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Dialing it in.
#1
I just completed my 11th night of therapy and for the first time my AHI was below 10. During my sleep study a month ago I was told I was having 59.7 events per hour, resulting in being put on a AirSense 10 Auto Set with Quattro Fx full face mask.

My first 5 nights the machine was set for a pressure of 10 with auto ramp off. AHI reading were 20.8, 15.5, 18.7, 25.3, 15.2 and 16.4

I changed the settings to AutoSet pressure 4-15 with auto ramp on for two nights with AHI readings of 26.1 and 20.2

I then changed the settings back to manual pressure with auto ramp on and had a AHI of 20. The next night I increased the pressure to 12 and my AHI was 19.9.

Still not happy with the results, last night I turned off the auto ramp and increased pressure to 13 resulting in a AHI of 9.6. Hopefully I'm working in the right direction and would welcome any helpful comments.

Have adjusted well to the machine and mask. The only complaint I have is when I inhale the machine makes the sound of a far off train whistle. Whoooo! Whooo! Whooo! It's very faint but still annoying, however my wife says it so much better than my snoring and she doesn't have to wear earplugs anymore. Can't believe how much better I feel since starting therapy. Haven't taken my daily nap since starting. With AHI under 10 last night was the best sleep I've had in years. Wonder what it would be like to get it under 5.

Thank you forum for providing first hand information that I'm not able to get from my health providers.
"Laugh and the world laughs with you, snore and you sleep alone." Anthony Burgess
Moconfed - Fighting Tyranny Since 1861!!!
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#2
My impression is that you are in too big of a hurry to find the "sweet spot" in your therapy.
Changes need to have time to settle in. You ran your first 5 nights at 10; and were able to see the results.
Sometimes the AHI increases with pressure due to pressure induced central apnea.

1) Make sure your leak rate is under control.
2) Make changes in small increments -- and give your body time to acclimate.
3) Study results with the software; and understand the type of apnea being scored.

Note that many people do not like using the ramp feature. Plus, for a FFM, you get to adjust it at pressure to form a good seal with the ramp off.

It's not uncommon to hear the blower motor whine with each breath. It has to speed up on inhale to maintain pressure; then slow on exhale. I barely hear mine as my hearing is poor at high frequencies.

Glad you are feeling better; and welcome to Apnea Board.

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#3
(05-15-2015, 07:23 AM)Moconfed Wrote: My first 5 nights the machine was set for a pressure of 10 with auto ramp off. AHI reading were 20.8 . . .

I changed the settings to AutoSet pressure 4-15 with auto ramp on for two nights with AHI readings of 26.1 and 20.2 . . .

I then changed the settings back to manual pressure with auto ramp on and had a AHI of 20. The next night I increased the pressure to 12 and my AHI was 19.9.

Still not happy with the results, last night I turned off the auto ramp and increased pressure to 13 resulting in a AHI of 9.6. Hopefully I'm working in the right direction and would welcome any helpful comments.

. . .

With AHI under 10 last night was the best sleep I've had in years. Wonder what it would be like to get it under 5.

Cool! You're headed in the right direction.

Since 13 isn't apparently quite enough, you could set the machine's lower limit to 13 and see how it goes.

You can also view your data in sleepyhead and see what's actually going on, which might be helpful.

Also, in an attempt to not wake you up, the machine raises pressure relatively slowly, so it's going to have a hard time fixing your apneas if it has to ramp up from 4 to 13 before anything useful happens, especially since the pressure will drop when your apneas stop, only to have to raise it up later again.

You might also want to try a nasal pillow mask like the Resmed P10 or Respironics Nuance. These don't tend to require as much pressure, for the same effect, and leak less, so you might get more effective treatment.

(05-15-2015, 07:23 AM)Moconfed Wrote: Thank you forum for providing first hand information that I'm not able to get from my health providers.

Enjoy!

Terry
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#4
Hi Moconfed,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy and getting it dialed in.
trish6hundred
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#5
To be honest it sounds like a shotgun approach to titration. You have an auto CPAP unit and it can help you narrow in on the "sweet spot" when used with the data it provides. The Sleepyhead program linked on this forum is a must-have to help you (and us) interpret your data. http://www.sleepfiles.com/SH2/

Download it and extract the files. The program just runs from the exe file in the extracted files. You can post data by following this tutorial https://sleep.tnet.com/reference/tips/imgur Later when you have more posts, you can just attach images. We will be looking for charts that contain Events, Flow Rate, Pressure, and Leaks, along with the summary of events and machine settings.

For titration, the best bet is to put the machine in auto CPAP mode. Based on results so far, I would not suggest a setting lower than 8.0 for minimum CPAP pressure, and you can let it range all the way to 20 for maximum. Your "sweet spot" for minimum pressure willl be approximate the 90 percentile pressure (pressure you were at or below 90% of the time). In your first post you did not say what kind of events make up your AHI with the current treatment. If the events are predominately CA, then more pressure is NOT the solution. If events are predominately OA then pressure is needed to stent the airway open. We really need to know more in order to advise you specifically.
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#6
Hi Mo, you are off to a good start! Congrats on that.

As the others have hinted (well ok, maybe hinted really loudly) you need to set whatever pressure you're going to try then leave it alone for awhile. You need to download, install and use Sleepyhead so you can see just what is actually going on.

So, if you're going to try it at 13 fixed, then that's fine for now, just let it do it's thing for a few days and see how you progress. All the changing around makes Mr. Brains go a little goofy, which results in what we lovingly call transitional CA's. Those will calm down over time. What's really needed at this point is to determine how well the therapy is resolving the leftover OA's and Hypops.

Go get em! Like I said, you're doing great.
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#7
Moconfed

I heard the whistling sound while inhaling on a couple of nights which was not normal for my machine (same model as yours).

When I checked into it on both occasions I found that I had not properly seated the water tank so there was a slight air leak in the connection that made the whistling sound when I inhaled.

It's a long shot, but next time you notice the whistling sound you might try reseating the water tank and make sure you press it on tightly and see if that makes it go away.

Saldus Miegas
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#8
Thanks everyone for the suggestions and comments.
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