New CPAP User - Need Help

[butterflyksses]

I finally after 8 months of back and forth have a CPAP machine. The first few days seemed good, but I wasn't home. I was traveling. I was home two nights, and then off again traveling again. Less than a few days away from home the second time, it seemed I was waking up still very tired and not well rested.

I kept using the mask, and waited until I came back home to my own bed to see how things went. I'm home now and still extremely tired and have a hard time getting up in the morning because I'm still not rested.

Called the DME because they had called after just a few days on the machine to see how it was going and I let them know it was hard to tell as I wasn't home. They had me bring them my sd card. I dropped it off today.

However, before I did that I downloaded the Sleepyhead software and imported the information. I need some help w/the interpretation. To me it looks like it's very good, so I can't quite understand why I am still so extremely tired.

CPAP Statistics
21 days of CPAP Data, between Tue Jul 8 2014 and Mon Jul 28 2014
Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 05:12 06:50 06:18 06:18 06:18
Compliance 100% 100% 86% 86% 86%
Therapy Efficiacy
AHI 0.77 1.17 1.59 1.59 1.59
Obstructive Apnea Index 0.38 0.33 0.43 0.43 0.43
Hypopnea Index 0.38 0.73 1.06 1.06 1.06
Clear Airway Apnea Index 0.00 0.08 0.08 0.08 0.08
Leak Statistics
Average Leak Rate 0.16 2.62 4.61 4.61 4.61
90% Leak Rate 0.00 7.20 12.00 12.00 12.00
% of time above Leak Rate threshold 0.00% 0.15% 0.05% 0.05% 0.05%
Pressure Statistics
Average Pressure 6.94 6.89 6.89 6.89 6.89
Min Pressure 4.16 4.14 4.12 4.12 4.12
Max Pressure 7.00 7.00 7.00 7.00 7.00
90% Pressure 7.00 7.00 7.00 7.00 7.00
Average EPAP 6.94 6.89 6.89 6.89 6.89
Min EPAP 4.16 4.14 4.12 4.12 4.12
Max EPAP 7.00 7.00 7.00 7.00 7.00

I copy and pasted from Sleepyhead. Not sure if there is a better way to do it. IF there is, Please let me know.

Thank you for any help. It will certainly be appreciated.

Sharon

[retired_guy]

Sharon, your numbers look pretty good. I do wonder about the pressures though. The AHI is doing ok, could be a tiny bet better but not really a concern. I notice you're bouncing off the top pressure of 7 quite a bit, averaging about 6.9 out of a top end of 7. That still results in an EPR pressure of just over 4, which is as low as the machine can go. If I were doing a minimum pressure of 4 I would spend the night fighting for air, and I'd really be tired the next day. But that's me, not necessarily you. Your therapy is a low of 4 and a high of 7, with EPR on of 3 it seems............. I think I'd consider turning the EPR off and just work with your low/high. Either that or move your max up a point to 8. But not both at the same time. See what your DME thinks of that.

[robysue]

I finally after 8 months of back and forth have a CPAP machine. The first few days seemed good, but I wasn't home. I was traveling. I was home two nights, and then off again traveling again.

I am really confused.

How long have you been PAPing with the current settings? 8 months or a few days?

And what do you mean by "I finally after 8 months of back and forth have a CPAP machine."

If you've only been PAPing for a very short time, well, it takes time. Most newbies don't feel better for at least a couple of weeks and many take a lot longer than that.

I was home two nights, and then off again traveling again. Less than a few days away from home the second time, it seemed I was waking up still very tired and not well rested.

Are you traveling WITH the CPAP machine?

And keep in mind too, that traveling all by itself can make you feel tired and not well rested.

At any rate, the data you posted looks very good. And unless you feel like you are struggling to inhale at 4-7cm of pressure I personally would NOT recommend changing the pressure. Then again, I suffer from pretty bad aerophagia (air in the stomach) when the pressure gets above 7cm.

[butterflyksses]

Thank you for your help.

My understanding is that it is set for 7. I know the ramp part starts at 4 though. Is that where you are getting the 4.

[butterflyksses]

How long have you been PAPing with the current settings? 8 months or a few days?

I have gone back and forth with the Dr. For 8 months. I have had the CPAP machine for a month.

If you've only been PAPing for a very short time, well, it takes time. Most newbies don't feel better for at least a couple of weeks and many take a lot longer than that.

Are you traveling WITH the CPAP machine?

Yes, I took it with me.

Thank you for your help.

[retired_guy]

Thank you for your help.

My understanding is that it is set for 7. I know the ramp part starts at 4 though. Is that where you are getting the 4.

Yes, I'm probably looking at what the ramp is doing.

So with no ramp, all your pressure settings would be sitting on 7 or nearly so? Well, they certainly are controlling your apnea so I suppose you could just wait it out for awhile and see how it goes.

Being rather impatient, I would choose to up the pressure a little, but then also being a procrastinator I'd probably not get around to doing it for awhile. But I'd continue to gripe about it.

[butterflyksses]

Thank You Again, guess I will wait it out a bit.

[bwexler]

Two things I notice.
First you are only sleeping 6 hours a night. Les than 8 doesn't seem to work well for me. If you can try to increase your sleeping hours.

If you could go to your profile and fill in your equipment and mask, in text format, not pictures, it would help us help you.

I would be very happy with your numbers, but would have a hard time with your low pressure settings.

[Rosanne]

I apologize if this is in the wrong area, but couldn't figure out where/how to put it elsewhere. I too have newbie questions--the first is how long are you considered a "newbie"?--no need to answer that.

My first question has to do with leaks, reading the charts etc. My ResMed Auto elite typically shows 1L/m (something like that--1 leak a minute?) when I check it. Does it automatically change should the leaks increase or is that a permanent setting? On the readout I got the other day there were periods of higher leak rates shown on the graph. I don't check for the leaks each day as the smiley face is always green.
Does opening my mouth to check to see if air is blowing count as a leak? Do I also skew the readings if I hold my breath to see if the air is blowing or to listen for some other operational process? I believe that the air blowing through my mouth (I use nasal pillows) does wake me up and has helped me learn to no longer breathe through my mouth--which is a good thing. I can't imagine having to wear a chin strap too.

I thought I was sleeping really well last night, and even used bag balm on my nose. Felt like the nasal pillows were set just right. Only aware of waking up once, but chose not to get up for the bathroom, but did note that I switched positions from side to side 4-6 times. Was very tired when I went to bed and had had a nap earlier in the evening. Lots of dreaming. When I read my results this morning it showed 10.2 hours of usage but my API was 8.5 ! This is the highest it's been since I started cpap at the end of June. The other times it was at 7 or above were also nights I was really tired but felt like I slept well and had lots of dreaming. So what's the deal?

Finally, my machine is set at continuous pressure of 6. Should I try and tweak it to an automatic readjustment, or wait for the doctor to recommend and let the DME do it? I see my medical doctor who ordered the sleep study later this month, but don't know if he will send me to the "specialist" or not--who would know more interpreting the results.

Again, I apologize if I butted in on somebody else's space, but it seems we all have "new user questions" until we get the hang of all this. Thanks again.

[NickDanger]

You're pretty much a "newbie" until you get to the point that you can't fall asleep without putting the mask on and powering up the machine!

1 L/m on the machine display means a leak of 1 liter/minute is your 70th percentile leak amount. With a ResMed (assuming you have set the mask type properly), leaks are considered under control if they are no higher than 24 L/m (you get Mr. Smiley Face as long as the 70th percentile doesn't exceed 24 L/m). Opening your mouth to check to see if air is blowing counts as a leak. Holding your breath for at least 10 secs should be identified as a central apnea or an unidentified apnea (assuming the machine is not in ramp mode and still ramping up). What are your 95th percentile leak figures? If those are also very low, then you probably don't need a chin strap unless you are waking frequently during the night.

Lots of dreaming = lots of REM sleep. For many people, apneas occur more frequently during REM sleep. Those additional apneas can be either obstructive or central - it is important to know which. Some of the forum members are very good at interpreting the software output - post your graphs from one of those difficult nights and a forum member will help you figure it out. If the additional apneas are obstructive in nature, it is possible that you had very little REM sleep during the titration part of your sleep study - if so, your pressure might not be high enough to handle the apneas during REM. Note that this is NOT the right solution if the apneas are central in nature.

Many of us are willing to change our own settings and many of us are not. It depends on the quality of your relationships with your doctor and DME weighed against how willing you are to make changes yourself.