Post Reply 
New User, chasing the numbers
Author Message
KMatch Offline

Members

Posts: 15
Joined: May 2016

Machine: DreamStation Auto CPAP
Mask Type: Nasal pillows
Mask Make & Model: Nuance/L X2
Humidifier: Part of Dreamstation
CPAP Pressure: Self testing
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Standing outside your window

Post: #1
New User, chasing the numbers
I had to go with self therapy for many reasons. I have known about my apnea for many years due to kicking, tearing off sheets, waking up gasping, snoring (I'm even aware of it in a light sleep), etc. My Doc told me some basics due to the lack of sleep study. SO...

I'm honing in on some settings. I believe my machine is visible here, I'm currently using very conservative settings due to: 1, too low of pressure (<6) makes me panicky. 2, higher pressure is similar but with added ear popping (>10) (another panic issue due to a history of ear issues, long story) so in the few days I've been learning the machine and titrating, I've had the best results with 8 low, 9 high, FLEX 2 (still a bit of panic on exhale, but very little with better results than 3) and running it on Auto Cpap. With these settings last night was the best so far. I still woke up a few times but it seems to be the usual "roll over to get comfortable" issues rather than breathing complications.

What's the question you asked?? Glad you asked! With my AHI for the moment at .77, down from 3.xx with a previously wider pressure margin, clear breathing at .53%, clear airway at .26, Hypo .52, RERA .77, VS 4.0, I noticed the little bit of AHI triggers at the time the machine goes from 8-9 in auto mode. Coincidence? Cause of apnea? Live with it because it's too soon to matter as a newbie? I'm overall content at the moment even though I don't "feel refreshed" since it's too soon, but should I live with these narrow settings for a bit, or ? While the AHI is very low, the ONLY instances of it last night were when the machine hit 9 and 2 out of 3 episodes were exactly at that point. At 8, there were zero AHIs. I'm just curious about this at the moment...
05-10-2016 09:47 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
rem52 Offline

Preferred Members

Posts: 36
Joined: Jan 2016

Machine: ResMed A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver Advance
Humidifier: built in heated
CPAP Pressure: 6-13 epr 2
CPAP Software: ResScan SleepyHead

Other Comments: continuous use 8+ hr/night since Feb 2016

Sex: Undisclosed
Location: Michigan

Post: #2
RE: New User, chasing the numbers
Did your AHI increase because the machine went from 8-9 or did the machine go from 8-9 because your AHI increased?
05-10-2016 12:28 PM
Find all posts by this user Post Reply Quote this message in a reply
green wings Offline

Advisory Members

Posts: 552
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #3
RE: New User, chasing the numbers
Hello, KMatch. Welcome to the Apnea Board forum. It sounds like you're doing a great job of getting your treatment off the ground on your own.

I started using xPAP therapy last winter and also had lots of issues with just tolerating the mask and machine, and a pressure of 7 cm felt like a gale force wind to me. It's good that you're paying attention to your body and taking things at a rate that you're comfortable with.

I don't know the answer to your question. I just thought I'd say "hi".
05-10-2016 12:40 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
KMatch Offline

Members

Posts: 15
Joined: May 2016

Machine: DreamStation Auto CPAP
Mask Type: Nasal pillows
Mask Make & Model: Nuance/L X2
Humidifier: Part of Dreamstation
CPAP Pressure: Self testing
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Standing outside your window

Post: #4
RE: New User, chasing the numbers
(05-10-2016 12:28 PM)rem52 Wrote:  Did your AHI increase because the machine went from 8-9 or did the machine go from 8-9 because your AHI increased?

Yeah, I went and looked at that a bit closer... Kind of a chicken or egg thing. For the moment, what if this is the machine's response to apnea? Should the 9 be left alone as there was no real response from me? I can't post pics yet, so bear with me: There were 3 AHI episodes lasting about an hour each.

2 episodes show AHI and the shift from 8-9 at the same moment with a slight bit of snoring.

1 episode shows the pressure increase without AHI, followed a few minutes later with some snoring, followed 30 minutes later with an hour's worth of AHI. I know I shouldn't be chasing the numbers this early, but it did get my attention.

Since I have such a small range of pressure using 8-9, this early should I "leave it be", "bump the 8-9 to 8-10 and see if the response is better", or "insert suggestion here"? I know it's way too early to really get a sample - I'm just a critical thinker and know I left a lot of room to work with while I get used to scuba diving in my sleep.
(This post was last modified: 05-10-2016 01:31 PM by KMatch.)
05-10-2016 01:29 PM
Find all posts by this user Post Reply Quote this message in a reply
Winterfrost Offline

Preferred Members

Posts: 33
Joined: Feb 2016

Machine: Respironics System One 560P
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit 10P For Her
Humidifier: none
CPAP Pressure: 8-14
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #5
RE: New User, chasing the numbers
(05-10-2016 12:40 PM)green wings Wrote:  Hello, KMatch. Welcome to the Apnea Board forum. It sounds like you're doing a great job of getting your treatment off the ground on your own.

I started using xPAP therapy last winter and also had lots of issues with just tolerating the mask and machine, and a pressure of 7 cm felt like a gale force wind to me. It's good that you're paying attention to your body and taking things at a rate that you're comfortable with.

I don't know the answer to your question. I just thought I'd say "hi".

Hee hee! Love your avatar! Good ol' Tubbs!
05-10-2016 01:38 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
chill Online

Advisory Members

Posts: 864
Joined: Mar 2016

Machine: DreamStation X500
Mask Type: Full face mask
Mask Make & Model: Walk-in Mask Closet
Humidifier: DreamStation
CPAP Pressure: 13-16
CPAP Software: SleepyHead

Other Comments: CPAP True Believer

Sex: Male
Location: Vancouver, Canada

Post: #6
RE: New User, chasing the numbers
Welcome! I will offer a few pointers. This machine will sometimes increase the pressure in "pulses" to see if a higher pressure yields better results. I think this sometimes wakes me up. You mentioned "an hour's worth of AHI". AHI is an hourly index. What are you seeing is one "event" that is is carried forward for an hour and then discarded. If a second event happens during that hour, the AHI number increases. What you are probably seeing is that the machine is detecting some events (snoring, hypopnea, apnea) and increasing the pressure to eliminate future events while at the same time scoring an event in the AHI. So the pressure increase is in response to previous apneas, not causing them. Though the increase could possibly trigger future ones or just wake you up.
05-10-2016 03:34 PM
Find all posts by this user Post Reply Quote this message in a reply
trish6hundred Offline

Advisory Members

Posts: 6,452
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #7
RE: New User, chasing the numbers
Hi KMatch,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy.

trish6hundred
05-10-2016 07:33 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
green wings Offline

Advisory Members

Posts: 552
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #8
RE: New User, chasing the numbers
(05-10-2016 01:38 PM)Winterfrost Wrote:  Hee hee! Love your avatar! Good ol' Tubbs!

He's my spirit animal.
05-10-2016 08:56 PM
Find all posts by this user Post Reply Quote this message in a reply
Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,390
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #9
RE: New User, chasing the numbers
Welcome to the forum. You don't need advise, you've completely got this under control. Your approach is perfect, from working with your doctor, to self titrating and just attitude.

Good luck!

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
05-10-2016 09:27 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
robysue Online
Wiki Editor
Advisory Members

Posts: 1,245
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #10
RE: New User, chasing the numbers
(05-10-2016 09:47 AM)KMatch Wrote:  I'm honing in on some settings. I believe my machine is visible here, I'm currently using very conservative settings due to: 1, too low of pressure (<6) makes me panicky. 2, higher pressure is similar but with added ear popping (>10) (another panic issue due to a history of ear issues, long story) so in the few days I've been learning the machine and titrating, I've had the best results with 8 low, 9 high, FLEX 2 (still a bit of panic on exhale, but very little with better results than 3) and running it on Auto Cpap.
It's extremely important to be able to sleep comfortably with the machine. It sounds like you've identified a sweet spot in terms of comfort: APAP 8-9 with Flex = 2. And more over it sounds like these settings are reasonably effective at treating your apnea since you also write:
Quote:What's the question you asked?? Glad you asked! With my AHI for the moment at .77, down from 3.xx with a previously wider pressure margin,
Rather than starting to chase a 0.0 AHI, you need to consolidate what you've accomplished and finish the job of learning how to sleep comfortably all night long with the machine.

Quote:I'm overall content at the moment even though I don't "feel refreshed" since it's too soon, but should I live with these narrow settings for a bit, or ?
Yes. Live with these settings for at least 4-5 days, or preferably a week or so. At that point you'll have enough data to decide whether you need to make any more tweaks.

You also write:
Quote: I noticed the little bit of AHI triggers at the time the machine goes from 8-9 in auto mode. Coincidence? Cause of apnea?
...
While the AHI is very low, the ONLY instances of it last night were when the machine hit 9 and 2 out of 3 episodes were exactly at that point. At 8, there were zero AHIs.
Chances are the OAs came first and the pressure increase was in response to them.

Quote:Yeah, I went and looked at that a bit closer... Kind of a chicken or egg thing. For the moment, what if this is the machine's response to apnea? Should the 9 be left alone as there was no real response from me?
Don't know what you mean by "there was no real response from me". But earlier you said that pressures >= 10 start causing problems with ear popping. In my opinion, you're better off just leaving the max pressure at 9cm for a week or so.


Quote:1 episode shows the pressure increase without AHI, followed a few minutes later with some snoring, followed 30 minutes later with an hour's worth of AHI. I know I shouldn't be chasing the numbers this early, but it did get my attention.
The pressure increase could either be the PR Search Algorithm OR the machine could be increasing the pressure in response to flow limitations.

Quote:Since I have such a small range of pressure using 8-9, this early should I "leave it be", "bump the 8-9 to 8-10 and see if the response is better", or "insert suggestion here"? I know it's way too early to really get a sample - I'm just a critical thinker and know I left a lot of room to work with while I get used to scuba diving in my sleep.
Give yourself the time to get used to the equipment and sleeping with the equipment before you start making more adjustments.

Also, you need to have a better idea of how your machine's auto algorithm works before you start increasing the pressure.

As an overview, your machine will increase the pressure in response to OAs, Hs, flow limitations (FL), RERAs, and snoring (VS in SH, not VS2). It's also important to realize that the machine does NOT respond to isolated events. And "isolated" means that there is at least two minutes between the two events. That's the way the PR machines are programed, and it is based on the protocols that are used in manual titration studies in the lab. If you open up the max pressure a bit, you will see that the machine increases the pressure 1cm at a time in response to events and then it waits to see if the breathing stablizes. If another event occurs within a couple of mintes or more snoring is scored the machine will increase the pressure again.

In addition to responding to events, the PR machines have a "Search" algorithm that kicks in when the breathing is relatively stable. The machine periodically increases the pressure (usually by 2cm) over a 4 minute period. The machine is looking for subtle improvements in the shape of the inhalations. If no improvement is found, the machine will lower the pressure back down over a 1 or 2 minute period. But if improvement is found, the machine continues to increase the pressure until either the max pressure is reached or no more improvement is found, in which case the machine readjusts the baseline pressure to the new "p_opt" level.

Your machine goes through a reverse "Search" algorithm to test whether the pressure can be lowered back down. It will periodically lower the pressure while examining the shape of the inhalations. As long as there is no deterioration, the machine will continue to lower the pressure. If deterioration is found, the machine bumps the pressure back up to the last "p_crit" pressure, which is the last pressure before the subtle deterioration was detected.

Since you are using a very, very tight pressure range it's important to realize that the Search algorithm is limited to 1cm increases and 1cm decreases. It's also important to understand that if the machine increases the pressure in response to a cluster of events and the events don't clear up, there's nothing else the machine can do.

Questions about SleepyHead?
See my Guide to SleepyHead
05-10-2016 09:46 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Long time CPAP user now with a problem PrkChps 5 183 12-07-2016 09:07 PM
Last Post: PrkChps
  New User Having Trouble Staying Asleep and more SnoreGalore 9 533 12-06-2016 08:00 PM
Last Post: SnoreGalore
  New User Problem with BiPAP AVAPS - Part 1 jmayer180 35 1,335 11-27-2016 09:50 AM
Last Post: jmayer180
  New User! SKClay 3 281 11-21-2016 08:52 PM
Last Post: trish6hundred
  new user wants advice Gazz 3 244 11-19-2016 11:06 AM
Last Post: trish6hundred
  Advice needed for struggling CPAP user Fubblin 35 1,993 11-18-2016 07:18 PM
Last Post: Sleeprider
  First time Bipap User, years of suffering SleepyMersim 18 669 11-16-2016 11:46 PM
Last Post: Galactus

Forum Jump:

Who's Online (Complete List)