Post Reply 
Getting Better - How do you know!
Author Message
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #11
RE: Getting Better - How do you know...!!!
(12-01-2013 11:13 AM)ENJ Wrote:  I have posted my current data...
If someone ha time I would appreciate a quick review and insight...
thanks
Ed
I cannot open the file so cannot comment on the content

Your,re asking "Getting Better - How do you know...!!!"
For me, the first thing noticed since day one, no longer waking up with that terrible headache in the morning but adjustment to CPAP took few good months even some people reported took them no time at all
Definitely the benefits are there ... just we need keep working on CPAP therapy, its a lots better than the alternative
12-01-2013 03:23 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #12
RE: Getting Better - How do you know...!!!
All I could understand or felt comfortable that I understood in the excel spreadsheet is that over 30 days, your AHI was 5.1 to 8 (roughly), that you did not have any leaks, your 90% pressure for 30 days was 7.5 to 10.5.

Maybe you could tighten up your pressure range and see if you can get your AHI lower than or closer to 5. Do you have an RT that is helping you with your supplies, etc.? They may be able to help you but there aren't very many RT's out there (DME's) that are helpful and some of them don't even know the answers to very basic questions!

I am sure others will have more thoughts for you. I am not familiar with your machine.
(This post was last modified: 12-01-2013 04:25 PM by me50.)
12-01-2013 04:19 PM
Find all posts by this user Post Reply Quote this message in a reply
ENJ Offline

Members

Posts: 15
Joined: Oct 2013

Machine: System One RemStar Auto with A-Flex (560P)
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironics
Humidifier: Phillips Respironics
CPAP Pressure: 4-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Wimberley, Texas

Post: #13
RE: Getting Better - How do you know...!!!
Thanks for all the input... sorry I couldn't get back sooner, but have been having computer problems... think they are fixed now... hopefully...

I'm definitely not dreaming any more ... the DME told me you weren't supposed to dream with REM... guess that shows the quality and knowledge of the DME I'm working with... No names, but all they wanted was to be sure I was in compliance so they could get their money... well they just talked themselves out of additional business... what a loss...

I find I spend more time readjusting the nasal pillows during the night... sleep is reasonable, but not like it was before I started the CPAP... I used to be able to sleep all night and dream but was really tired during the day... I have more energy and am more active during the day now... Guess I need the CPAP machine...!!!

Regarding "tighten up your pressure range" ... HOW do you do that... I can obviously adjust the range (currently 4 to 14), but I don't understand what the data is telling me...

Could someone please elaborate and point me in the right direction... I'd like to try some additional fine tuning...

Thanks in advance...
Ed
12-08-2013 12:35 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
bwexler Offline

Advisory Members

Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #14
RE: Getting Better - How do you know...!!!
I am on my iPad now so I can't look at your excel spreadsheet. I would start by adjusting your minimum preasure.
Look at sleepy head and make note of the lowest and highest preasure you see during the night.
Change your setting of 4 cm H2O to .5 below your lowest on the graph and change 14cm to 1 above your highest. Perhaps you may wind up at 6-12.
That is what we mean by tighten up your settings. Also look at leaks. When you see a spike in the leak graph notice if you also have an event around the same time or even a cluster if events.
If your AHI is above 5 but most events occur as you go to sleep, wake up or have a spike in leak rate, you are actually doing pretty well. You need to work on eliminating leaks either by changing masks or adjusting your mask or learning to keep your mouth closed. This is probably the biggest, toughest and most correctable issue with XPAP therapy.
As you make changes come back here and tell us what you did and how it worked.
12-08-2013 08:27 PM
Find all posts by this user Post Reply Quote this message in a reply
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #15
RE: Getting Better - How do you know...!!!
ENJ's data well that didn't work too well first 3 columns are about leaks, next 3 are about AHI's, next 3 are about periodic breathing and the final 3 are 90% pressure.

Large Leak AHI Periodic Breathing 90% Pressure
1 day 7 day 30 day 1 day 7 day 30 day 1 day 7 day 30 day 1 day 7 day 30 day

0% 3% 3% 0.0 4.7 5.6 0% 5% 7% 0.0 12.5 12.8
1% 4% 3% 4.6 5.0 5.6 4% 6% 6% 11.0 12.1 12.7
6% 5% 3% 6.6 5.3 5.6 5% 5% 6% 13.0 12.0 12.7
0% 5% 3% 3.8 5.6 5.5 5% 5% 6% 12.5 11.8 12.7
0% 4% 3% 4.6 5.1 5.5 6% 6% 6% 14.0 12.5 12.8
1% 2% 3% 3.5 4.3 5.3 3% 4% 6% 14.0 12.7 12.9
0% 1% 3% 6.3 5.1 5.4 7% 5% 6% 14.0 12.9 12.9
0% 1% 2% 7.4 5.2 5.5 8% 5% 6% 13.5 13.2 12.9
0% 1% 2% 8.3 5.6 5.6 9% 6% 6% 13.5 13.5 13.0
0% 0% 2% 4.9 5.4 5.6 11% 7% 6% 13.0 13.5 13.0
0% 0% 2% 3.7 5.3 5.5 3% 6% 6% 13.5 13.6 13.0
3% 1% 2% 7.2 5.7 5.5 8% 7% 6% 12.0 13.3 13.0
0% 0% 2% 2.2 5.6 5.4 2% 6% 6% 14.0 13.3 13.0
14% 1% 2% 6.1 5.4 5.4 4% 6% 6% 12.0 13.1 13.0
12% 3% 3% 5.8 5.3 5.4 25% 9% 7% 12.5 13.0 13.0
0% 3% 3% 10.2 5.4 5.5 11% 9% 7% 13.0 13.0 13.0
0% 3% 3% 3.7 5.1 5.4 5% 8% 7% 14.0 13.1 13.0
2% 4% 3% 4.2 5.3 5.4 2% 8% 7% 13.5 13.1 13.0
0% 3% 2% 6.0 5.0 5.4 6% 8% 7% 13.0 13.3 13.0
0% 3% 2% 6.5 5.6 5.3 4% 9% 6% 14.0 13.3 13.1
0% 2% 2% 6.3 5.9 5.4 7% 9% 6% 12.5 13.4 13.1
6% 2% 2% 4.6 5.7 5.3 10% 6% 6% 12.5 13.3 13.1
0% 1% 2% 5.1 5.1 5.2 3% 5% 6% 14.0 13.4 13.1
0% 1% 2% 3.3 5.2 5.1 0% 5% 6% 11.0 13.0 13.0
0% 1% 2% 3.0 4.9 5.1 2% 5% 6% 14.0 13.0 13.0
0% 1% 2% 4.6 4.8 5.2 4% 4% 6% 13.5 13.1 13.0
1% 1% 2% 4.5 4.6 5.2 4% 4% 6% 13.5 13.1 13.0
0% 1% 2% 4.0 4.1 5.1 4% 4% 6% 14.0 13.1 13.1
0% 0% 1% 8.3 4.4 5.1 6% 3% 6% 9.0 13.1 13.1
0% 0% 1% 4.5 4.3 5.1 7% 4% 6% 14.0 13.1 13.1

0% 0% 1% 7.1 5.1 5.2 3% 4% 6% 12.5 13.2 13.2
1% 0% 1% 4.4 5.1 5.1 5% 4% 6% 11.5 12.8 13.2
3% 1% 1% 2.5 4.8 5.0 1% 4% 6% 14.0 12.9 13.2
0% 1% 1% 6.8 5.3 5.1 7% 4% 6% 14.0 12.9 13.2
0% 1% 1% 3.8 4.9 5.1 0% 4% 6% 6.0 13.0 13.1
0% 1% 1% 3.8 4.8 5.1 0% 3% 6% 7.5 12.1 13.0
0% 1% 1% 5.7 4.9 5.0 1% 3% 5% 8.5 11.6 12.8
0% 1% 1% 3.1 4.4 4.9 1% 2% 5% 9.5 11.0 12.7
0% 1% 1% 4.9 4.3 4.9 0% 2% 5% 9.0 10.6 12.5
0% 0% 1% 5.2 4.8 4.9 0% 1% 5% 8.5 9.6 12.3
0% 0% 1% 5.6 4.7 4.9 0% 0% 4% 8.5 8.7 12.2
0% 0% 1% 5.8 4.9 5.0 0% 0% 4% 7.5 8.5 12.0
0% 0% 1% 4.5 5.1 5.0 0% 0% 4% 9.0 8.7 11.9
0% 0% 1% 3.7 4.8 4.9 0% 0% 3% 8.5 8.8 11.8
0% 0% 1% 4.1 5.0 4.8 0% 0% 3% 8.0 8.6 11.6
0% 0% 1% 4.7 4.9 4.8 1% 0% 3% 8.0 8.4 11.4
0% 0% 1% 5.4 4.8 4.8 1% 0% 3% 7.0 8.3 11.1
0% 0% 1% 7.3 5.0 4.9 1% 0% 2% 8.0 8.2 11.0
0% 0% 1% 5.1 5.1 4.9 0% 0% 2% 10.0 7.6 10.8
0% 0% 1% 5.9 5.0 4.8 0% 0% 2% 9.5 8.5 10.7
0% 0% 0% 5.9 5.5 4.9 0% 0% 2% 7.5 8.4 10.5
0% 0% 0% 8.0 5.7 4.9 1% 0% 2% 9.0 8.5 10.4
0% 0% 0% 6.2 6.2 5.1 1% 1% 2% 8.5 8.6 10.3
0% 0% 0% 6.6 6.5 5.2 0% 1% 2% 8.0 8.6 10.0
0% 0% 0% 6.3 6.2 5.2 1% 1% 2% 8.5 8.7 9.9
0% 0% 0% 7.4 6.5 5.3 0% 1% 1% 9.5 8.5 9.7
0% 0% 0% 6.1 6.7 5.5 0% 1% 1% 9.0 8.6 9.5
(This post was last modified: 12-08-2013 08:48 PM by me50.)
12-08-2013 08:41 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
ENJ Offline

Members

Posts: 15
Joined: Oct 2013

Machine: System One RemStar Auto with A-Flex (560P)
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironics
Humidifier: Phillips Respironics
CPAP Pressure: 4-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Wimberley, Texas

Post: #16
RE: Getting Better - How do you know...!!!
PRESSURE ADJUSTMENTS: Just to be certain I am understanding...
1. If I look at SH daily Pressure graphs for the last week, I see spikes at 14.5 and some sustained at 15.0...
2. Scaling on these graphs doesn't go below 10.0... I see numerous flat lines at 10.0...

AND/OR
1. If I export the last weeks Pressure information to an Excel spread sheet and then sort the data, I see four highs at 12.6, two 12.20, two 11.90, eight 11.10, etc...
2. The lowest I see are 152 events at 4.0...

THEREFORE;
1. Assuming the exported data is MORE accurate...
2. Based on your recommendation "Change your setting of 4 cm H2O to .5 below your lowest on the graph and change 14cm to 1 above your highest. Perhaps you may wind up at 6-12."
3. I should set Pressure at 3.5 to 13.6 or since I am already at 4 to 14 probably no change...

HOWEVER (from the SH Statistics Summary) we see the following:
Most Recent / Last 7 Days / Last 30 Days
Average Pressure 4.00 4.00 4.30
95% Pressure 8.70 10.00 9.60

So which settings should I use...???

LEAKAGE RATES & PRESSURE:
There doesn't appear to be a SH export for Leakage Rates, but the SH Statistics Summary are shown below...
There is no explanation for the meaning of the LEAK graph, it has two graphs which basically mirror each other... After searching I still can't find any detail explanations...

Most Recent / Last 7 Days / Last 30 Days
Average Total Leaks 14.66 17.30 17.72
95% Total Leaks 22.00 27.00 30.00

Other Daily Data read directly from the machine shows LARGE LEAKS to be 0%...

So what is this tell me...?

NEW MASKS
9/19/13 Started with the Quattro FFM... Had leaks and sore nose... did not seem to find a solution until I got the GECKO pad and used it... some help there but still had leaks...
11/5/13 After a lot of reading went to Nuance nasal pillows... the most dramatic change (besides comfort increase) was in my numbers... PERIODIC BREATHING (from 7% to 0%) and 90% PRESSURE numbers dropped (FROM 14.0 TO 6.0)...
12/3/13 Mask change to Nuance Pro... basically same mask but with GEL sides on the cheek which seem to prevent slippage...
Don't see any serious change in numbers, but I seem to have less adjustments during the night to correct small leakage...

I believe I am sleeping with my mouth closed since I don't see any large leaks... but maybe I'm not looking at the right number...

I know this is a long post with several imbedded questions, but hopefully it's clear enough...
Any input will be greatly appreciated...
I'd really like to optimize the CPAP benefits as much as possible/reasonable...
Thanks again for your time and insight...
Ed
12-09-2013 03:12 PM
Find all posts by this user Post Reply Quote this message in a reply
bwexler Offline

Advisory Members

Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #17
RE: Getting Better - How do you know...!!!
I meant to look at the actual graphs not the averages. The ranges displayed in the graphs in SleepyHead are user adjustable I believe. Many people find a pressure of 4 too low to breath comfortably, that is why I suggested an increase to ~6. finding a cap for the top pressure is less critical. By condensing the range the machine can adjust automatically and observing any plateaus you can fine tune things so the auto adjustments do not bump into your preset limits.

Next you need to look at your leaks. large leaks of 0% is great but you need to look at the graphs and compare any indication of a spike in leaks with an Apnea or Hypopnea event. That will tell you if your AHI is being affected by your leaks.
12-09-2013 03:34 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #18
RE: Getting Better - How do you know...!!!
Look at your daily graphs for your pressures at median and 95% and maximum for at least 2 weeks. Find the lowest pressure over the 2 week period and the highest pressure (maximum) for at least 2 weeks. Then you can adjust your pressures according to that information. You don't want to adjust it according to the settings that you currently have (4-14) because your pressure of 4 is too low. The information that you provided in one of your earlier posts (in the spreadsheet) shows you had a low of 7.5 with the exception of one time you had a 6 and a 7 and a high of 13.2. If it were me, I would adjust to 7 to 14 or 15. Hope this helps. What bwexler said.
(This post was last modified: 12-09-2013 03:45 PM by me50.)
12-09-2013 03:41 PM
Find all posts by this user Post Reply Quote this message in a reply
ENJ Offline

Members

Posts: 15
Joined: Oct 2013

Machine: System One RemStar Auto with A-Flex (560P)
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironics
Humidifier: Phillips Respironics
CPAP Pressure: 4-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Wimberley, Texas

Post: #19
RE: Getting Better - How do you know!
Thanks for the input...
I am looking at the data per your recommendations...
As I progress with analysis I will be checking back...
Again many thanks...
Ed
12-10-2013 11:27 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
ENJ Offline

Members

Posts: 15
Joined: Oct 2013

Machine: System One RemStar Auto with A-Flex (560P)
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironics
Humidifier: Phillips Respironics
CPAP Pressure: 4-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Wimberley, Texas

Post: #20
RE: Getting Better - How do you know!
OBSERVATION:
Using the SH Daily Statistics (per your suggestion and comparing to daily graphs) I see the following values for the last 13 days: (I am excluding the 14th day because Pressure Med number is a single occurrence of 5.0)...

DATA:
Pressure Med Low 5.60 Avg 6.90
Pressure 95% Low 7.70 Avg 11.10
Pressure Max High 10.48 Avg 12.60

THEREFORE:
The first adjustment I will make is from 4.0 to 6.0...
I would assume I could adjust top limit from 14.0 to 13.0...but I will make the lower adjustment first and see what occurs...

YOUR SUGGESTIONS:
After giving your input some thought, the suggestions made make perfect sense from a simply Physical standpoint... If one is laying on the back and the airway is collapsing creating an Apnea event then you would want increased CPAP Pressure to keep the airway open which should reduce the number of events and thus lower AHI...

OTHER ITEMS:
Looking at the graphs there does not seem to be any obvious correlation between leaks and an Apnea or Hypopnea events...
There is a lot of data in SH and it will take some time to digest it all... It's a learning process...

I have a new CMS50E with which I am collection nightly data... however, the file format must have changed, I am unable to get SH to accept a file... I have followed instructions here on the Board but have not been successful... Any ideas...?

Any other suggestions to make this process easier...?
Thanks for taking time to follow this thread...
Ed
12-11-2013 04:01 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Forum Jump:

Who's Online (Complete List)