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Help [varying AHI levels]
#1
[attachment=3385][attachment=3386]
I was diagnosed with sleep apnea about 4 months ago- have been using a mask in earnest for the last 3 months or so- 100% compliance. As I was coincidentaly diagnose with elevated pulmonary pressures as a result of an exercise stress test , which were attributed to my sleep apnea, it is very important for me to get the most out of my treatment. Herein lies the problem, statistics have been all over the place- from an AHI at 10 plus to a low of .80- I am doing nothing different- I have tried different masks from full face, to nasal to nasal pillow. The results on each have been varaiable just as my overall numbers have been- I have not been able to see any correlation at all with changes in masks. Shortly after I began my treatment and anticipating I may have trouble with a mask, I invested in a very expensive mouth re-positioning device (SomnoMed Classic) which I have been using along with the various masks- figuring that 2 forms of treatment is better than one.

I have attached some screen shots which hopefully someone may be able to offer some insights as to what the problem may be- I went to my Pulmonogist about a month ago or so and he wasn't overly concerned- trying to get any help from the respiratory people at the Respira place where I am supposed to go is like pulling teeth- they are no help at all! From reading the posts on this board, it is obvious that there are many knowledge people here that can probably be of more help than I have received from these other sources.
Thanks in advance for any insights!
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#2
Hello Haynbo.  I would recommend you tweak your data settings in Sleepyhead.  See my signature line on how to arrange your data.  Specifically you will want to remove the pie chart and calendar to make room for all of the data down below.  I would also turn off VS2 and add the snore chart in place of Resp rate.  See the line on "how to arrange your Sleepyhead data."

Your range is very wide and I am seeing a lot of Hypopneas as well as some other events that could benefit with a higher minimum pressure.  If I was you, I would increase your minimum to 7 and reduce your Maximum to 12 to improve on the algorithm for the machine and improve on the response time for events.  What is your flex setting at?  I would try to reduce that to 1 to see if that helps some of the CA events.  At least if the setting is at 1 you would get a quicker response and less chance of CA events being introduced (as happened to me at higher pressure relief settings.)

Some of the more experienced folks should be along soon that could also offer you some further advice.  Stay tuned!
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#3
yeah.  picking a mask, the one you most like, and sticking it out will give you trends.

other places / posts / people has talked to the rationale for adjusted ranges:
minimum - set it at 30 day "Average Pressure" 6.5 [6.38] or "90% Pressure" minus 2.  6.5 [8.20 - 2 = 6.2]
maximum - set it at 30 day "Max Pressure" 13.0 [12.8]

7 to 12 as Marillion suggests is basically in agreement with that.

Any adjustments beyond that should be done (if at all) after about 10 days, to see the average benefit of that selected treatment.

I found that each change I made caused a few extra CA per night for about 3 nights.

Good luck.

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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#4
(04-21-2017, 02:26 PM)quiescence at last Wrote: yeah.  picking a mask, the one you most like, and sticking it out will give you trends.

Any adjustments beyond that should be done (if at all) after about 10 days, to see the average benefit of that selected treatment.

I found that each change I made caused a few extra CA per night for about 3 nights.

Good luck.

QAL

Excellent points here and ones I forgot to mention.
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#5
I just found out how to adjust pressure and I did as you guys suggested- 7.0 min to 12.0 max. I think the one suggestion about sticking with a mask is probably one of the mistakes that I have made- the full face has not worked that well because I seem to get alot of leaks-  I recently got a Dreamwear Nasal and I had a great week with that when I was away and what was ironic was that I slept in a fairly soft bed-  not what I have at home- I have a pretty significant back problem and I am wondering if the soft bed may have actually been better for me. The 5 nights that I was away my number averaged about 2.0 and, for me, that has probably been the best average over an extended period of time. Since I have been home(probably 2 weeks or so) and sleeping on my expensive, back friendly? bed-my numbers have been erratic and definitely going in the wrong direction. Anyway, after a few days home and the numbers turning bad I switched for a night to a full face mask(no good) and then ultimately tried a nasal pillow which worked just ok. I have decided, after reading your comments thast I am going to stick with the Dreamwear nasal for at least 2 weeks and see how it works along with the new settings. Thanks again for your suggestions!
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#6
How are you sleeping?  Are you restless, do you wake up often and re-postion due to back pain?  The machine can pick up changes in your breathing at these times and record then as events when they really are not.
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#7
Good call Haynbo.

If it ever comes time for you to replace your bed. I would encourage you to take a serious look at Tempurpedic beds. The softer versions specifically. Ever since we got ours about 2 years ago, I actually look forward to sleeping in that bed every single night. Still do, no joke. For us, the Cloud Luxe model solved any back aches we had and we barely move the whole night.

Often I wake up in the morning in the same position I went to sleep in. A far cry from any other bed we have owned or used. They aren't cheap but you can get a good price if you negotiate hard. There is a tremendous markup on mattresses.
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#8
Yes I'm sure I do move around- I was wondering about that very point- When you look at my event flags, the hypopneas, for the most part, far outnumber the OA's- when I look at my original sleep test, I had many more OA's than hypopneas- now, it seems that the number of hypopneas are what has the most impact on my AHI- without those, my AHI would be much better. I have always been under the impression that firmer beds are better for back sufferers but maybe my experience from my week away shows otherwise.

I have spent the entire day trying to educate myself on sleep apnea because getting effective treatment is particularly important for me because of the elevated pulmonary pressures. Anyway, it is amazing how much can be learned by listening to people like you guys who have gone through all this and know what needs to be done. Thanks again!
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#9
Our pleasure. Keep us posted!
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#10
Pretty much agree here, raise the min to 7 cm to start then see. Setting your max to 20, 12 or 10 for that matter should have no impact on you because your max is not going into that territory.
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