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New User, chasing the numbers
#1
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...
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#2
Did your AHI increase because the machine went from 8-9 or did the machine go from 8-9 because your AHI increased?
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#3
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".
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#4
(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.
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#5
(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!
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#6
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.
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#7
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
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#8
(05-10-2016, 01:38 PM)Winterfrost Wrote: Hee hee! Love your avatar! Good ol' Tubbs!

He's my spirit animal.
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#9
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!
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#10
(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.


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