Completed First Night

[MoApnea]

I have two recommendations for you.  First, you have Ramp on, and your therapy starts out of the box at too low of a pressure.  Your ramp starts at 4 cm pressure and rises to therapy pressure (8-cm) in about 30 minutes.  Meanwhile, you already are experiencing snores, and hypopnea and even RERA as a result of your pressure being too low at startup.  This is a comfort setting and you are allowed to change it. You should increase the starting pressure to 6.0 cm and reduce the time to 15 minutes, or just turn it off once you don't need ramp.  This is a consistent pattern, and fixing ramp will reduce your event rate significantly depending on the number of therapy breaks.

Your pressures are borderline low resulting in obstructive apnea (OA) and hypopnea (H).  These are fairly distributed through the night.  For fixed pressure, I would increase the pressure setting to 8.5, or simply change to Auto mode and use a minimum setting of 8.0 (prescription), and a maximum pressure of 10.0.  This will nearly fix the problems and be more comfortable.  It complies with your prescription, but will quickly show you that laboratory titration is imperfect because it is nothing more than a sample of your sleep.  Your titrated pressure is technically correct and your AHI is less than 5.0, but it is NOT optimal. The best way to handle this is to simply make the change.  If anyone objects, call the doctor's receptionist and leave a message why the change was made (excess events that cleared with in auto mode). This will not affect your compliance which is based solely on your use of the machine for 4 or more hours per day for 21 of 30 consecutive days in the first 90 days of therapy.

Your leaks are not a problem. You have almost no leaks through the night.  The Respironics machines show two leak lines, the top one is the total leak (intentional venting + unintentional leak), and the bottom line is the unintentional leak.  On your graphs, only the top line is visible, therefore you have no problem with this.

Ramp: Thanks, i'm able to clearly see what you are saying on my report with regards to my lower pressure at the start and the events.  I will probably just get rid of the ramp since it's not a huge deal to have it.

Compliance:  I have no set standards through my insurance for any type of compliance, I can pretty much do what I want with it. 

Pressure changes: I plan to evaluate this a little further.  I do think my Rx pressure is probably not for optimal use and I like the idea of the machine adjusting pressure in the auto setting.

[MoApnea]

Question: during the night when i have to disconnect (bathroom, kids, etc) should I always leave the machine on and just disconnect my mask from the tube/take mask off? Or should I turn the machine off while I'm up, even if it's for 5 minutes or less.

[Walla Walla]

I turn mine it off. If you leave it on it throws off your numbers for leaks and other flow information in the long term as far as averages.

[MoApnea]

I turn mine it off. If you leave it on it throws off your numbers for leaks and other flow information in the long term as far as averages.

Ok cool, I didn't know if stopping and starting middle of the night throws things off.  I'm glad that turning it off is an option... disconnecting the hose from the mask made it sound like a vacuum was being ran in dead of night :-)

[MoApnea]

Should I turn off the wifi setting? It sends out info to the RT (and maybe doctor?) and if I'm not really relying on them for therapy advice, any reason to be sending off that info? I do still plan on having a dr appt in a month so not sure if that is sending info their way also

[Walla Walla]

It depends on a couple of things. One are you renting the Dreamstation or did you buy it? If your renting it than I would say leave the wifi alone.

Also you said your insurance didn't require any compliance. I'm guessing your insurance bought the machine so no reason to have compliance. If thats the case than yes you could turn off the wifi. But remember if your going to the Doctor for his input than you want to make sure he has access to your data. It's the only way he can advise you.

I'd leave it on.

[MoApnea]

It depends on a couple of things. One are you renting the Dreamstation or did you buy it? If your renting it than I would say leave the wifi alone.

Also you said your insurance didn't require any compliance. I'm guessing your insurance bought the machine so no reason to have compliance. If thats the case than yes you could turn off the wifi. But remember if your going to the Doctor for his input than you want to make sure he has access to your data. It's the only way he can advise you.

I'd leave it on.

Ok I'll leave it.  It's not like the RT is really analyzing my data on their end to check for discrepancies and ratting me out.  I had a large upfront co-pay but then I am technically renting to own for the next 12 months.  I even asked specifically to the RT if I had insurance requirements for compliance and she said she already checked and no.

[Sleeprider]

Sounds like you won't be monitored too closely. Leaving Wi-Fi on is not a liability unless you get unrequested changes to your settings, or calls about any changes you make. It also confirms you should be okay to go to Auto mode.

Try it, you'll like it.

[MoApnea]

To help me better understand what's going on during the night, here's a screen shot from my first night.  I woke up at this point and went to the bathroom.  Before I woke up, there was clearly things going on.  Help me understands the things at play.

• I clearly had a snore (something I do rarely)  
  
• Tidal volume starts going haywire, does that mean I'm trying to suck in more air than normal?
  
• Flow Rate:  What does it mean when the graph starts jumping up and down.  I see that I have events but not sure what flow rate is telling me.  The rate definitely becomes erratic around an event.
  

  

[Walla Walla]

The Grayed out area and black area is where you took off the mask. Your flow get erratic due to a obstructive event just before you wake up. the clear airway event after you put the mask back on was probably from holding your breath as you turned over. The VS2 may or may not be a snore. VS2 is been known to pick up other noises that aren't snores like maybe grunting or talking. Here's a link to Beginners Guide to Sleepyhead http://www.apneaboard.com/wiki/index.php...SleepyHead