and it took a long time to get my chronic migraines under control. And I was fighting that battle at the same time as dealing with a super nasty adjustment period to CPAP/BiPAP.
I'd had ocular migraines - visual symptoms, no pain though - for decades. These consist of grayed out blotches in my vision, or sparkling lines along the blood vessels (the theory is the retina can't understand the pulses, so it gives you a light show), skewed double vision, and occasionally, nystagmus (the eyes twitch to one direction repeatedly).

I was told to take 400 mg of Vitamin B-2, 200 mg of magnesium, and Petadolux (an extract of butterbur). Of these, the first 2 worked fairly well to control the visual issues. I didn't like the taste of the latter, so discontinued it. These have clinical research showing effectiveness in some patients as preventatives; your mileage may vary.

I'd ended up in the ER back in September with an acute vertigo attack, complete with losing all of breakfast and being unable to stand up. I've been told that this was a vestibular migraine. I've been started on lamotrigine (Lamictil) using the Bisdorf protocol for vestibular migraine, to prevent further attacks. This begins with a low dose to allow the liver to accommodate processing it, then steps up to a higher dose. Three days so far, with no blatantly adverse effects. I've been taking it before bed.

Lamotrigine is used for regular migraine, too.


                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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